The relevance of telehealth across the digital divided the transfer of knowledge over distance

This paper explores the concept of Relevance as an explanatory factor to the diffusion of ITuse, or, in this paper particularly, the use of Telehealth. Relevance is the net value of performance expectancy and effort expectancy and contains both micro-relevance (i.e. here-and-now) and macro-relevance (i.e. actual goals) Following the case-study approach, two Telehealth situations were studied in Rwanda and The Netherlands. In the comparison, two more existing studies in Canada and Tanzania were included. The conclusion is that Relevance is the explanatory factor, whereas particularly micro-relevance is crucial. Without the micro-relevant occasions that initiate use, there will be no use on longer term In the cases studied the micro-relevance of knowledge-transfer was crucial. Furthermore distance determined Telehealth relevance. Practical conclusions to cases were drawn

ADOPTION OF TELEHEALTH BY HEALTHCARE PROFESSIONALS: AN OVERVIEW OF THEORETICAL MODELS AND THEIR APPLICATION

It has long been advocated that Information and Communication Technology (ICT) offers a huge potential to answer many of the challenges that the healthcare sector is facing. Therefore, information technology applications are abundantly present in healthcare sector. ICT applications promise efficient tools to collect, store, process and communicate health-related data and information. In that respect, it is believed that ICT could improve safety, quality, and costefficiency of healthcare services. For this reason, the integration of ICT into the health system constitutes a priority for many countries given regional disparities in the availability of health care services and in the distribution of health care human resources. However, telehealth adoption by healthcare professionals still represents a challenge. Indeed, the recognition of the utility of telemedicine by managers will not justify its adoption by physicians if they are reluctant to its use. In that sense, physicians’ lack of acceptance of the technology represents one of the main reasons why telemedicine implementation projects have failed. This paper presents an overview of the theoretical models that have been applied to the study of ICT adoption in the specific sector of healthcare, presents a synthesis of actual knowledge on factors involved in ICT adoption among healthcare professionals, and identifies key elements to design strategies aimed at optimizing the use of telehealth in healthcare settings

Applying Theoretical Frameworks to Explicate Physician Acceptance of Computerized Physician Order Entry (CPOE)

This paper reports the findings of a pilot study undertaken to ascertain the feasibility of incorporating the Theory of Planned Behavior and the Taxonomy of Work Values into the explanation of physician technology acceptance of a new organizational technology – Computerized Physician Order Entry (CPOE). While Davis’s Technology Acceptance Model has received much empirical support, we posit that certain complexities associated with the physician population and the hospital environment warrant the inclusion of other theoretical models as a means of furthering our understanding of technology acceptance. Although preliminary in nature, this study finds support for the inclusion of both the Theory of Planned Behavior and the Taxonomy of Work Values in further research examining this complex phenomenon

Acceptance of Telemedicine in Pediatric Rheumatology: A National Survey of Pediatricians

