Conference Paper

Investigating Barriers for the Implementation of Telemedicine Initiatives:A Systematic Review of Reviews

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Abstract

Telemedicine is said to change the way care is delivered. Nevertheless, it still faces barriers to overcome the pilot stage and reach a majority of patients in regular care. Although research widely exists on telemedicine barriers in isolated settings, a systematic overview to summarize key scientific contributions is missing. This paper aims to close this gap with a systematic review of already existing reviews. In sum, 98 barriers for telemedicine implementation were found and categorized depending on the factors triggering the barriers. These factors include patient, healthcare provider, culture and disease (people-related); health sector, standards/guidelines, legal framework, finance, organization and methodology (process-related); and technology (object-related). Recommendations for researchers and practitioners were drawn to overcome the barriers identified.

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... This perspective (i.e., that there are multiple barriers and all of them affect the implementation of a telemedicine project) is also highlighted in the review of Otto and Harst (2019), which encompasses 98 barriers grouped in the following categories: people, process, and object. Concerning people, the main barriers are individual characteristics, social support, the usability of telemedicine services, patient expectations, culture, and disease. ...
... The review of Otto and Harst (2019) traces the determinants identified in Broens et al. (2007) but does not discriminate the factors according to the life cycle. In addition, Broens et al. (2007) group the determinants in distinct domains, whereas the categories identified by Otto and Harst (2019) are too wide, and in many cases, the barriers can belong to more than one category. ...
... The review of Otto and Harst (2019) traces the determinants identified in Broens et al. (2007) but does not discriminate the factors according to the life cycle. In addition, Broens et al. (2007) group the determinants in distinct domains, whereas the categories identified by Otto and Harst (2019) are too wide, and in many cases, the barriers can belong to more than one category. The domains of Broens et al. (2007) also emerged as the main domains for e-health implementations based on a literature review (Cremers et al., 2021). ...
Article
Over the past two decades, different drivers have prompted institutional players to adopt digital innovations in healthcare systems. Telemedicine represents a digital innovation solution to guaranteeing the continuity of care, and patient and personnel safety. However, despite its potential benefits (such as improving care access in rural areas, reduction in hospitalization stay, and saving time for patients and healthcare professionals) and its rapid acceleration in use during the Covid-19 pandemic, the diffusion of telemedicine services remains limited and uneven across Europe. Adopting an explorative approach, this paper analyzes the implementation of telemedicine projects, investigating not only the factors but also the ways in which the analyzed organizations, in order to move from the design to implementation phase, managed the change needed to overcome barriers and to leverage enabling factors. Our research focus is on Southern Italy; a disadvantaged area in comparison to other Italian and European regions. The goal of the paper is to shed light on the characterization of leverages and barriers, as well as the related managerial actions for change implemented in a context whereby the diffusion of telemedicine remains limited.
... Functionality problems imply difficulties in bringing proof of the technical feasibility, system efficiency, or technological capabilities (Frederix et al. 2019). The overall technological complexity refers to implementation and maintenance of digital services (Lim and Anderson 2016;Harst et al. 2019). The complexity is highly dependent on the level of required integration within the hospitals' systems in terms of required data (semantics and syntactics), available APIs, and workflow alignment, which often have to be harmonized with existing systems. ...
... This claim belongs to the barriers most mentioned by the startups (#2, #4, #6, #12, 14, #22, #24). Hierarchical deficiency includes missing top-management support, low change management, and scattered key players that operate independently within the organization causing unclear roles and responsibilities (Mason et al. 2017;Mohamadali and Zahari 2017a;Harst et al. 2019). The startups confirmed that such opacities are a major barrier for them (#2, #4, # 26) and so are long decisionmaking processes (#2, #26). ...
... The startups confirmed that such opacities are a major barrier for them (#2, #4, # 26) and so are long decisionmaking processes (#2, #26). At last, there are also cultural barriers which evolve around the issue of differences in adopting and accessing digital resources (Lim and Anderson 2016;Otto and Harst 2019). Especially, a cultural resistance toward (technology-induced) changes might hamper the adoption or implementation of digital innovations and requires adequate change management approaches (Lluch 2011). ...
Article
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Aim Hospitals noticeably struggle with maintaining hundreds of IT systems and applications in compliance with the latest IT standards and regulations. Thus, hospitals search for efficient opportunities to discover and integrate useful digital health innovations into their existing IT landscapes. In addition, although a multitude of digital innovations from digital health startups enter the market, numerous barriers impede their successful implementation and adoption. Against this background, the aim of this study was to explore typical digital innovation barriers in hospitals, and to assess how a hospital data management platform (HDMP) architecture might help hospitals to extract such innovative capabilities. Subject and methods Based on the concept of organizational ambidexterity (OA), we pursued a qualitative mixed-methods approach. First, we explored and consolidated innovation barriers through a systematic literature review, interviews with 20 startup representatives, and a focus group interview with a hospital IT team and the CEO of an HDMP provider. Finally, we conducted a case-study analysis of 36 digital health startups to explore and conceptualize the potential impact of DI and apply the morphological method to synthesize our findings from a multi-level perspective. Results We first provide a systematic and conceptual overview of typical barriers for digital innovation in hospitals. Hereupon, we explain how an HDMP might enable hospitals to mitigate such barriers and extract value from digital innovations at both individual and organizational level. Conclusion Our results imply that an HDMP can help hospitals to approach organizational ambidexterity through integrating and maintaining hundreds of systems and applications, which allows for a structured and controlled integration of external digital innovations.
... A systematic overview of implementation barriers for telemedicine initiatives, which summarized existing reviews, found 98 barriers for telemedicine implementation (Otto and Harst 2019). These barriers include 11 factors triggering the barriers: patients and health care providers, their culture and the patient's disease, the health sector, standards/guidelines, legal framework, finance, organization, and methodology as well as the technology applied. ...
... These barriers include 11 factors triggering the barriers: patients and health care providers, their culture and the patient's disease, the health sector, standards/guidelines, legal framework, finance, organization, and methodology as well as the technology applied. Typical barriers of telemedical problems in current times are limited financial resources, the resistance of individual end-users (especially patients and health care providers), and lacking regional infrastructure (Otto and Harst 2019). The barrier categories are further illustrated in Table 2 by presenting examples per category. ...
... Also, in pandemic times, barriers (such as data security) long assumed to be paramount can be overcome with sufficient financial, organizational, and technological resources, as Bashshur et al. (2020) argue in a recent collection of lessons learned from the COVID-19 pandemic. However, barriers persist despite core readiness being present, as the STARPAHC project demonstrates: In remote and thinly populated areas, remote consultation of patients is certainly useful; however, funding for any telemedicine system must be ensured beyond the pilot project phase and sustained even when a major stakeholder drops out of the project (Huang et al. 2017;Otto and Harst 2019). Lacking strategic readiness leads to chaotic telemedicine implementation processes during a pandemic, as the COVID-19 pandemic has demonstrated as well (Patel et al. 2020). ...
Article
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Aim Telemedicine is a promising solution to extend traditional health care services. Even though mainly discussed during the past two decades, its roots go back into the past century and even further, considering the use of bonfires to warn other villages of diseases. Insights from historical cases can therefore be useful for the ongoing discussion regarding the successful implementation of telemedicine. Subject and Methods We analyzed three historical telemedicine cases (varying regarding time and place) and extracted their success factors and barriers as well as assessed their maturity by using the Telemedicine Community Readiness Model (TCRM). Evidence-based categories of success factors and barriers as well as the TCRM’s dimensions were used as deductive categories to analyze the study material’s content. Results The analysis showed that the readiness for telemedicine is higher when the technology is the only option to access health care services. In all three cases, core readiness played a central role. However, the health sector, existing technology, and finance were barriers present at all times, while during pandemics, some barriers are only temporarily removed, for example, by putting legal issues on hold. The analyzed cases were all on lower levels of maturity as they mainly represent pilot tests or exceptional circumstances. Conclusion Results indicate the important core functions in telemedicine initiatives as well as the diversity of their circumstances. Insights from such historical meta-perspectives can, for example, help to strengthen the sustainability of the increased use of telemedicine during the COVID-19 pandemic and scale up current telemedicine projects.
... The evaluation results would also be the foundation for trust-building certifications similar to energy efficiency labels of consumer products, which can be used by patients and health professionals alike to find the "right" DHIs. Moreover, barriers for implementation and scaling-up of DHIs remain [65] that intervention authors must be aware of and that need to be addressed during and after the development process. A successful DHI conclusively needs to consider both, the selection of suitable evaluation criteria and the overcoming of implementation barriers. ...
