Championing telemedicine adoption and utilization in healthcare organizations in New Zealand
Introduction
Ongoing restructuring of healthcare delivery includes the concept of “continuity of care”. The complete shift from hospital-centred healthcare to patient-centred healthcare and from “cure” to “prevention” has called for the introduction of new innovations which could assist healthcare providers in providing efficient services to patients and health clients [1]. This call came as a result of major societal changes, progress in science and technology (nano- and mobile technology) and increased medical knowledge [1].
The current health and disability sector in New Zealand (NZ) is characterised by a large number of structurally separate service organizations (e.g., primary, secondary, tertiary, and community care providers) who are functionally interdependent in providing an integrated health and disability support service to individuals [2]. Care is provided within an overall framework where the patterns of care services delivered are largely determined by fund-providers and purchasers, who have a duty to meet the needs of the population they represent in the most effective and efficient ways possible. Without agreement on how these individual organizations relate and communicate, the current devolved approach in providing healthcare services could lead to serious shortfalls at the national level [2]. Therefore, further collaboration and integration amongst these organizations is needed to provide seamless access to coordinated and quality medical care.
Diminishing funds from the government and cost control in most of the developed countries in the world including NZ has led to the need for alternative and more cost-effective means of providing care [3], [4]. In many cases, this has become essential to sustain the increased competition among healthcare providers [3]. The business of healthcare has become so competitive that many small rural hospitals are trying to align themselves with larger tertiary care centres in a community health-information network, a telemedicine (TM) network, or some other type of partnership in order to survive and to retain their local patients [5].
TM means medicine from a distance where distant and dispersed patients are brought closer to their medical providers through the means of telecommunication technologies [6], [7], [8], [9], [10]. TM can assist in reaching out to rural patients [6], [11] and to areas where patient volumes for certain services are limited [3]. It can also assist in implementing administrative and clinical meetings (case discussion), in providing different health-awareness courses to patients (smoke treatment centres), in delivering training courses to physicians (discussing research journal), nurses, and other medical staffs [9], [10], and even to a level where telemedicine could be used to promote disease prevention, lifestyle management and well-being [1].
TM introduces by means of, e.g., video conferencing different benefits to healthcare organizations in different clinical and administrative areas such as consultations, diagnostics, treatment, transfer of patient related records, case management, training and in conduction clinical and administrative meetings. This mounting hype amongst researchers and practitioners about TM advantages lead to a conclusion that TM could be an essential building block in the strategic plan of many healthcare organizations [6]. In a rural setting, TM could help NZ health providers in supplying quality, fast, and economical medical services to rural patients and hence, saves doctors and patients valuable time wasted in commuting large distances [12]. Specialists could utilise this extra time in seeing more patients at the main hospital.
This research was interested in exploring TM adoption and usage in Health and Hospital Services (HHSs)1 in NZ. Therefore, the following research questions were posited, What are the factors that could influence TM adoption and use in HHSs in NZ and how do these factors influence its adoption and use in these HHSs?
Therefore, as an objective, it is important to identify the factors that could accelerate or hinder TM adoption and utilisation in HHSs in NZ. On the other hand, it is important to look for key adoption and usage behaviour amongst the adopting HHSs in NZ. At the outset, the uniqueness of the NZ context however, stems from the fact that NZ is geographically isolated from the rest of the world and has small population (3.82 million) [13]—served by 23 HHSs. These unique aspects raise issues pertaining to the feasibility of TM in NZ as an effective medical solution. These objectives are of importance to other HHSs in NZ interested in adopting TM, to other healthcare organizations in the world, and to researchers and policymakers interested in identifying the factors that could influence TM success in hospitals.
Section snippets
Telemedicine
Since its real inception in the 1950 in the area of video conferencing [9], reported limited TM growth and pointed to the fact that only few TM projects were instituted in the 1970s and 1980s at several sites in North America and Australia. They confirmed that none of the programs begun before 1986 has survived. Although data is limited, the early reviews and evaluations of those programs suggest that the equipment was reasonably effective at transmitting the information needed for most
Theoretical framework
In search for a guiding theoretical framework that could assist this research in explaining factors influencing TM success, the classical innovation diffusion theory model [25], [26], appeared to be the most widely accepted framework by researchers in identifying critical characteristics for technological innovations [27], [28], [29]. Rogers’ [26] framework comprised the following factors: relative advantage, complexity, compatibility, observability, and trialability. Relative advantage is the
Research methodology
Case studies are appropriate for the exploratory phase of an investigation where Yin's [36] case study approach matched the one depicted by the hard-case methodology. Therefore, this research will follow the qualitative (interpretivist) paradigm by adopting Yin's [36] hard case-study methodology. His positivist approach is acceptable by the interpretivist school as well [37]. For example, Walsham [37] indicated that although Yin [36] adopted an implicit positivist stance in describing case
Research analysis
Table 1 summarises the research results across the two cases before and after adopting the TMVC project. The key themes emerging from the two cases are discussed next.
Discussion
It was suggested in this research that factors like relative advantage, cost effectiveness, observability, trialability and image were the main contributors to TMVC adoption in the two cases. It could be agreed that the first two factors were the main factors behind TMVC assessment and adoption in the cases and the rest acted as facilitators and accelerators but were not of significant importance to the adoption decision as such. This substantiates Bacon's [33] findings, which indicated that
Conclusion
What could be understood from the cases before the adoption decision was made concerning the TMVC technology is that it was useful to both cases in filling an important clinical void between the speciality centre in the main hospital and the rural health centre/patients. It was perceived as being as cost effective, as not complex, as compatible with the existing environment (clinicians, administrators and patients) and as enhancing and endorsing their image as specialists in the fields of
References (39)
- et al.
Adoption of new information technologies in rural small businesses
Int. J. Manage. Sci. (OMEGA)
(1999) - et al.
Intelligent biomedical clothing for personal health and disease management: state of the art and future vision
Telemed. J. e-Health (J. Am. Telemed. Assoc.)
(2003) - (NZHIS) New Zealand Health Information Service, Health Information Strategy for the Year 2000, Ministry of Health,...
Careful telemedicine planning limits costly liability exposure
Healthcare Financ. Manage.
(1999)Issues in Developing and Implementing a Health Information System
(1995)- et al.
Is telemedicine a practical reality?
Assoc. Comput. Mach. Commun. ACM
(2000) Telemedicine can lower costs and improve access
Healthcare Financ. Manage. Assoc.
(2000)- Office of Technology Assessment US Congress (OTA), Bringing Health Care On Line: The Role of Information Technologies,...
Telemedicine and telehealth: principles, policies, performance, and pitfalls
Am. J. Public Health
(2000)- et al.
TMVC technology and clinical applications
J. Am. Med. Assoc. (JAMA)
(1995, February 8)
The maturing of TMVC technology Part I
Health Syst. Rev.
Introducing computer-based telemedicine in three rural Missouri countries
J. End User Comput.
Patient cost-benefits of realtime teledermatology—a comparison of data from Northern Ireland and New Zealand
J. Telemed. Telecare
4th annual telemedicine program review
Telemed. Today
Surprise from the Rural Telemedicine Survey
Telemed. Today
Success in telemedicine: some empirical evidence
Telemed. J. e-Health
Telemedicine in the state of Maine: a model for growth driven by rural needs
Telemed. J. e-Health
Clearing the way for physicians: use of clinical information systems
Commun. ACM
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