Key Factors Affecting the Adoption of Telemedicine by Ambulatory Clinics: Insights from a Statewide Survey
Key Factors Affecting the Adoption of Telemedicine by Ambulatory Clinics: Insights from a Statewide Survey
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DOI：
10.1089/tmj.2018.0114
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发表时间：
2020-02-01
影响因子：
4.7
通讯作者：
Balaji, S.
中科院分区：
文献类型：
--
作者：
Ranganathan, C.;Balaji, S.
背景：尽管远程医疗的好处和需求有所改善，但美国门诊诊所的采用率仍然很低。迫切需要确定为什么远程医疗采用率在门诊提供者中仍然很低。前言：本研究的目的是评估门诊诊所采用远程医疗的关键预测因素，并评估采用者和非采用者之间的显著差异。研究了临床特征、健康信息技术（HIT）相关因素和组织变量三大类预测因子。材料和方法：该研究使用了明尼苏达州卫生部（MDH）于2016年收集的对明尼苏达州（MN） 1285家诊所的调查数据。采用SPSS软件进行探索性统计分析和二元logistic回归分析。结果：明尼苏达州55%的门诊诊所采用了远程医疗。超过26%的诊所采用实时会诊，15%的诊所采用远程患者监护，约7%的诊所采用存储转发会诊。27%的诊所采用现场远程咨询，23%的诊所采用远程咨询的初级保健和专科服务。Logistic回归显示，卫生系统所属诊所、农村诊所和初级保健诊所采用远程医疗的水平较高。拥有无纸化电子健康记录（EHR）系统、健康信息交换（HIE）支持和更好的技术基础设施的诊所采用远程医疗的几率更高。此外，重新设计工作流程的诊所采用远程医疗的几率也更高。面临远程医疗设备成本高、需求不足的诊所采用水平较低。面临高托管和人员成本的诊所更有可能采用存储转发式远程医疗和实时患者监测，而不是其他高端远程医疗服务。报告覆盖面或报销不足的诊所更有可能采用一套限制性的远程医疗服务。讨论：远程医疗在明尼苏达州的门诊诊所还不是很普遍。超过45%的诊所不提供任何远程医疗服务。采用的障碍差别很大，与HIT和组织因素有关。结论：随着远程医疗服务需求的增加，旨在改善报销模式的政策变化、远程医疗的数字基础设施、HIE能力、组织向无纸化电子病历系统的努力以及重新设计工作流程都有助于加快远程医疗的采用。
Background: Despite demonstrated benefits and improved demand for telemedicine, adoption rates by U.S. ambulatory clinics remain low. There is a critical need to identify why telemedicine adoption rates remain low among ambulatory providers.Introduction: The aim of this study is to evaluate key predictors of telemedicine adoption by ambulatory clinics and assess salient differences between adopters and nonadopters. Three categories of predictors namely clinic characteristics, health information technology (HIT)-related factor, and organizational variables were examined.Materials and Methods: The study used data from a survey of 1,285 clinics in Minnesota (MN) that was collected by Minnesota Department of Health (MDH) in 2016. Exploratory statistical analyses as well as binary logistic regression analyses were carried out using SPSS software.Results: Fifty-five percent of ambulatory clinics in Minnesota had adopted telemedicine. Real-time consultations were adopted in over 26% clinics, remote patient monitoring in 15% clinics, and store-and-forward consultations in about 7% clinics. Originating site teleconsulting was prevalent in 27% clinics, whereas primary care and specialist services through teleconsulting were adopted by 23% clinics. Logistic regression revealed health system-owned clinics, rural clinics, and primary care ones to exhibit higher levels of telemedicine adoption. Clinics with paperless electronic health record (EHR) systems, health information exchange (HIE)-enablement, and better technological infrastructure had higher odds of telemedicine adoption. Furthermore, clinics that had redesigned their workflows also exhibited higher odds of telemedicine adoption. Clinics that faced high costs of telemedicine equipment, lack of demand had lower adoption levels. Clinics that faced high costs for hosting and staffing were more likely to adopt store-and-forward telemedicine and real-time patient monitoring rather than other high-end telemedicine services. Clinics that reported inadequate coverage or reimbursement were more likely to adopt a restrictive set of telemedicine services.Discussion: Telemedicine is not yet very prevalent among Minnesota ambulatory clinics. Over 45% of the clinics do not offer any telemedicine services. The barriers to adoption vary widely and pertain to HIT as well as organizational factors.Conclusion: With increased demand for telemedicine services, policy changes aimed at improving the reimbursement models, digital infrastructure for telemedicine, HIE capabilities, organizational efforts to move toward paperless EHR systems, and redesigning workflows can facilitate in accelerating telemedicine adoption.