|Year : 2015 | Volume
| Issue : 4 | Page : 189-194
Telemedicine operational feasibility in selected hospitals of Isfahan University of Medical Sciences in 1393
Sakine Saghaeiannejad-Isfahany1, Maryam Jahanbakhsh2, Azadeh Shayan3
1 Health Information Technology Research Center, Social Determinant of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Statistical and Informatics Management, Student of Health Information Technology, Medical Informatics and Management Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||11-Aug-2015|
Student of Health Information Technology, Medical Informatics and Management Faculty, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Context: According to W.H.O., the vision of "Health for everyone in 21 st Century," a big challenge which all human communities face is access to healthcare facilities with a high-quality for everyone. Aims: This article aimed to investigate telemedicine operational feasibility in the selected hospitals of Isfahan University of Medical Sciences in 1393. Settings and Design: This research was performed in the selected hospitals and health centers of Isfahan University of Medical Sciences. Subjects and Methods: This applied research was a cross-sectional descriptive study, which was performed to determine telemedicine operational feasibility of the selected hospitals and health centers of Isfahan University of Medical Sciences, which had better conditions in terms of bandwidth and the speed of information exchange (50 Mb/s) with the university. Statistical Analysis Used: Data were collected by using a researcher made questionnaire and analyzed using descriptive statistics such as mean, standard deviation (SD), and frequency distribution tables in SPSS software. Results: The score of telemedicine operational feasibility was 68.5% from doctors' perspective and 65.4% according to managers' perspective with SD of 14.4. Doctors were considered as five significant medical references including cardiology, obstetrics and gynecology, burn, orthopedics, and pulmonologist. In using telemedicine, doctors showed the highest interest in consultation with 63% and the lowest interest in providing care with 10.1%. Most experts considered initial costs, legal issues related to doctors, while most managers referred to initial costs, medical staff resistance, and issues related to confidentiality, and licensing problems as the basic barriers to telemedicine implementation. Conclusion: Telemedicine operational feasibility in the selected hospitals of Isfahan University of Medical Sciences was positive and managers; and most doctors believed that the proposed system was able to address many work challenges. Investigating technological infrastructure problems, internet speed, and in general telemedicine Technical feasibility will lead to propose a system, which is consistent with existing facilities. Investment, in order to strengthen cultural infrastructure, will be effective in the success of system implementation.
Keywords: Feasibility study, operational feasibility, telemedicine
|How to cite this article:|
Saghaeiannejad-Isfahany S, Jahanbakhsh M, Shayan A. Telemedicine operational feasibility in selected hospitals of Isfahan University of Medical Sciences in 1393. Int J Health Syst Disaster Manage 2015;3:189-94
|How to cite this URL:|
Saghaeiannejad-Isfahany S, Jahanbakhsh M, Shayan A. Telemedicine operational feasibility in selected hospitals of Isfahan University of Medical Sciences in 1393. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2018 Apr 20];3:189-94. Available from: http://www.ijhsdm.org/text.asp?2015/3/4/189/162549
| Introduction|| |
Developing countries face many challenges in providing medical and healthcare services including financial needs, resources, and a shortage of doctors and other experts.  Moreover, paper exchange of health information and lack of electronic records in traditional systems has led to the loss of valuable data and lack of quick access to them.  The rapid development of technology has encouraged hospitals to acquire necessary infrastructure and skills to deliver high-quality medical services.  Fortunately, in modern world's new interactions human have been able to overcome many time and space limitations in different aspects of daily life including health sector where telemedicine has been a significant achievement.  Telemedicine does not have a single definition due to its widespread use and methods; however, it can be mentioned as providing medical services in the least time so that time and space interval between experts and patients will be covered by information and communication technology.  Telemedicine is an important factor in countries such as Iran, which suffer a poor transportation network, scattered population, lack of access to expert medical centers, and a high aging population who need special medical care. It plays a significant role in the quick diagnosis of diseases, adoption of correct treatment tactics, time-saving, reduction of related costs (direct and direct), and the relationship among expert hospitals in big cities.  Undoubtedly, technical expertise of other countries along with technical and operational feasibility of different areas will lead to the selection of a suitable solution for each area.  An important point, which should be taken into account before implementation of every telemedicine system is performing an exact feasibility study.  A feasibility study is an evaluation tool for determining feasibility/profitability of a specific proposal. This tool systematically determines if suggested proposal should be implemented or not. Evaluation takes place based on organization's past and current information. As an evaluation tool, feasibility study is used in different areas such as starting of a new job, acceptance of a new method, changing organizational structures, acceptance of a new technology, and selection of various alternatives. Different kinds of feasibility studies include operational feasibility, technical feasibility, scheduling feasibility, economic feasibility, legal feasibility, and political feasibility. Feasibility helps to determine the use of valuable resources in a project, decrease potential risks of project failure, and find critical issues in a project.  