Telehealth Implementation Response to COVID-19 in the OneFlorida+ Clinical Research Network: Perspectives of Clinicians and Health Systems Leaders
Publication: Telemedicine and e-Health
Volume 30, Issue Number 1
Abstract
Introduction: The COVID-19 pandemic forced health systems worldwide to make rapid adjustments to patient care. Nationwide stay-at-home mandates and public health concerns increased demand for telehealth to maintain patients' continuity of care. These circumstances permitted observation of telehealth implementation in real-world settings at a large scale. This study aimed to understand clinician and health system leader (HSL) experiences in expanding, implementing, and sustaining telehealth during COVID-19 in the OneFlorida+ clinical research network.
Methods: We conducted semistructured videoconference interviews with 5 primary care providers, 7 specialist providers, and 12 HSLs across 7 OneFlorida+ health systems and settings. Interviews were audiorecorded, transcribed, and summarized using deductive team-based template coding. We then used matrix analysis to organize the qualitative data and identify inductive themes.
Results: Rapid telehealth implementation occurred even among sites with low readiness, facilitated by responsive planning, shifts in resource allocation, and training. Common hurdles in routine telehealth use, including technical and reimbursement issues, were also barriers to telehealth implementation. Acceptability of telehealth was influenced by benefits such as the providers' ability to view a patient's home environment and the availability of tools to enhance patient education. Lower acceptability stemmed from the inability to conduct physical examinations during the shutdown.
Conclusions: This study identified a broad range of barriers, facilitators, and strategies for implementing telehealth within large clinical research networks. The findings can contribute to optimizing the effectiveness of telehealth implementation in similar settings, and point toward promising directions for telehealth provider training to improve acceptability and promote sustainability.
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REFERENCES
1. World Health Organization, International Telecommunication Union. WHO-ITU Global Standard for Accessibility of Telehealth Services. Geneva: World Health Organization; 2022. Available from: https://apps.who.int/iris/handle/10665/356160 [Last accessed: December 22, 2022].
2. Hincapié MA, Gallego JC, Gempeler A, et al. Implementation and usefulness of telemedicine during the COVID-19 pandemic: A scoping review. J Prim Care Community Health 2020;11:2150132720980612;
3. Khoshrounejad F, Hamednia M, Mehrjerd A, et al. Telehealth-based services during the COVID-19 pandemic: A systematic review of features and challenges. Front Public Health 2021;9:711762;
4. Lieneck C, Garvey J, Collins C, et al. Rapid telehealth implementation during the COVID-19 global pandemic: A rapid review. Healthcare (Basel) 2020;8:517;
5. Lieneck C, Weaver E, Maryon T. Outpatient telehealth implementation in the united states during the COVID-19 global pandemic: A systematic review. Medicina (Kaunas) 2021;57:462;
6. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health 2020;20:1193;
7. Barney A, Buckelew S, Mesheriakova V, et al. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: Challenges and opportunities for innovation. J Adolesc Health 2020;67:164–171;
8. Patel SY, Mehrotra A, Huskamp HA, et al. Variation in telemedicine use and outpatient care during the COVID-19 Pandemic in the United States. Health Aff 2021;40(2):349–358;
9. Casillas A, Valdovinos C, Wang E, et al. Perspectives from leadership and frontline staff on telehealth transitions in the Los Angeles safety net during the COVID-19 pandemic and beyond. Front Digit Health 2022;4:944860;
10. Srinivasan M, Asch S, Vilendrer S, et al. Qualitative assessment of rapid system transformation to primary care video visits at an academic medical center. Ann Intern Med 2020;173(7):527–535;
11. Forrest CB, McTigue KM, Hernandez AF, et al. PCORnet® 2020: current state, accomplishments, and future directions. J Clin Epidemiol 2021;129:60–67;
12. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci 2009;4:50;
13. Gale NK, Heath G, Cameron E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013;13:117;
14. MacQueen KM, McLellan E, Kay K, et al. Codebook development for team-based qualitative analysis. Cult Anthropol Methods 1998;10:31–36.
