The healthcare sector has substantially
developed over the years thanks to the ease and convenience brought by the current
technologies advancements. Nevertheless, there are still many difficulties that
the industry has to deal with, especially when it comes to accessibility, provision
and convenience of services both for the patients and the medical providers.
One of the solutions the medical
profession and the healthcare industry have brought up to deal with these
issues is telemedicine. What is telemedicine? It is the remote diagnosis and
treatment of patients by means of telecommunications technology. Aside from
connecting patients and medical providers, telemedicine also provides a way for
health care professionals to consult with other physicians. Telemedicine is the use of
telecommunications technology such as phones and computers to provide clinical
services to patients over long distance communication. Through phone calls,
emails, mobile apps, and even video chat, health care professionals are able to
diagnose and treat patients without the need for long travels or in-person
In the early days, telemedicine was
used mostly to connect doctors working with a patient in one location to
specialists somewhere else. This was of great benefit to rural or hard to reach
populations where specialists aren’t readily available. Throughout the next several
decades, the equipment necessary to conduct remote visits remained expensive
and complex, so the use of the approach, while growing, was limited.
The rise of the internet age brought
with it profound changes for the practice of telemedicine. The proliferation of
smart devices, capable of high-quality video transmission, opened up the
possibility of delivering remote healthcare to patients in their homes,
workplaces or assisted living facilities as an alternative to in-person visits
for both primary and specialty care.
Impacting the rise of telemedicine
today is the growing mobile health field. With the wide variety of mobile
health apps and new mobile medical devices that are consumer-friendly, patients
are starting to use technology to monitor and track their health. Simple
home-use medical devices that can take vitals and diagnose ear infections,
monitor glucose levels, or measure blood pressure let patients gather needed
medical information for a doctor’s diagnosis, without going into the doctor’s
office. And again, as more patients get proactive about using technology to
manage their health, they also will be more open to alternative ways to get
care – through telemedicine!
CHAPTER 2: METHODOLOGY
Having explored the nature and
purpose of qualitative research, this article explores data collection techniques
used in qualitative research. There are a variety of methods of data collection
in qualitative research, i.e. observations, textual or visual analysis (e.g.
from books or videos) and interviews (individual or group). However, the most
common methods used, particularly in healthcare research, are interviews and
There are three fundamental
types of research interviews: structured, semi-structured and unstructured.
Structured interviews are, verbally administered questionnaires, in which a
list of predetermined questions are asked, with little or no variation and with
no scope for follow-up questions to responses that warrant further elaboration.
interviews do not reflect any preconceived theories or ideas and are performed with
little or no organisation. Such an interview may simply start with an opening
question and will then progress based, primarily, upon the initial response.
consist of several key questions that help to define the areas to be explored,
but also allows the interviewer or interviewee to diverge in order to pursue an
idea or response in more detail. This interview format is used most frequently
in healthcare, as it provides participants with some guidance on what to talk
about, which many find helpful.
The purpose of research
The aim of the research
interview is to explore the views from various individuals on specific matters.
Qualitative methods, such as interviews, are believed to enlighten us on social
phenomena than would be obtained from purely quantitative methods, such as questionnaires.
Interviews are, therefore, most appropriate where little is already known about
the study phenomenon or where detailed insights are required from individual
participants. They are also particularly appropriate for exploring sensitive
topics, where participants may not want to talk about such issues in a group
When designing an interview
schedule it is imperative to ask questions that are likely to yield as much
information about the study phenomenon as possible and also be able to address
the aims and objectives of the research. In a qualitative interview, good
questions should be open-ended (i.e., require more than a yes/no answer),
neutral, sensitive and understandable. It is usually best to start with
questions that participants can answer easily and then proceed to more
difficult or sensitive topics. This can help put respondents at ease, build up
confidence and rapport and often generates rich data that subsequently develops
the interview further.
The length of interviews varies
depending on the topic, researcher and participant. However, on average,
healthcare interviews last 20-60 minutes. Interviews can be performed on a
one-off or, if change over time is of interest, repeated basis, for example
exploring the psychosocial impact of oral trauma on participants and their
subsequent experiences of cosmetic dental surgery.
