Telehealth Readiness Research Articles

Healthcare Across Boundaries: Urban-Rural Differences in the Consequences of Telehealth Adoption

We study the impacts of telehealth adoption on geographic competition among urban and rural healthcare providers. We consider a quasinatural experiment: states’ entry into the Interstate Medical Licensure Compact, wherein the entry events facilitate healthcare providers to adopt telehealth technology. By analyzing a representative sample of providers, we first establish the Compact entry shock’s validity and its positive effect on the supply of medical services. We then report evidence that there are service and payment shifts from rural providers to urban providers (i.e., urban providers are more likely to benefit from the Compact entry financially). Relying on patients’ telehealth reimbursement claim data, we observe two mechanisms contributing to the revenue redistribution: the substitution and gateway effects of telehealth. Finally, we show that telehealth readiness and service quality moderate the impact of telehealth adoption. These findings speak to both potentially positive and negative consequences for welfare.

Exploring the telehealth readiness and its related factors among palliative care specialist nurses: a cross-sectional study in China

BackgroundsThe majority of Chinese people who are nearing the end of their lives prefer to receive home-based palliative care. Telehealth, as a new service model, has the potential to meet the increasing demand for this service, especially in remote areas with limited resources. However, nurse-led telehealth-based palliative care services are still in the pilot implementation phase. Assessing the telehealth readiness among palliative care specialist nurses and identifying associated factors is crucial to facilitate the successful implementation of telehealth services. Therefore, this study aimed to examine TH readiness and its related factors among Chinese palliative care specialist nurses.MethodsFour hundred nine Chinese palliative care specialist nurses from 28 provinces or municipalities participated in this study between July and August 2022. The Chinese version of Telehealth Readiness Assessment Tools (TRAT-C), and Innovative Self-Efficacy Scale (ISES-C) were used to assess the degree of TH readiness and the levels of innovative self-efficacy.ResultsThe total score of the TRAT-C was 65.31 ± 9.09, and the total score of ISES was 29.27 ± 5.78. The statistically significant factors that influenced telehealth readiness were the experience of using telehealth platforms or services, the willingness to provide telehealth to patients, and the level of nurses’ innovative self-efficacy. The innovative self-efficacy is positively correlated to telehealth readiness (r = 0.482, P < 0.01). These related factors could explain 27.3% of the difference in telehealth readiness.ConclusionThe telehealth readiness of Chinese palliative care specialist nurses are at a moderate level. Measures such as providing incentives to promote nurses’ innovation self-efficacy by nurse managers, and establishing a comprehensive telehealth training system for palliative care specialist nurses should be taken to facilitate the implementation of telehealth services in the field of palliative care.

Telehealth Readiness of Healthcare Providers during COVID-19 Pandemic in Saudi Arabia

This study aimed to assess and explore the telehealth readiness of healthcare providers in Saudi Arabia. This descriptive cross-sectional survey was conducted in a government healthcare facility in Saudi Arabia between August and October 2020. The Telehealth Readiness Assessment (TRA) tool was used. A total of 372 healthcare providers participated in this study. Their mean age was 35.5 years (SD = 10.46). The majority of respondents were female (65.6%), nurses (68.0%), married (60.2%), and non-Saudi nationals (64.2%). The analysis shows that healthcare providers generally had moderate-to-high telehealth readiness. Of the five domains, financial contributions had the lowest rating among nurses and physicians, 63.4% and 66.1%, respectively. Gender (β = 7.64, p = 0.001), years of experience in the organization (β = 11.75, p = 0.001), and years of experience in the profession (β = 10.04, p = 0.023) predicted the telehealth readiness of healthcare providers. The telehealth readiness of healthcare providers in Saudi Arabia showed moderate to high levels. The COVID-19 pandemic poses a catastrophic threat to both patients and healthcare providers. Assessing telehealth readiness should include both patients and healthcare provider factors. A better understanding of the factors of organizational readiness, particularly healthcare providers, could help avoid costly implementation errors.

