Adoption of telemedicine in India: perceptions of decision makers and clinicians

Abstract

This research identified factors that influenced telemedicine adoption at an organisation (decision makers) as well as individual level (clinicians), in India. In India, there is still lack of funding for public healthcare. Only basic care is provided at such facilities. They are badly managed and ill equipped. Lack of trained personnel is also common in rural areas as most doctors prefer to work in urban areas. Telemedicine can help bridge this gap between patients and clinicians by enabling access to specialist care and advice. Telemedicine, in this research, is the use of communication technology to provide clinical advice to doctors or patients, irrespective of geographical location. Telemedicine is advocated as a provider of several benefits such as improved access to healthcare. Decision makers, are individuals who are responsible for investing in Information and Communication Technology (ICT). Clinicians are healthcare professionals that are employed in the private and/or public healthcare sector in both countries. This research sought to explore the reasons for adopting telemedicine by these individuals. Thus, the research questions are 1.What are the key drivers for telemedicine adoption? 1.1. What factors initiate the adoption of telemedicine by decision makers in healthcare organisations? 1.2. Why do clinicians choose to adopt telemedicine? 2.What are the contextual variables that affect the adoption of telemedicine? The aims of this research were to develop a multi-level framework (Telemedicine Adoption Framework (TAF) that can be used to comprehend the factors that influence the adoption of telemedicine by decision makers and clinicians. It identifies the factors that influence the adoption of telemedicine by decision makers (organisation) and clinicians (individual). Specifically, this research focuses on the factors that influence the decision or choice to continue using telemedicine. Another aim was to understand some of the reasons behind the adoption of telemedicine in India. In addition, the research sought to provide information for potential adopters of telemedicine on the aspects that they need to consider before implementation of this innovation. This research involved eight case studies. Each organization was using telemedicine in various specialties. All participants were using telemedicine at the time of the interviews. All participants were interviewed in Chennai, India. Chennai is said to be the birthplace of telemedicine. Thus, it is an ideal place for the researcher’s data collection. 28 participants were interviewed in total. In addition to decision makers and clinicians, administrators of telemedicine projects were also interviewed. Administrators had more knowledge of the technical infrastructure and requirements. Results highlight that management support is an important factor at an organization (decision maker) level. Many telemedicine initiatives are being provided free of cost to the patient. This indeed can be a massive undertaking for organisations and their decision makers. Thus, their support of such an initiative is crucial. The personal values of clinicians were found to be important. Many clinicians are providing tele-consultations without incentives such as pay. They want to provide a service to the society. There were some common perceptions amongst decision makers and clinicians. Both stakeholders felt that telemedicine improved access to advice for both patients and clinicians. There was a common concern for the welfare of the patients. Aside from these factors, the geographical, cultural and political variables also played a key role in adoption. Due to the lack of proper roads and transportation, it was a requisite that patients travel long distances to seek advice from specialists (geographical). This meant a waste of time and money. From an organisation’s and clinicians’ perspectives, many patients were going untreated. Doctors are perceived as Gods in India (cultural). From the clinicians’ perspective, they did not fear treating patients at a distance or its legal implications due to this reason. Lastly, government policies, particularly in Tamil Nadu played a role in the adoption of telemedicine. The government wanted health services to be improved in the state. They thus supported the adoption of telemedicine.