Facilitators of Physician Adoption of Telemedicine Programs — Part 2 of 3
This article focus on two factors influencing physician engagement and adoption of telemedicine: Social Influence and Facilitation Conditions
November 25, 2019 — This is the second article in a series of three where I’m discussing factors that facilitate the adoption of telemedicine (TM) by physicians. In the first article I discussed the concepts of usefulness and ease of use. As mentioned previously, physician’s adoption and participation in a TM program is crucial for its success. This can be achieved by having in place a thorough Physician Adoption Strategy (PAS) as part of the design and implementation plan of the program.
Read: Facilitators of Physician Adoption of Telemedicine Programs — Part 1 of 3
Read: Facilitators of Physician Adoption of Telemedicine Programs — Part 3 of 3
The 5 factors that influence the physician’s adoption of TM programs are:
Usefulness of the program
Ease of use of the program
Facilitation and IT support
Social Influence (from patients, peers and management)
Financial Incentives/Reinforcement factor
This article will be focusing on two (2) factors: Social Influence and Facilitation Conditions
Social Influence
Humans are social beings and much of our behavior is influenced by the interactions with our environment. The opinions of important others (patients, peers and managers) — who approve or disapprove the use of TM — exert influence in the physician’s decision to (or not to) adopt the use of TM. The Technology Acceptance Model (TAM) defines this as social influence, also called subjective norm(1). The Unified Theory of Acceptance and Use of Technology (UTAUT) defines social influence as the extent to which clinicians perceive that the influence of others will make them use TM(2).
Social influence can be direct or indirect(1):
Direct: by being told directly to use or not to use TM
Indirect: through a culture of TM use — when physicians are influenced by vicariously observing the actions and attitudes of others around them.
Who might exert influence on physicians(1):
Patients and their families
Professional groups
Regulatory agencies
Employing organizations
Supervisors
Insurance providers
Fellow physicians
Nurses
Measures of Social Influence which should be included in a PAS include(1):
Colleagues who are important to me think I should use TM
People who are important to me think I should use TM
People who whose opinion I value think I should use TM
People who are important in my health care services think I should use TM
Senior management of hospital has been helpful
Hospital supported the use of TM
Superior at work think I should use TM
Subordinates at work think I should use TM
Other health professionals (nurses, pharmacists) would approve that I use TM(3)
Most patients would welcome that I use TM(3)
Another factor related to social influence is the concept of Professional norms. “Norms” generally refers to something that is usual, typical, standard, or expected. These norms establish a sort of “contract” among colleagues which allows collaboration among the group. Some metrics for professional norms among physicians include(3):
It would be normal for a physician in my organization to use TM
A physician in my specialty should use TM
I think using TM would be proper for a physician in my area
As part of a PAS management should consider allowing physicians to try the technology (trial of use) and to interact with clinicians who use TM routinely. This can be achieved through professional meetings, CME seminars and/or cross-institutional collaborative programs(4).
Facilitation Conditions
Facilitating Conditions (FC) is the perception that organizational and technical infrastructure exists to support using the telemedicine system(1). There is a significant positive relationship between FC and clinicians’ intention to use telemedicine. Clinicians agree that organizational and technical facilitating conditions are necessary to drive telemedicine adoption. Availability of technical and organizational resources is a prerequisite to widespread adoption(2).
Measures of FC which should be included in a PAS include(1):
I have the necessary resources to use the TM system
I have the knowledge to use the TM system
The TM system is compatible with other systems
There is availability of technical assistance
I’m able to use the TM system at work
I’m able to use the TM system for patient care and management
Using the TM is entirely under my control
From a physician's point of view, it’s important to receive adequate education and training on the TM program. Also, I will be more inclined to use a TM program knowing that there is technical support available at any moment, to help when I need it.
In summary, it is important to create an environment where physician can be influenced to adopt and engage in the TM program. Find those TM champions within your organization that are going to be role models for others. You may even need to recruit physicians to lead the initiative. Educating your patients about the availability of TM in your organization may influence the physician's decision to adopt the TM program. Also, designing an internal marketing campaign directed at your physicians is a good idea. Focus on the usefulness of the TM program and how it can facilitate patient care, as well as physicians workflow.
In addition, it is wise to invest in a reliable IT help-desk for technical support. This needs to be reliable or physicians will stop using the system. Also, a good TM education and training program will focus not only on the technical aspects of the program, but on the basics of TM as a model of health care delivery. Physicians need to be educated on the basics of TM to really understand the usefulness of it.
In the next and last article of the series, I will be discussing Financial Incentives as a facilitator of physician adoption.
If you have any question about this article, feel free to contact me.
References
Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. Journal of biomedical informatics. 2010;43(1):159-172.
Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. International journal of medical informatics. 2017;104:84-96.
Gagnon MP, Ghandour el K, Talla PK, et al. Electronic health record acceptance by physicians: testing an integrated theoretical model. Journal of biomedical informatics. 2014;48:17-27.
Hu PJ, Chau PY. Physician acceptance of telemedicine technology: an empirical investigation. Topics in health information management. 1999;19(4):20-35.