Operational feasibility helps us to understand if the proposed system will be able to address work problems and create organizational profitability.  Moreover, it is used to determine the suitability of the proposed solution, solve problems, and determine people's attitudes toward the proposed system. The operational feasibility study will answer the following questions: Is there a solution for the problem? Is the solution suitable according to managers and users' attitudes or based on organizational perspective? Is the solution consistent with rules and regulations?  Telemedicine project is mainly associated with human communication development and organizational infrastructures; it is aimed to find out if organizational strategic goals and plans are considered in telemedicine and whether there are suitable strategies to support the project or not.  According to CHAOS report by Standish group, 15% of information technology projects were stopped in 2004 before they were completed. About 20% of projects incurred costs up to 43% higher than organizational estimations and only 43% of software projects were completed on time and based on determined budget. Therefore, before investment on a proposed project, it should be determined if the project is operationally and technically feasible and can deal with potential risks. Based on CHAOS, the overall cost of information technology projects has been 255 billion dollars in 2004.  Judi et al. studied feasibility of Malaysians hospitals regarding four main operational, technical, schedule, and economic factors and showed that technical and operational measures are more important that schedule and economic factors and only a few hospitals are able to implement telemedicine.  Given the importance, benefits, and problems of using telemedicine and also the failure of some information technology projects due to implementation without operational and technical feasibility studies, the present article aims to investigate telemedicine operational feasibility in the selected hospitals of Isfahan University of Medical Sciences and suggest strategies for correct, efficient, and effective implementation of this technology.
| Subjects and Methods|| |
This applied research was a cross-sectional descriptive study, which was performed to determine telemedicine operational feasibility of the selected hospitals of Isfahan University of Medical Sciences. These hospitals had better conditions in terms of bandwidth and the speed of information exchange (50 Mb/s or higher) with the university and included Al-Zahra training center (2 Gb/s), Farabi Hospital (50 Mb/s), Modarres Hospital (50 Mb/s), Sae and Ashrafi Hospitals (50 Mb/s), Imam Khomeini Hospital (50 Mb/s), and Montazeri Hospital (50 Mb/s). Other hospitals and clinics had 2 Mb/s point to point lines, which were not suitable for image transmission. The study population consisted of managers, general practitioners, and experts employed in selected hospitals of the Isfahan University of Medical Silences. The population included 119 general practitioners and experts, and 6 managers. Sampling was done based on census method, and data were collected using researcher made questionnaire. The questionnaire included four sections; section 1 investigated telemedicine operational feasibility from doctors and managers' perspective, section 2 determined priority of medical references from doctors' perspective, section 3 determined doctors' priority regarding interest in telemedicine services, and section 4 considered barriers to implementation of telemedicine project from doctors and managers' perspective. Data were analyzed using descriptive statistics such as mean, standard deviation, and frequency distribution tables in PASW statistics 18 (SPSS 18 software).
| Results|| |
From 125 physician and managers who completed the questionnaire, 39 participants (31.2%) were female and 86 participants (68.8%) were male. From 119 physician who completed the questionnaire, 38 (31.9%) were general practitioners, and 81 (68.1%) were specialists. Of this number, 27 (22.7%) were working in Al-Zahra center, 9 (7.6%) in Farabi, 11 (9.2%) in Modarres, 25 (30%) in Sae and Ashrafi, 20 (16.8%) in Imam Khomeini, and 27 (22.7%) in Montazeri hospital. Telemedicine operational feasibility based on managers and physician perspective was scored from 0 to 100 [Table 1].
|Table 1: The average score of telemedicine operational feasibility from managers and physician perspective|
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Based on the results, most physician (84%) and all managers believed that telemedicine could reduce the required time to address patients' medical needs, which was the most important role of telemedicine from participants' perspective. After that, 80.7% of physician and all managers mentioned telemedicine as an important factor in saving human resources and time in an organization. Moreover, they believed that telemedicine could reduce healthcare costs (77.3% of physician and all managers). Other applications of telemedicine according to physician and managers' priority included: Higher access to healthcare services (73.9% of physician and 83.3% of managers), more patient satisfaction (61.3% of physician and all managers), and advancements in medical sciences (60.5%). The least important role of telemedicine was its effects on quality of healthcare services (47.9% of physician and 66.7% of managers). About 50% of managers believed that there was no background regarding the use of telemedicine in projects or pilot plans. Managers believed that technical support should be provided by legal rather than actual individuals. Moreover, 83.3% of managers agreed with long-term support, and 16.7% agreed short-term support from telemedicine software. Regarding the manner of support, all managers agreed on centralized method. The results also showed that five required medical references were cardiology, obstetrics and gynecology, burn, orthopedics, and pulmonologist based on physician perspective. According to findings, the last reference priority was dermatology. In addition, findings showed that physician were more interested in consultation (63%) and less interested in providing care by telemedicine (10.1%) [Table 2].
