Adoption of Telemedicine to Support Postoperative Visits: Mixed Methods Study of Technological Readiness and Attitudes Among Surgeons (Preprint) Institutional Repository Document

Despite the promise shown by telemedicine technologies, the adoption among clinicians before the COVID-19 pandemic was relatively slow, particularly with untapped potential in postoperative applications. Consistent with this trend, we also noticed underutilization of telemedicine in our organizations surgery department for postoperative follow-up visits.

To explore the barriers of telemedicine adoption for use in postoperative follow-up visits in an environment where such technology has been available.

Surgeons were recruited from a large tertiary care hospital in the Southwestern United States. We assessed readiness and attitudes towards new technology quantitatively (Technology Readiness Index, Technology Acceptance Model, and modified Van der Laans Technology Acceptance Questionnaire); conducted a usability study with mock patient encounters (System Usability Scale); and engaged the participants in semi-structured interviews (employing qualitative thematic analysis). Construct validity of quantitative measures and rater convergence on qualitative analysis were satisfactory.

Nine non-adopting surgeons (4 general, 3 surgical oncology, 1 wound specialist, and 1 thoracic) were recruited. Our quantitative analysis suggested a strong positive influence of surgeons perceived ease of use and optimism traits on the perceived usefulness of the technology, which suggests that surgeons perception of practical worth and applicability influence their perception of telemedicines usefulness. Contrary to our expectations, a significant negative relationship between visual appeal and perceived ease of use resulted from the analysis. It could be inferred that health care professionals may give more value to the efficiency and overall usability of the technology compared to its visual aesthetics. Qualitative analysis of short interviews revealed surgeons generally perceive the telemedicine platform to be beneficial for postoperative visits, with an emphasis on patient-centered benefits such as time- and cost-related savings. However, several important barriers to adoption exist including the lack of time for proper training, lack of patients interest, concerns regarding potential disruption to clinical workflow, concerns regarding the impact in the patient-physician relationship, and the requirement for additional features in the existing platform. Additionally, concerns were raised regarding the appropriateness for telemedicine to be used for certain medical conditions (i.e., oncology-related care).

While attitudes towards technology adoption were positive, many clinicians expressed desire to continue the traditional modality of in-clinic visits and indicated that their patients shared the same desire. In addition, concerns were raised regarding the nature of medical cases for which telemedicine would be utilized. Our findings suggested that improved awareness of telemedicine systems and their capabilities in large healthcare system in addition to increased optimism may play a major role in their eventual adoption.