... Then, a systematic literature review is described and a consolidated list of evaluation criteria for DHIs are presented. Afterwards and based on a previous literature review [65], a consolidated list of implementation barriers for DHIs are outlined. In the following main results section, the consolidated evaluation criteria and implementation barriers for DHIs are both mapped to the DEDHI framework. ...
... A list of implementation barriers of DHIs was already identified in prior work by means of a systematic literature review of reviews [65]. For the purpose of the current work, the 98 identified implementation barriers were summarized into inductive categories according to qualitative content analysis [55]. ...
Article
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Digital health interventions (DHIs) have the potential to help the growing number of chronic disease patients better manage their everyday lives. However, guidelines for the systematic development of DHIs are still scarce. The current work has, therefore, the objective to propose a framework for the design and evaluation of DHIs (DEDHI). The DEDHI framework is meant to support both researchers and practitioners alike from early conceptual DHI models to large-scale implementations of DHIs in the healthcare market.
... The digital dermatology service cannot be adequately evaluated in isolation from the organizational context in which it is implemented. Organizational factors such as the lack of adequate training and technological support, existing and new policies, leadership and change management, and communication needs can hinder the adoption and implementation of digital health tools [13,14]. Moreover, digital dermatology is used in a complex health system that consists of numerous interconnected components (eg, technological elements and social human system aspects) that interact and must work together to positively contribute to the delivery of such a service [15,16]. ...
... Digital services affect the work processes of health care providers and the way in which they deliver care to patients. Ideally, such telemedicine service should be seamlessly incorporated into the provider's day-to-day work processes [13], but achieving that goal requires insight into the aspects that affect GPs' satisfaction and the continued use of the service. ...
Article
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Background The COVID-19 pandemic affected the delivery of primary care and stimulated the use of digital health solutions such as remote digital dermatology care. In the Netherlands, remote store-and-forward dermatology care was already integrated into Dutch general practice before the COVID-19 pandemic. However, it is unclear how general practitioners (GPs) experienced this existing digital dermatology care during the pandemic period. Objective We investigated GPs’ perspectives about facilitators and barriers related to store-and-forward digital dermatology care during the COVID-19 pandemic in the Netherlands, using a sociotechnical approach. Methods In December 2021, a web-based questionnaire was distributed via email to approximately 3257 GPs who could perform a digital dermatology consultation and who had started a digital consultation (not necessarily dermatology) in the previous 2 years. The questionnaire consisted of general background questions, questions from a previously validated telemedicine service user satisfaction questionnaire, and newly added questions related to the pandemic and use of the digital dermatology service in general practice. The open-ended and free-text responses were analyzed for facilitators and barriers using content analysis, guided by an 8-dimensional sociotechnical model. Results In total, 71 GPs completed the entire questionnaire, and 66 (93%) questionnaires were included in the data analysis. During the questionnaire distribution period, another national lockdown, social distancing, and stay-at-home mandates were announced; thus, GPs may have had increased workload and limited time to complete the questionnaire. Of the 66 responding GPs, 36 (55%) were female, 25 (38%) were aged 35-44 years, 33 (50%) were weekly platform users, 34 (52%) were working with the telemedicine organization for >5 years, 42 (64%) reported that they used the store-and-forward platform as often during as before the pandemic, 61 (92%) would use the platform again, 53 (80%) would recommend the platform to a colleague, and 10 (15%) used digital dermatology home consultation. Although GPs were generally satisfied with the digital dermatology service, platform, and telemedicine organization, they also experienced crucial barriers to the use of the service during the pandemic. These barriers were GPs’ and patients’ limited digital photography skills, costs and the lack of appropriate equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service. Conclusions Although remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs about the use of the service, barriers impeded the full potential of its use during the pandemic. Training is needed to improve the use of equipment and quality of (dermoscopy) images taken by GPs and to inform GPs in which circumstances they can or cannot use digital dermatology. Furthermore, the dermatology platform should be improved to also guide patients in taking photographs with sufficient quality.
... High OC allow organizations and employees to learn quickly; identify new resource strategies; integrate, build, and reconfigure internal resources, and have the ability to cope with dynamic environments [26]. The literature emphasizes that the main barriers in improving OC are related to people (about 60%) and resources (about 30%) [66]. Other barriers include low availability [67], inadequate workforce (e.g., high rotation of medical personnel) [68], and lack of cooperation (e.g., potential for conflict) [67] and planning (e.g., no scale-up strategy) [69]. ...
... All variables for assessing TC were rated below 3.5 on average. Weak TC make it challenging to use telemedicine and have a negative impact on medical care [66]. The barriers related to TC have been confirmed in other studies. ...
Article
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The COVID-19 pandemic has forced many countries to implement a variety of restrictive measures to prevent it from spreading more widely, including the introduction of medical teleconsultations and the use of various tools in the field of inpatient telemedicine care. Digital technologies provide a wide range of treatment options for patients, and at the same time pose a number of organizational challenges for medical entities. Therefore, the question arises of whether organizations are ready to use modern telemedicine tools during the COVID-19 pandemic. The aim of this article is to examine two factors that impact the level of organizational e-readiness for digital transformation in Polish primary healthcare providers (PHC). The first factor comprises operational capabilities, which are the sum of valuable, scarce, unique, and irreplaceable resources and the ability to use them. The second factor comprises technological capabilities, which determine the adoption and usage of innovative technologies. Contrary to the commonly analyzed impacts of technology on operational capabilities, we state the reverse hypothesis. The verification confirms the significant influence of operational capabilities on technological capabilities. The research is conducted using a questionnaire covering organizational e-readiness for digital transformation prepared by the authors. Out of the 32 items examined, four are related to the operational capabilities and four to the technological capabilities. The result of our evaluation shows that: (i) a basic set of four variables can effectively measure the dimensions of OC, namely the degree of agility, level of process integration, quality of resources, and quality of cooperation; (ii) a basic set of three variables can effectively measure the dimensions of TC, namely adoption and usage of technologies, customer interaction, and process automation; (iii) the empirical results show that OC is on a higher level than TC in Polish PHCs; (iv) the assessment of the relationship between OC and TC reveals a significant influence of operational capabilities on technological capabilities with a structural coefficient of 0.697. We recommend increasing the level of technological capability in PHC providers in order to improve the contact between patients and general practitioners (GPs) via telemedicine in lockdown conditions.
... However, despite telemedicine receiving growing attention, currently available solutions are often still in an infant stage and have not matured to reach regular care (Huang et al. 2017;Harst et al. 2019b), as barriers for the implementation of telemedicine applications are diverse, originating from a lack of technology acceptance by both providers and patients (Harst et al. 2019a), from insufficient technological or financial infrastructural conditions (Otto and Harst 2019), as well as from low-quality evidence . Telemedicine applications may be highly diverse, potentially encompassing prevention (Alcantara-Aragon et al. 2018), care delivery (Birns et al. 2013) and rehabilitation for different diseases (Anderson et al. 2017). ...
... This is especially important as generating evidence for the effectiveness of telemedicine is one major barrier to the scale-up (i.e. successful implementation) of telemedicine (Otto and Harst 2019). ...
Article
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Aim Because the field of information systems (IS) research is vast and diverse, structuring it is a necessary precondition for any further analysis of artefacts. To structure research fields, taxonomies are a useful tool. Approaches aiming to develop sound taxonomies exist, but they do not focus on empirical development. We aimed to close this gap by providing the CAFE methodology, which is based on quantitative content analysis. Subject and methods Existing taxonomies are used to build a coding scheme, which is then validated on an IS project database. After describing the methodology, it is applied to develop a telemedicine taxonomy. Results The CAFE methodology consists of four steps, including applicable methods. It helps in producing quantitative data for statistical analysis to empirically ground any newly developed taxonomy. By applying the methodology, a taxonomy for telemedicine is presented, including, e.g. application types, settings or the technology involved in telemedicine initiatives. Conclusion Taxonomies can serve in identifying both components and outcomes to analyse. As such, our empirically sound methodology for deriving those is a contribution not only to evaluation research but also to the development of future successful telemedicine or other digital applications.
