Addressing telehealth's foremost barrier: Provider as initial gatekeeper

Center for Healthcare Engineering, Purdue University, 100 N. University Street, Beering Hall Rm. 214, West Lafayette, IN 47907-2098, USA.
International Journal of Technology Assessment in Health Care (Impact Factor: 1.31). 02/2005; 21(4):517-21. DOI: 10.1017/S0266462305050725
Source: PubMed


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

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    • "In hindsight, including clients in the development process rather than only in the evaluation process could have better guaranteed that the system answered the computer literacy and information needs of clients. However, it may be even more important to involve audiologists because clinicians are known to act as gatekeepers for telehealth uptake (Whitten & Mackert, 2005). "
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    ABSTRACT: Background: In audiologic practice, complementary information sources and access to the clinician between appointments improve information retention and facilitate adjustment behaviors. An Internet-based support system is a novel way to support information sharing and clinician access. Purpose: This research forum article describes the process of developing an Internet-based support system for audiologists and their first-time hearing aid clients. Method: The iterative development process, including revisions by 4 research audiologists and 4 clinical audiologists, is described. The final system is exemplified. Conclusion: An Internet-based support system was successfully developed for audiologic practice.
    American Journal of Audiology 08/2015; 24(3). DOI:10.1044/2015_AJA-14-0094 · 1.28 Impact Factor
    • "Without staff advocating the use of ICTs, most WCs will not have access to these systems (Whitten & Mackert, 2005). Actions to support staff in technical and related ethical aspects are therefore important for the overall care and support of older people and their WCs (European Commission, 2010) as well as in specific ICT-based support interventions (Whitten & Mackert, 2005; Magnusson & Hanson, 2012). "
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    ABSTRACT: Family care support services have mainly focused on older spousal carers of older people and have largely overlooked working carers, whom combine paid work with informal/family care responsibilities. Recently, however, information and communication technology (ICT) systems have been identified as a potentially flexible way of supporting working carers. The aim of this study was to describe nursing and support staff's experiences of using ICT for information, e-learning and support of working carers of older people. The study employed a descriptive, qualitative approach conducting a qualitative secondary analysis of two original data sets. In total, seventeen professional staff members from two municipal family carer support units in Sweden that had implemented ICTs were interviewed using a semi-structured interview guide consisting of open-ended questions. Two data sets were merged using latent qualitative content analysis. Secondary analysis produced three subthemes and an overall theme, a virtual road as a carriageway for the support of working carers, consisting of both enabling and hindering aspects in family support. This theme provides access points in both directions and is based on caring instruments that enable nursing staff's support role. The staff's sustainability and ability to support is influenced by caring opportunities and barriers. The findings suggest the ICTs to be flexible structures that provided nursing staff with a means and method to support working carers of older people. To overcome barriers to its use, measures to optimise support for working carers and the older person are needed. The use of ICTs provides nurses with a means to offer support to working carers of older people and enables carers to be informed, to learn and to share their burdens with others when caring for an older family member. © 2015 John Wiley & Sons Ltd.
    International Journal of Older People Nursing 06/2015; DOI:10.1111/opn.12087
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    • "Participants in the primary studies included in this review were either patients/caregivers receiving palliative care [3,9-23], health professionals providing palliative care [24-29] or both [30,31]. The other articles were either descriptive reports regarding the provision, predictors, costs, barriers and ethical considerations regarding telehealth services for palliative care [32-37], or systematic/literature reviews [38-40]. "
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    ABSTRACT: Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.
    BMC Palliative Care 02/2013; 12(1):4. DOI:10.1186/1472-684X-12-4 · 1.78 Impact Factor
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