Addressing the need for a telehealth readiness assessment tool as a digital health strategy

Immediate public health interventions and solutions, including the virtual provision of patient care via telehealth, were exponentially employed in response to the coronavirus disease 2019 pandemic. As a result, the U.S. Department of Health and Human Services temporarily waived Medicare telehealth restrictions. Dramatic increases in the provision of care via telehealth were observed, beginning in March 2020. Yet, despite these changes, there was a deficit in relevant telehealth readiness assessment, resources, and training that incorporated critical elements brought forth by the pandemic. This article describes the need for and provides a telehealth readiness assessment tool as a digital health strategy for health professional students, clinicians, and organizations to be prepared for patient care engagement during and beyond the pandemic.

Exploring Telehealth Readiness in a Resource Limited Setting: Digital and Health Literacy among Older People in Rural India (DAHLIA).

An ageing population, disproportionally affecting developing countries, increases demand on healthcare systems. Digital health offers access to healthcare for older people, particularly those residing in rural areas, as is the case for 71% of older adults in India. This research examined technology uptake and digital and health literacy (eHEALS) among a sample of 150 older adults in rural Mysore and Suttur, India. The study utilised mixed-method, with descriptive analysis of quantitative data and thematic analysis of qualitative data. Low rates of digital (11%) and health literacy (3–27% across domains) were identified. Mobile phone ownership was 50%, but very few owned or used a smartphone and less than 10% used the Internet to contact health professionals. Qualitative analysis found low technology usage, driven by limited exposure and confidence in using digital devices. Barriers to usage included poor traditional literacy and physical aspects of ageing like poor vision. Social support from neighbours, family and local primary healthcare staff may enable adoption of digital health. Access to healthcare through digital means among Indian rural older adults needs to consider low rates of both digital and health literacy and leverage the value of support from family and primary healthcare providers.

Telehealth Readiness Assessment of Perinatal Nurses

ObjectiveTo assess telehealth readiness among perinatal nurses in New Jersey. DesignCohort survey study. Setting/Local ProblemNew Jersey was one of the hardest hit areas in the early months of the COVID-19 pandemic. Telehealth represented an opportunity to provide continuity of perinatal care at a time when health care was significantly disrupted. ParticipantsPerinatal nurses in New Jersey. Intervention/MeasurementsThe intervention was a five-part, 90-question online survey provided via e-mail invitation to New Jersey State Nursing Association members. Data were collected from June 25 to July 9, 2020. Descriptive statistics, frequency analyses, a Mann-Whitney test on nonparametric measures of groups by age, and a one-tailed t test were completed. Results of the Telehealth Readiness Assessment tool were calculated. Open-text responses were organized and used to illustrate the findings. ResultsFifty-two perinatal nurses responded to the survey. Twenty-two (42%) completed all 90 questions. Partial answers were accepted. Synchronous live telehealth expanded 66% in the wake of COVID-19. Results showed that 37% (n = 15) of participants used telehealth at work, and 27% (n = 11) used it in getting care for themselves or a family member (M = 2.0, SD = 0.86; one-tailed t test, p = .25). In comparing nervousness in using technology with age, scores for those younger than 45 years (Mdn = 3) and those older than 45 years (Mdn = 2) showed no statistically significant difference, U(n<45years = 15, n≥45 years = 17) = 11, z = –0.02, p < .83. Overall, 46% (n = 26) indicated that telehealth could be extremely helpful or very helpful in reducing health care disparities and improving quality. Overall, telehealth readiness was ranked almost ready. ConclusionA telehealth readiness assessment may identify barriers and opportunities that can predict success and failure. Nurses generally accept technology and believe that telehealth could be useful in reducing poor maternal health outcomes and health care disparities.