... The regulation of virtual medical activity must move forward to overcome the legal gap in which teleneurology care currently finds itself. While TN services can overcome geographical barriers and travel costs, the absence of specific legislation on TM and TN has been found to leave unresolved the problem of universal access to this service [90], as well as the inherent challenges of data protection and professional responsibilities [30,34,46,58,67,72], all of which creates a degree of uncertainty for healthcare professionals [89,91]. However, despite this absence of a specific legal framework for TN, important steps have been taken in the implementation of TN. ...
Article
Full-text available
Background: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. Methods: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. Results: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. Conclusions: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
... The regulation of virtual medical activity must move forward to overcome the legal gap in which teleneurology care currently finds itself. While TN services can overcome geographical barriers and travel costs, the absence of specific legislation on TM and TN has been found to leave unresolved the problem of universal access to this service [90], as well as the inherent challenges of data protection and professional responsibilities [30,34,46,58,67,72], all of which creates a degree of uncertainty for healthcare professionals [89,91]. However, despite this absence of a specific legal framework for TN, important steps have been taken in the implementation of TN. ...
Article
Full-text available
Background: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. Methods: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. Results: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. Conclusions: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
... It will be signifcant to incorporate telehealth into medical curricula so that future healthcare professionals may realize the importance of telehealth being a legitimate part of the healthcare setup. In the literature, researchers reported some issues in implementing technologies such as telemedicine systems (teleconsultation or eHealth systems in general) in healthcare institutions [31][32][33][34], indicating internal resistance (within health institutes) to changing normal work processes to accommodate telehealth in organizations [35,36]. Te international literature also pointed out some economic factors, which are huge barriers. ...
Article
Full-text available
The world has been going through the global crisis of the coronavirus (COVID-19). It is a challenging situation for every country to tackle its healthcare system. COVID-19 spreads through physical contact with COVID-positive patients and causes potential damage to the country's health and economic system. Therefore, to overcome the chance of spreading the disease, the only preventive measure is to maintain social distancing. In this vulnerable situation, virtual resources have been utilized in order to maintain social distance, i.e., the telehealth system has been proposed and developed to access healthcare services remotely and manage people's health conditions. The telehealth system could become a regular part of our healthcare system, and during any calamity or natural disaster, it could be used as an emergency response to deal with the catastrophe. For this purpose, we proposed a conceptual telehealth framework in response to COVID-19. We focused on identifying critical issues concerning the use of telehealth in healthcare settings. Furthermore, the factors influencing the implementation of the telehealth system have been explored in detail. The proposed telehealth system utilizes artificial intelligence and data science to regulate and maintain the system efficiently. Before implementing the telehealth system, it is required prearrangements be made, such as appropriate funding measures, the skills to know technological usage, training sessions, and staff endorsement. The barriers and influencing factors provided in this article can be helpful for future developments in telehealth systems and for making fruitful progress in fighting pandemics like COVID-19. At the same time, the same approach can be used to save the lives of many frontline workers.
... Among these, social factors are seen as the most problematic [33]. A comprehensive overview compiled by researchers at the Technical University of Dresden provides more information on the barriers to telemedicine implementation Through a detailed analysis of international studies related to the implementation of telemedicine initiatives into regular care, they demonstrated that the introduction of telemedicine is hindered worldwide, regardless of the political system, legal framework or development status [34]. Indeed, as described earlier, particularly, the individual characteristics and skills of patients and healthcare providers as well as sufficient regional infrastructure are the most relevant identified categories of barriers [35]. ...
Article
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The outbreak of the COVID-19 pandemic caused the healthcare system to drastically reduce in-person visits and suddenly switch to telemedicine services to provide clinical care to patients. The implementation of teleconsultation in medical facilities was a novelty for most Polish patients. In Poland, the main telehealth services were provided in the form of telephone consultations. The aim of this study is to determine patients’ perceptions of telemedicine in the context of their experiences with the healthcare system during the COVID-19 pandemic. In this study, we presented how the evaluation of telemedicine services from the perspective of patients in Poland changed in the context of the ongoing pandemic. We conducted two surveys (year by year) on a representative quota sample of the Polish population (N = 623). This ensured that our observations took into account the evolution of views on telemedicine over time. We confirmed the well-known relationship that innovations introduced in the healthcare sector require a longer period of adaptation. We also identified significant concerns that limit the positive perception of telemedicine and compared them with experiences described in other countries.
... Un reporte reciente señaló las barreras más relevantes y sus pesos ponderados según 3 categorías de análisis: expectativas de los pacientes (en categoría Personas (40,6%); falta de financiamiento e insuficiente implementación, en categoría Procesos (52,6%); y falta de infraestructura local, en categoría Objetos (34,5%) 19 . En un contexto de heterogeneidad de modalidades de telemedicina y formas de organización de atención de salud, también se ha reportado discordancia entre beneficios reportados sobre telemedicina y las experiencias de los equipos clínicos en condiciones reales 20,21 . Esta situación ha promovido la emergencia de investigaciones que recogen elementos contextuales de las organizaciones de salud para el diseño e implementación de la telemedicina, además de los abordajes investigativos de predominio positivista. ...
Article
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Introducción: La telemedicina emerge como una alternativa para dar continuidad a las pres¬taciones de salud en el contexto pandémico. Nuestro trabajo analizó las condicionantes de uso y desarrollo de la telemedicina (modalidad de atención remota por especialista) en un contexto territorial de alta dispersión geográfica y ruralidad, y un contexto organizacional de instituciones públicas en redes crónicamente afectadas por las reformas neoliberales del sector. Material y Métodos: Se utilizó un diseño cualitativo de corte hermenéutico basado en entre¬vistas semiestructuradas con equipos de salud y gestores de una red asistencial pública del sur de Chile. Resultados: Los resultados muestran que se validan beneficios como el acercamiento de la atención del médico especialista al territorio, el aprendizaje entre profesionales y la continuidad de cuidados entre niveles de atención. Las motivaciones, intereses y resistencias de las personas emergen como los principales condicionantes del uso y desarrollo de la tele¬medicina, con importantes asimetrías de carga de trabajo en los procesos de gestión clínica y de recursos entre niveles de atención. Discusión: la pandemia habría facilitado la extensión de la telemedicina, mientras que sus beneficios y efectividad dependerían del valor que los equipos le otorguen para apoyar la atención de salud y de su traducción en un aprendizaje colectivo para la institución, antes que el cumplimiento de marcos normativos. Se vuelve prioritario, en este nuevo escenario, explorar las percepciones de los usuarios respecto a la expansión de la telemedicina.
... Telemedicine, particularly when building a new platform, necessitates a constant process of technical support and development (7,36,37). Otto and Harst found that an effective telemedicine application requires a multilevel approach that includes 11 key factors: patient, healthcare provider, culture, and disease (people-related); health sector, standards/guidelines, legal framework, finance, organization, and methodology (process-related); and technology (object-related) (81). Thus, before implementing telemedicine infrastructure, it should be ensured that prerequisites are met. ...
Article
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Background: COVID-19 has impacted the capacity of healthcare systems worldwide, particularly in low- and middle-income countries (LMICs), which are already under strain due to population growth and insufficient resources. Since the COVID-19 pandemic’s emergence, there has been an urgent need for a rapid and adequate reaction to the pandemic’s disruption of healthcare systems. To this end, telemedicine has been shown in prior research to be a feasible approach. The overarching objective of this scoping review was to determine the extent and acceptance of telemedicine in healthcare in low- and middle-income countries (LMICs) during the COVID-19 pandemic. Methods: This scoping review followed PRISMA guidelines and Arksey and O’Malley’s five-stage framework to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between January 2020 and April 2021: Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for grey literature. Results: The search identified 54 articles with 45,843 participants, including 6,966 healthcare professionals and 36,877 healthcare users. We identified a range of reasons for introducing telemedicine in LMICs during COVID-19, most notably to maintain non-emergency healthcare, enhance access to healthcare providers, and reduce the risk of infection among health users and providers. Overall, healthcare providers and users have shown a high level of acceptance for telemedicine services. During the COVID-19 pandemic, telemedicine provided access to healthcare in the majority of included articles. Nonetheless, some challenges to accepting telemedicine as a method of healthcare delivery have been reported, including technological, regulatory, and economical challenges. Conclusion: Telemedicine was found to improve access to high-quality healthcare and decrease infection risk in LMICs during COVID-19. In general, infrastructure and regulatory barriers found to be the most significant barriers to wider telemedicine use, and should be considered when implementing telemedicine more broadly. There appears to be a need to prioritize patient data safety, as many healthcare practitioners utilized commercial apps and services as telemedicine systems. Additionally, it appears as though there is a need to increase capacity, skill, and transparency, as well as to educate patients about telemedicine.
