Assessing advantages and barriers to telemedicine adoption in the practice setting

Abstract

Purpose Telemedicine is an evolving field that holds great potential to improve patient outcomes. The National Organization of Nurse Practitioner Faculties core competencies now require all nurse practitioners (NPs) to be competent utilizing telemedicine to address various patient and healthcare system needs. While telemedicine offers advantages to patient care, adoption of new technologies can be challenging. Data sources An assessment of perceived advantages and barriers to MyCareTeam, an online diabetes management system, was conducted at an adult diabetes clinic. Two survey questionnaires were developed based on the Diffusion of Innovations (DOI) theory. The surveys were administered to patients in the clinic waiting room and sent to all clinical staff via an e‐mail link. Conclusions The findings of this project suggested a novel way to classify patients with regard to their use of the technology with implications for practice. Recommendations include outreach to enhance knowledge and awareness of MyCareTeam, reinforcing the full scope of the system, and improved technical support. Implications for practice DOI theory is a framework that may be utilized by NPs as a tool for assessing advantages and barriers to telemedicine applications in the practice setting in order to identify strategies to promote adoption and use.

Understanding Clinicians’ Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks

“…The studies also cover diverse disease areas and medical specialties, including ambulatory care [ 58 ], cognitive behavioral therapy [ 40 ], cardiovascular disease [ 56 , 83 ], dermatology [ 73 ], diabetes [ 50 , 63 , 65 ], general practice [ 35 , 52 , 59 ], intensive care [ 36 ], neurology [ 48 ], pediatric [ 45 ], primary and acute care [ 46 , 49 , 55 , 71 , 74 ], psychiatry and mental health [ 41 , 53 , 68 ], residential aged care [ 57 ], reproductive health [ 37 ], and substance use recovery [ 39 , 44 ].…”

“…DOI was used in 16% (8/50) of the studies [ 37 , 40 , 50 , 53 , 56 , 62 , 76 , 78 ], and UTAUT extensions were used in 12% (6/50) of the studies; some of these UTAUT extensions were based on the research context and previous research [ 64 , 66 , 84 ], and other included extensions from other frameworks such as the De Lone and McLean information success model [ 54 ], use of technology [ 65 ], and a combination of TAM, TPB, and DOI [ 82 ]. Furthermore, certain studies used a combination of the TAM and DOI frameworks (3/50, 6%) [ 42 , 43 , 59 ]; others used the consolidated framework for implementation research (CFIR; 3/50, 6%) [ 39 , 41 , 67 ] and the STS (2/50, 4%) [ 49 , 55 ].…”

“…For example, Gagnon et al [ 83 ] and Orruno et al [ 73 ] assumed that compatibility with one’s work would impact the perception of a tool’s usefulness, whereas Liu and Cheng [ 81 ] anticipated that a user’s perception that a tool is a threat to their job would also impact their perceived usefulness, and Ray et al [ 45 ] proposed that there is a whole cluster of contextual elements such as organizational and individual factors that may impact perceived usefulness. Most of the studies found that usefulness is one of the most if not the most influential factor when it comes to adoption decisions [ 36 , 66 , 69 , 71 , 83 ], whereas other studies reported that a lack of perceived advantage of the system would be considered a barrier to adoption [ 50 ].…”

“…This is a health care specific factor, as mHealth was seen as the most useful and adding value when it enhances patient care [ 42 , 46 , 67 ] and facilitates access to care for people who would not otherwise access it easily [ 45 , 53 ]. Moreover, eight studies named increased efficiency or effectiveness (APEASE) as a facilitating factor, as it allows optimal use of staff time [ 47 , 50 ], but some also reported mixed views on whether such tools can really improve efficiency and the necessity of streamlining processes to enable such gains [ 35 , 52 ]. Similarly, eight studies specified communication; however, some saw it as a facilitator [ 42 , 47 , 50 ], and others reported the risk of miscommunication as a barrier [ 51 , 53 , 76 ], whereas six studies specified evidence (CFIR) or appraisal, showing that growing the evidence base and the positive stories about such tools can help increase adoption [ 39 , 48 , 53 ].…”

“…Similarly, if the tool is not integrated into or interoperable with the hospital or clinical systems, it becomes harder to adopt it as it usually creates an increased workload (eg, inputting data), and therefore, the potential for information to be lost [ 44 , 47 , 53 , 78 ]. Several studies also reported that an insufficient IT infrastructure could be a barrier [ 42 , 53 , 62 , 73 , 76 , 83 ] and some specified difficulties such as technical and connectivity issues that seem to be a common problem in some hospitals [ 50 , 62 , 67 , 68 , 79 ].…”