Barriers for Implementation of Telemedicine and Telehealth

Barriers for Implementation of Telehealth Services in Rural Australia and solutions

Introduction

Health care providers across the globe are adopting telehealth measures in service delivery. It entails providing healthcare services virtually using ICT. Its benefits include e-consultations, improved care for patients with chronic diseases, improved efficiency by the workforce, and reduced hospitalization costs.

Background of the Problem

Australia is a large country with a low population density. A third of the Australia population lives in rural and remote areas. This population is characterized by high levels of poverty thus causing poor health standards as compared to the urban population. The population experiences high mortality rates and has a low life expectancy. This is attributed to limited access to quality health due to their geographical location, there is also inconsistency in the delivery of care for this population. Health care services in rural areas are considered expensive and there are challenges of retaining health care providers in these settings. Delivery of health care is therefore as a concern to the healthcare authorities in the country. To address these concerns the authorities consider application of information technology in delivery of health care services. (Australia Bradford, Caffery, and Smith 2016).

Justification of the Research

Most people are aware of the benefits of telehealth services but its uptake is very slow.. The uptake of telehealth services is influenced by facilitators and barriers. Facilitators are a positive aspect that encourages the utilization of telemedicine while barriers are negative influencers that limit the uptake. Therefore there is a need to identify the factors both internal and external that are encountered during the implementation of Telehealth services. The systematic research will enable deduce the barriers of telehealth services that influence their uptake in rural Australia and provide for solutions to address the barriers.

Content of the Research

To establish the underlying issues of implementation I will conduct a literature review on barriers for implementation of telehealth in rural Australia from the works that have been published following clinical trials. This will help me to come up with a research question for my topic, from which I will develop the aims and objectives for my research while considering the ethical issues for my objectives. I will adopt a qualitative approach method to develop new ideas regarding the possible solutions for the barriers. I will derive data from the published articles and conduct semi-structured interviews. This will enable me to realize the implications of the study and the limitations.

Literature Review

Criteria

I  conducted a literature review from peer reviews, grey literature, searched for results from electronic databases for relevant articles. I also searched for reference lists from retrieved articles and looked for the results of the previous clinical trials and studies for the period between 1990 and 2019 and the World Health Organization (WHO) data that explains the underlying issues of telehealth implementation in rural Australia.

World Health Organization (2010) describes telemedicine refers to application of information technology in providing medical solutions to patients. Tele is a Greek prefix which means distance and therefore when connected to medicine the complete term refers to the act of sharing health information between healthcare providers and patients in the rural area. Health care providers use video conferencing and audio content to relay information regarding the health status of an individual (Pollard, Karimi, & Ficcaglia, 2017). Telehealth can also be used to provide medical service and education through ICT thus cutting on costs while enhancing the quality of service delivered to the rural population.

There is enough evidence that describes about the application of information technology in medical interventions for the rural population. This entails; reduced stays in hospitals, costs, and inconveniences, improved accessibility to quality healthcare, and improvement in the management of chronic and emergencies (Moffatt and Eley, 2010). Despite the obvious benefits, the rural population is still reluctant to adopt Telehealth services. There are very few programs by the Australia government to steer delivery of these services in rural and remote locations (Parliament, 2014). World Health Organization, (2010) indicates that complying with quality and international requirements for telemedicine service delivery is a challenging task, the researchers indicated that technology is changing day by day and therefore it is difficult for the government to keep up with the technological advancement through the purchase of the new equipment and improvement of infrastructure to meet the technological needs. Almathami,  Win,  and Vlahu-Gjorgievska, (2020) depicts that lack of funding and insufficient infrastructure makes it difficult for the government to implement telehealth services, he identified that the government recognized the need for ICT in provision of medical services but its current focus is on the provision of basic healthcare services due to limited budget. According to Almatham, Win, and Vlahu-Gjorgievska (2020) there is a challenge in sustaining a telemedicine program in rural Australia, the government does not allocate funds for technological improvements although the program is important to the population. Parliament, (2014) pointed out that there is a lack of government coordination by the government which undermines the management of the rural-telemedicine program this challenge results from unpredictable political situations and alteration of the government thus rendering the policy responsible for the implementation of telemedicine fragile. Telehealth implementation is also affected by changes in management practices, inadequate resources in terms of time, finances, and health care providers. WHO identifies that health care providers globally are inconsistent in the application of communication technologies in the delivery of health services, it further emphasizes that for telemedicine to meet global standards it should be based on advanced technology which is not the case in rural Australia since rural-telemedicine is based on simple technology like e-consultation (World Health Organization, 2010). Aziz and Abochar( 2015) indicate that most patients prefer face to face consultations over e-consultations, other patients feel that there is limited doctor-patient confidentiality

Research Gap

The gap I identified in the literature is that it highlights the challenges to telehealth service delivery in rural Australia alongside global health organizations. There is very limited knowledge regarding the pre-existing information technology measures in the field of medicine in Australian villages. Where they are located, and reasons behind their sustainability and success. However, to successfully deliver Telehealth services in Australia outskirts, there is a need to shift focus to factors that will render Telehealth services successful. In this case, I consider telehealth services’ success as improved sustainability and the integration of Telehealth in clinical activities. Therefore this research will focus on establishing ideas regarding the pre-existing facilities in Australia outskirts using information technology in service delivery and deduce the reasons behind their success and sustainability as in the case of e-consultation.