ACCEPTANCE OF TELEMEDICINE IN PEDIATRIC RHEUMATOLOGY: A NATIONAL SURVEY OF PEDIATRICIANS. Kathleen Jo E. Corbin, Lisa G. Suter. Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. The specific aims of this study were to characterize: 1) the impact of the pediatric rheumatology workforce shortage from the perspective of pediatric rheumatologists and general pediatricians, and 2) the acceptance of telemedicine, including both video conferencing and store and forward technology, as a potential solution for the pediatric rheumatology workforce shortage. We hypothesized that physicians practicing in settings with decreased access to pediatric rheumatology would perceive a greater impact of the workforce shortage and would be more likely to accept telemedicine as a substitute for face-to-face patient care. A web-based survey was distributed to members of the American Academy of Pediatrics (AAP) Section on Rheumatology, American College of Rheumatology Section on Pediatric Rheumatology, and a geographically representative sample of AAP state chapters. In addition to responses from 141 pediatric rheumatologists and 613 general pediatricians, we also received responses from 140 other pediatric subspecialists. Rheumatologists were significantly more likely than general pediatricians and other subspecialists to report that the workforce shortage adversely affected their patients (79.2% vs. 61% and 42.2%, respectively; all p\u3c0.001). Delay of diagnosis was identified as one of the most important consequences of the workforce shortage by 64.5% of rheumatologists, 43.7% of general pediatricians, and 30% of other subspecialists. Rheumatologists and general pediatricians practicing in predominantly rural states were more likely than those in urban states to report their patients were affected by the workforce shortage (90.9% vs. 73.5%, p=0.039 for rheumatologists, 71.6% vs. 46.6%, p=0.001 for general pediatricians). A minority of rheumatologists, general pediatricians, and other subspecialists accepted video conferencing as a substitute for face-to-face patient care for routine new (23.4% vs. 30.8% vs. 25%, respectively), routine follow-up (31.2% vs. 38.5% vs. 37.1%, respectively), and urgent visits (34% vs. 35.7% vs. 35.7%, respectively). Similarly, a minority of all respondents accepted store and forward telemedicine as a substitute for face-to-face patient care. In multivariable analysis adjusting for technology use, number of years in practice, and concern about liability, general pediatricians practicing in predominantly rural states were significantly more likely to accept video conferencing (e.g. OR 1.70, 95% CI 1.16-2.48 for new visits). For rheumatologists and general pediatricians, concern about liability was significantly negatively associated with acceptance of video conferencing (e.g. OR 0.43, 95% CI 0.23-0.80 and OR 0.68, 95% CI 0.52-0.90, respectively for new visits) as well as store and forward telemedicine (e.g. OR 0.35, 95% CI 0.14-0.87 and OR 0.54, 95% CI 0.38-0.76, respectively for new visits). Open-ended responses highlighted the need for experienced examiners at the remote end of telemedicine consultations as well as the potential educational value of telemedicine. Our data suggest that telemedicine would best be utilized for the care of children with rheumatic diseases in under-resourced areas, either for urgent triage decision-making or in the context of multidisciplinary care to allow for communication and education with both providers and parents. In addition, telemedicine cannot be effectively adopted on a large-scale basis until liability concerns regarding remote care are addressed

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces

Tele Critical Care Implementation and Education Project

Abstract Problem: The intensive care unit has the highest rate of mortality and patient care costs in the hospital. There are significant challenges in improving care and controlling costs. One solution adopted by many healthcare organizations is intensive care telemedicine. Commonly known as eICUs or Tele Critical Care (TCC). These specialty units provide access to intensivists and nurses 24-hours a day and has shown success in reducing mortality and length of stay while providing cost savings. Challenges exist in introducing telemedicine to a new setting. Barriers identified are high initial cost of equipment, competing priorities for resources, and nurse acceptance. The purpose of this paper is to focus on improving RN acceptance and perceived usefulness of telemedicine technology by providing staff education through a live class to introduce and familiarize staff with the benefits and rationale for implementing TCC in the target unit. Context: An 8-bed ICU located in a 50-bed medical center was selected as the target unit for this project. The study population consists of ICU nurses regularly staffed to the unit who will have regular interactions with TCC. Intervention: A pre and postsurvey using a validated tool, the TCC Implementation Survey, was envisioned for use in this project. These data will inform the direction and content of the educational component. Additional data from ICU quality reports could also guide development of the presentations. The postsurvey would be administered following the class. The goal of this project is to increase staff acceptance and perceived usefulness by 15% above presurvey levels with a 75% attendance rate in class and 80% response rate to the survey. It was intended for the project to go forward contemporaneously with TCC implementation. Due to impacts of the COVID-19, TCC implementation was halted and the initial plan could not go forward. Also, discussions with union-represented employees did not occur, preventing their participation as a survey group. As a substitute, a small convenience sample of non-represented employees was selected; however, due to IRB concerns for anonymity, the original survey could not be used with this group. A modified qualitative survey was selected and administered to this cohort. The 25-question survey focused on areas of quality, safety, communication, availability of ICU consultation, and clinical decision making. The small sample size of nine participants limited making statistically significant conclusions regarding the results, but the impressions given by the responses give insight into staff acceptance and opportunities to improve care. Results: The results were graded on a scale of 1 (strongly disagree) to 5 (strongly agree). Of note, the question, “I think new technology would diminish independence in my practice,” was found to have the lowest score of 2.4, indicating the staff seem receptive to new technology. In the sections, “Safety climate in your ICU” and “Quality outcomes in your ICU,” the lowest scores were regarding RNs’ (3.2) and doctors’ (3.1.) rounding on the unit, showing a possible need for improvement. Clinical decision-making at night found a positive association regarding the management of antibiotics and pain and sedative medication, with scores of 4.2 in each category. Whereas, the decision to intubate had the lowest mark in this section (3.6). An indication that decision-making in this area may need to be supported. Conclusions: The initial planning and tools are readily available to proceed when the TCC program resumes. Utilizing the modified survey allowed some data gathering and provided insights into the ICU staff’s perceived needs and perceptions of technology. Going forward, the design of this project could be used to support new-hire on-boarding and provide a refresher to staff during annual skill events

