‘Massive potential’ or ‘safety risk’? Health worker views on telehealth in the care of older people and implications for successful normalization

This is an open access article. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background Telehealth technologies, which enable delivery of healthcare services at distance, offer promise for responding to the challenges created by an ageing population. However, successful implementation of telehealth into mainstream healthcare systems has been slow and fraught with failure. Understanding of frontline providers’ experiences and attitudes regarding telehealth is a crucial aspect of successful implementation. This study aims to examine healthcare worker views on telehealth, and their implications for implementation to mainstream healthcare services for older people. The study includes a focus on two further dimensions of urban versus rural services and level of clinician experience with telehealth. Methods Seven semi-structured focus groups were conducted with a total of 44 healthcare workers providing services to older people in the areas of rehabilitation and allied health, residential aged care and palliative care. Focus groups included both telehealth experienced and inexperienced groups. Of the experienced groups, two provided services to both urban and rural patients, and two to rural patients. Inexperienced groups included one rural and two urban. Thematic analysis was undertaken to identify predominant themes. Between-group differences and agreement in viewpoints for each of these themes are discussed and mapped to the theoretical constructs of Normalization Process Theory. Results The views of participants varied with the extent of telehealth experience and perception of accessibility of healthcare services. Four themes describing clinician attitudes and perceptions that could impact on successful implementation of telehealth services are outlined: 1) Workability of telehealth: exponential growth in access or decay in the quality of healthcare? 2) What is an acceptable level of risk to patient safety with telehealth? 3) Shifting responsibilities and recalibrating the team; and 4) Change of architecture required to enable integration of telehealth service delivery. Conclusions The use of telehealth technologies to provide healthcare services to older people may be more readily normalized in areas where existing services are limited. Though exposure to telehealth may be a factor, changes to the perceived feasibility of telehealth in relation to conventional services, as well as supportive infrastructure and training and skill recalibration may be more critical to successful normalization of telehealth services for older people

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

BACKGROUND: Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. METHODS: A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. RESULTS: According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering telehealth within the broader organisation of health care services in remote and rural regions. CONCLUSION: This study identified core elements that should be considered when implementing telehealth applications with the purpose of supporting medical practice in rural and remote regions. Decision-makers need to be aware of the specific conditions that could influence telehealth integration into clinical practices and health care organisations. Thus, strategies addressing the identified conditions for telehealth success would facilitate the optimal implementation of this technology

A study of general practitioners' perspectives on electronic medical records systems in NHS Scotland

<b>Background</b> Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. <p></p><b> Methods</b> We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. <p></p> <b>Results</b> The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. <b>Conclusion </b>Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors

Using Telemedicine in Practice: Implications for Workforce Development

The aim of this article is to present a discussion of the impact of telemedicine on professional practice, and the implications for the workforce. Telemedicine, or the use of video-conferencing for remote consultations between clinician(s) and patients, is now a mature technology. Many pilot studies have taken place, generally showing positive benefits to patients. There is emerging evidence that the impact on staff is more mixed; with concerns about changes to job role, skills development, and poor understanding of the organisational benefits. Evidence also highlights enablers of successful telemedicine implementation, including senior leadership, peer motivation, understanding of patient benefits, and time for safe experimentation. Following a review of qualitative data from four case study telemedicine projects undertaken within the authors’ research group, evidence from published literature is discussed. The four projects explore telemedicine services provided between an acute hospital service and nursing homes (remote assessment of swallowing difficulties), an acute hospital service and home (video-link to renal patients undergoing home dialysis), between a specialist teaching hospital service and a district general hospital (fetal abnormalities ultrasound telemedicine clinic), and a survey of mental health professionals across acute and community services within a locality. The introduction of telemedicine at scale requires an organisational and system-level approach that recognises the specific challenges and issues for the workforce. Education and training need to be provided at all levels. In conclusion: there are significant opportunities to realise the benefits of remote consultations, to improve the patient experience and staff productivity, if workforce issues are addressed

Connected Hearing Devices and Audiologists: The User-Centered Development of Digital Service Innovations