Research Questions Aims and Ethical Considerations

Research  Questions

My research will address the questions ;

• What is the current position of application of ICT in delivery of health care services Australia villages?
• What is the success story behind delivery of Tele health services in the Australia Villages?
• What are the requirements for sustaining information technology in health care in these villages?

This will address the gap by identifying the measures to overcome barriers of successful application of ICT in these facilities.

Objectives and Aims

The aims of my project are;

• To identify the pre-existing medical facilities using ICT in service delivery
• To explore solutions to barriers for application of ICT in service delivery in the Australia villages
• To identify the success factors for delivery of telehealth services in the outskirts of Australia
• To identify factors for sustaining telehealth services in rural and  remote  Australia

The main objective of my project is;

• To produce a map of key factors that informs the Australian government and the health care providers about the best way to avail telehealth services to the rural population.

Ethical Considerations

My research recognizes the field of technology is surrounded by ethical, legal, and regulatory issues and therefore Telehealth study requires informed consent and competencies from all the individuals exploring the field. Before the onset of the research, I will gain clearance by the ethics committee, clearance procedures, and guidelines. My research will focus on educating the members of the society regarding Telehealth services by informing the benefits of adopting the services. Since my research focuses on rural and remote setups where individuals are economically disadvantaged I will further explore the issue of equitable distribution of care in the implementation of Telehealth services especially in disadvantaged households where they deserve the services most. I will further explore the problem of internet connections and provide options to mitigate the problem as my recommendation.

Information needs, Pragmatics and Philosophical Concerns

The information needs of my project entail words and factual statements regarding Telehealth services while the practical concerns are that it might be difficult to trace individuals with experience on Telehealth services in the rural population. The project will provide a scientific solution to the way we seek medical interventions.

Methodology

I will adopt a qualitative approach method in my study. This is because only a few studies have been done regarding the factors that contribute to sustainability and success of application of information technology in the villages of Australia. This method will enable me to create new ideas and this approach facilitates the gathering of these ideas.

Methods

Systematic Literature Review

I will conduct a systematic literature review according to the established methodology. I will carry out the study in five phases which entail planning, searching for the articles, arranging them according to the level of importance, and synthesizing the collected data. During planning I will develop research questions with appropriate search terms, this will be followed by a limited search in the MEDLINE database with the term ‘telemedicine and rural Australia ‘and analyze for the keywords in the search results. Next I will search for electronic databases with telemedicine and telehealth, rural and remote Australia as keywords. I will consider all searches from the past ten years. Also, I will search for electronic databases such as the MEDLINE, grey literature, Embase, and with keywords as, telehealth, telemedicine, and e-consultation, rural and remote Australia. I will derive data regarding the author and the date of publication, the study setting, type of telehealth utilized by the clinicians, and the target patient population. Study design and the outcome of telehealth services. During the screening and evaluation stage  I will screen the titles and abstract of the articles derived from the search results objectively and finally during the synthesis phase I will categorize data according to clinical specialty, setting, and details of telehealth services delivered. I will group data on the success factors of application of information technology in provision of health care thematically using an inductive approach to identify the elements that are consistent with my research questions.

Strengths

The strength associated with the systematic review method of data collection is it provides high-quality literature. This occurs since it provides in-depth knowledge regarding the topic of study, it also provides empirical evidence. The review will provide for information from different authors at a different time thus valid to make study conclusions valid and consistent. The systematic review process is also essential in guiding the researcher throughout the search process thus ensuring that ensuring transparency for future replication.

Weaknesses

However, the method has its drawbacks which entail; the need to acquire a wide range of databases and systematic peer-reviews yet I possess limited resources to fund the project. The data from institutional websites might also be subjective due to the exclusion of some information for inevitable reasons.