... 12,13,14 Numerous barriers such as lack of social support, lack of technological infrastructure and patients' preferences hampering adoption have been ascertained. 15 Notably, patient acceptance of telemedicine has been perceived as a major determinant of its widespread and sustained uptake, 16,17 and assessing it is important during initial development and evaluation of digital health interventions. 18 However, current acceptance among cancer patients is unclear. ...
Article
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Background Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objectives This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Methods An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Results Respondents ( n = 278; mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71–10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30–8.97). Conclusion Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients.
... The startups confirmed that such opacities are a major barrier for them (#2, #4, # 26) and so are long decision-making processes (#2, #26). At last, there are also cultural barriers which evolve around the issue of differences in adopting and accessing digital resources(Lim and Anderson 2016;Otto and Harst 2019). Especially, a cultural resistance towards (technology-induced) changes might hamper the adoption or implementation of digital innovations and requires adequate change management approaches(Lluch 2011).Behavioral Barriers Many barriers occur on an individual, i.e., staff or patient-related, level. ...
Thesis
Digital transformation (DT) has not only been a major challenge in recent years, it is also supposed to continue to enormously impact our society and economy in the forthcoming decade. On the one hand, digital technologies have emerged, diffusing and determining our private and professional lives. On the other hand, digital platforms have leveraged the potentials of digital technologies to provide new business models. These dynamics have a massive effect on individuals, companies, and entire ecosystems. Digital technologies and platforms have changed the way persons consume or interact with each other. Moreover, they offer companies new opportunities to conduct their business in terms of value creation (e.g., business processes), value proposition (e.g., business models), or customer interaction (e.g., communication channels), i.e., the three dimensions of DT. However, they also can become a threat for a company's competitiveness or even survival. Eventually, the emergence, diffusion, and employment of digital technologies and platforms bear the potential to transform entire markets and ecosystems. Against this background, IS research has explored and theorized the phenomena in the context of DT in the past decade, but not to its full extent. This is not surprising, given the complexity and pervasiveness of DT, which still requires far more research to further understand DT with its interdependencies in its entirety and in greater detail, particularly through the IS perspective at the confluence of technology, economy, and society. Consequently, the IS research discipline has determined and emphasized several relevant research gaps for exploring and understanding DT, including empirical data, theories as well as knowledge of the dynamic and transformative capabilities of digital technologies and platforms for both organizations and entire industries. Hence, this thesis aims to address these research gaps on the IS research agenda and consists of two streams. The first stream of this thesis includes four papers that investigate the impact of digital technologies on organizations. In particular, these papers study the effects of new technologies on firms (paper II.1) and their innovative capabilities (II.2), the nature and characteristics of data-driven business models (II.3), and current developments in research and practice regarding on-demand healthcare (II.4). Consequently, the papers provide novel insights on the dynamic capabilities of digital technologies along the three dimensions of DT. Furthermore, they offer companies some opportunities to systematically explore, employ, and evaluate digital technologies to modify or redesign their organizations or business models. The second stream comprises three papers that explore and theorize the impact of digital platforms on traditional companies, markets, and the economy and society at large. At this, paper III.1 examines the implications for the business of traditional insurance companies through the emergence and diffusion of multi-sided platforms, particularly in terms of value creation, value proposition, and customer interaction. Paper III.2 approaches the platform impact more holistically and investigates how the ongoing digital transformation and "platformization" in healthcare lastingly transform value creation in the healthcare market. Paper III.3 moves on from the level of single businesses or markets to the regulatory problems that result from the platform economy for economy and society, and proposes appropriate regulatory approaches for addressing these problems. Hence, these papers bring new insights on the table about the transformative capabilities of digital platforms for incumbent companies in particular and entire ecosystems in general. Altogether, this thesis contributes to the understanding of the impact of DT on organizations and markets through the conduction of multiple-case study analyses that are systematically reflected with the current state of the art in research. On this empirical basis, the thesis also provides conceptual models, taxonomies, and frameworks that help describing, explaining, or predicting the impact of digital technologies and digital platforms on companies, markets and the economy or society at large from an interdisciplinary viewpoint.
... Prior research is facing this issue from different points of view. It provides definitional relationships of key concepts and types of digital health soultions (Iyawa et al., 2016;Otto et al., 2018), consolidates valuable insights of domain-specific diffusion barriers (Hobeck et al., 2021;Otto and Harst, 2019), and derives success factors to overcome hurdles (Kowatsch et al., 2019;Otto, 2019). Also, such scientifically stated knowledge already found its way into international political programs, recommendations and interdisciplinary frameworks (European Commision, 2019;WHO, 2015). ...
Conference Paper
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Integrating Digital Health Innovations (DHI) into healthcare practice remains a challenging task for innovators. They continuously seek for actionable ways to fulfil the complex web of requirements set by the target environment. A socio-technical understanding of interoperability offers structurization to this complexity and becomes a key property that innovators want to ensure during the innovation process. Nevertheless, scientific guidance remains abstract rather than applicable. This research paper builds on this point and follows the question how innovators can evaluate their DHI process holistically and tangibly to promote the later integration into complex healthcare systems. It therefore presents an evaluation approach based on the Refined eHealth European Interoperability Framework (ReEIF) and results of a qualitative content analysis. Here, detailed descriptions of the six ReEIF levels and 181 potential parameters for a self-assessment tool have been derived from prior literature. These findings stimulate future research on interdependencies within identified aspects of socio-technical interoperability and promote applicable tools for digital health innovators.
... On an organizational level, healthcare providers have been slow to adopt new technologies and have relied on paper-based processes for a long time (Agarwal et al. 2010). On a structural level, high costs, complex regulatory systems, and missing standards have impeded digital progress (Otto and Harst 2019). However, the healthcare sector faces an expensive and massive digital transformation (Burton-Jones et al. 2020) owing to new digital technologies and personal expectations (Menvielle et al. 2017;Safavi and Kalis 2020). ...
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The healthcare industry has been slow to adopt new technologies and practices. However, digital and data-enabled innovations diffuse the market, and the COVID-19 pandemic has recently emphasized the necessity of a fundamental digital transformation. Available research indicates the relevance of digital platforms in this process but has not studied their economic impact to date. In view of this research gap and the social and economic relevance of healthcare, we explore how digital platforms might affect value creation in this market with a particular focus on Google, Apple, Facebook, Amazon, and Microsoft (GAFAM). We rely on value network analyses to examine how GAFAM platforms introduce new value-creating roles and mechanisms in healthcare through their manifold products and services. Hereupon, we examine the GAFAM-impact on healthcare by scrutinizing the facilitators, activities, and effects. Our analyses show how GAFAM platforms multifacetedly untie conventional relationships and transform value creation structures in the healthcare market. Supplementary information: The online version contains supplementary material available at 10.1007/s12525-021-00467-2.
Conference Paper
As long as telemedicine is not implemented and scaled up successfully, its promises of increased access to care and decreased costs cannot be kept. Extant literature already identified factors to be addressed when implementing a telemedicine solution but lacks clear guidance on how to support successful telemedicine implementation and scaling up. The aim of this paper is to identify and combine evidence on barriers and success factors from different countries. Structuring the results in different layers helps describing the context of telemedicine initiatives within the FraTelIni framework. Aspects for improvement and responsible stakeholders are named, resulting in general recommendations to be followed. Such, a conclusive picture on that topic can be drawn which actively addresses stakeholders and their tasks on different levels to support successful telemedicine initiatives.
Conference Paper
Telemedicine is said to change the way care is delivered. Nevertheless, it still faces barriers to overcome the pilot stage and reach a majority of patients in regular care. Missing consideration of user-centred design processes is one major reason for this development as individuals are a key component for the technology’s success. Therefore, we aim to provide recommendations for a user-centred design process, which is, in turn, crucial to successfully implementing telemedicine innovations. To reach this aim, we identified individual-related barriers for telemedicine with an umbrella review. Furthermore, we related the barriers to the Unified Theory of Acceptance and Use of Technology (UTAUT2) proposed by Venkatesh and colleagues. A theoretical explanation helps to generate a broader understanding of what prevents individual acceptance of telemedicine innovations. The provided recommendations are supposed to support researchers and practitioners planning future telemedicine solutions.