|Table 2: The frequency distribution of interest in type of telemedicine services from physician perspective|
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According to results, most managers and physician considered initial costs, the basic barrier to telemedicine implementation [Table 3]. Moreover, lack of knowledge by physician and patients on telemedicine, public culture, patients' expectations, and infrastructure; and internet problems were other factors mentioned as barriers to implementation of this technology.
|Table 3: The frequency distribution of priorities of barriers to implementation of telemedicine from managers and physician perspective|
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| Discussion|| |
According to findings, implementation of telemedicine has not been present in strategic plans of the studied hospitals and training centers; however, all managers will support the project if they are convinced about telemedicine technology, and there is telemedicine operational feasibility in the selected hospitals. In according to a study done by Alipour et al., Hormozgan University of Medical Sciences has a strategic plan including telemedicine, and the board of directors supports its implementation and application. Based on their results, there is also a physician in the university to support the project, but telemedicine services have not been provided by this university yet.  The presence of telemedicine strategic plan is a positive point in Hormozgan University that the present study was different with Alipour's study in this regard. When telemedicine is considered in the strategic plan of hospitals and centers and managers become familiar with the technology through training courses, their complete support will be expected.
According to results, most general practitioners and experts supported the implementation of this technology in healthcare organizations. According to the results of Valley, in 91% of clinics most physician agreed with application of telemedicine, so that over 89% of clinics were interested in holding training courses for their staff in order to implement telemedicine successfully.  In the present study, although almost all physician agreed on the application of telemedicine, their lack of knowledge on this technology, fear of legal problems, and challenges regarding infrastructures led to concerns in this regard. A comparison between Valley's findings and the present research shows that in-service training courses can familiarize physician and hospital staff with telemedicine technology and will lead to its successful implementation.
In this study, most physician and managers believed that telemedicine could reduce the time required to respond to patients' needs, and the majority of respondents agreed on this issue. Therefore, it can be claimed that the most important role of telemedicine from managers' and physician perspective in Isfahan University of Medical Sciences was reducing the time needed to respond to patients' demands. Saving organizational time and human resources, reduction in healthcare costs, more access to healthcare services, higher patient satisfaction, and finally advancement of medical science were next priorities. Five main challenges in healthcare sector include high healthcare costs, quality of care services, increased demand for care, lack of service providers, and decreased patient satisfaction all of which could be somehow overcome by telemedicine. Studies show that healthcare cost has increased so that in the United States it has increased from 2.3 trillion dollars in 2008 to 2.5 trillion in 2009. Studies done in California show that telemedicine will save about 511 million dollars a year.  Patients' quick access to medical services, particularly in remote areas will increase their satisfaction; however, lack of patients' trust in technology, its confidentiality and privacy will lead to patients' dissatisfaction. Holding training courses will increase patients' satisfaction. Mekhjian et al. in a study entitled "patients' satisfaction with telemedicine in prison" designed a questionnaire to evaluate prisoners' satisfaction from telemedicine. A total of 221 questionnaires were collected from 299 prisoners who had received a remote consultation. The results showed that most prisoners were satisfied with this consulting method, and only 9% of them did not have favorable attitudes toward telemedicine.  In a research, which was done in Berlin in 2010, the results of studies on 92 patients with heart failure being controlled at home through telemedicine were compared with the results of a study, which had been done 12 months earlier without telemedicine application. According to findings, the quality of care had increased up to 62%, and hospitalization had decreased by 68%. Moreover, 22% decrease was observed in patients' dissatisfaction.  In most cases, the results of investigations were consistent with the present study. In the present study, the least important role of telemedicine services was associated with an increased quality of care from doctors' perspective. The most physician believed firmly in physical examination and treatment. It seems that technological infrastructure problems, internet speed, and semi IT projects in hospitals and university affiliated units due to management change have caused a kind of distrust to this technology. Naturally, in a country like Iran, telemedicine is lesser evident in increasing the quality of care compared to developed countries.
