Adoption of telemedicine: from pilot stage to routine delivery

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Abstract

Background

Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery.

Discussion

We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur.

Summary

The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and professional incentives for potential telemedicine users and understand their importance for widespread adoption.

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Determinants of successful telemedicine implementations: a literature study.

Rene van der Heijden, Hermie Hermens, Tom H F Broens … (2006)

Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had influenced their implementation. The identified determinants, which would influence the future implementation of telemedicine interventions, can be classified into five major categories: (1) Technology, (2) Acceptance, (3) Financing, (4) Organization and (5) Policy and Legislation. Each category contains determinants that are relevant to different stakeholders in different domains. We propose a layered implementation model in which the primary focus on individual determinants changes throughout the development life cycle of the telemedicine implementation. For success, a visionary approach is required from the multidisciplinary stakeholders, which goes beyond tackling specific issues in a particular development phase. Thus the right philosophy is: 'start small, think big'.

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Systematic review of cost effectiveness studies of telemedicine interventions.

Pamela S Whitten, Alan Haycox, P Whitten … (2002)

To systematically review cost benefit studies of telemedicine. Systematic review of English language, peer reviewed journal articles. Searches of Medline, Embase, ISI citation indexes, and database of Telemedicine Information Exchange. STUDIES SELECTED: 55 of 612 identified articles that presented actual cost benefit data. Scientific quality of reports assessed by use of an established instrument for adjudicating on the quality of economic analyses. 557 articles without cost data categorised by topic. 55 articles with data initially categorised by cost variables employed in the study and conclusions. Only 24/55 (44%) studies met quality criteria justifying inclusion in a quality review. 20/24 (83%) restricted to simple cost comparisons. No study used cost utility analysis, the conventional means of establishing the "value for money" that a therapeutic intervention represents. Only 7/24 (29%) studies attempted to explore the level of utilisation that would be needed for telemedicine services to compare favourably with traditionally organised health care. None addressed this question in sufficient detail to adequately answer it. 15/24 (62.5%) of articles reviewed here provided no details of sensitivity analysis, a method all economic analyses should incorporate. There is no good evidence that telemedicine is a cost effective means of delivering health care.

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Why is it difficult to implement e-health initiatives? A qualitative study

Elizabeth Murray, Joanne Burns, Carl May … (2011)

Background The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives. Methods We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT). Results Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization. Conclusions Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Med Inform Decis Mak

Title: BMC Medical Informatics and Decision Making

Publisher: BioMed Central

ISSN (Electronic): 1472-6947

Publication date Collection: 2012

Publication date (Electronic): 4 January 2012

Volume: 12

Page: 1

Affiliations

[1 ]Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway

[2 ]Faculty of Medicine, University of Tromsø, Tromsø, Norway

Article

Publisher ID: 1472-6947-12-1

DOI: 10.1186/1472-6947-12-1

PMC ID: 3280930

PubMed ID: 22217121

SO-VID: 23c88ec4-5d4e-4fef-bc34-98bd90268079

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Adoption of telemedicine: from pilot stage to routine delivery

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Abstract

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Most cited references 59

Determinants of successful telemedicine implementations: a literature study.

Systematic review of cost effectiveness studies of telemedicine interventions.

Why is it difficult to implement e-health initiatives? A qualitative study

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