Today, medical technology manufacturers enter the service market through the development of digital service innovations. In the field of audiology, these developments increasingly shift the service capacities from audiologists to manufacturers and technical systems. However, the technology-driven developments of manufacturers lack acceptance of hearing device users and undermine the important role of audiologists within the service provision. By following a user-centered design approach in order to deal with the technological and social challenges of disruptive services, we aim to develop service innovations on an integrated service platform in the field of tele-audiology. To ensure the acceptance of technology-driven service innovations among hearing device users and audiologists, we systematically integrated these actors in a participatory innovation process. With qualitative and quantitative data we identified several requirements and preferences for different service innovations in the field of tele-audiology. According to the preferences of the different actors, we proposed a service platform approach based on a connected hearing device in three pillars of application: 1) one-to-one (1:1) service innovations based on a remote fitting concept directly improve the availability of services offered by audiologists without being physically present. Based on this, 2) one-to-many (1:N) service innovations allow the use of the connected hearing device as an indirect data source for training a machine learning algorithm that empowers users through the automation of service processes. A centralized server system collects the data and performs the training of this algorithm. As a future outlook, we show potentials to use the connected hearing device for 3) cross-industry (N:M) service innovations in contexts outside the healthcare domain and give practical implications for the market launch of successful service innovations in the field of tele-audiology

Conceptual framework for telehealth adoption in Indian healthcare

India is a developing country with a large landmass and a huge socio-culturally, economically and, ethnically diverse population. The healthcare system for such a diverse and complex country could entail challenges and difficulties in execution and outreach. Here, the emerging area of Telehealth could afford a place for itself in providing healthcare and health education to a large section of people residing in areas where there is acute shortage of healthcare professionals. Almost, seventy per cent of the population in India are rural. The infrastructure in India, similar to other developing countries, is erratic and differs throughout the country. Similarly, the ICT infrastructure is developed in the urban areas whereas there are insufficient ICT facilities in the rural areas. As telehealth depends on the utilisation of ICT infrastructure it is essential to conduct a study to find out the determinants of ICT adoption in the Indian telehealth environment. Moreover, as evident from relevant literature, telehealth is in a nascent stage in India, with most of the projects currently in a pilot study level. As such, it would be practical to conduct the study from an organisational point of view because the organisational adoption of ICT will eventually foster the implementation of telehealth in the domain of Indian healthcare. The study focuses on developing a conceptual framework of ICT adoption in the Indian telehealth environment, as limited research has been conducted in this area. The study highlighted the drivers and barriers of telehealth around the world, reviewed the relevant models of ICT adoption and generated themes to develop the conceptual framework. Empirical testing of the conceptual framework may have the potential to establish and confirm the determinants of ICT adoption in the Indian telehealth environment. The conceptual framework may be utilised for governmental and non-governmental policy level decision making

Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews

Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).Peer reviewedPublisher PD

Patient Satisfaction Management in Office Visits and Telehealth in Health Care Technology

Telehealth and remote medical treatments have begun to be more commonly used in healthcare systems. Researchers have theorized that providers\u27 abilities to treat patients are not directly tied to the proximity of the patient to the doctor, but by the identification and treatment of the patient\u27s symptoms. Although the treatment and cure rates are being established within individual health systems and professional medical associations, empirical research is lacking regarding patient satisfaction with this remote treatment situation. The purpose of this quantitative study was to address this gap by examining satisfaction ratings of patients between virtual provider visits and face-to-face provider visits. The Clinician & Group Survey developed by the Consumer Assessment of Health Care Providers and Systems (CAHPS), through the United States government department, Agency for Health Care Research and Quality, measured patient satisfaction. Data from health care patients in the United States (N=8854) were randomly selected from the CAHPS data set containing 457,418 encounters. Of this number, 4,427 unique patient encounters were with face-to-face health care visits and 4,427 unique patient encounters were with telehealth providers. The ANOVA results showed no significant differences in patient satisfaction management between the availability of providers to meet face-to-face with patients who met with providers in a telehealth setting. Possible social change implications are a shift from face-to-face visits to virtual visits structured in the need to shift all patients from the standard office visit system to the on-demand network opportunity that virtual telehealth and mobile commerce health care offers to allow the benefit of technology to assist these patients