Telemedicine is one of the technological developments in the healthcare sector, which can aid physicians to do a remote assessment, arrangement of meetings, do follow-up to patients, among others. Grand Hospital, which is a propriety organization located in a rural setting, can adopt this innovation to solve the current challenges of few physicians to serve community needs. The three specialties that are expected to benefit most include radiology, psychiatry, and intensive care. Given that Grand Hospital had initially adopted a health information system, it has the necessary experience which it can apply in this new proposal. It is also expected that there will be lesser technological anxiety, although the issues of security and privacy may arise. Radiology will experience much easier telemedicine, followed by human behavior and then intensive care due to differences in the degree of challenges involved. Four basic steps can be used by Grand Hospital to adopt telemedicine. The feasibility and resource allocation is then made before the execution. At each stage, evaluation should be done to ensure that the expected outcome is realized. To implement the proposal, the input of all employees will be needed during all phases of the project.
Technological advancement in the health care industry has many advantages, such as enhancing efficiency, increasing competitiveness, and increasing convenience. According to Kho et al. (2020), telemedicine is one of the innovations that allows clinicians to offer services such as assessment and management of illnesses remotely. The result is the reduction of traffic in the clinical premises and cost-saving for the patient. This is especially factual for rural patients who, according to LeRouge et al. (2019), are marginalized and have limited access to specialized doctors. However, there are certain organizational, licensure law barriers, reimbursement issues, and human factors that may result in resistant telemedicine. The degree to which these aspects negatively affect the execution process is dependent on the healthcare department. The objective of this case study is to discuss the efficacy of the adoption of the telemedicine technologies for Grand Hospital to solve the challenge of shortage of physicians in three departments.
Background of the Case
Grand Hospital is a proprietary hospital in the midwestern rural area which was established in 1995. It has a 209-bed capacity and employs about 1600 individuals. In addition, the annual budget for Grand Hospital is more than $130, and it has assets amounting to $150. Since its establishment, Grand Hospital has managed to build a strong brand in the community and even has an A credit in Fitch Ratings and Moody’s, Standard & Poor’s. Earlier, the organization was among the first to integrate healthcare information systems in its service delivery.
The downside of these developments is that the company is now having an influx of patients who require medical care. Regrettably, the hospital is unable to meet the demand for physicians either for replacing those that are retired or to serve the increased capacity of clients. Resultantly, the reputation of the hospital can be ruined, while the clinicians may have work overload and suffer burnout. The recommended solution is to integrate the telemedicine as a way of increasing client coverage. The primary departments where the new technology is expected to help are radiology, behavioral health, and critical care medicine. This development requires the hospital to employ radiologists and psychiatrists to attend to the telephone 24 hours, seven days a week. In addition, Grand Hospital will also need to employee intensivist physician who will be available around the clock to attend to patients in the absence of volunteers.
Effect of Early Technological Adoption on Telemedicine Integration
Any changes that an organization makes in digitalizing its services always provide lessons that can be used for consecutive adoption of new technology. The implication is that since Grand Hospital is one of the earliest to start using healthcare information systems, there is some knowledge that they can borrow from the experience they had. For example, if there was resistance by patients or even employees and they managed to convince them to accept the transition, similar skills and strategies can be effective in telehealth. Moreover, people who have used technology before are less likely to have technology anxiety which, as stated by Kaium et al. (2019), is one factor that makes people reluctant to adopt mobile health (mHealth). In summary, having experience in adopting digital healthcare in the past provides wisdom on how to implement the success and avoid the mistakes that may have been made.
Medical technologies are often connected in the form of the internet of things (IoT) which may enhance efficiency but also pose additional. In the current case, Grand Hospital is already using health information system. If it adopts the telemedicine solution, the two systems will have to be connected such that if a physician conducts a mobile phone assessment and type the records for electronic storage. Therefore, the advantage that Grand Hospital has is that it will increase its connectivity and utilize the previous digitalization to its full capacity. The threat of relying so much on medical technology is that it increases information insecurity, fraud, and privacy issues. Having previously adopted information technology, Grand Hospital has the suitable base for telemedicine as the two work together, but caution should be taken to minimize the drawbacks of computerization.