As it was mentioned in findings, doctors considered five necessary expert references including cardiology, obstetrics and gynecology, burn, physician, and pulmonologist while the last priority belonged to dermatology. Scalvini et al. designed a project entitled SUMMA in order to evaluate telemedicine services applications feasibility among Italian general practitioners and experts. According to the results, of 1396 consultations, 1264 cases are for cardiology, 65 cases for dermatology, 32 cases for diabetes, 22 cases for rheumatology, and 13 cases for lung patients which are all done by telemedicine.  Alipour et al. mention radiology, pathology, emergency medicine, infectious diseases, and obstetrics and gynecology as the main shortages of medical services in Hormozgan University of Medical Sciences.  Valley performed a research entitled "Evaluation of Telemedicine Preparedness in San Joaquin Valley" in 2009 and showed that 10 the most common emergency references include cardiology (73%), dermatology (71%), psychiatry (46%), digestion (32%), orthopedics (31%), neurology (25%), psychology (21%), radiology (19%), and diet therapy (13%).  Comparing the results of this research and similar studies, it can be concluded that required expert references regarding telemedicine have been almost similar in all situations, and the only difference has been in the priority of references.
According to the results, the physician mentioned consultation, training, patients' referral, purchase of equipment, and providing of care services as telemedicine priorities. According to Alipour et al., of 141 specialists, 85.8% considered consultation and 71.6% referred to training through telemedicine as the most important applications of the technology,  which was consistent with similar studies. Rahimzade et al. also showed that of 108 scholars, 56.2% considered training and 18.6% considered consultation as the best applications of telemedicine.  However, in Vitacca's study, telemedicine was mainly used for tele-nursing, electronic transmission of information to experts and hospitals, and remote consultation among providers and experts.  According to the results of this study and similar studies, it can be concluded that applications of telemedicine are somehow similar but information technology infrastructures and the nature of health sector in each country will affect capabilities of telemedicine.
In the present research, the main barriers to implementation of telemedicine are initial costs and legal issues associated with doctors from doctors' perspective while from managers' perspective the main barriers are initial costs and medical staff resistance. Other barriers from managers and physician perspective include insurance problems and refunding, lack of technical personnel, licensing problems, issues related to confidentiality, lack of familiarity of medical staff, and patients with telemedicine, lack of patients' trust in medical staff, and infrastructure as well as internet problems. Different studies have mentioned various barriers in implementation and application of telemedicine. Moffatt and Eley investigated barriers to implementation of telemedicine in Australia and considered financial problems as the main factor, which was completely consistent with the present study in this regard. Time limitation, especially given workload of rural doctors in rural areas, lack of access to internet and facilities such as software, and finally lack of users skills and lack of interest in learning computers skills were next mentioned factors.  The results of Dargahi and Razavi research showed that from managers' perspective the most important barrier to telemedicine implementation after initial costs is medical staff resistance, which is completely consistent with the present study.  According to Rahimzade et al., 63% of experts referred to the lack of technical personnel and 16.98% of them initial costs as the biggest challenges for implementation of telemedicine in hospitals.  Moreover, in Alipour's study 68.8% of experts referred to the lack of technical personnel and 66.7% of them initial costs as the main barriers to the application of this technology.  Comparing the results of this research and similar studies will confirm that almost all barriers mentioned in this research have been considered in other studies as well; however, priorities are somehow different which can be due to differences in attitudes, mechanisms of health care services, and infrastructures of each country. It can be concluded that an important influencing factor in telemedicine is macro-policies in this sector which is related to issues such as financing, civil rights legislation, determining physician and managers' scope of responsibility, determining security and privacy policies, telecommunication policies, setting standards and credentials, as well as licensing to experts. Regarding medical staff resistance, it should be said that resistance to change is in different forms such as verbal opposition or lack of co-operation, which can be due to some factors such as fear from unknown, distrust, fear of failure, loss of credibility or job security, and pressure by colleagues. These problems can be overcome by teaching ICT skills and creating backgrounds for acceptance of the new technology.
| Conclusion|| |
Telemedicine, operational feasibility in the selected hospitals of Isfahan University of Medical Sciences, was positive and managers; and most doctors believed that the proposed system was able to address many work challenges. Investigating technological infrastructure problems, internet speed, and in general telemedicine technical feasibility will lead to propose a system, which is consistent with existing facilities. Investment, in order to strengthen cultural infrastructure will be effective in the success of system implementation.
Financial support and sponsorship
Isfahan University of Medical Sciences, Number code: 393329.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]