Patient perspectives of telemedicine quality.

BACKGROUND: The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. METHODS: We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. RESULTS: The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. CONCLUSION: Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding.

Crossing the telemedicine chasm: have the U.S. barriers to widespread adoption of telemedicine been significantly reduced?

Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends-events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks.

Telemedicine: technology mediated service relationship, encounter, or something else?

PURPOSE: Service interactions between service providers and health care consumers happen daily in health care organizations, and can occur face-to-face or through mediating technology. We use the demanding and rich environment of telemedicine to better understand the nature of the real time service-encounter interactions among the human and technology actors engaged in the process and to inform telemedicine providers about key factors to consider in telemedicine design. METHODS: We conducted a case study of medical video conferencing (MVC) for the delivery of patient healthcare (a form of telemedicine) using multiple data collection and analysis techniques involving a range of telemedicine stakeholders. RESULTS: The research reveals that telemedicine requires a new kind of service relationship, an Advanced Encounter, with unique relationships between the telemedicine service providers, presenters, patients, and technology. Seven facilitating factors for the Advanced Encounter of telemedicine are identified and discussed, including the telemedicine servicescape: a set of supporting structures that are critical to telemedicine success. CONCLUSIONS: Key contributions are a deep understanding of the relationships between telemedicine actors, and the organizational actions needed to deploy a technology-mediated telemedicine service.

Four case studies in state-supported telemedicine initiatives.

Four case studies were conducted in Georgia, Pennsylvania, Ohio, and Wisconsin to uncover factors that played key roles in state telemedicine initiatives. Factors that affect the success of state telemedicine initiatives include telecommunications infrastructure, correctional facilities, need for a champion, user buy-in, competition in the healthcare market, timing of the government's action, and financial support for the initiatives. How these factors affect state telemedicine networks, the level of importance of the various factors, and potential state actions to leverage or dampen the effects of the various factors are reviewed.