Home-Based Care in the Context of COVID-19: Disruptions, Innovations, and Lessons for the Future

During the initial surge of the COVID-19 pandemic, home-based primary and palliative care (HBPC) practices played a valuable role in maintaining access to health-related services and keeping older, medically complex patients out of hospitals and congregate settings that could heighten their risk for COVID-19. At the same time, these practices faced unique challenges in adapting a traditionally hands-on model of care to accommodate restrictions on in-person contact. In this symposium, we present innovative research highlighting the challenges faced by HBPC practices and patients during spring 2020, as well as their rapid innovations and adaptations. First, Ritchie et al. provide national context with findings from a survey of U.S. home-based primary care practices that highlights the field’s most pressing challenges and successful strategies. Shifting to the initial epicenter of the pandemic in New York City, Reckrey et al. present a qualitative study of the perspectives of paid and unpaid caregivers of dementia patients served by an HBPC practice, while Franzosa et al. describe care disruptions among individuals with dementia who died during the initial surge, using a novel chart-based abstraction technique. Finally, two studies (Gorbenko et al. and Kalicki et al.) explore HBPC practices’ experience of rapidly transitioning to telehealth through qualitative interviews with NYC-based practices and a provider survey exploring telehealth adoption and readiness in the homebound population. Together, these studies yield important insights into the challenges of providing community-based care for at-risk populations during a pandemic, and practical strategies for home-based models of care moving forward.

Telehealth readiness and its influencing factors among Chinese clinical nurses: A cross-sectional study

Aim/objectiveThis study aimed to assess telehealth readiness among clinical nurses in China and explore the factors that affect their telehealth readiness and the relationships of telehealth readiness and telehealth practice-related variables. BackgroundTelehealth is a new service model that uses information and communication technology to provide professional health care services for resource-poor areas. With the global spread of COVID-19, nurses urgently need to adapt and apply telehealth technology to replace conventional face-to-face treatment. However, nurse-led telehealth services in China are currently only in the pilot phase and the readiness of clinical nurses needs to be assessed to facilitate successful telehealth implementation. DesignA cross-sectional, multicentre study was undertaken with the questionnaire survey method. MethodsData were collected in October-December 2020 used online questionnaires. A convenience sample of 3386 nurses from 19 hospitals in China completed the Chinese version of Telehealth Readiness Assessment Tools. ResultsThe mean score of the telehealth readiness was in the category between 61 and 80 points (mean 61.23, SD 11.61). The percentages of nurses meeting the following levels of telehealth readiness were as follows: low (49.9%), moderate (42.0%) and high (8.1%). Significantly higher domain scores were recorded for nurses in the unmarried, head of responsible nursing group. Moreover, there were positive correlations between telehealth readiness level and service experience, service willingness, mode cognition, manpower allocation and policy guidance. ConclusionsThere are still many factors hindering the successful implementation of telehealth. Nursing educators should formulate telehealth education curriculum and service standards to improve the telehealth readiness of nurses.

Policy Facilitators Versus Structural Barriers: Integrative Therapy Telehealth Changes in the United States During the COVID-19 Pandemic.

Introduction: Complementary and integrative therapies such as physical therapy (PT) and occupational therapy (OT) have been shown to improve functional outcomes and reduce opioid use. Due to the COVID-19 (or SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) pandemic, these therapies are switching to telehealth and telemedicine practices, but access and utilization may be limited due to state policies and social vulnerability. Objective: The objective of this cross-sectional analysis was to evaluate the policy changes to telehealth provisions during the pandemic and the degree to which structural barriers could stymie the intended impact of these policies (e.g., PT/OT accessibility). Materials and Methods: Our analysis examined each states' telehealth policies in relation to PT/OT, ranked their telehealth readiness, identified relationships between existing policies and opioid prescription rates, and discussed how social determinants of health may be associated with telehealth availability and accessibility. Results: Approximately two of five states have both telehealth and telemedicine policies, whereas the majority of states had either a PT- or OT-specific policy in place. In addition, almost all states and the District of Columbia (90%) had general telehealth/medicine policy changes as a result of the pandemic. Discussion: Although such policy changes could reduce COVID-19-related barriers, the degree to which these policies can have a large and long-lasting impact may be contingent on structural barriers. Many states that lack broadband access and have high social vulnerability need more improvements to ensure the utilization of telehealth care, including PT and OT. Conclusion: Despite the policies expanding PT/OT telehealth capabilities, structural barriers may further exacerbate inequities in care accessibility.

