In February 2020, we conducted a web-based cross-sectional survey among health care professionals and medical students in Vietnam. Participants were recruited if they met the following inclusion criteria: (1) living in Vietnam, (2) studying or working at hospitals or medical universities in Vietnam and having clinical experiences, (3) having either an email account or an account on social networking sites for inviting peers, and (4) providing electronic consent to participate in this study. The snowball sampling technique was used to recruit participants. Initially, a core group of health care professionals and students from three universities (Hanoi Medical University, University of Medicine and Pharmacy at Ho Chi Minh City, and Hue University of Medicine and Pharmacy) representing the three regions of Vietnam was selected for recruitment. These participants were selected due to their wide social and peer networks, which were important for the sampling technique. A web-based survey link containing a structured questionnaire was sent to the core group from the three universities via their emails. We asked participants to invite any acquaintances who met the selection criteria to participate in this web-based survey. A total of 523 health care professionals and medical students met the above criteria and were recruited in this study.

The study protocol was approved by the Institutional Review Board of Vietnam Youth Research Institute (decision number: 177 QĐ/TWĐTN-VNCTN; date: December 28, 2018).

Both descriptive and analytical statistics were performed by using Stata 15 (StataCorp LLC). Continuous variables were presented as means and SDs, while categorical variables were presented as frequencies and percentages. We used the Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables to compare differences between participants who were using and not using eHealth tools in clinical practices. A multivariate Tobit censored regression was performed to determine factors associated with the three domain scores and the overall score for the perceptions toward the benefits of eHealth application. Additionally, a multivariate logistic regression model was carried out to examine determinants of eHealth tool use in clinical practices. We applied a stepwise forward strategy, which involved using a log-likelihood ratio test in which the P value was set at .20, to select variables for the reduced models. The collinearity between variables in the model was tested by using the collin packages in the Stata software [33]. The number of years of clinical experience was found to have collinearity with age; thus, we excluded the years of clinical experience variable. Afterward, the variance inflation factor of predictor variables was less than 10, and the average of the variance inflation factor was 3.6, suggesting that there was no collinearity. The statistical significance was set at an α level of .05.

Health technology and eHealth have been becoming indispensable components in hospital operation and patient care. This study contributed to the current literature to facilitate the use of eHealth principles in Vietnamese clinical settings. Our findings indicated that eHealth tools were widely used among the health care professionals, but only more than half of the medical students (280/476, 58.8%) frequently used these tools in their clinical practices. Perceived benefits and barriers in using eHealth were also explored, and the results of the multivariate analysis indicated further implications for facilitating the use of eHealth in clinical practices.

Promoting the development of the eHealth system in Vietnam plays an important role in improving the quality of patient care and hospital efficiency [34]. Current eHealth systems are being applied in Vietnam, such as telemedicine systems that help support patients remotely during the COVID-19 pandemic; artificial intelligence systems that help diagnose cancer and lung diseases; and other eHealth systems, including an eHealth book system that helps manage disease status [35-37]. Especially in the context of emergency events and disasters, such as the COVID-19 pandemic, the use of eHealth tools has become even more urgent [38]. This requires current physicians and medical students to be fully equipped with sufficient eHealth literacy, which is needed to adapt to the increasing demands of these systems.

The use of eHealth tools in clinical settings was commonly observed among health care professionals but was still limited among medical students. However, our proportion of participants who were using eHealth tools was higher than that of a 2017 study in China, which revealed that only 51.1% of health care professionals and 41.6% of medical students had heard of telehealth [27]. Prior research in Tanzania and Ghana found that only 29.4% and 60% of health care workers have ever used computers, respectively [20]. Another study in the United States showed that merely 17.4% of medical students had experience with telemedicine [39]. Our results were understandable since, in recent years, the advancement and popularity of the internet and electronic devices (eg, laptops, smartphones, or tablets) has increasingly allowed health care professionals and medical students to conveniently access a variety of eHealth tools that are available on the internet. Moreover, the national strategy on eHealth has promoted the use of eHealth tools in clinical settings, which provides opportunities for these groups to approach and use such tools. Nonetheless, compared to findings from European countries, where 99.7% of practitioners use computers in clinical practice [19], the proportion of participants who were using eHealth tools in our study was considerably lower, suggesting that there is a huge gap that needs to be filled for the success of digital transformation in health care.