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Background: There is increased research interest in the use of mobile phone apps to support diabetes management. However, there are divergent views on what constitute the minimum standards for inclusion in the development of mobile phone apps. Mobile phone apps require an evidence-based approach to development which will consequently impact on their effectiveness. Therefore, comprehensive information on developmental considerations could help designers and researchers to develop innovative and effective patient-centered self-management mobile phone apps for diabetes patients. Objective: This systematic review examined the developmental considerations adopted in trials that engaged mobile phone applications for diabetes self-management. Methods: A comprehensive search strategy was implemented across 5 electronic databases; Medline, Scopus, Social Science Citation Index, the Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature (CINALHL) and supplemented by reference list from identified studies. Study quality was evaluated using the Joanna Briggs Critical appraisal checklist for trials. Information on developmental factors (health behavioral theory, functionality, pilot testing, user and clinical expert involvements, data privacy and app security) were assessed across experimental studies using a template developed for the review. Results: A total of 11 studies (10 randomized controlled trials and 1 quasi-experimental trial) that fitted the inclusion criteria were identified. All the included studies had the functionality of self-monitoring of blood glucose. However, only some of them included functions for data analytics (7/11, 63.6%), education (6/11, 54.5%) and reminder (6/11, 54.5%). There were 5/11(45.5%) studies with significantly improved glycosylated hemoglobin in the intervention groups where educational functionality was present in the apps used in the 5 trials. Only 1 (1/11, 9.1%) study considered health behavioral theory and user involvement, while 2 (2/11, 18.1%) other studies reported the involvement of clinical experts in the development of their apps. There were 4 (4/11, 36.4%) studies which referred to data security and privacy considerations during their app development while 7 (7/12, 63.6%) studies provided information on pilot testing of apps before use in the full trial. Overall, none of the studies provided information on all developmental factors assessed in the review. Conclusions: There is a lack of elaborate and detailed information in the literature regarding the factors considered in the development of apps used as interventions for diabetes self-management. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of practical and user-friendly self-management apps that can enhance the quality of life for diabetes patients.
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Telemedicine is considered to be an effective strategy to aid in the recruitment and retention of physicians in underserved areas and, in doing so, improve access to healthcare. Telemedicine’s use, however, depends on individual and contextual factors. Using a mixed methods design, we studied these factors in Senegal based on a micro, meso and macro framework. A quantitative questionnaire administered to 165 physicians working in public hospitals and 151 physicians working in district health centres was used to identify individual (micro) factors. This was augmented with qualitative descriptive data involving individual interviews with 30 physicians working in public hospitals, 36 physicians working in district health centres and 10 telemedicine project managers to identify contextual (meso and macro) factors. Physicians were selected using purposeful random sampling; managers through snowball sampling. Quantitative data were analyzed descriptively using SPSS 23 and qualitative data thematically using NVivo 10. At the micro level, we found that 72.1% of the physicians working in public hospitals and 82.1% of the physicians working in district health centres were likely to use telemedicine in their professional activities. At the meso level, we identified several technical, organizational and ethical factors, while at the macro level the study revealed a number of financial, political, legal, socioeconomic and cultural factors. We conclude that better awareness of the interplay between factors can assist health authorities to develop telemedicine in ways that will attract use by physicians, thus improving physicians’ recruitment and retention in underserved areas. Copyright: © 2017 Ly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Purpose: Mobile health (mHealth) solutions have become an inevitable element of the healthcare landscape. The recommendation and use of mHealth is important, but it is often underutilised. This study was conducted in England. It aimed to determine the use and recommendation of mHealth apps by pharmacists, the public’s perceptions of mHealth apps in general, and the awareness and use of health apps by diabetic patients in particular. Methods: The study used a mixed research approach, utilising a sequence of survey-based questionnaires with pharmacists and the general public, followed by semi-structured interviews with diabetic patients. Results: Pharmacists’ questionnaires revealed that 56% of the respondents were aware of health apps, 60% of which recommended them to patients. Over 76% of the individuals owned a smartphone. The types of applications that saw the most use from the general public were health and lifestyle apps (24%), social apps (19%), followed by news (18%). Although eight out of nine diabetic patients owned a smartphone, only three used diabetes apps. Diabetic patients also suggested an interest in using diabetes apps to aid in optimising care via the utilisation of visual aids, reminders, recording patient data, social coaching, and remote collaboration with healthcare professionals (HCPs), but time was seen as the biggest obstacle to using a diabetes mHealth application. Conclusion: Despite the growing number of mHealth apps, the level of awareness and usability of such apps by patients and pharmacists was still relatively low. Nevertheless, the majority who used health apps found them to be beneficial, and the public agreed that it helped them to live a healthier lifestyle. Therefore, health apps have great potential in health promotion. Pharmacists are ideally placed to promote them and make patients more aware of them. To increase the use of these apps, it is necessary to first increase awareness and knowledge of these apps, both to the public and to healthcare professionals.
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Background Mobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. Objective The aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. Methods We developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. Results Across 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.77%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.36%, 95% CI 0.08%-0.81%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.16%, 95% CI 0.16%-0.48%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.18%, 95% CI 0.21%-0.56% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.10). Conclusions The use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps.
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Background: mHealth, or the use of mobile technology in healthcare, is becoming increasingly common. In heart failure (HF), mHealth has been associated with improved self-management and quality of life. However, it is known that older adults continue to lag behind their younger counterparts when it comes to mobile technology adoption. Objective: The primary aim of this study was to examine factors that influence intention to use mHealth among older adults with HF. Methods: An adapted Technology Acceptance Model was used to guide this cross-sectional, correlational study. Convenience sampling was used to identify participants from a large university hospital and online. Results: A total of 129 older adults with HF participated in the study. Social influence (β = 0.17, P = .010), perceived ease of use (β = 0.16, P < .001), and perceived usefulness (β = 0.33, P < .001) were significantly associated with intention to use mHealth even after controlling for potential confounders (age, gender, race, education, income, and smartphone use). Perceived financial cost and eHealth literacy were not significantly associated with intention to use mHealth. Conclusions: Researchers should consider using the participatory approach in developing their interventions to ensure that their mHealth-based interventions will not only address the patient's HF self-management needs but also be easy enough to use even for those who are less technology savvy.
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Objective The primary objective of this systematic review is to assess the effectiveness of telemedicine in managing chronic heart disease patients concerning improvement in varied health attributes. Design This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. Setting We adopted a logical search process used in two main research databases, the Cumulative Index to Nursing and Allied Health Literature and PubMed (MEDLINE). Four reviewers meticulously screened 151 abstracts to determine relevancy and significance to our research objectives. The final sample in the literature review consisted of 20 articles. Main outcome measures We looked for improved medical outcomes as the main outcome measure. Results Our results indicated that telemedicine is highly associated with the reduction in hospitalisations and readmissions (9 of 20 articles, 45%). The other significant attributes most commonly encountered were improved mortality and cost-effectiveness (both 40%) and improved health outcomes (35%). Patient satisfaction occurred the least in the literature, mentioned in only 2 of 20 articles (10%). There was no significant mention of an increase in patient satisfaction because of telemedicine. Conclusions We concluded that telemedicine is considered to be effective in quality measures such as readmissions, moderately effective in health outcomes, only marginally effective in customer satisfaction. Telemedicine shows promise on an alternative modality of care for cardiovascular disease, but additional exploration should continue to quantify the quality measures.
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Understanding end-user populations is required in designing telepractice applications. This study explored computer literacy and health locus of control in head/neck cancer (HNC) patients to inform suitability for telerehabilitation. Sixty individuals with oropharygneal cancer were recruited. Computer literacy was examined using a 10-question survey. The Multidimensional Health Locus of Control Scale Form C (MHLC-C) examined perceptions of health “control”. Participants were mostly middle-aged males, from high socioeconomic backgrounds. Only 10% were non-computer users. Of the computers users, 91% reported daily use, 66% used multiple devices and over 75% rated themselves as “confident” users. More than half were open to using technology for health-related activities. High internal scores (MHLC-C) signified a belief that own behaviour influenced health status. HNC patients have high computer literacy and an internal health locus of control, both are positive factors to support telepractice models of care. This may include asynchronous models requiring heightened capacity for self-management.
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Background Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients.
