A nurse practitioner in a private practice alluded to telemedicine as a threat to professional autonomy when she said, “I have experienced times when, although the intentions were good, the community has rejected it hands down because they didn’t need help from the outside.”
Efficacy
This theme refers to the participants’ desire to know that telemedicine will fill a functional need in their practice before they invest time and money in making such a big change. Telemedicine has no track record of directly improving patient care outcomes. Unlike drug therapies or medical procedures, telemedicine exerts indirect effects on outcomes with its abilities to enhance, streamline, or improve the process of health care delivery.
Some physicians we interviewed saw no compelling reason to integrate telemedicine into their practices. One physician in private practice who rarely used the computer said, “It doesn’t really help a lot. I think computers are good for specialists, and in primary care you know basically most of the stuff…then the other 20% of it that’s more difficult, you look it up in routine journals.”
Although some physicians saw no reason to integrate the new technology, others simply “don’t think about it.” Still other physicians—mostly those affiliated with a tertiary care center where computer technology figured prominently in patient care—welcomed telemedicine and quickly saw capabilities that would enhance their practices.
Practice Context
This theme refers to barriers to adopting telemedicine that clinics may face because they practice in rural areas where technologic change moves at a slower pace than in urban communities. One nurse practitioner in a private practice said, “We got 911 [emergency] 3 years ago. Three years before that, we finally had a 7-digit phone number. So, I think that the expectations for the rate of change and the learning curve should be pretty generous.” However, several participants, particularly those affiliated with a tertiary center, were positive that telemedicine would eventually catch on.
Apprehension
In contrast to the practice context, this theme refers to the apprehension of individual providers. When it comes to adopting new technology, some participants were philosophical about what they described as a human aversion to change. “People are scared of technology,” said one physician. Another physician in private practice said, “We don’t want to change. Everybody’s just fine the way it is…. I’m not prepared for this.”
Some providers had little confidence in their ability to operate the technology, and one nurse feared that her ignorance would get her into legal trouble: “I’m always afraid I’ll push the wrong button and…something will come up and it will say ‘illegal action.’ It scares me. I think ‘Oh my gosh, I’ve done something against the law.’“
Participants were also concerned about whether the information they would get though the videoconferencing channel would be reliable. A similar concern applied to information on the Internet. A physician in a private practice who was reluctant to use the computer workstation said: “The biggest problem I have with it (the Internet) is you don’t know [what] you’re getting…. There’s a lot of stuff on the Internet that’s no good.”
Although several physicians, particularly those in private practice, were apprehensive about telemedicine, they were willing to let others in their practice learn and use the technology. Some physicians in private practice, however, reflected on the seeming inevitability of change and were resigned to having to learn the technology.
Time to learn
This theme refers to hesitancy among providers to take the time to learn a new technology and to persuade patients of its worth.
One nurse/office manager said, “If I’m looking up something in a book, maybe the book is old, but at least I could have it done in 5 minutes…until I get good at this [computer], it’s taking me much longer.”
One physician in private practice bemoaned spending his time persuading patients that this new technology could benefit them. In contrast, a physician affiliated with a tertiary center noted several advantages of videoconferencing.
Ownership
This theme refers to participants who were professionally and emotionally invested in the technology—stakeholders who acknowledged its benefits, adapted it to their needs, and tried to help others learn. Predictably, this higher level of investment was most common in administrators, because of their familiarity with computerized procedures and records. One administrator affiliated with a tertiary center offered an example of this keen interest: “Yeah, we developed our own policies. We took some of the training modules and modified them to match what we thought. And we really had…everybody buy into using the same policies.”