Telemedicine recommendations

Summary Conclusions and Recommendations Regarding Use of Telemedicine by Michigan Physicians M3J Communications

Defining Telemedicine
Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care. It has existed for decades and may be as simple as two physicians discussing a patient on the telephone. Now with the advent of new technologies, it has become more complex. Video-conferencing equipment allows physicians to conduct a real-time consultation between medical specialists separated by hundreds or even thousands of miles.

Benefits of Telemedicine
Distance-patients don’t have to travel as far
Eliminates a barrier to care-the specialist can see and speak with the patient leading to a recommendation.
Make the trip to see the specialist
Prescribe a course of action for the primary care physician
Make a diagnosis using technology, such as, digital stethoscopes, capture and forward video or high definition cameras.

The Challenge
Physicians in rural parts of Michigan have been slow to adopt telemedicine as part of their practices.

Previous Studies
Michigan State University conducted a study for the Michigan Upper Peninsula Telehealth Network that tracked telemedicine usage from 1995-2008 and measured patient satisfaction.
Key Finding:
Patients said that the decision to use telemedicine technology comes from the physician, another healthcare provider or a telehealth staff member in a majority of cases. Only 10% of patients said that they had asked for the service themselves.

Previous Studies
Patient responses regarding telehealth from the Michigan State study.
“ For people who aren’t mobile, it’s a blessing to not have to travel.”
“ My doctor said that riding long distances might hurt the healing process of my incision. So, it was just an obvious choice to not drive that long distance to Marquette.”
“ It is so much quicker and convenient. It is really hard to beat an hour versus about 12.”
ALMOST 90% OF THE RESPONDENTS STATED THAT THEY WOULD USE TELEHEALTH SERVICES AGAIN.

Telemedicine Success Story
Leonard Cardinal of Michigan
Suffered a stroke, broken hip and was undergoing dialysis.
Complications from the broken hip rehab required him to see a specialist a great distance from his home, and his other medical conditions limited his ability to travel.
Employed telemedicine to meet with specialist, diagnosed and treated the complication and the telemedicine appointment was in the same building as his dialysis appointments.

Strategy
Determine why rural physicians in Michigan are slow to adopt telemedicine
Gauge current use
Gauge current attitude and beliefs
Assess barriers, perceived and real, to using telemedicine

Tactics
Mailed a questionnaire to 1,000 physicians identified as rural physicians in Michigan.
Received 115 responses.
The following data reflects 80 of the responses that were collected.

Research Questions
How strongly are years in practice and gender among rural physicians related to behavior and intent to use telemedicine?
How strongly is physician setting related to behavior and intent to use telemedicine?
How strongly is a physician’s experience with telemedicine related to behavioral attitudes toward telemedicine?
Is the physician’s access to equipment related to intent to use telemedicine?

The Instrument
22 Questions that gauged attitudes and beliefs about telemedicine
Two questions that measured use and intent to use telemedicine
Two questions that measured perceived value of telemedicine to the practice.
Four questions that measured the technical abilities of the physician’s office and staff
Two questions that measured the significance of access to equipment in implementing telemedicine.
Physicians were asked to rate a series of statements on a scale of 1-5 with 1 meaning that they strongly disagree with the statement and 5 meaning that they strongly agree.

Physician Demographics
73% of physicians in the sample are male, 21% female.
60 of the 82 physicians represented have practices between 11-and-30 years.
The median age of the physicians in the sample is 52 years old.

Telemedicine Usage
How often do you use live/interactive telemedicine in your practice?
Median answer was 1.45. Between never and less than once a month.
The likelihood that I will use live/interactive telemedicine in my practice in the future is?
Median answer was 2.20. Between moderately low and moderate.

Significant Findings
Physicians with fewer than ten years of experience expressed a higher intent to use telemedicine in the future than more experienced physicians in the 11-30 years of practice category.
Physicians with fewer than five years of experience had the best general attitude toward telemedicine.
Physicians employed by a hospital showed the best general attitude toward telemedicine with a single doctor in an independent practice showing the worst general attitude toward telemedicine.
Hospital employees showed the most general comfort with telemedicine.
Female physicians showed a higher intent to use telemedicine in their practices than their male counterparts.

Factors Influencing Telemedicine Experience
General pressure to use telemedicine
Intent to use telemedicine
General comfort with telemedicine
Support from colleagues
Endorsement from a professional organization

Factors Influencing Intent to Use Telemedicine
General comfort with telemedicine.
General attitude toward telemedicine.
Will adapt well to my way of managing patients.
Something my patients would want to have access to.
General pressure to use telemedicine.
Negative beliefs relating to intent to use telemedicine
Requires a large commitment of time
Number one barrier relating to the intent to use telemedicine
The equipment is not located in my office.

Recommendations
Rural Physician Focused
Public relations campaign to educate independent physicians about telemedicine
Implementation specialist to travel to rural parts of Michigan and make personal consultations to physicians and medical staff about benefits of telemedicine and how it can be used in their practices.
Implementation specialist to make presentations at annual medical conferences in Michigan.
Actively distribute telemedicine (MATTeR) toolkits with follow-up by implementation specialist.
Increase awareness of resources available to physicians to implement telemedicine including grants.
Pursue other grant funding and attempt to encourage legislation that would subsidize telemedicine equipment for rural physicians.

Recommendations
Specialist Physician Focused
Education effort to inform specialists about telemedicine
Partner with existing specialist associations to promote telemedicine use in their practices.
Subsidize videoconferencing equipment for specialists.
Implementation specialist would provide training on videoconferencing equipment use.
Communicate benefits to specialist’s practice: more patients, less traffic in the office and overall patient satisfaction.

Recommendations
Patient Focused
Advertising and public relations campaign to increase demand for telemedicine among patients.
Television and print advertising campaign to build awareness of telemedicine among rural patients.
Target support groups and foundations to provide literature and in-person speaking engagements on telemedicine to patients.

Conclusions
The major barrier to the use of telemedicine among rural physicians is access to the equipment and a general perceived lack of resources.
The group most likely to respond positively to using telemedicine are physicians who have been practicing less than 10 years.
More education, training and subsidy for the telemedicine equipment is needed to increase use by Michigan’s rural physicians.

Telemedicine recommendations

by Joel Thomas on Nov 06, 2011

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