Investigating the Adoption of Telemedicine to Support Postoperative Visits
TimeWednesday, April 142:40pm - 3:00pm EDT
DescriptionTelemedicine, as a telehealth modality to provide remote medical care, provides a wide-range of benefits including increased access to specialty care and time and cost savings (Adler-Milstein et al., 2014; Williams et al., 2018). Despite the promise shown by telemedicine technologies, the adoption among clinicians before the COVID-19 pandemic was relatively slow, with untapped potential in post-surgical applications in particular. In this study, we explore the limitations of telemedicine adoption in a large tertiary care hospital in the Southwestern United States, where the technology is available to a surgical department for use in postoperative follow-up visits.
We applied a mixed methods approach to assess surgeons’ readiness and attitudes towards new technology quantitatively via multiple instruments including the Technology Readiness Index (TRI; Parasuraman, 2000), Technology Acceptance Model (TAM; Davis, 1985), and modified Van der Laan’s Technology Acceptance Questionnaire (TAQ; Van Der Laan et al., 1997); conducted a usability study with mock patient encounters (System Usability Scale [SUS]; Brooke, 1996); and engaged the participants in semi-structured interviews to elicit their perspectives towards the adoption and integration of telemedicine in their practices. Data collection activities consisted of a brief 30-minute session with each participant.
Data collected from the brief surveys were used as the input for the statistical analyses. Reliability and construct validity of the survey instruments were evaluated using Cronbach's alpha and factor analysis, respectively. A correlation matrix was developed to quantify the strength of the association between each predictor variable and parameters. Three structural equation models were developed using the Partial Least Square (PLS) estimation technique to investigate whether the elements of relevant adoption models are interrelated and have impacted the surgeons’ intention to use telemedicine at the hospital. Additionally, a thematic analysis of the audio-recorded sessions was conducted following a set of established phases (Braun & Clarke, 2006) to identify prominent themes from the interviews.
Nine surgeons who were not users of the telemedicine platform participated in the study (4 general, 3 surgical oncology, 1 wound specialist and 1 thoracic surgeon). Despite the convenience and availability of telemedicine, it was found to be thoroughly underutilized in the target organization. Our quantitative analysis suggested a strong positive influence of surgeons’ perceived ease of use and optimism traits on the perceived usefulness of the technology, which suggests that surgeons’ perception of practical worth and applicability influence their perception of telemedicine’s usefulness. Contrary to our expectations, a significant negative relationship between visual appeal and perceived ease of use resulted from the analysis. It could be inferred that health care professionals may give more value to the efficiency and overall usability of the technology compared to its visual aesthetics.
Qualitative analysis of short interviews revealed surgeons generally perceive the telemedicine platform to be beneficial for postoperative visits, with an emphasis on patient-centered benefits such as time- and cost-related savings. However, several important barriers to adoption exist including the lack of time for proper training, lack of patients’ interest, concerns regarding potential disruption to clinical workflow, concerns regarding the impact in the patient-physician relationship, and the requirement for additional features in the existing platform. Additionally, concerns were raised regarding the appropriateness for telemedicine to be used for certain medical conditions (i.e., oncology-related care).
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