Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting

Aminoff, Hedvig; Meijer, Sebastiaan

doi:10.2196/26580

Cited by 5 publications

(2 citation statements)

References 145 publications

(95 reference statements)

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“…Tenets of a CAS include emergent behaviour (system interactions may result in an outcome that is unpredictable) and non-linearity (a small change in one part of the system may lead to a large change in another part of the system) [38,39]. The components must be meaningfully integrated to achieve desired outcomes such as accurate diagnostic outcomes, improved patient care, and user satisfaction [9,40]. Teledermatology exhibits characteristics of a CAS where users (e.g.…”

Section: Not Able To Codementioning

confidence: 99%

An Exploration of Dutch Dermatologists’ Experience and Satisfaction With Teledermatology: Sociotechnical and Complex Adaptive System Perspective

van Sinderen,

Kuziemsky,

W Jaspers

et al. 2024

JMIR Dermatol

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Background: Despite the global upscale of teledermatology during the COVID-19 pandemic, persistent barriers, such as the quality of the anamnesis and photos, continue to hinder the effective use of teledermatology in practice. A better understanding of the dermatologists' experiences and satisfaction with using the teledermatology system necessitates surveying. A holistic evaluation may provide valuable insight to understand how barriers interrelate which is deemed necessary for the innovation of teledermatology in practice. Objective:We aim to understand dermatologists' experience and satisfaction with their training, support communication, interaction and usage of a teledermatology platform of a Dutch digital hospital during the COVID-19 pandemic.Methods: An online questionnaire was sent in December 2021 to Dutch dermatologists who 1) had an active teledermatology platform account, and 2) responded to a teledermatology consultation between 01-10-2019 and 30-09-2021. The questionnaire consisted of questions from the validated SAF-TSUQ questionnaire, and new questions regarding; demographics of teledermatologists, the use of teledermatology during the COVID-19 pandemic, the performance of teledermatology by general practitioners (GP), and the role of dermatologists in the teledermatology process. The open-ended questions were analysed by a grounded theory approach guided by a sociotechnical model and complemented by a complex adaptive system perspective. A panel discussion with three dermatologists was performed to provide additional insight into the responses to the questionnaire. Results:We obtained responses from 25 out of the 249 invited dermatologists (10%). Overall, dermatologists had a positive experience with teledermatology. Interestingly, the frequency of teledermatology use was unaffected by the COVID-19 pandemic. However, the insufficient quality and incompleteness of the clinical content (photos and anamneses information) of the teledermatology consultation were experienced as critical factors impacting the efficiency of the teledermatology workflow. Dermatologists expressed the need to improve these aspects to avoid a time-consuming process or the need to request physical referrals of patients. Questionnaire responses were confirmed and enriched during the panel discussion and potential solutions to enforce more complete anamnesis information (e.g. mandatory fields) were suggested.Conclusions: Dermatologists see teledermatology as a valuable tool to provide access to dermatology care. However, the quality and completeness of the provided photos and anamnesis information need to be improved to guarantee the effectiveness and efficiency of the complex teledermatology system. This could increase both the dermatologists' satisfaction and the quality of teledermatology services. Implementing teledermatology requires management of trade-offs such as time investments (workload) of practitioners in taking images versus image quality. Teledermatology implementation should be assessed from a complexity perspe...

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Section: Not Able To Codementioning

confidence: 99%

An Exploration of Dutch Dermatologists’ Experience and Satisfaction With Teledermatology: Sociotechnical and Complex Adaptive System Perspective

van Sinderen,

Kuziemsky,

W Jaspers

et al. 2024

JMIR Dermatol

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“…A major obstacle facing those developing telemedicine services is an understanding of what are the essential components of implementing an integrated telemedicine service, as a part of a broader digital health transformation agenda. 20 , 21 Although numerous resources and tools are available to assist telemedicine implementers, a gap has been identified for an easy-to-use, comprehensive, evidence-based tool that delineates universally acknowledged essential requirements for the successful design, deployment and optimisation of telemedicine services. 22 , 23 The lack of an agreed-upon definition of telemedicine adds to the complexity.…”

Section: Introductionmentioning

confidence: 99%

Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process

Katz,

Robles,

Novillo-Ortiz

et al. 2024

DIGITAL HEALTH

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Objectives The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool. Methods A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores: Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains: Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items. Global telemedicine specialists ( n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%. Results Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest. Conclusions This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.

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Approaches to Evaluating Digital Health Technologies: Scoping Review

Rauwerdink,

Spinazze,

Gijsbers

et al. 2024

J Med Internet Res

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Background: Profound scientific evaluation of novel Digital Health Technologies (DHT) is key to enhance successful development and implementation. In such, we developed the eHealth evaluation cycle in previous research. The eHealth evaluation cycle contains five consecutive study phases: conceptual, development, feasibility, effectiveness, and implementation. Objective:The objective of this study was to create a visual overview of DHTs' evaluation approaches used in original research and to determine to what extent the study phases of the eHealth evaluation cycle have been utilised. Methods:We conducted a systematic literature search in PubMed including the MeSH term 'telemedicine' in combination with a wide variety of evaluation approaches. Original studies from 2019 (pre-COVID-19 cohort) were included. Data on the following variables were extracted and systematically analysed: journal, country, publication date, medical specialty, primary user, functional classification, evaluation study phases, and evaluation approach.Results: 824 studies were included after 1583 titles and abstracts were screened. The majority of the evaluation studies focused on the effectiveness (impact) (36.9%) study phase, whereas uptake (implementation) (8.5%) was the least. The RCT (19.0%) was the most commonly used DHT evaluation method. Within the effectiveness (impact) study phase, the RCT was used in half of the studies. In the conceptual and planning phases, survey research (34.6%) and interview studies (34.6%) were most frequently used. The United States published the largest amount of DHT evaluation studies (36.9%). Psychiatry / mental health (10.6%) and cardiology (8.9%) published the majority of the studies within the field. Conclusions:We found that the study phases of the eHealth evaluation cycle are in equally studied. Also, the majority of the studies in the effectiveness study phase still uses a RCT design. However, in order to successful develop and implement novel DHTs, stimulating equal evaluation of the sequential study phases of DHTs and selecting the right evaluation approach that fits to the iterative nature of technology, might be of utmost importance.

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Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting

Cited by 5 publications

References 145 publications

An Exploration of Dutch Dermatologists’ Experience and Satisfaction With Teledermatology: Sociotechnical and Complex Adaptive System Perspective

An Exploration of Dutch Dermatologists’ Experience and Satisfaction With Teledermatology: Sociotechnical and Complex Adaptive System Perspective

Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process

Approaches to Evaluating Digital Health Technologies: Scoping Review

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