Capstone Project: Telemedicine

Introduction

Aims of the Project

The following purposes were formulated to be addressed during this capstone project:

  1. To evaluate the effectiveness of telemedicine in the University of Maryland Medical Center as a mode of providing high-quality care with reference to the standard that is equally applied to all programs.
  2. To analyze the effectiveness of the applied model, standards, and guidelines to evaluate telemedicine.

Theory

To guide this capstone project, it is necessary to propose a theoretical framework. The focus of the project is on evaluating telemedicine tools used in the selected facility. Therefore, the Standards Framework developed by the American Telemedicine Association (ATA) and adopted by the Maryland Department of Health is chosen as the framework for assessing the application and use of telemedicine tools in the University of Maryland Medical Center (“American Telemedicine Association,” n.d.; Myers et al., 2017). In the United States, there is no one specific evaluation model to assess telemedicine in healthcare organizations. For the purpose of this project, the Model for Assessment of Telemedicine (MAST) that is used in European countries and globally is proposed as the assessment tool (Dinesen et al., 2016).

Significance of the Project

The problem is that the development of a unified model for assessing telemedicine in the United States, which is similar to the MAST, is only at the stage of debates and recommendations. The significance of this project is that its findings will be important for the organization to assess the MAST in its settings in the context of the ATA standards and guidelines as a model to effectively evaluate telemedicine programs (“American Telemedicine Association,” n.d.). As a result, it will be possible to develop a model that corresponds with the ATA standards and addresses the needs of the University of Maryland Medical Center in the context of creating a national model of assessment. Thus, the success of the project will provide implications for leaders in the organization to arrange finances, manage telemedicine, and develop new policies oriented to improving care (Mistry, Garnvwa, & Oppong, 2014). The project will also contribute to the health administration in terms of proposing a cost- and time-efficient preliminary variant of the model to be used for the assessment of telemedicine in the organization.

Review of Literature

Telemedicine is actively used in the United States with the focus on providing support and care for patients from remote and rural areas. Telemedicine tools and programs are also applied to provide consultation for home-based treatment and care (Minet et al., 2015; Wallace & Dhingra, 2014). In the United States, these tools and programs work according to the ATA standards and guidelines that are widely adopted in different regions of the country and applied in healthcare organizations (“American Telemedicine Association,” n.d.). These standards guarantee that services provided with the help of telemedicine are of high quality and suitable in a certain case or environment. However, to guarantee the effective work of telemedicine programs, it is necessary to regularly evaluate their effectiveness in terms of the work of technology, appropriateness for a certain community, and effectiveness in health promotion (Chakraborty, Gupta, Ghosh, & Das, 2016). Currently, there is no one model for evaluating telemedicine that is used in all hospitals, and studies demonstrate that organizations need to adapt general program evaluation models to control and assess telemedicine services (Krupinski & Bernard, 2014). This situation creates barriers to evaluating telemedicine in facilities according to only one standard.

Existing research in the field is focused on two key topics related to the discussed problem. The first topic is associated with the necessity of proposing and adopting a standard evaluation model for telemedicine as a process and used tools to help healthcare providers organize their work effectively (Rasmussen et al., 2015). Thus, researchers found that there is a lack of effective models that are evidence-based and tested in different healthcare organizations (George, Moran, Fish, & Ogunyemi, 2013). The majority of hospitals in the United States use the ATA standards and guidelines in their practice for planning and implementing telemedicine, but they do not have specific models to assess the results. Researchers propose developing new assessment models with reference to the theories of assessment in the field, outcomes of previous studies on the problem, the integration of research on evaluation that was conducted earlier and cost analysis to ensure the model is cost-efficient (Doarn & Merrell, 2014). The necessity of developing such models is declared in many studies while accentuating the gap in research.

The second topic observed in the literature on telemedicine in the United States is associated with the debates on possibilities to adapt European models of assessment that have been recently developed and adopted by hospitals and other healthcare organizations. According to Dinesen et al. (2016), the MAST is a model that is actively used in the countries of the European Union because it proposes an effective assessment process that is based on three stages. The first step is associated with the preliminary assessment of the used technology and its appropriateness (Ekeland & Grøttland, 2015; Kidholm, Clemensen, Caffery, & Smith, 2017). At the second stage, a multidisciplinary assessment of the effectiveness of the tool is conducted in accordance with such criteria as safety, finance, patient outcomes, and clinical effectiveness among others (Kidholm, Jensen, & Kotzeva, 2015). The third step involves a transferability assessment. This model is approved in Europe as the most effective one, and it can be adapted to other contexts.

Capstone Site Project Mentor

The capstone project mentor assigned from the University of Maryland Medical Center will help the researcher to contact managers and leaders of the departments and units where telemedicine programs are applied. This step is necessary to collect the required information in order to understand how managers assess telemedicine and what they think about evaluation models. The mentor will also help with organizing the delivery of the project results.

