Skip to main content
×
Home

Addressing telehealth's foremost barrier: Provider as initial gatekeeper

  • Pamela S. Whitten (a1) and Michael S. Mackert (a2)
Abstract

Objectives: During the past decade, telehealth has enjoyed a plethora of public funding and publication outlets around the world. Yet, rhetoric appears to be outpacing the actual diffusion and utilization of telehealth technologies for patient care. Several barriers, such as reimbursement and legal/regulatory issues, are commonly cited as impeding the successful deployment of this innovation. However, two separate studies carried out in Michigan that controlled for these barriers point out a more significant initial gatekeeper to the deployment of telehealth, namely providers.

Methods: Multiple data collection strategies were used in both the telehospice and telepsychiatry projects, including utilization logs, surveys, telehospice nursing notes, cost frame data collection, patient interviews, caregiver interviews and focus groups, and videotaped visits.

Results: This study summarizes data from the two studies to support the hypothesis that the provider is the most important initial gatekeeper for telemedicine.

Conclusions: The implications from this conclusion have important consequences for health system deployment strategies. Specifically, telemedicine project managers must keep providers' needs (ease of use and incentives) in mind when designing a telemedicine system.

Copyright
References
Hide All
Boulanger B, Kearney P, Ochoa J, Tsuei B, Sands F. 2001 Tele- medicine: A solution to the follow-up of rural trauma patients? J Am Coll Surg. 192: 447452.
Bracale A. 2001: Today telemedicine across Europe: Potentiality and barriers to the implementation. In: Proceedings of the 9th Mediterranean Conference on Medical and Biological Engineering and Computing: MEDICON 2001. University of Zagreb, Croatia. 3335.
Bratton R. 2001 Patient and physician satisfaction with telemedicine for monitoring vital signs. J Telemed Telecare. 7 (Suppl 1): 72S73S.
Campbell JD, Harris KD, Hodge R. 2001 Introducing telemedicine technology to rural physicians and settings. J Fam Pract. 50: 419424.
Campbell T, Martel RF. 1999 Realtime remote consultation in the outpatient clinic: Experience at a teaching hospital. J Telemed Telecare. 5 (Suppl): 7071.
Chan WM, Woo J, Hui E, Hjelm NM. 2001 The role of telenursing in the provision of geriatric outreach services to residential homes in Hong Kong. J Telemed Telecare. 7: 3846.
Council on Competitiveness. 1995 Council on competitiveness identifies telemedicine barriers in report summarizing fall conference. Healthcare Telecom Rep. 3: 67.
Cunningham N, Marshall C, Glazer E. 1978 Telemedicine in pediatric primary care: Favorable experience in nurse-staffed inner-city clinic. JAMA. 240: 27492751.
Dansky KH, Bowles KH. 2002 Lessons learned from a telehomecare project. Caring. 21: 1822.
Elford DR, White H, St John K, et al. 2001 A prospective satisfaction study and cost analysis of a pilot child telepsychiatry service in Newfoundland. J Telemed Telecare. 7: 7381.
Gregg J. 2002: Telehospice: Changing health care policy to enhance social support for caregivers in rural areas. East Lansing: Michigan State University Department of Telecommunication; 119.
Grigsby J, Rigby M, Hiemstra A, et al. 2002 The diffusion of tele- medicine. Telemed J E Health. 8: 7994.
Higgins CA, Conrath DW, Dunn EV. 1984 Provider acceptance of telemedicine systems in remote areas of Ontario. J Fam Pract. 18: 285289.
Hui E, Woo J. 2002 Telehealth for older patients: The Hong Kong experience. J Telemed Telecare. 8 (Suppl 3): 3941.
Kjaer NK, Karlsen KO. 2002 Telemedicine and general practice future of present: Telemedicine, a way to strengthen the gatekeeper role? [Danish]. Ugeskr Laeger. 164: 52625266.
Kobb R, Hoffman N, Lodge R, Kline S. 2003 Enhancing elder chronic care through technology and care coordination: Report from a pilot. Telemed J E Health. 9: 189195.
Kvedar JC, Menn ER, Baradagunta S, Smulders-Meyer O, Gonzalez E. 1999 Teledermatology in a capitated delivery system using distributed information architecture: Design and develop- ment. Telemed J. 5: 357366.
Mazmanian P, McCue MJ, Parpart CF, et al. 1996: Evaluating telemedicine. In: International Conference on AIDS, July 7–12, Vancouver, Canada. 172.
Nesbitt TS, Hilty DM, Kuenneth CA, Siefkin A. 2000 Development of a telemedicine program: A review of 1,000 videoconferencing consultations. West J Med. 173: 169174.
Nielsen PE, Thomson BA, Jackson RB, Kosman K, Kiley KC. 2000 Standard obstetric record charting system: Evaluation of a new electronic medical record. Obstet Gynecol. 96: 10031008.
Nordal EJ, Moseng D, Kvammen B, Lochen ML. 2001 A comparative study of teleconsultations versus face-to-face consultations. J Telemed Telecare. 7: 257265.
Schlachta-Fairchild L. 2002 Telehealth: Practice in home care, synopsis of the 2000 US telenursing role study. Caring. 21: 1013.
Sjögren LH, Tornqvist H, Schwieler A, Karlsson L. 2001 The potential of telemedicine: Barriers, incentives and possibilities in the implementation phase. J Telemed Telecare. 7 (Suppl 1): 1213.
Valenta AL, Wigger U. 1996: Early results of user profiles: Physicians' opinions on the use of information technology. In: Proceedings of the AMIA Annual Symposium, Philadelphia. 6569.
Whitten P, Collins B, Mair F. 1998 Nurse and patient reactions to a developmental home telecare system. J Telemed Telecare. 4: 152160.
Whitten P, Doolittle G. 2003 Telehospice in Michigan and Kansas: Final study results. Telemed J E Health. 9 (Suppl 1): 50.
Whitten P, Doolittle G, Mackert M. 2004 Telehospice in Michigan: Study results regarding utilization and patient acceptance. Am J Hosp Palliat Care. 21: 191195.
Whitten P, Kuwahara E. 2003 Telemedicine from the payor perspective. Dis Manage Health Outcomes. 11: 291298.
Whitten P, Kuwahara E. 2004 A multi-phase telepsychiatry program in Michigan: Organizational factors impacting utilization and perceptions. J Telemed Telecare. 10: 254261.
Whitten P, Kuwahara E. 2004 A multi-phase telepsychiatry program in Michigan: Organizational factors impacting utilization and perceptions. J Telemed Telecare. 10: 254261.
Zollo S, Kienzle M, Loeffelholz P, Sebille S. 1999 Telemedicine to Iowa's correctional facilities: Initial clinical experience and assessment of program costs. Telemed J. 5: 291301.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 4
Total number of PDF views: 33 *
Loading metrics...

Abstract views

Total abstract views: 240 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.