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Introduction: This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. Materials and methods: The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. Results: The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. Conclusions: Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
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Native American communities face serious health disparities and, living in rural areas, often lack regular access to healthcare services as compared to other Americans. Since the early 1970’s, telecommunication technology has been explored as a means to address the cost and quality of, as well as access to, healthcare on rural reservations. This systematic review seeks to explore the use of telemedicine in rural Native American communities using the framework of cost, quality, and access as promulgated by the Affordable Care Act of 2010 and urge additional legislation to increase its use in this vulnerable population. As a systematic literature review, this study analyzes 15 peer-reviewed articles from four databases using the themes of cost, quality, and access. The theme of access was referenced most frequently in the reviewed literature, indicating that access to healthcare may be the biggest obstacle facing widespread adoption of telemedicine programs on rural Native American reservations. The use of telemedicine mitigates the costs of healthcare, which impede access to high-quality care delivery and, in some cases, deters prospective patients from accessing healthcare at all. Telemedicine offers rural Native American communities a means of accessing healthcare without incurring high costs. With attention to reimbursement policies, educational services, technological infrastructure, and culturally competent care, telemedicine has the potential to decrease costs, increase quality, and increase access to healthcare for rural Native American patients. While challenges facing the implementation of telemedicine programs exist, there is great potential for it to improve healthcare delivery in rural Native American communities. Public policy that increases funding for programs that help to expand access to healthcare for Native Americans will improve outcomes because of the increase in access.
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Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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Aims: With the increase in the number of systematic reviews available, a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of reviews of existing systematic reviews. Syntheses of existing systematic reviews are referred to by many different names, one of which is an umbrella review. An umbrella review allows the findings of reviews relevant to a review question to be compared and contrasted. An umbrella review's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence, namely other systematic reviews and meta-analyses. A methodology working group was formed by the Joanna Briggs Institute to develop methodological guidance for the conduct of an umbrella review, including diverse types of evidence, both quantitative and qualitative. The aim of this study is to describe the development and guidance for the conduct of an umbrella review. Methods: Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group. The working group comprised six participants who corresponded via teleconference, e-mail and face-to-face meeting during this development period. In October 2013, the methodology was presented in a workshop at the Joanna Briggs Institute Convention. Workshop participants, review authors and methodologists provided further testing, critique and feedback on the proposed methodology. Results: This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic reviews and meta-analyses as the analytical unit of the review. Details are provided regarding the essential elements of an umbrella review, including presentation of the review question in a Population, Intervention, Comparator, Outcome format, nuances of the inclusion criteria and search strategy. A critical appraisal tool with 10 questions to help assess risk of bias in systematic reviews and meta-analyses was also developed and tested. Relevant details to extract from included reviews and how to best present the findings of both quantitative and qualitative systematic reviews in a reader friendly format are provided. Conclusions: Umbrella reviews provide a ready means for decision makers in healthcare to gain a clear understanding of a broad topic area. The umbrella review methodology described here is the first to consider reviews that report other than quantitative evidence derived from randomized controlled trials. The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available, highest level of evidence relevant to the question posed.
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The use of mobile apps for health and well being promotion has grown exponentially in recent years. Yet, there is currently no app-quality assessment tool beyond "star"-ratings. The objective of this study was to develop a reliable, multidimensional measure for trialling, classifying, and rating the quality of mobile health apps. A literature search was conducted to identify articles containing explicit Web or app quality rating criteria published between January 2000 and January 2013. Existing criteria for the assessment of app quality were categorized by an expert panel to develop the new Mobile App Rating Scale (MARS) subscales, items, descriptors, and anchors. There were sixty well being apps that were randomly selected using an iTunes search for MARS rating. There were ten that were used to pilot the rating procedure, and the remaining 50 provided data on interrater reliability. There were 372 explicit criteria for assessing Web or app quality that were extracted from 25 published papers, conference proceedings, and Internet resources. There were five broad categories of criteria that were identified including four objective quality scales: engagement, functionality, aesthetics, and information quality; and one subjective quality scale; which were refined into the 23-item MARS. The MARS demonstrated excellent internal consistency (alpha = .90) and interrater reliability intraclass correlation coefficient (ICC = .79). The MARS is a simple, objective, and reliable tool for classifying and assessing the quality of mobile health apps. It can also be used to provide a checklist for the design and development of new high quality health apps.
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Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can contribute to the success rate of future endeavors. After a thorough discussion of these frameworks, this paper outlines the development methodologies in terms of theoretical background, methodology and validation. Finally, the common themes and formats are identified for consideration in future implementation. It was confirmed that a holistic implementation approach is needed, which includes technology, organizational structures, change management, economic feasibility, societal impacts, perceptions, user-friendliness, evaluation and evidence, legislation, policy and governance. Furthermore, there is some scope for scientifically rigorous framework development and validation approaches.
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The Community Readiness Model is a theory-based model that is strategic in nature. It is designed both to assess and to build a community's capacity to take action on social issues. It partners well with social marketing research by providing a framework for assessing the social contexts in which individual behaviour takes place and by measuring changes in readiness related to community-wide efforts. This arti- cle describes the theoretical roots of the model and describes how the model can be used as a tool for formative research, programme evaluation and as a catalyst for community mobilisation. Key Wordssocial marketingcommunity readiness • stages of readinesscommunity-based preventionprogramme development • evaluationcommunity needs assessment The Community Readiness Model is a theory-based model that is strategic in nature. It is designed both to assess and to build a community's capacity to take action on social issues. It partners well with social marketing research by pro- viding a framework for assessing the social contexts in which individual behavior
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Telemental health is the use of information and communications technologies and broadband networks to deliver mental health services and support wellness. Although numerous studies have demonstrated the efficiency and utility of telemental health, certain barriers may impede its implementation, including the attitudes of mental health service providers. The current study draws on the technology acceptance model (TAM) to understand the role of mental health service providers' attitudes and perceptions of telemental health (psychotherapy delivered via videoconferencing) on their intention to use this technology with their patients. A sample of 205 broadly defined mental health service providers working on 32 First Nations reserves in the province of Quebec completed the questionnaire adapted to assess TAM for telepsychotherapy. Confirmatory factor analysis and structural equation modeling provided evidence for the factor validity and reliability of the TAM in this sample. The key predictor of the intention to use telepsychotherapy was not mental health providers' attitude toward telepsychotherapy, nor how much they expected this service to be complicated to use, but essentially how useful they expect it to be for their First Nations patients. If telemental health via videoconferencing is to be implemented in First Nations communities, it is essential to thoroughly demonstrate its utility to mental health providers. Perceived usefulness will have a positive impact on attitudes toward this technology, and perceived ease of use will positively influence perceived usefulness. Cultural issues specific to the populations receiving telemental health services may be more efficiently addressed from the angle of perceived usefulness.
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Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption. Conclusions Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).
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This paper examines the context and status of evaluation research in telemedicine, and it proposes a two-pronged strategy for addressing the critical policy and programmatic concerns in this field. It explains the evolution of evaluation research in the United States, and it describes a comprehensive typology and requirements for valid evaluation. Major impediments for definitive evaluation are discussed, together with a summary of major trends in empirical studies. Two concurrent strategies are proposed for producing definitive findings and for assessing the available empirical evidence. These consist of large-scale experimental studies and theoretical and empirical triangulation for assessing the available empirical evidence.
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Nearly half a century ago, telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Practitioners from a variety of medical specialties have claimed success in their telemedicine pursuits. Gradually, this new modality of healthcare delivery is finding its way into the mainstream medicine. As a multidisciplinary, dynamic, and continually evolving tool in medicine, researchers and users have developed various definitions for telemedicine. The meaning of telemedicine encapsulated in these definitions varies with the context in which the term was applied. An analysis of these definitions can play an important role in improving understanding about telemedicine. In this paper we present an extensive literature review that produced 104 peer-reviewed definitions of telemedicine. These definitions have been analyzed to highlight the context in which the term has been defined. The paper also suggests a definition of modern telemedicine. The authors suggest that telemedicine is a branch of e-health that uses communications networks for delivery of healthcare services and medical education from one geographical location to another. It is deployed to overcome issues like uneven distribution and shortage of infrastructural and human resources. We expect that this study will enhance the level of understanding and meaning of telemedicine among stakeholders, new entrants, and researchers, eventually enabling a better quality of life.
