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Facilitators and Barriers to Adoption of a Successful Urban Telemedicine Model

Project Final Report (PDF, 704.69 KB) Disclaimer

Project Details -
Completed

Since its inception in 2001, the Health-e-Access (HeA) telemedicine network in Rochester, NY, has been used to manage acute childhood illness. HeA has developed three telemedicine service models focusing on care in schools, daycare facilities, and after-hours neighborhood settings, giving families in Rochester new options for care of children with acute illnesses. Each of the models is highly flexible in meeting patient needs, particularly given HeA’s use of Web-based and mobile patient access units.

This project deployed and solidified sustainable business models for each of the three telemedicine service models in the four inner-city zip code areas of Rochester. Additionally, the project identified facilitators of and barriers to implementation, monitored the impact on utilization patterns, and created and disseminated an implementation and sustainability toolkit.

The specific aims of this project were as follows:

  • Achieve substantial deployment and solidify sustainable business models for each of the three urban telemedicine service models. 
  • Identify facilitators and barriers to dissemination of the three telemedicine service models. 
  • Monitor impact of the HeA models on utilization patterns. 
  • Create and disseminate an implementation and sustainability toolkit. 

The HeA program completed 13,566 visits between May 2001 and June 2013, of which 4,985 visits occurred during the grant period. Fifty-five percent of visits were made by children dwelling in the inner-city target area. Primary parent concerns included 32 percent focused on the ear, 31 percent on the upper respiratory system, 20 percent on the skin, 11 percent on the eye, 2 percent on the lower respiratory system, and 4 percent on other miscellaneous causes. This breakdown informs the requirements for cameras and sound capture as well as clinical protocols that should be included in telemedicine initiatives, and were summarized in the developed implementation and sustainability toolkit.

Physicians identified convenience for parents; fast appointments; proximity to school, daycare, or home; and provider commitment to promotion as facilitators of adoption. Barriers were non-compatibility with the electronic medical record, limited provider time, lack of provider communication to patients about the availability of telemedicine, and discomfort with the unknown. Parents described telemedicine as a more convenient way to obtain medical care for children because it did not require waiting for an appointment or a visit to the doctor’s office. Ninety-eight percent of parents were satisfied or highly satisfied with telemedicine, and 95 percent agreed that it provides greater convenience than alternatives. The project showed that service provided by telemedicine holds potential to meet a large demand for care of acute childhood illness.