Methods

Description of the Methods

The setting for completing the project is the University of Maryland Medical Center. The mixed-methods approach is proposed for this project as it is necessary to collect and analyze both quantitative and qualitative data. The managers and leaders who have agreed to assist in realizing the project and who are responsible for telemedicine in the center will be provided with the ATA standards and guidelines and the protocol for the MAST to evaluate the effectiveness of telemedicine programs used in different units of the hospital. For the quantitative part of this research, these participants will provide the filled-in questionnaires on the results of the evaluation and their views on the appropriateness of this tool (Abildgaard, Saksvik, & Nielsen, 2016). These data will be analyzed with the help of descriptive statistical tests in SPSS.

For the qualitative part of this research, it is necessary to collect data on managers’ views regarding the effectiveness of telemedicine, the application and usefulness of the ATA standards and guidelines, and the use of the MAST as an alternative evaluation model to be adapted to the needs of this hospital. The data will be collected with the help of semi-structured interviews. The analysis of qualitative data will be based on thematic analysis and coding.

Description of the Project Deliverables

The project deliverables will include the report on research or project results completed by the researcher and the PowerPoint presentation to be demonstrated to the staff working with telemedicine programs in the University of Maryland Medical Center. The report will be provided to the supervisors in the university and hospital, and it will include an introduction, literature review, methodology, data analysis, discussion, limitations, recommendations or suggestions, and conclusion. Thus, the report will provide the conclusion regarding the approaches and models to use in the medical center for evaluating telemedicine according to the set standards. It will also provide recommendations regarding the adaptation of the MAST in combination with the ATA standards and guidelines to the needs of the hospital and teams working with telemedicine. The PowerPoint presentation will include the findings of the project to demonstrate how telemedicine is evaluated in the University of Maryland Medical Center at the current stage and how the evidence-based model used in European countries can be applied in the hospital in combination with the ATA standards and guidelines and what changes to promote to guarantee the effective use of telemedicine in the medical center.

References

Abildgaard, J. S., Saksvik, P. Ø., & Nielsen, K. (2016). How to measure the intervention process? An assessment of qualitative and quantitative approaches to data collection in the process evaluation of organizational interventions. Frontiers in Psychology, 7, 1380-1390.

American Telemedicine Association: Standards framework. (n.d.). Web.

Chakraborty, C., Gupta, B., Ghosh, S. K., & Das, D. K. (2016). Telemedicine supported chronic wound tissue prediction using classification approaches. Journal of Medical Systems, 40(3), 68-74.

Dinesen, B., Nonnecke, B., Lindeman, D., Toft, E., Kidholm, K., Jethwani, K.,… Gutierrez, M. (2016). Personalized telehealth in the future: A global research agenda. Journal of Medical Internet Research, 18(3), 53-59.

Doarn, C. R., & Merrell, R. C. (2014). Standards and guidelines for telemedicine–An evolution. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 20(3), 187-189.

Ekeland, A. G., & Grøttland, A. (2015). Assessment of MAST in European patient-centered telemedicine pilots. International Journal of Technology Assessment in Health Care, 31(5), 304-311.

George, S., Moran, E., Fish, A., & Ogunyemi, L. (2013). Understanding the digital divide in the clinical setting: The technology knowledge gap experienced by US safety net patients during teleretinal screening. Studies in Health Technology and Informatics, 192, 946-946.

Kidholm, K., Clemensen, J., Caffery, L. J., & Smith, A. C. (2017). The Model for Assessment of Telemedicine (MAST): A scoping review of empirical studies. Journal of Telemedicine and Telecare, 23(9), 803-813.

Kidholm, K., Jensen, L. K., & Kotzeva, A. (2015). On the use of the MAST model in assessment of telemedicine: A comment on Ekeland and Grøttland. International Journal of Technology Assessment in Health Care, 31(5), 312-313.

Krupinski, E. A., & Bernard, J. (2014). Standards and guidelines in telemedicine and telehealth. Healthcare, 2(1), 74-93.

Minet, L. R., Hansen, L. W., Pedersen, C. D., Titlestad, I. L., Christensen, J. K., Kidholm, K.,… Møllegård, L. (2015). Early telemedicine training and counselling after hospitalization in patients with severe chronic obstructive pulmonary disease: A feasibility study. BMC Medical Informatics and Decision Making, 15(1), 3-12.

Mistry, H., Garnvwa, H., & Oppong, R. (2014). Critical appraisal of published systematic reviews assessing the cost-effectiveness of telemedicine studies. Telemedicine and E-Health, 20(7), 609-618.

Myers, K., Nelson, E. L., Rabinowitz, T., Hilty, D., Baker, D., Barnwell, S. S.,… Comer, J. S. (2017). American Telemedicine Association practice guidelines for telemental health with children and adolescents. Telemedicine and E-Health, 23(10), 779-804.

Rasmussen, B. S., Froekjaer, J., Bjerregaard, M. R., Lauritsen, J., Hangaard, J., Henriksen, C. W.,… Yderstraede, K. B. (2015). A randomized controlled trial comparing telemedical and standard outpatient monitoring of diabetic foot ulcers. Diabetes Care, 38(9), 1723-1729.

Wallace, L. S., & Dhingra, L. K. (2014). A systematic review of smartphone applications for chronic pain available for download in the United States. Journal of Opioid Management, 10(1), 63-68.