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Background: With the growing population of older adults as a potential user group of mHealth, the need increases for mHealth interventions to address specific aging characteristics of older adults. The existence of aging barriers to computer use is widely acknowledged. Yet, usability studies show that mHealth still fails to be appropriately designed for older adults and their expectations. To enhance designs of mHealth aimed at older adult populations, it is essential to gain insight into aging barriers that impact the usability of mHealth as experienced by these adults. Objectives: This study aims to synthesize literature on aging barriers to digital (health) computer use, and explain, map and visualize these barriers in relation to the usability of mHealth by means of a framework. Methods: We performed a scoping review to synthesize and summarize reported physical and functional age barriers in relation to digital (mobile) health applications use. Aging barriers reported in the literature were mapped onto usability aspects categorized by Nielsen to explain their influence on user experience of mHealth. A framework (MOLD-US) was developed summarizing the evidence on the influence of aging barriers on mHealth use experienced by older adults. Results: Four key categories of aging barriers influencing usability of mHealth were identified: cognition, motivation, physical ability and perception. Effective and satisfactory use of mHealth by older adults is complicated by cognition and motivation barriers. Physical ability and perceptual barriers further increase the risk of user errors and fail to notice important interaction tasks. Complexities of medical conditions, such as diminished eye sight related to diabetes or deteriorated motor skills as a result of rheumatism, can cause errors in user interaction. Conclusions: This research provides a novel framework for the exploration of aging barriers and their causes influencing mHealth usability in older adults. This framework allows for further systematic empirical testing and analysis of mHealth usability issues, as it enables results to be classified and interpreted based on impediments intrinsic to usability issues experienced by older adults. Importantly, the paper identifies a key need for future research on motivational barriers impeding mhealth use of older adults. More insights are needed in particular to disaggregating normal age related functional changes from specific medical conditions that influence experienced usefulness of mHealth by these adults.
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Innovativehealthcareservicesandtechnologiesshowgreatpromises for reducing individual and societal burdens, but predominantly fail to attract sufficient end user acceptance and usage. This renders the aspect of technology adoption as key weakness of most health technology development endeavors, but also as most promising area for implementing changes that can dramatically increase the likelihood of project success. The purpose of this paper is to discuss some core assumptions of a user-centered process framework for technology adoption that addresses three major weaknesses of many current adoption models: First, the inadequate consideration of the process character of health technology adoptions. Second, the restricted view of human motivation, information processing, and behavior as being primarily rational and utilitarian in nature. And third, the insufficient attention to situational and social influences, and the role of individual differences. Theoretical, methodological, user inclusion-related and communication-related implications of the proposed prespective changes are discussed.
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Background: Telemedicine systems are gaining attention nationwide as a means for providing care in remote areas and allowing a small number of providers to impact a large geographic region. We systematically reviewed the literature to identify the efficacy and implementation challenges of telemedicine systems in ambulances. Methods: A search for published studies on Web of Science and PubMed was completed. Studies were selected if they included at least a pilot study and they focused on feasibility or implementation of telemedicine systems in ambulances. Results: A total of 864 articles were used for title and abstract screening. Full text screening was completed for 102 articles, with 23 being selected for final review. Sixty-one percent of the studies included in the review focused on general emergency care, while 26% focused on stroke care and 13% focused on myocardial infarction care. The reviewed studies found that telemedicine is feasible and effective in decreasing treatment times, report a high diagnosis accuracy rate, show higher rates of positive task completion than in regular ambulances, and demonstrate that stroke evaluation is completed with comparable accuracy to the standard way of delivering care. Conclusions: Although this review identified life-saving benefits of telemedicine, it also showed the paucity of the scientifically sound research in its implementation, prompting further studies. Further research is needed to analyze the capabilities and challenges involved in implementing telemedicine in ambulances, especially studies focusing on human-system integration and human factors' considerations in the implementation of telemedicine systems in ambulances, the development of advanced Internet connectivity paradigms, additional applications for triaging, and the implications of ambulance location.
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Aims: We aim to describe tele-audiology services conducted to facilitate audiological management for children in both the rural and urban context and to determine the strengths, challenges and clinical implications of such services. Methods: A scoping review was conducted by searching for peer-reviewed publications from five databases. Inclusion criteria and search strategies were outlined. Results: Of the 23 studies that met the inclusion criteria, reliability of automated testing was comparable to conventional testing; however, these studies were based primarily on screening programmes. Eight (35%) of the 23 papers were concordance studies evaluating feasibility and validity of tele-audiology systems when compared with conventional testing, while one study (4%) evaluated a tele-audiology service. A further four studies (17%) evaluated the feasibility of introducing telehealth methods to evaluate middle ear pathology. Tele-auditory brainstem response was investigated in three studies (13%) and another five (22%) used smartphone and/or iPad technology to screen hearing. Only two studies (9%) evaluated the feasibility of providing intervention through telehealth methods. All included studies demonstrated improved access to and coverage of rural areas. Services such as video otoscopy and synchronous (online) hearing testing in remote areas were successfully implemented. Challenges included lack of diagnostic studies, inadequate training of staff and the need to standardize protocols and procedures in order to ensure that tele-audiology services are provided in a standardized and valid manner. Conclusion: Tele-audiology services are feasible and can be useful in identifying auditory pathology for children in rural and remote areas.
Chapter
Our modern society has been transformed by the arrival of the digital era – computers, communication and the impending era of cognitive computing. The roots of this digitalization transformation are deep and extensively distributed through our United States society, as well as globally. Healthcare likewise has evolved and is well launched down this digitalization journey. This chapter is written from the perspective of a practicing surgeon with over 25 years of experience, based in an academic medical center and who has also been actively engaged in EHR adoption locally as well as numerous international telehealth and EHR collaborations. The chapter reviews how our modern healthcare system has adopted six transformative core competencies – EHRs, communication, telemedicine, analytics, data/security, and the virtual point of care (healthcare takes place in the cloud). The aggregate result of these forces is immense lever forcing the transformation of healthcare far beyond economic reform as envisioned by federal policy changes. The digital era is an unstoppable and empowering driver of healthcare that will be best seen in the near future through advances in EHR functionality, streaming analytics, virtual care teams and remote monitoring. In this era of tremendous uncertainty in healthcare it is the digital evolution of our society throwing healthcare a proverbial digital lifeline of survival.
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Psychotherapy services are limited in remote and rural areas in Australia and across the globe. Videoconferencing has become well established as a feasible and acceptable mode of psychological treatment delivery. Therapeutic alliance (TA) is an essential factor underlying successful therapy across therapeutic models. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. The databases searched were Medline, PsycArticles, PsycINFO, PsycEXTRA and EMBASE. Searching identified 9915 articles that measured satisfaction, acceptability or therapeutic rapport, of which 23 met criteria for the review. Three studies were carried out in Australia, 11 in USA, 4 in Canada, 3 in Scotland and 2 in England. Studies overwhelmingly supported the notion that TA can be developed in psychotherapy by videoconference, with clients rating bond and presence at least equally as strongly as in-person settings across a range of diagnostic groups. Therapists also rated high levels of TA, but often not quite as high as that of their clients early in treatment. The evidence was examined in the context of important aspects of TA, including bond, presence, therapist attitudes and abilities, and client attitudes and beliefs. Barriers and facilitators of alliance were identified. Future studies should include observational measures of bond and presence to supplement self-report.
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Background: Australians in rural and remote areas live with far poorer health outcomes than those in urban areas. Telehealth services have emerged as a promising solution to narrow this health gap, as they improve the level and diversity of health services delivery to rural and remote Australian communities. Although the benefits of telehealth services are well studied and understood, the uptake has been very slow. Materials and methods: To understand the underpinning issues, we conducted a literature review on barriers to telehealth adoption in rural and remote Australian communities, based on the published works of Australian clinical trials and studies. Results: This article presents our findings using a comprehensive barrier matrix. This matrix is composed of four stakeholders (governments, technology developers and providers, health professionals, and patients) and five different categorizations of barriers (regulatory, financial, cultural, technological, and workforce). We explain each cell of the matrix (four stakeholders×five categories) and map the reported work into the matrix. Conclusions: Several exemplary barrier cases are also described to give more insights into the complexity and dilemma of adopting telehealth services. Finally, we outline recent technological advancements that have a great potential to overcome some of the identified barriers.
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There has been increasing interest in using video telehealth to deliver evidence-based psychotherapies (EBPs). Telehealth may have numerous advantages over standard in-person care, including decreasing patients’ and providers’ costs and increasing system coverage area. However, little is known regarding the effectiveness of EBPs via video telehealth. This review had two goals, including a review of the existing literature and ongoing research on using video telehealth technologies to deliver EBPs as well as an informal survey of telehealth experts to discuss the special considerations and challenges present in adapting practices to video telehealth. Together, findings suggest that telehealth practices could represent an important component of the future of psychotherapy and clinical practice, especially in dissemination and implementation of EBPs in traditionally underserved areas and populations.