An academic-community interprofessional telehealth online training partnership: Impact on students and providers

ABSTRACT Telehealth can be used to improve rural communities’ access to specialized healthcare services and ameliorate rural care barriers. Use of telehealth quickly increased with the COVID-19 pandemic, and universities shifted to online instruction for the safety of students and faculty. This rapid uptake of telehealth and online instruction has created an urgent need for examples of online training for health professional students in telehealth. Participants for this study included 44 students enrolled in an interprofessional online mental health telehealth course and four health care professionals from rural clinics. Qualitative data were collected and analyzed from students and providers. Four primary themes were identified: student benefits from the IPE telehealth course, patient benefits, clinic benefits, and technological challenges. Student subthemes included learning skills needed for telehealth, improving team skills, learning about professional roles and responsibilities, and understanding rural health needs. Clinic benefits included improving telehealth readiness. This study presents an early example of online interprofessional mental health telehealth training using an academic-community partnership. Our pilot findings suggest that this course experience resulted in positive benefits for students and rural clinic providers.

Key features to ensure sustainability of a tele-oncology program at a national cancer center.

e13613 Background: Prior to COVID-19, there were few telehealth services offered in the oncology specialty area. During the pandemic, we at a national cancer center rapidly scaled our oncology telehealth program to meet the needs of our patients. At the peak of the pandemic, telehealth initially served as a risk-mitigation strategy providing continued care to our patients while socially distancing, yet additionally, we have embedded necessary processes in place to create a sustained a telehealth oncology program that encompasses a hybrid model including face to face visits augmented with telehealth visits, where appropriate. Here we describe the key telehealth program features that have enabled a national cancer center to evolve into a hybrid model of oncology care across its five geographically distinct hospitals. Methods: Transitioning into a sustainable hybrid telehealth model of care involves a foundation of clinical leadership and partnerships among multiple departments. The telehealth oncology program leaders collaborate with the operations, technology, finance, clinical care teams, and governance council to implement telehealth growth initiatives and nimbly troubleshoot and ameliorate issues. A concierge service provides telehealth readiness checks to ensure timely resolution of issues. Workflows are followed to standardize processes. Telehealth use-cases ensure patients who need on-site services keep their in-person appointments, allowing telehealth visits for symptom management to enhance patient outcomes. A provider education session includes training on telehealth technology and “webside manner” training to ensure we preserve the personal touch with our patients in each telehealth encounter. Program data is regularly collected and reviewed to track the program’s success and opportunities for improvement. Results: After the initial peak of telehealth visits driven by the COVID pandemic, we continue to see a sustained 10-fold increase in service volume versus Jan/Feb 2020. There were 25,328 total telehealth visits from Mar. 2020-Jan. 2021, 75 clinical trial visits between July-Dec. 2020, and 848 readiness check escalations from Nov. 2020-Dec. 2021. Service lines expanded from 2 to 33, including growing rural health partnerships and a home chemotherapy infusion model. Use-cases expanded to bridge to on-site care, rapid initial visits, preop/postop checks, symptom management, and surveillance. Press Ganey patient satisfaction rates are as high as 92% and 90% of providers reported overall satisfaction with the telehealth consultations. Conclusions: Our key program features have enabled the growth and success of our enterprise tele-oncology program. One of the most promising indicators of success is the positive provider and patient satisfaction rates. Telehealth provides an effective means to provide a bridge to onsite cancer care even for our complex oncology patients.

Perceptions of Practitioners on Telehealth and App Use for Smoking Cessation and COPD Care-An Exploratory Study.

