Improving the introduction of telemedicine in pre-hospital emergency medicine: Understanding users and how Acceptability, Usability and Effectiveness influence this process

Abstract

Introduction: Increasing numbers of ambulance calls, vacant positions and growing workloads in Emergency Medicine (EM) are increasing the pressure to find adequate solutions. With telemedicine providing health-care services by bridging large distances, connecting remote providers and even patients while using modern communication technologies, such a technology seems beneficial. As the process of developing an optimal solution is challenging, a need to quantify involved processes could improve implementation. Existing models are based on qualitative studies although standardised questionnaires for factors such as Usability, Acceptability and Effectiveness exist. Methods: A survey was provided to participants within a German county. It was based on telemedical-surveys, the System Usabilty Scale (SUS) and earlier works describing Usability, Acceptability and Effectiveness. Meanwhile the investigated county introduced a telemedical system. A comparison between user-groups and an exploratory factor analysis (EFA) was performed. Results: Of n=91 included participants n=73 (80,2 %) were qualified as emergency medical staff (including paramedics (39,56 %), EMTs (30,77 %), call handlers (9,89 %)) and n=18 (19,8%) as emergency physicians. Most participants approved that telemedicine positively impacts EM and improved treatment options with an overall Usabilty Score of 68,68. EFA provided a 3-factor solution involving Usability,Acceptability and Effectiveness. Discussion: With our results being comparable to earlier studies but telemedicine only having being sparsely introduced, a positive attitude could still be attested. While our model could only describe 51,28% of the underlying factors of implementation, more research is needed to identify these. We showed that Usability is correlated with Acceptability (strong effect), Usability and Effectiveness with a medium effect, likewise Acceptability and Effectiveness. Therefore we see a need to improve available systems. Our approach can provide as a guide for decision makers and developers, that a focus during implementation should be on improving usability and on a quantifiable data driven implementation process.