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Abstract Diabetes is a chronic disease that is often comorbid with cardiovascular disease, hypertension, kidney disease, and neuropathy. Its management is complex, requiring ongoing clinical management, lifestyle changes, and self-care. This article examines recent literature on telehealth and emerging technological tools for supporting self-management of diabetes and identifies best practices. The authors conducted a PubMed search (January 2008-2012) that was supplemented by review of meeting materials and a scan of the Internet to identify emerging technologies. Fifty-eight papers were reviewed; 12 were selected for greater analysis. This review supports earlier findings that the delivery of diabetes self-management and training (DSME/T) via telehealth is useful, appropriate, and acceptable to patients and providers. Best practices are emerging; not all technology is appropriate for all populations-interactive technology needs to be appropriate to the patient's age, abilities, and sensitivities. Telehealth is scalable and sustainable provided that it adds value, does not add to the provider's workload, and is fairly reimbursed. However, there are multiple barriers (patient, provider, health system) to remotely provided DSME/T. DSME/T delivered via telehealth offers effective, efficient, and affordable ways to reach and support underserved minorities and other people with diabetes and related comorbidities. The new generation of smartphones, apps, and other technologies increase access, and the newest interventions are designed to meet patient needs, do not increase workloads, are highly appropriate, enhance self-management, and are desired by patients. (Population Health Management 2013;16:XXX-XXX).
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Purpose: Innovative technologies to deliver health care across borders have attracted both evangelists and sceptics. Our aim was to systematically identify factors that hinder or support implementation of cross-border telemedicine services worldwide in the last two decades. Methods: Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011 including citations from 1990 onwards when at least an abstract was available in English. We also searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or (b) described the factors that hinder or support implementation of cross-border telemedicine services. All study designs were included. Two reviewers independently assessed titles and abstracts of articles identified. Papers were allocated to one of four reviewers who extracted relevant data and validated it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence. Results: 6026 records were identified of which 5806 were excluded following screening of titles and abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide, most involving collaborations between high and low or middle income countries. Most described services delivering a combination of types of telemedicine but specialties most represented were telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health professionals, with only a few linking professionals directly to patients. A main driver for the development of cross-border telemedicine is the need to improve access to specialist services in low and middle income countries and in underserved rural areas in high income countries. Factors that hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability factors; (3) cultural factors; and (4) contextual factors. Conclusions: National telemedicine programmes may build infrastructure and change mindsets, laying the foundations for successful engagement in cross-border services. Regional networks can also help with sharing of expertise and innovative ways of overcoming barriers to the implementation of services. Strong team leadership, training, flexible and locally responsive services delivered at low cost, using simple technologies, and within a clear legal and regulatory framework, are all important factors for the successful implementation of cross-border telemedicine services.
Article
Aims and objectives: The primary aim is to provide insight into client characteristics and characteristics of home telecare contacts, which may influence the adoption of home telecare. Secondary aim is to examine the applicability of four perceived attributes in Rogers' diffusion of innovations theory, which may influence the adoption: relative advantage, compatibility, complexity and observability. Background: Western countries face strongly increasing healthcare demands. At the same time, a growing nursing shortage exists. The use of home telecare may be instrumental in improving independence and safety and can provide support to older and chronically ill people, but a precondition for its uptake is that clients consider it as a useful and helpful technological tool. Design: A survey conducted among clients of seven home care organisations in the Netherlands connected to a home telecare system. Methods: In 2007, a postal questionnaire was distributed to 468 older or chronically ill clients: 254 responded (54%). The data were analysed by regression techniques, employing a theoretical model. Results: This study showed that clients' perceived attributes - relative advantage, compatibility, complexity and observability - have a significant effect on adoption of home telecare explaining 61% of the variance. The chance of adoption is higher when a client already receives long-term personal and/or nursing care, he/she lives alone and when there are fixed daily contacts via the home telecare system. The perception of possible benefits can still be enhanced. Conclusions: The concept of perceived attributes, derived from Rogers' diffusion of innovation theory, has been useful to explain clients' adoption of home telecare. Relevance to clinical practice: Home care organisations can best focus on clients already in care and people living alone, in offering home telecare. Nurses, who aim to enhance the client's adoption of home telecare, have to take into account clients' perceived attributes of such new technology.
Conference Paper
Telemedicine is one proposed solution to problems of accessibility, quality, and costs of medical care. Although telemedicine applications have proliferated in recent years, their diffusion has remained low in terms of the volume of consultations. In this study, Attewell’s (1992) theory of knowledge barriers is extended to explain why diffusion of telemedicine remains low. In case studies of telemedicine programs in three worldrenowned medical centers in Boston, Massachusetts, we find that, in addition to technical knowledge barriers, as suggested by Attewell, there are economic, organizational, and behavioral knowledge barriers that inhibit the diffusion of telemedicine. The lowering of these barriers entails intensive learning efforts by proponents of applications within adopter organizations. They need to develop technically feasible, medically valid, reimbursable, and institutionally supported applications in order to justify the value of telemedicine and engender frequent and consistent use by physicians.
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Abstract Telecare is the use of information and communication systems to facilitate care delivery to individuals in their homes. Although the expectations of telecare are high, its implementation has proved complex. This case study demonstrates this complexity through a structurational analysis of a telecare implementation process. The paper shows how structuration concepts enable a combined analysis of actors' interactions with a technology and of the interaction among these actors from different institutional contexts. In this example, fragmented multi-actor agency induced an inconsistent implementation mode, leading to unsuccessful telecare appropriation. This paper concludes with a preliminary proposal for more consistent telecare implementation modes. These modes may better support the actors' reflexive monitoring and dialogue and inform further research.
Article
A review of prior, relevant literature is an essential feature of any academic project. An effective review creates a firm foundation for advancing knowledge. It facilitates theory development, closes areas where a plethora of research exists, and uncovers areas where research is needed.
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The objective of this study was to assess the validity of an index of the scientific quality of research overviews, the Overview Quality Assessment Questionnaire (OQAQ). Thirty-six published review articles were assessed by 9 judges using the OQAQ. Authors reports of what they had done were compared to OQAQ ratings. The sensibility of the OQAQ was assessed using a 13 item questionnaire. Seven a priori hypotheses were used to assess construct validity. The review articles were drawn from three sampling frames: articles highly rated by criteria external to the study, meta-analyses, and a broad spectrum of medical journals. Three categories of judges were used to assess the articles: research assistants, clinicians with research training and experts in research methodology, with 3 judges in each category. The sensibility of the index was assessed by 15 randomly selected faculty members of the Department of Clinical Epidemiology and Biostatistics at McMaster. Authors' reports of their methods related closely to ratings from corresponding OQAQ items: for each criterion, the mean score was significantly higher for articles for which the authors responses indicated that they had used more rigorous methods. For 10 of the 13 questions used to assess sensibility the mean rating was 5 or greater, indicating general satisfaction with the instrument. The primary shortcoming noted was the need for judgement in applying the index. Six of the 7 hypotheses used to test construct validity held true. The OQAQ is a valid measure of the quality of research overviews.
Telemedizin in Deutschland
  • H.-J Brauns
  • W Loos
Brauns, H.-J., and Loos, W. 2015. "Telemedizin in Deutschland," Bundesgesundheitsblatt -Gesundheitsforschung -Gesundheitsschutz (58:10), pp. 1068-1073.
Adoption of Telemedicine -Challenges and Opportunities
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Dantu, R., and Mahapatra, R. 2013. "Adoption of Telemedicine -Challenges and Opportunities," in Proceedings of the Nineteenth Americas Conference on Information Systems, Chicago, Illinois, August 15.
Global Telehealth Market Set to Expand Tenfold by 2018 | IHS Online Newsroom
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IHS Markit. 2014. "Global Telehealth Market Set to Expand Tenfold by 2018 | IHS Online Newsroom," News Releases. (http://news.ihsmarkit.com/press-release/design-supply-chain-media/globaltelehealth-market-set-expand-tenfold-2018, accessed May 7, 2018).
Towards a Classification of Maturity Models in Information Systems
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Mettler, T., Rohner, P., and Winter, R. 2010. "Towards a Classification of Maturity Models in Information Systems," in Management of the Interconnected World, A. D'Atri, M. De Marco, A. M. Braccini, and F. Cabiddu (eds.), Physica-Verlag HD, pp. 333-340.
Barrier | Definition of Barrier in English by Oxford Dictionaries
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