Focus groups share many common
features with less structured interviews, but there is more to them than merely
collecting similar data from many participants at once. A focus group is a
group discussion on a particular topic organized for research purposes. This
discussion is guided, monitored and recorded by a researcher (sometimes called
a moderator or facilitator).
focus groups are used
Focus groups are used for
generating information on collective views, and the meanings that lie behind
those views. They are also useful in generating a rich understanding of
participants’ experiences and beliefs. Suggested criteria for using focus
As a standalone method, for research relating to
group norms, meanings and processes
In a multi-method design, to explore a topic or
collect group language or narratives to be used in later stages
To clarify, extend, qualify or challenge data collected
through other methods
To feedback results to research participants.
an interview schedule
Like research interviews, the
interview schedule for focus groups is often no more structured than a loose
schedule of topics to be discussed. However, in preparing an interview schedule
for focus groups, two general principles suggested by Stewart and Shamdasani
should move from general to more specific questions
order should be relative to importance of issues in the research agenda.
There can, however, be some
conflict between these two principles, and tradeoffs are often needed, although
often discussions will take on a life of their own, which will influence or
determine the order in which issues are covered. Usually, less than a dozen
predetermined questions are needed and, as with research interviews, the
researcher will also probe and expand on issues according to the discussion.
Moderating a focus group looks
easy when done well, but requires a complex set of skills. The moderator should
facilitate group discussion, keeping it focused without leading it. They should
also be able to prevent the discussion being dominated by one member, ensure
that all participants have ample opportunity to contribute, allow differences
of opinions to be discussed fairly and, if required, encourage reticent
Interviews and focus groups
remain the most common methods of data collection in qualitative research, and
are now being used with increasing frequency in dental research, particularly
to access areas not amendable to quantitative methods and/or where depth, insight
and understanding of particular phenomena are required. The examples of dental
studies that have employed these methods also help to demonstrate the range of
research contexts to which interview and focus group research.
CHAPTER 3: LITERATURE REVIEW
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The app is a 2 way communication tools
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materials; Streamlined Patient Workflow: Automated appointment reminder emails
and an experience that mimics the in-office workflow with a virtual waiting
CHAPTER 4: FINDINGS AND OBSERVATION
How is Telemedicine impacting
patients and providers?
A fast-growing field in the
healthcare industry, telemedicine holds a lot of promise in solving various
challenges that health professionals and patients are facing today. Providing a
range of benefits for both patients and medical providers, it offers:
Adopting the latest telemedicine
initiatives can help your practice achieve numerous benefits. You can lower
healthcare costs, drive up practice efficiency and revenue, provide your
patients better access to healthcare services, and ultimately get happier,
healthier patients who stay in your practice.
Convenient and Accessible Patient Care
According to a recent Cisco
global survey, 74% of patients prefer easy access to healthcare services over
in-person interactions with providers.
Remote analysis and monitoring
services and electronic data storage significantly reduce healthcare service
costs, saving money for you, your patients, and insurance companies.
Telemedicine also reduces unnecessary non-urgent ER visits and eliminates
transportation expenses for regular checkups. Recently, the American Hospital
Association reported on a telemedicine program that saved 11% in costs and more
than tripled ROI for investors. Beyond these general cost-savings, telehealth
can help boost doctors’ revenue by turning on-call hours into billable time,
attracting new patients, reducing no-shows, and even reducing overhead for
physicians who decide to switch to a flexible work-from-home model for part of
Specialist and Referring Physician Access
With telehealth, patients in
rural or remote areas benefit from quicker and more convenient specialist
access. In the U.S., for every 100,000 rural patients, there are only 43
specialists available. These patients endure longer appointment commutes and
have trouble accessing lifesaving consultations for specific diseases or
chronic care plans.
When patients are committed to
their own healthcare goals, it leads to lower costs and improved health. Ernst
& Young Senior Advisory Services Manager Jan Oldenburg told Healthcare IT
News that the high cost of disengaged consumers affects everybody.”
