title: Addressing telehealth's foremost barrier: provider as initial gatekeeper.
abstract: OBJECTIVE
  During the past decade, telehealth has enjoyed a plethora of public funding and publication outlets around the world. Yet, rhetoric appears to be outpacing the actual diffusion and utilization of telehealth technologies for patient care. Several barriers, such as reimbursement and legal/regulatory issues, are commonly cited as impeding the successful deployment of this innovation. However, two separate studies carried out in Michigan that controlled for these barriers point out a more significant initial gatekeeper to the deployment of telehealth, namely providers.
  
  
  METHODS
  Multiple data collection strategies were used in both the telehospice and telepsychiatry projects, including utilization logs, surveys, telehospice nursing notes, cost frame data collection, patient interviews, caregiver interviews and focus groups, and videotaped visits.
  
  
  RESULTS
  This study summarizes data from the two studies to support the hypothesis that the provider is the most important initial gatekeeper for telemedicine.
  
  
  CONCLUSIONS
  The implications from this conclusion have important consequences for health system deployment strategies. Specifically, telemedicine project managers must keep providers' needs (ease of use and incentives) in mind when designing a telemedicine system.
authors.affiliation: Center for Healthcare Engineering, Purdue University, 100 N. University Street, Beering Hall Rm. 214, West Lafayette, IN 47907-2098, USA. pwhitten@purdue.edu
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Whitten
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mackert
mesh_terms: D003625:Data Collection; D003695:Delivery of Health Care; D020793:Gatekeeping; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008824:Michigan; D011369:Professional-Patient Relations; D011570:Psychiatry; D017216:Telemedicine / Q000706:statistics & numerical data*; D014743:Videotape Recording