15. Nevedal AL, Reardon CM, Opra Widerquist MA, et al. Rapid versus traditional qualitative analysis using the consolidated framework for implementation research (CFIR). Implement Sci 2021;16:67;
16. Averill JB. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res 2002;12:855–866;
17. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care 2022;49:517–530;
18. Chang JE, Lindenfeld Z, Albert SL, et al. Telephone vs. video visits during COVID-19: Safety-net provider perspectives. J Am Board Fam Med 2021;34:1103–1114;
19. Gomez T, Anaya YB, Shih KJ, et al. A qualitative study of primary care physicians' experiences with telemedicine during COVID-19. J Am Board Fam Med 2021;34:S61–S70;
20. Hirko KA, Kerver JM, Ford S, et al. Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities. J Am Med Inform Assoc 2020;27:1816–1818;
21. Cataldi M, Lonardo SM, Cacciapuoti N, et al. Facilitators and barriers for the implementation of a telemedicine program in nutrition during the COVID-19 pandemic. Nutr Metab Cardiovasc Dis 2021;31:2987–2988;
22. U.S. Department of Health and Human Services. Telehealth Policy Updates. Washington, DC: Health Resources and Services Administration; 2023. Available from: https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-policy-updates [Last accessed: May 1, 2023].
23. Bouabida K, Lebouché B, Pomey M-P. Telehealth and COVID-19 pandemic: An overview of the telehealth use, advantages, challenges, and opportunities during COVID-19 Pandemic. Healthcare (Basel) 2022;10:2293;
24. Snoswell CL, Chelberg G, DeGuzman KR, et al. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2021 [Epub ahead of Print];
25. Quinton JK, Ong MK, Sarkisian C, et al. The impact of telemedicine on quality of care for patients with diabetes after March 2020. J Gen Intern Med 2022;37:1198–1203;
26. DePuccio MJ, Gaughan AA, Shiu-Yee K, et al. Doctoring from home: Physicians' perspectives on the advantages of remote care delivery during the COVID-19 pandemic. PLoS One 2022;17(6):e0269264;
27. Chowdhury D, Hope KD, Arthur LC, et al. Telehealth for pediatric cardiology practitioners in the time of COVID-19. Pediatr Cardiol 2020;41:1081–1091;
28. Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020;26(5):309–313;
29. Eisman AB, Kim B, Salloum RG, et al. Advancing rapid adaptation for urgent public health crises: Using implementation science to facilitate effective and efficient responses. Front Public Health 2022;10:959567;
30. Buckley PR, Edwards D, Ladika A, et al. Implementing evidence-based preventive interventions during a pandemic. Glob Implement Res Appl 2022;2(4):266–277;
31. Der-Martirosian C, Wyte-Lake T, Balut M, et al. Implementation of telehealth services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study. JMIR Form Res 2021;5(9):e29429;
32. Kho J, Gillespie N, Martin-Khan M. A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Serv Res 2020;20:815;
33. Basu A, Kuziemsky C, de Araújo Novaes M, et al. Telehealth and the COVID-19 pandemic: International perspectives and a health systems framework for telehealth implementation to support critical response. Yearb Med Inform 2021;30:126–133;
Information & Authors
Information
Published In
Telemedicine and e-Health
Volume 30 • Issue Number 1 • January 2024
Pages: 268 - 277
PubMed: 37358611
Copyright
Copyright 2024, Mary Ann Liebert, Inc., publishers.
History
Published online: 5 January 2024
Published in print: January 2024
Published ahead of print: 26 June 2023
Accepted: 2 May 2023
Revision received: 1 May 2023
Received: 27 January 2023
Topics
Authors
Authors' Contributions
R.T.: Conceptualization, Methodology, Writing—Original Draft, Review & Editing, Formal analysis, Resources, Data Curation, and Supervision. J.D.: Investigation, Writing—Original Draft, Review & Editing, Formal analysis, Resources, Data Curation, and Project Administration. M.M.: Investigation, Writing—Original Draft, Review & Editing, Formal analysis, and Data Curation. R.G.: Investigation, Writing—Original Draft, Review & Editing, Formal analysis, and Data Curation. S.W.: Review & Editing, and Formal analysis. T.D.: Conceptualization, Methodology, and Review & Editing. F.M.: Conceptualization, Methodology, Review & Editing, Supervision, and Funding Acquisition. O.C.: Conceptualization, Methodology, Review & Editing, Supervision, and Funding Acquisition. E.S.: Conceptualization, Methodology, Review & Editing, Supervision, and Funding Acquisition.
Disclosure Statement
All authors have reviewed the article and approve its submission, and none has potential conflicts of interest. The study was approved by the University of Florida Institutional Review Board (IRB-01).
Funding Information
Research reported in this publication was supported by the OneFlorida+ Clinical Data Network and funded by the Agency for Healthcare Research and Quality (No. R01HS028283). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality, its Board of Governors or Methodology, the OneFlorida+ Clinical Research Consortium, or the University of Florida's Clinical and Translational Science Institute.
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