Semi-Structured Interviews

I will also interview the residents by asking well structured questions from several rural towns, one of which telehealth services have been successfully implemented and two others where the implementation process is stale. This will enable me to collect field notes regarding the reasons behind uninterrupted delivery of telehealth services in those areas and identify the barriers to implementation in the other two towns then develop a solution that can be logically applied. I will ask probing questions regarding their awareness experiences and perceptions about access to telehealth services. I will sample individuals from local public areas with the capacity to provide informed consent. I will ensure a balance in the demographic structure by selecting individuals from diverse age groups and gender and provide them with all the information about the study as a basis deciding whether to take part or not. I will conduct my interviews in public resting places where their counterparts are unlikely to hear. This will be important to help the residents reflect on telehealth services that contribute to improved health quality in their lives and why it is important to adopt them.

Strengths

The strengths associated with interviewing individuals will entail individuals expressing their views on perceptions and awareness of telehealth services openly. I will deduce health issues encountered by the diverse demographic structure which will serve as a motivation to steer my project forward.

Weaknesses

One of the weaknesses I am likely to encounter during the interviews is the issue of negativism from the respondents. They may associate the use of telehealth as a system that will undermine their doctor-patient confidentiality or high costs thus give negative comments about the research question. It will also be difficult to identify individuals with a capacity for informed consent and also a lot of time will be required to sit down with the respondents. Also,there are very few individuals in the rural and remote Australia who have experienced telehealth services thus limited knowledge is available for the topic.

Conclusion

Implications

This research will benefit the patients, residents, policymakers, health care providers, and the community of rural Australia. It will serve as a source of information that telehealth services should be a priority for any population and that the government should prioritize on policies regarding the delivery of these services in the villages of Australia. The study will also focus on barriers for adopting information technology by health care providers working in the remote areas of Australia and seek possible solutions. It will equip the users with the required information to shift to Telehealth services. To realize this potential special consideration should be put in place. This entail;

Education and community awareness

Successful application of ICT in health care in rural areas is facilitated by providing education to end-users. Information regarding the technical, situational, and medical solutions of telehealth services will reduce technology negativity among the members of the community and therefore encourage them to appreciate the role of its role in their daily activities. Education to healthcare providers imparts knowledge that is important for patient care and addressing any concerns the patients might have about the service. Education at all levels enhances understanding regarding the use of ICT in provision of quality health care.

Practice

Use of ICT in health care allows the providers to monitor their patient’s progress at home through e-consultation. This serves as a benefit to patients who monitor their diseases at home while getting sufficient information regarding their health status from their nurses. Implementation of telehealth services will enhance the well being and increase positive results of patients in the Australia population.

It will also serve as evidence for successful and sustained Information technology in healthcare services and that the implementation is practical for all settings. It will provide for examples of sustained Telehealth services in broader. My research will give an insight into the growth of positive telehealth work being reported, ways to overcome the barriers, and point out areas that an individual should consider in the implementation of the services. My study will inform about efficiency and adaptability which has not been reported earlier. It will inform about the need to modify the service model by improving its efficiency, the strategy that the government should adopt in funding the telehealth services, and the retention of the Telehealth service providers. The study will also provide for the factors associated with sustainability and successful implementation of Telehealth services in rural and remote Australia

Limitations

The key limitations of my project will be positivity bias among the respondents. Negative information is likely to prevail during the actual trial. There is also a limited number of respondents who have experienced the telehealth services hence insufficient information regarding Telehealth services. The research will limited by time as the research time might coincide with other study activities. There will also be problems finding all the databases for the study and raising accessibility fees will be quite challenging. There is also a possibility for bias as some of the databases I will use for research will contain outdated information.

List of References

Almathami, H.K.Y., Win, K.T., and Vlahu-Gjorgievska, E., 2020: Systematic Literature Review. Journal of medical Internet research, 22(2), p.e16407.

Aziz, H.A., and Abochar, H., 2015. Telemedicine. Clinical Laboratory Science, 28(4), pp.256-259.

Bradford, N., Caffery, L., and Smith, A., 2016: a systematic review of models of care and factors influencing success and sustainability.

Bradford, N.K., Caffery, L.J., and Smith, A.C., 2015. BMC health services research, 15(1), p.427.

Edirippulige, S., and Armfield, N.R., 2017. A review of the literature. Journal of telemedicine and telecare, 23(2), pp.273-282.

Johnson, K.A., Meyer, J., Yazar, S., and Turner, A.W., 2015. Australian Journal of Rural Health, 23(3), pp.142-149.

Moffatt, J.J., and Eley, D.S., 2010. Australian Health Review, 34(3), pp.276-281.

Parliament, Q., 2014. Inquiry into telehealth services in Queensland. Terms of Reference.

Pollard, J.S., Karimi, K.A., and Ficcaglia, M.B., 2017. Behavior Analysis: Research and Practice, 17(4), p.298.

World Health Organization, 2010. Telemedicine: World Health Organization.