Physicians’ experiences, attitudes and challenges in a Pediatric Telemedicine Service

Haimi, Motti; Brammli‐Greenberg, Shuli; Waisman, Yehezkel; Baron‐Epel, Orna

doi:10.1038/s41390-018-0117-6

Cited by 53 publications

(98 citation statements)

References 33 publications

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“…Many of the barriers to telemedicine acceptability identified in this study are consistent with previously reported findings. These barriers include technology challenges, poor workflow integration, and uncertainty of the benefits . To our knowledge, classifying certain barriers as negative biases toward telemedicine is unique to our study.…”

Section: Discussionmentioning

confidence: 97%

“…Despite its recognized value and availability, telemedicine is not universally employed during hospital‐to‐hospital transfers, suggesting that barriers exist that prevent its adoption and uptake . Prior studies have explored the acceptability of telemedicine; however, these studies have included mostly participants with little to no pediatric telemedicine experience, have explored telemedicine use for nonemergency settings, or have used survey data collection methods rather than in‐depth interviews . Identified barriers to telemedicine use from these prior studies include technology challenges, workflow integration, perceived usefulness, regulatory issues, and costs .…”

mentioning

confidence: 99%

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Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Sauers‐Ford

Hamline

Gosdin

et al. 2019

Academic Emergency Medicine

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Background: Pediatric emergency telemedicine consultations have been shown to provide support to community emergency departments treating critically ill pediatric patients. However, despite the recognized value of telemedicine, adoption has been slow. To determine why clinicians frequently do not use telemedicine when it is available for pediatric patients, as well as to learn how to improve telemedicine programs, we conducted a qualitative study using stakeholder interviews.Methods: We conducted a qualitative study using grounded theory methodology, with in-depth interviews of referring and accepting physicians and referring, transport, and transfer center nurses. We analyzed data iteratively and adapted the interview guide based on early interviews. We solicited feedback from the participants on the conceptual model.Results: Sixteen interviews were conducted; all respondents had been involved in a telemedicine consultation at least five times, with some having used telemedicine more than 30 times. Analysis resulted in three themes: 1) recognizing and addressing telemedicine biases are central to gaining buy-in; 2) as technology advances, telemedicine processes need to adapt accordingly; and 3) telemedicine increases collaboration among health care providers and patients/families in the patient care process.Conclusions: To improve patient care through increased use of telemedicine for pediatric emergency consultations, processes need to be modified to address provider biases and end-user concerns. Processes should be adapted to allow users to utilize a variety of technologies (including smartphones) and to enable more users, such as nurses, to participate. Finally, telemedicine can be used to improve the patient and family experience by including them in consultations.

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Sauers‐Ford

Hamline

Gosdin

et al. 2019

Academic Emergency Medicine

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“…Using an interview questionnaire, the physicians were asked about the difficulties they faced when working as an online physician, and about factors that affected their ability to provide a correct diagnosis, make reasonable decisions, and decide about appropriate treatmentall while maintaining patient safety. The physicians were also asked about their professional training and experience, perceptions and opinions about the ability to maintain patient safety in this tele-triage setting, and suggestions they may have for increasing diagnosis appropriateness and decision reasonableness [3]. Table 1 presents medical factors and non-medical characteristics relating to the patient, family, doctor, and shift.…”

Section: Section IImentioning

confidence: 99%

“…Unlike regular face-to-face medical encounters, physicians in the telemedicine setting are required to provide a diagnosis without being able to perform a physical examination. Telemedicine has presented numerous advantages and achievements [2], yet this means of medical service poses several difficulties and challenges for physicians [3].…”

Section: Introductionmentioning

confidence: 99%

“…In general, it is agreed that in order to improve patient safety and maintain a high quality of healthcare, professional and experienced physicians are needed, as are means for optimizing clinical decision-making [19]. In relation to telemedicine, these insights may be even more crucial, as physicians who provide telemedicine and tele-triage services face unique and additional difficulties and challengesespecially in pediatric telemedicine settings [3].…”

Section: Introductionmentioning

confidence: 99%

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Assessing patient safety in a pediatric telemedicine setting: a multi-methods study

Haimi

Brammli‐Greenberg

Baron‐Epel

et al. 2020

BMC Med Inform Decis Mak

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Background: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. Methods: This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014-2017. The consultations were analyzed for factors that may have affected the online physicians' decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians' decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. Results: The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians' means for ensuring high patient safetyby implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions.

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Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic

et al. 2022

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Key Points Question How has telehealth use during the COVID-19 pandemic varied across pediatric subspecialties, and was telehealth associated with changes in no-show rates and access disparities? Findings This cohort study of 8 large pediatric medical groups in California found high variability in telehealth use across subspecialties but no association between telehealth volume and clinic no-show rates. Although overall visits remained stable from the prepandemic to pandemic periods, English-speaking patients and patients of ethnicities other than Hispanic were more likely to be seen via telehealth. Meaning Documenting variation in telehealth adoption can inform telehealth policy, including the appropriateness of telehealth for different patient needs and areas where additional tools are needed to promote use.

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Physicians’ experiences, attitudes and challenges in a Pediatric Telemedicine Service

Abstract: In telemedicine setting, physicians face various difficulties and challenges, requiring special expertise, qualities and skills. Special measures are needed to obtain proper diagnosis and decisions.

Cited by 53 publications

References 33 publications

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study

Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic

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