Identifying barriers in telemedicine-supported integrated care research: scoping reviews and qualitative content analysis
- 199 Downloads
Integrated care is said to improve the way in which care is delivered. To support integrated care by ensuring close collaboration between involved stakeholders, information and communication technologies, especially telemedicine, are needed. Despite their potential, most telemedicine solutions never make it from pilot project stage to full implementation into usual care. Especially in integrated care scenarios, understanding of the barriers hampering successful telemedicine implementation and application is limited.
Objective and method
Four rapid scoping reviews were carried out to cover the following broad sets of barriers in telemedicine implementation: technical, behavioural, economical and organisational barriers. The identified barriers and obstacles were categorised into problem areas with sub-categories and, afterwards, combined in order to identify future research potentials for telemedicine implementation.
A total of 118 studies were included for further analysis. The findings suggest that the individuals’ characteristics, as well as the surrounding social and health care system, are the most important barriers for telemedicine-supported integrated care. The information system development and application, as well as missing data and evidence for the effectiveness of telemedicine and integrated care, are hampering successful implementation.
The consolidated problem areas deepen the understanding on how barriers for telemedicine solutions in integrated care settings are interrelated. Conclusively, this helps to successfully develop and implement telemedicine-supported integrated care.
KeywordsIntegrated care Telemedicine Barriers for implementation Digitisation Scoping review
This research was supported by the European Social Funds (ESF) and the Free State of Saxony (Junior Research Group, project number: 100310385).
Compliance with ethical standards
Conflict of interest
All authors declare no conflict of interest.
- Alam S, Elwyn G, Percac-Lima S, Grande S, Durand MA (2016) Assessing the acceptability and feasibility of encounter decision aids for early stage breast cancer targeted at underserved patients. BMC Med Inform Decis Mak 16:147. https://doi.org/10.1186/s12911-016-0384-2 CrossRefPubMedPubMedCentralGoogle Scholar
- Allen D, Rixson L (2008) How has the impact of ‘care pathway technologies’ on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? Int J Evid Based Healthc 6:78–110. https://doi.org/10.1111/j.1744-1609.2007.00098.x CrossRefPubMedGoogle Scholar
- Alvarado MM, Kum H-C, Gonzalez Coronado K, Foster MJ, Ortega P, Lawley MA (2017) Barriers to remote health interventions for type 2 diabetes: a systematic review and proposed classification scheme. J Med Internet Res 19:e28. https://doi.org/10.2196/jmir.6382 CrossRefPubMedPubMedCentralGoogle Scholar
- Cooper SB (2015) Opinion leaders’ perspective of the benefits and barriers in telemedicine. Q Rev Dist Educ 16:25–53Google Scholar
- European Commission (2017) EHEALTH. In: Public health. https://ec.europa.eu/health/home_en. Accessed 27 Oct 2017
- Ferrua M, Couralet M, Nitenberg G, Morin S, Serin D, Minvielle E (2012) Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery. BMC Health Serv Res 12:167–175CrossRefPubMedPubMedCentralGoogle Scholar
- Hastall MR, Dockweiler C, Mühlhaus J (2017) Achieving end user acceptance: Building blocks for an evidence-based user-centered framework for health technology development and assessment. In: Proceedings of the International Conference on Universal Access in Human–Computer Interaction (UAHCI 2017). Human and Technological Environments, Vancouver, BC, Canada, July 2017. Springer, Cham, pp 13–25Google Scholar
- Lovelock K, Martin G, Gauld R, MacRae J (2017) Better, Sooner, More Convenient? The reality of pursuing greater integration between primary and secondary healthcare providers in New Zealand. SAGE Open Med 5:2050312117701052. https://doi.org/10.1177/2050312117701052 CrossRefPubMedPubMedCentralGoogle Scholar
- Mayring P (2000) Qualitative content analysis. Forum Qual Soc Res 1:1–10Google Scholar
- Meyer-Delpho C, Strotbaum V, Roth C, Schubert HJ (2015) Nutzenbewertung der Informations- und Kommunikationstechnologie aus Sicht von Akteuren der spezialisierten ambulanten Palliativversorgung (SAPV)/Benefit analysis of digital technologies from the perspective of actors in the outpatient palliative care (SAPV). Gesundh ökon Qual manag 20:262–269. https://doi.org/10.1055/s-0034-1398893 CrossRefGoogle Scholar
- Miller P (2017) Telehealth and mobile health applied to integrated behavioral care: opportunities for progress in New HampshireGoogle Scholar
- O’Connor S, Hanlon P, O’Donnell CA, Garcia S, Glanville J, Mair FS (2016) Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Med Inform Decis Mak 16:120. https://doi.org/10.1186/s12911-016-0359-3 CrossRefPubMedPubMedCentralGoogle Scholar
- Otto L, Harst L, Schlieter H, Wollschlaeger B, Richter P, Timpel P (2018) Towards a unified understanding of eHealth and related terms—proposal of a consolidated terminological basis. In: Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2018), Madeira, Portugal, January 2018, vol 5, pp 533–539Google Scholar
- Rogers EM (2003) Diffusion of innovations, 5th edn. Free Press, New YorkGoogle Scholar
- Saket B, Endert A, Stasko J (2016) Beyond usability and performance: a review of user experience-focused evaluations in visualization. In: Proceedings of the Sixth Workshop on Beyond Time and Errors on Novel Evaluation Methods for Visualization, Baltimore, MD, October 2016. ACM, New York, pp 133–142Google Scholar
- Schrappe M (2015) Qualität 2030. Die umfassende Strategie für das Gesundheitswesen. Medizinisch Wissenschaftliche VerlagsgesellschaftGoogle Scholar
- Shaw S, Rosen R, Rumbold B (2011) What is integrated care? Nuffield TrustGoogle Scholar
- Stroetmann KA, Kubitschke L, Robinson S, Stroetmann V, Cullen K, McDaid D (2010) How can telehealth help in the provision of integrated care? World Health OrganizationGoogle Scholar
- Tanriverdi H, Iacono CS (1998) Knowledge barriers to diffusion of telemedicine. In: Proceedings of the International Conference on Information Systems (ICIS 1998), Helsinki, Finland, December 1998. Association for Information Systems, Atlanta, pp 39–50Google Scholar
- Totten AM, Womack DM, Eden KB et al (2016) Telehealth: mapping the evidence for patient outcomes from systematic reviews. Agency for Healthcare Research and Quality (US), Rockville, MDGoogle Scholar
- Webster J, Watson RT (2002) Analyzing the past to prepare for the future: writing a literature review. MIS Q 26:xiii–xxiiiGoogle Scholar