Background and objectives: With the digitalization of modern healthcare delivery, digital media adoption in clinical practice is increasing. Also, healthcare professionals are more and more confronted with patients using smartphone-based health applications (apps). This exploratory study aimed at surveying perceptions on such apps in the context of lung health among a cross section of Austrian practitioners involved in pulmonary care. Materials and Methods: The online questionnaire in German assessed socio-demographic characteristics, telehealth readiness as well as opinions on smoke-free and COPD (chronic obstructive pulmonary disease) apps. We used descriptive statistics to report the finding. Results: We received valid responses from 55 participants (mean age 52.3 years, 69.1% males). Telehealth readiness was medium, indicating existence of certain barriers adversely impacting telehealth use. As for apps targeting smoking cessation and COPD, respondents indicated high relevance for visualization aspects for patients and control/overview features for the treating doctors. Only 40% of participants indicated that they would recommend a COPD app to an older patient. Conclusions: In smoking cessation therapy, doctors commonly adhere to the “5 A’s”: Ask, Advise, Assess, Assist, and Arrange. We suggest adding “App” as sixth A, assuming that in patient follow-up most of the other A’s could also be supported or even replaced by app features in the challenging task to tackle smoking-associated non-communicable diseases.

Comparison of Telehealth-Related Ethics and Guidelines and a Checklist for Ethical Decision Making in the Midst of the COVID-19 Pandemic.

Applied behavior analysis (ABA) services have been provided primarily in the fields of health care and education across various settings using an in-person service delivery model. Due to the COVID-19 pandemic, the necessity of and demand for ABA services using telehealth have increased. The purpose of the present article was to cross-examine the ethical codes and guidelines of different, but related fields of practice and to discuss potential implications for telehealth-based ABA service delivery. We reviewed the telehealth-specific ethical codes and guidelines of the American Psychological Association, the American Academy of Pediatrics, and the National Association of Social Workers, along with the related ABA literature. These organizations addressed several useful and unique ethical concerns that have not been addressed in ABA literature. We also developed a brief checklist for ABA practitioners to evaluate their telehealth readiness by meeting the legal, professional, and ethical requirements of ABA services.

Letter: Implementation of a Neurosurgery Telehealth Program Amid the COVID-19 Crisis-Challenges, Lessons Learned, and a Way Forward.

Letter: Implementation of a Neurosurgery Telehealth Program Amid the COVID-19 Crisis-Challenges, Lessons Learned, and a Way Forward.

Telemonitoring readiness among Austrian diabetic patients: A cross-sectional validation study.

Digitalized healthcare services offer remote and cost-effective treatment of diabetes patients. Thus, the present online study analyzed the readiness to use telemonitoring among Austrian diabetes patients. We developed and validated a German version of the patient telehealth readiness assessment tool and performed quantitative context analysis of free-text comments on perceived barriers and benefits of telemonitoring. Participants (n = 41, 42.6% females) achieved a medium average readiness level for telemonitoring. The three top benefits were intensified care, shorter travel and waiting times, and better therapy adjustment. The top three barriers were data privacy issues, loss of personal communication and focus on blood sugar, and teledoctor competence. Diabetes patients represent a suitable target group for remote treatment opportunities. However, a shift from traditional face-to-face medical care to exclusive telemonitoring treatment from diagnosis to consultation and treatment requires fundamental new legal framework conditions.

Are Austrian practitioners ready to use medical apps? Results of a validation study

BackgroundAs part of the mobile revolution, smartphone-based applications (apps) have become almost indispensable in today’s information society. Consequently, the use of medical apps among healthcare professionals has increased heavily over the past years. As little is known on medical app use in day-to-day clinical practice in Austria, the present study aims at closing this knowledge gap by assessing respective prevalence, readiness, and concerns among Austrian practitioners.MethodsWe conducted a cross-sectional online survey among a sample of 151 Austrian doctors (mean age 45.0, SD 12.0, 55.0% females). We developed a German study questionnaire on the basis of the Practitioner Telehealth Readiness Assessment Tool (PRAT) to assess medical app use-related readiness and attitudes, and validated it using principal component analysis.ResultsIn our study, 74% of participants used medical apps on a daily basis, with clarity, ease of use, speed, and support in clinical routine mentioned as most important app features. However, the majority of participants perceived certain barriers to use medical apps. Younger participants used more medical apps, were more likely to use them during work, and yielded higher readiness scores. The most often used medical apps were Diagnosia and Embryotox (both 28.5%).ConclusionsNowadays, medical apps serve as an important source of information for many doctors and are especially popular among younger physicians. The omnipresence of smartphones in the smocks of healthcare workers raised awareness for potential shortcomings regarding disruption of traditional face-to-face doctor-patient interaction among all healthcare stakeholders. This study’s finding thus highlight the need for initiating a public discussion on legal and social frameworks to successfully integrate mobile apps into everyday clinical.

