Summary Conclusions and Recommendations Regarding Use of Telemedicine by Michigan Physicians

M3J Communications

Defining Telemedicine Telemedicine generally refers to the use of

communications and information technologies for the delivery of clinical care. It has existed for decades and may be as simple as two physicians discussing a patient on the telephone. Now with the advent of new technologies, it has become more complex. Video-conferencing equipment allows physicians to conduct a real-time consultation between medical specialists separated by hundreds or even thousands of miles.

Benefits of Telemedicine

Distance-patients don’t have to travel as far

Eliminates a barrier to care-the specialist can see and speak with the patient leading to a recommendation. Make the trip to see the specialist Prescribe a course of action for the primary care

physician Make a diagnosis using technology, such as, digital

stethoscopes, capture and forward video or high definition cameras.

The Challenge

Physicians in rural parts of Michigan have been slow to adopt telemedicine as part of their practices.

Previous Studies

Michigan State University conducted a study for the Michigan Upper Peninsula Telehealth Network that tracked telemedicine usage from 1995-2008 and measured patient satisfaction.

Key Finding:

Patients said that the decision to use telemedicine technology comes from the physician, another healthcare provider or a telehealth staff member in a majority of cases. Only 10% of patients said that they had asked for the service themselves.

Previous Studies

Patient responses regarding telehealth from the Michigan State study. “For people who aren’t mobile, it’s a blessing to not

have to travel.” “My doctor said that riding long distances might hurt

the healing process of my incision. So, it was just an obvious choice to not drive that long distance to Marquette.”

“It is so much quicker and convenient. It is really hard to beat an hour versus about 12.”

ALMOST 90% OF THE RESPONDENTS STATED THAT THEY WOULD USE TELEHEALTH SERVICES AGAIN.

Telemedicine Success Story

Leonard Cardinal of Michigan Suffered a stroke, broken

hip and was undergoing dialysis.

Complications from the broken hip rehab required him to see a specialist a great distance from his home, and his other medical conditions limited his ability to travel.

Employed telemedicine to meet with specialist, diagnosed and treated the complication and the telemedicine appointment was in the same building as his dialysis appointments.

Strategy

Determine why rural physicians in Michigan are slow to adopt telemedicine

Gauge current use Gauge current attitude and beliefs Assess barriers, perceived and real, to using

telemedicine

Tactics

Mailed a questionnaire to 1,000 physicians identified as rural physicians in Michigan.

Received 115 responses.

The following data reflects 80 of the responses that were collected.

Research Questions

1. How strongly are years in practice and gender among rural physicians related to behavior and intent to use telemedicine?

2. How strongly is physician setting related to behavior and intent to use telemedicine?

3. How strongly is a physician’s experience with telemedicine related to behavioral attitudes toward telemedicine?

4. Is the physician’s access to equipment related to intent to use telemedicine?

The Instrument

22 Questions that gauged attitudes and beliefs about telemedicine

Two questions that measured use and intent to use telemedicine

Two questions that measured perceived value of telemedicine to the practice.

Four questions that measured the technical abilities of the physician’s office and staff

Two questions that measured the significance of access to equipment in implementing telemedicine.

Physicians were asked to rate a series of statements on a scale of 1-5 with 1 meaning that they strongly disagree with the statement and 5 meaning that they strongly agree.

Physician Demographics

73% of physicians in the sample are male, 21% female.

60 of the 82 physicians represented have practices between 11-and-30 years.

The median age of the physicians in the sample is 52 years old.

Telemedicine Usage

How often do you use live/interactive telemedicine in your practice? Median answer was 1.45. Between never and less than

once a month.

The likelihood that I will use live/interactive telemedicine in my practice in the future is? Median answer was 2.20. Between moderately low and

moderate.

Significant Findings

Physicians with fewer than ten years of experience expressed a higher intent to use telemedicine in the future than more experienced physicians in the 11-30 years of practice category.

Physicians with fewer than five years of experience had the best general attitude toward telemedicine.

Physicians employed by a hospital showed the best general attitude toward telemedicine with a single doctor in an independent practice showing the worst general attitude toward telemedicine.

Hospital employees showed the most general comfort with telemedicine.

Female physicians showed a higher intent to use telemedicine in their practices than their male counterparts.

Factors Influencing Telemedicine Experience

General pressure to use telemedicine

Intent to use telemedicine General comfort with

telemedicine Support from colleagues Endorsement from a professional

organization

Factors Influencing Intent to Use Telemedicine

General comfort with telemedicine. General attitude toward telemedicine. Will adapt well to my way of managing patients. Something my patients would want to have access to. General pressure to use telemedicine.

Negative beliefs relating to intent to use telemedicine

Requires a large commitment of time

Number one barrier relating to the intent to use telemedicine

The equipment is not located in my office.

Recommendations

Rural Physician Focused Public relations campaign to educate independent

physicians about telemedicine Implementation specialist to travel to rural parts of Michigan

and make personal consultations to physicians and medical staff about benefits of telemedicine and how it can be used in their practices.

Implementation specialist to make presentations at annual medical conferences in Michigan.

Actively distribute telemedicine (MATTeR) toolkits with follow-up by implementation specialist.

Increase awareness of resources available to physicians to implement telemedicine including grants.

Pursue other grant funding and attempt to encourage legislation that would subsidize telemedicine equipment for rural physicians.

Recommendations

Specialist Physician Focused Education effort to inform specialists about

telemedicine Partner with existing specialist associations to promote

telemedicine use in their practices. Subsidize videoconferencing equipment for specialists. Implementation specialist would provide training on

videoconferencing equipment use. Communicate benefits to specialist’s practice: more

patients, less traffic in the office and overall patient satisfaction.

Recommendations

Patient Focused Advertising and public relations campaign to increase

demand for telemedicine among patients. Television and print advertising campaign to build

awareness of telemedicine among rural patients. Target support groups and foundations to provide literature

and in-person speaking engagements on telemedicine to patients.

Conclusions

The major barrier to the use of telemedicine among rural physicians is access to the equipment and a general perceived lack of resources.

The group most likely to respond positively to using telemedicine are physicians who have been practicing less than 10 years.

More education, training and subsidy for the telemedicine equipment is needed to increase use by Michigan’s rural physicians.