Creating and testing a theoretical framework for evaluating telemedicine technology acceptance in a clinical trial involving consultations between neonatologists and pediatric surgeons

Telemedicine is an information system using computers and telecommunications technologies to provide medical information and services to patients separated geographically from a provider. Although past demonstration projects have shown great promise, the true merit of telemedicine has yet to be determined by systematic empirical study. The absence of data concerning the medical effectiveness and usefulness of telemedicine in clinical settings has contributed to the lack of provider acceptance, a problem that must be overcome before the technology can be sustained.; Theoretical models from the information systems field were applied to the problem of lack of physician acceptance. The primary purpose of the dissertation was to develop and test a telemedicine technology acceptance model for use as a theoretical framework for telemedicine evaluations. Eight relationships were hypothesized between six constructs depicted in the model: consultation modality, effectiveness, usefulness, ease of use, flow, and intent to use the technology in the future. These relationships were based on the technology acceptance model (Davis, 1986) and information system models based on the social psychology theory of optimal flow (Csikszentmihalyi, 1975).; The model was tested by means of a controlled, randomized clinical trial that involved attending neonatologists and in-patients in the neonatal intensive care unit of the National Naval Medical Center in Bethesda, Maryland, and pediatric surgeons based at Walter Reed Army Medical Center in the District of Columbia. The units of analyses were neonate patients assessed by clinicians. Neonates (N = 17) were randomly assigned to a treatment (telemedicine consultation) group or to a control (conventional in-person consultation) group. Two research instruments were used, one for the neonatologists and another for the surgeons, which contained slightly modified versions of proven reliable and valid scales drawn from computer user acceptance studies in the information systems field.; Results from independent samples t-tests suggested that perceptions of usefulness, effectiveness and flow were greater for conventional surgical consultations than for telemedicine consultations. Results from correlation analysis showed that usefulness and ease of use have a strong positive correlation with intent to use the technology in the future and with perceptions of flow. Diagnostic confidence levels recorded after conventional consultations were significantly higher than those recorded after telemedicine consultations, as measured by the intraclass correlation coefficient. Due to small sample size and the resulting inability to disaggregate the experimental results from the two different telemedicine modalities and the variable quality of the telemedicine sessions, the policy implications of the findings should be seen as preliminary and subject to further testing. The true utility of this dissertation lies in (a) supplying baseline data as well as a guide for future studies; and, (b) providing a richly detailed basis for evaluation of a technology which is costly and which can directly influence lives.