The results of this study show that the participants' levels of eHealth literacy were moderate. Given the nature of eHealth tools and systems to be innovative and to change continuously, these results indicate a potential barrier to the use and adaptation of eHealth tools [40]. Indeed, nearly half of the participants found a lack of ICT skills (207/523, 39.6%) and a lack of training (223/523, 42.6%) to be considerable challenges to using eHealth tools in clinical practices. This phenomenon could be explained by the fact that eHealth capabilities have not been systematically integrated into the current undergraduate and graduate medical curricula in Vietnam and only appear in several continuing medical education training programs. This gap can become serious if the curricula are not reformed, due to the rapid development of medical technology. Providing the most foundational eHealth skills to medical students and medical practitioners will help them adapt to the digital transformation and proficiently use eHealth tools to serve their practices [34,40].

The findings of this study also show that a great barrier to the application of eHealth in Vietnam was that physicians and medical students did not recognize the roles and benefits of eHealth tools in clinical practices. Specifically, the scores for the perceived benefits of eHealth tools were below moderate, suggesting that the benefits of eHealth for participants were not quite clear. This issue might be justified by the fact that although a national eHealth strategy had been proposed and implemented, eHealth systems in hospitals at the time of this study were still in their beginning stages, despite the major presence of the eHealth management system. Only a few central hospitals and private hospitals adopt advanced eHealth systems, such as artificial intelligence systems. Therefore, it is understandable that the physicians and medical students, particularly the latter, did not have much exposure to eHealth tools and were not fully aware of the role of eHealth. However, the COVID-19 pandemic has accelerated the digital transformation process in all levels of the Vietnamese health care system [38]. Further, all hospitals benefited from this innovation. These benefits included the implementation of telemedicine and remote disease management and diagnosis, which fostered cooperation and technology transfer between central hospitals and primary health care facilities [37,41]. Therefore, it is expected that the perceptions of health care professionals will change and that they will quickly prepare for the process of adapting to future eHealth technologies.

In our study, medical students had lower scores for the perceptions about the organization and economic aspects and clinical aspects of the usefulness of eHealth. This study was different from a study in Austria, wherein the authors found that medical students were more optimistic about the use of eHealth to reduce health care costs but more pessimistic about the use of eHealth to improve patients’ knowledge when compared to health care professionals [26]. Another study in China reported that medical students have more concerns about telehealth than health care professionals, which might be due to their low awareness and utilization of telehealth [27]. A study in the United States found that increasing exposure to telemedicine could raise the awareness and attitudes of medical students regarding telemedicine [39]. Given their bridging role between health care professionals and patients, medical students are suggested to have more positive views of eHealth application than those of other groups. Moreover, medical schools and hospitals should offer more opportunities to medical students that expose them to eHealth tools in clinical settings. This might improve their opinions about eHealth and provide them with the capacity to perform clinical practices in the future.

This study demonstrates the important role of systematically building and integrating eHealth capacities into current medical training curricula. This would be useful for physicians and medical students who can adapt to the great digital transformation of health care in Vietnam. These individuals may have good ICT skills, but they may also have limitations in evaluating the medical information they find and using medical information in clinical practice. Further studies on the development of practical training frameworks for eHealth techniques that narrow the gaps between academia and reality should also be considered and implemented.

This study has several limitations that need to be considered when interpreting the results. First, our cross-sectional survey was based on self-reported information, which might result in recall bias. Second, this study had the limitations of a cross-sectional design, which did not allow us to draw causal relationships between eHealth practices, perceived benefits of eHealth, and associated factors. Third, the snowball sampling method limited the generalizability of the study results to health care professionals and medical students in Vietnam. Fourth, the sample of health care professionals was small. To develop a full picture of the perceptions and practices regarding the application of eHealth in diagnosis and treatment among health care workers in Vietnam, additional studies should be conducted with larger sample sizes. Moreover, qualitative research should be performed to more comprehensively understand the perceptions of these populations regarding the use of eHealth tools.

This paper informs that in Vietnam, eHealth tools are moderately used in clinical practices, and the benefits of eHealth are underestimated among health care professionals and medical students. Renovating the current medical education curriculum to integrate eHealth principles should be required to equip health care professionals and medical students with essential skills for rapid digital transformation.