Management of telemedicine technology in healthcare organizations: Technology acceptance, adoption, evaluation, and their implications

摘要

As an exciting information technology-based innovation, telemedicine has potential to enhance physicians' patient care and management, improve healthcare organizations' operations and performance, and cause a paradigmatic shift in health care toward a progressively emerging digital practice. Previous research has concentrated on technology developments and clinical applications and therefore offers limited discussion of technology management. Managing telemedicine technology in healthcare organizations is so complex and dynamic that it has been an important factor in the failure of many early telemedicine attempts. This dissertation research directly addressed organizational management of telemedicine technology. To deal with complexity and dynamism, the research took a multi-phase approach, using a research framework built upon a well-established theoretical foundation. Case study was used in the exploratory phase to provide detailed understanding of the underlying technology implementation process and to generate specific research questions or models for the subsequent descriptive/explanatory phase. Systematic linkage of these investigations was safeguarded by desired methodological triangulation. Findings from the case study and substantiating interviews identified technology acceptance, adoption and evaluation as problematic areas in organizational technology management. Findings of a survey study administered to most physicians practicing in public tertiary hospitals in Hong Kong suggested that perceived usefulness and ease of use, self-efficacy, and subjective norms were important to their accepting telemedicine technology. Similarly, a survey conducted with hospital executive officers, chiefs of service and center directors of all Hong Kong public healthcare establishments indicated that service needs, attitudes of medical staff, and the technology's benefits, risks and compatibility were essential to organizational technology adoption. In addition, results of an evaluative experimental study showed that the clinical decision- making of physicians can be improved through use of appropriate telemedicine technology. The combined findings suggested that these separate technology management issues were closely interrelated rather than isolated. Effects of a technology on physicians' patient care and management practice have important impacts on their technology acceptance, which, in turn, needs to be considered by their affiliating organization when making an adoption decision.