Engaging your patients through
telemedicine can help them maintain appointments and care schedules. Increased
engagement initiatives can also curb obesity rates and tobacco use by helping
you to encourage your patients’ healthy lifestyle choices.
Patient Care Quality
patient-centered approaches, such as improved timeliness of care. This is
critical to quality patient care. Patients can address healthcare issues
quickly with real-time urgent care consultations and learn about treatment
options within minutes. A new study shows that telemedicine patients score
lower for depression, anxiety, and stress, and have 38% fewer hospital
While telemedicine promises to
grow rapidly over the next decade and has clear benefits, it still poses some
technical and practical problems for healthcare providers.
Training and Equipment
Restructuring IT staff
responsibilities and purchasing equipment takes time and costs money. Training
is crucial to building an effective telemedicine program. Physicians, practice
managers, and other medical staff need to be trained on the new systems to
ensure a solid ROI. In addition, your staffing requirements may decrease. For
instance, a nurse in a rural Alaska facility can monitor up to 33 patients at
once from a single location using telemedicine services.
In cases where patients are
using on-demand telemedicine services that connect them with a random
healthcare provider, care continuity suffers. A patient’s primary care provider
may not have access to records from those other visits and end up with an
incomplete history for the patient. Service provider shuffling increases the
risk that a doctor won’t know a patient’s history or have notes about care
Worried about technology’s
limitations? You’re not alone. Many doctors worry about technical problems
associated with telemedicine. Senior Healthcare Group Consultant Arun Ravi told
Becker’s Hospital Review that poor broadband connections could lead to
“possible patient mismanagement.”
Many physicians and patients
alike still like a “personal touch,” and not all procedures – even simple
checkups – can be performed digitally. However, in cases where patients just
can’t get in to see their doctors’ in-person, and for many cases that don’t
require a physical exam, telehealth can be a good alternative.
Policies and Reimbursement Rules
Healthcare laws, reimbursement
policies, and privacy protection rules struggle to keep up with this
fast-growing industry. As a healthcare provider, you want to promote best
practices when approaching telemedicine. While major developments have been
made to telehealth reimbursement over the past couple years, it still remains a
common stumbling block for providers interested in telemedicine. It’s best to do a little research into the
reimbursement policy landscape in your state before you get started.
CHAPTER 5: RECOMMENDATIONS
Improving patient assessment and
All sites chose to improve the
process for assessing and reviewing telehealth users to ensure efficient use of
resources. This included collecting additional information from referring
clinicians at assessment to identify goals for use and specify a date for
Improving service delivery
Three sites aimed to improve the
processes for monitoring and triage of telehealth patients. Each site had
previously completed some standardization, and therefore targeted specific
elements of their service that were not working efficiently, or where practice
was variable. Case study findings helped to identify which processes needing
Improving data sharing and
Three sites worked on improving
data sharing and access. Acknowledging that solutions to address the
interoperability problems between monitoring software and electronic patient
record systems were not readily available, participants considered other ways
to reduce the additional workload associated with having to access two, and
sometimes three, different systems. Other work focused on how to ensure that
patient records were updated with monitoring information so that other
clinicians involved in the care of a patient could access this information.
Raising awareness of telehealth
All sites were keen to raise
awareness of telehealth and ideas for action included training sessions for
nursing teams who were reluctant to use telehealth; working more closely with
new clinical commissioning groups; and hosting events to promote telehealth to
other clinical providers. Because of competing priorities, this work was
difficult to achieve and in two sites was discontinued after the first cycle.
Improving evaluation of
All sites agreed that better evaluation
was required to understand more about telemedicine outcomes. However, only two
sites chose to work on this activity. Divided opinions about the rationale for
investment in telehealth created uncertainties about which outcomes to measure
and consequently, while participants agreed that this work was important, they
could not agree on how to take it forward.
Securing financial investment
The short-term funding of
telehealth was identified as a barrier to implementation. To secure future
investment, participants focused on establishing relationships with technology
providers and local decision-makers; scoping out the potential of new
technologies that were available; and identifying the needs of users and
clinicians that could be addressed with telehealth. Only one site was able to
secure financial investment during the study timeframe, and in two sites there
were real concerns about the future of telehealth.