Readiness to use telemonitoring in diabetes care: a cross-sectional study among Austrian practitioners

BackgroundTelemonitoring services could dramatically improve the care of diabetes patients by enhancing their quality of life while decreasing healthcare expenditures. However, the potential for implementing innovative treatment options in the Austrian public and private health system is not known yet. Thus, we analyzed the readiness to use telemonitoring in diabetes care among Austrian practitioners.MethodsWe conducted an online survey among a purposive sample of Austrian practitioners (n = 41) using an adapted German version of the practitioner telehealth readiness assessment tool. We assessed three readiness domains for telemonitoring in the context of diabetes care, i.e. core readiness, engagement readiness, and structural readiness, and validated the German tool using principal components analysis.ResultsStudy subjects perceived themselves as open to innovations and also expressed optimistic attitudes towards telemonitoring in general and offering telemonitoring-based services for their patients. Participants achieved a medium average readiness level for telemonitoring (58.2, 95% CI 53.9–62.5) and were thus in a good position to use telemonitoring, although some arguments may adversely affected its use. The top three perceived benefits of telemonitoring were enhanced quality of treatment, better therapy adjustment, and reduced travel and waiting times for patients. The top three barriers were reduced personal communication, practitioner time expenditure and equally placed poor financial compensation as well as data security and privacy issues.ConclusionOur data revealed that Austrian practitioners showed a quite moderate readiness to use telemonitoring in diabetes care. To further advance telemonitoring readiness among all pillars of diabetes care in Austria, joint efforts among healthcare stakeholders are required to overcome existing financial, organizational, and technical obstacles.

Developing a telehealth readiness assessment framework and tool for least developed countries: A case of Yemen

Developing a telehealth readiness assessment framework and tool for least developed countries: A case of Yemen

Developing and validating the French-Canadian version of the practitioner and organizational telehealth readiness assessment tools

Only one telehealth readiness assessment tool, that of Jennett et al., covers all types of telehealth projects, regardless of health-care provision context. However, this instrument is only available in English and has not undergone psychometric evaluation. We developed a French-Canadian version of the Practitioner Telehealth Readiness Assessment Tool and the Organizational Telehealth Readiness Assessment Tool. Transcultural validity was assessed by nine practitioners and 12 clinical project co-ordinators or administrators. For practitioners and managers, there was no significant difference between the scores of the English and the French versions of the questionnaires. The results showed that the telehealth readiness of co-ordinators or administrators was greater than that of practitioners when the range in scores was taken into account. The French-Canadian versions of the two questionnaires make it possible to assess telehealth readiness among French speakers. However, other studies involving patients will be necessary to validate the Patient-Public Telehealth Readiness Assessment Tool.

Telehealth readiness assessment tools

In planning a telehealth project, a readiness assessment can help to improve the chances of successful implementation by identifying the stakeholders and the factors that should be targeted. We conducted a literature search and identified six questionnaires on readiness that can be used when implementing telehealth projects. Only one of them was sufficiently generic to be used with all kinds of telehealth projects and with different groups of participants (patients and public, health-care practitioners and organization personnel like health-care managers and technical support managers), but it had rather limited psychometric evaluation. Two of them had had good psychometric evaluation but they were specific to particular telehealth projects and groups of stakeholders. All six published questionnaires were in English. We have developed and validated a French-Canadian version of the practitioner and organizational telehealth readiness assessment tool.