UNDERSTANDING PREDICTORS OF TELEMEDICINE ADOPTION BEFORE, DURING, AND AFTER THE COVID-19 PANDEMIC

This study examined change in physicians’ use of telemedicine before, during, and expectations after the COVID-19 pandemic. It also examined the ability of personal and environmental variables to predict telemedicine adoption, and applied the theory of reasoned action and technology acceptance model to physicians’ adoption of telemedicine during the pandemic. A total of 230 licensed physicians currently practicing in the United States were recruited. Telemedicine accounted for 3.72% of physicians’ clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less telemedicine use during the pandemic (M = 31.72%) than within group practice (M = 53.42%, p = .016) and less change in use at hospitals (M = 28.02%) compared to academic medical centers (M = 43.22%, p = .027) and group practice (M = 51.09%, p = .008). Results indicate greater use of telemedicine was predicted by greater years in practice (β = .17, p = .009), supportive organizational policies (β = .26, p = .001), organizational encouragement (β = .28, p = .003), expectations of greater patient volume (β = .20, p = .003), and higher quality of patient care (β = .17, p = .032). Model testing indicated the TRA was an adequate to poor fit, while the TAM demonstrated better fit, although a slightly trimmed TAM was ultimately retained for parsimony. Implications of the results, limitations, and future directions are discussed

THE DOCTOR WILL SKYPE YOU NOW: COLLEGE STUDENT ATTITUDES TOWARDS THE INTEGRATION OF TELEMEDICINE (HEALTHSPOT® Kiosk) AT JOHN CARROLL UNIVERSITY

There has been a spike in the nation’s interest in telemedicine over the past decade. Mobile applications, remote-monitoring devices, and image-sharing software have been designed to provide patients convenient access to medical attention. One of these technologies, an enclosed medical booth called the HealthSpot® kiosk (HSK), was installed in the John Carroll University Student Health and Wellness Center in 2014. The HealthSpot® kiosk utilizes videoconferencing technology to simulate face-to-face communication between providers and patients. This new technology would seem to be a good fit for a small college campus, as college-aged students accept technology quickly, and small campuses often have limited access to physicians; however, only 32 students used the HSK during its 13-month tenure. The current study utilizes the Theory of Planned Behavior to identify barriers that prevented many students from trying the HSK. Students at John Carroll University (n = 125) responded to a 25-item survey about their attitudes, subjective normative beliefs, perceived behavioral control, and intentions regarding using the HSK, as well as for face-to-face physician visits. Results revealed that intention to use the kiosk was significantly correlated with attitude and subjective norms. Participants who expressed positive opinions about the HealthSpot® kiosk and those who believed their close friends and family would express positive options about the HealthSpot® kiosk reported stronger intentions to use the HSK. Qualitative evidence suggest lack of knowledge and access may have also played a role in the limited use of the HSK. Findings from this study should inform future campaigns to promote the use of telemedicine technology on college campuses

AN EMPIRICAL STUDY ON THE PHYSICIANS’ BEHAVIORAL INTENTION WITH ELECTRONIC MEDICAL RECORD SYSTEMS IN TAIWAN

Currently in healthcare organizations paper-based patient record management faces many challenges. Most countries are promoting the full implementation of electronic medical records in every hospital. Medical environments change frequently and dramatically, which makes full acceptance of electronic medical records (EMR) by physicians an important issue. This empirical study combines the theory on reasoned action (TRA) and information technology acceptance model (TAM) resulted in a modified TAM to find what critical factors influence the acceptance behavior of EMR by physicians. To test these hypotheses, this study administered a cross-sectional mailed questionnaire survey during the period of three months in 2012. The survey was deployed to1000 physicians randomly from the estimated total 2000 physicians of 50 regional acute hospitals (more than 300 beds) in Taiwan currently. From these, 252effective responses were received, resulting in a net response rate of 25%. These research findings indicate that four variables significantly positively impact the intention to adopt EMR. Among these, attitude has the most significant positive impact on adoption intentions. Moreover, it shows that the professional autonomy might play an important role to moderate the attitude with significant statistics. These results maintain enough explanatory power (R2 =78.4%) to help explain the attitudes and intentions of physicians in adopting electronic medical record information systems. Our analysis revealed the importance of the perception usefulness which moderated by professional autonomy and pragmatism by physicians for their adoption electronic medical record systems in clinical practice