Barriers to Telemedicine Success
In all the three departments, telemedicine can be used in decision making, collaborative arrangements of one-on-one meetings, and remote sensing. The degree of success for the three departments is expected to differ due to the nature of clients needing the service. With regards to teleradiology, there may be reimbursement challenges since Medicare has restrictions for paying for services which have not been offered in person at a healthcare center. Billing of services can also be a challenge because the technical aspect (such as imaging) is done at a different location and the interpretation at a different location. The legal considerations such as licensure, credential, and competency of the radiologist may also present more challenges. With telepsychiatry, some of the common issues are videoconferencing fatigue, reimbursement, differences in interstate laws. With intensive care, the problems involve poor access to patient-related information, many varieties of ICU processes, limited ICU nurse experience, dealing with different staff, and documentation issues.
It will be easiest to integrate telemedicine in radiology, followed by behavioral health, and lastly the intensive care. According to Rhoman (2018), the department that has the highest use of telemedicine is radiology at 42.7% compared to psychiatry 25.8%. The reason why the technology is common for the former is because it is more convenient and has a wide area of application. For example, the radiologist can make interpretations for professions such as soldiers and wardens who get injury. It is easy for the patient to describe how their feelings and even take photographs of the body part that is ailing and send it to the radiologist using a smartphone. In turn, the remote assessment, scheduling of meetings, referrals and documentation of the image is easily achieved for these patients
The reason why behavioral health is rated second is that the method is not complex if the patient is dealing with the same mental health professional. However, it may be difficult to assess people with psychological challenges through phone calls when a client is having difficult issues such as lack of orientation. Finally, the hardest department to implement telemedicine is the intensive care unit due to the fact that the patients are vulnerable and a slight communication mistake may endanger their life. Moreover, the medical issues for each patient in intensive care are unique, and coordination with many professionals is required.
Steps in Implementation of Telemedicine
For successful implementation of telehealth services, it is essential to understand the interaction between technology, economy, society, and the environment. First, the technical aspects that need to be considered include the availability of a stable network for communication and mobile phone penetration in the rural area (Lin et al., 2018). The financial aspects include if the organization is in a position to purchase the equipment and employ additional people. Social aspects such as if patients and caregivers will adjust to the new changes should also be considered. Lastly, the project manager should understand the nature of the hospital and its administration. When the interplay between these aspects is put into consideration before the adoption of technology, it will be possible to realize the usefulness and usability of the technology.
The first step in implementing telemedicine is to involve all the leaders of Grand Hospital and explain the process. The rationale is so that they, in turn, will prepare the employees or clients that are subject to them. The second step is to identify the champions who will motivate people to accept the changes being made throughout the project. Next, all the technical resources that are needed are identified and purchased. The actual implementation is carried out while evaluating and assessing each stage.
The entire Grand Hospital administration will be involved in the process, but some managers will have more responsibilities than others. For example, the director of the finance department will be responsible for disbursing the funds needed. The Chief information officer will also have a big role during adoption and evaluation process because they understand how medical technology works. In addition, the heads of the three departments, radiologists, psychiatry, and intensive care, will be present so that they receive training to start using telemedicine. In summary, all employees will have a role to play, but specific staff will have special responsibilities.
Telemedicine can potentially help to address some of the challenges faced by hospitals in rural areas where there are few specialized physicians. The process of integrating the new technology may be easier to healthcare organizations which have previously adopted other information system. The digitalization process can be merged to realize the full benefit. Even so, change is not an easy process, and implementation may be faced by challenges due to lack of resources and resistance from staff and patients. Making a proper plan for each of the beneficiary departments while considering the economic, technical, social, and organizational factors will aid in the smooth integration of the innovation. Last but not least, employees that are directly affected by the change must work together to ensure that the project is successful.
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Kho, J., Gillespie, N., & Martin-Khan, M. (2020). A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Services Research, 20(1), 1-16.
LeRouge, C. M., Gupta, M., Corpart, G., & Arrieta, A. (2019). Health system approaches are needed to expand telemedicine use across nine Latin American nation. Health Affairs, 38(2), 212-221,221A-221L.
Lin, C. C., Dievler, A., Robbins, C., Sripipatana, A., Quinn, M., & Nair, S. (2018). Telehealth in health centers: key adoption factors, barriers, and opportunities. Health Affairs, 37(12), 1967-1974,1974A-1974D.
Rhoman, M. (2018). Radiology uses telemedicine more than any other specialty, AMA survey finds. Health Imaging.