title: Barriers to telemedicine: survey of current users in acute care units.
abstract: BACKGROUND
  The present study of current telemedicine users is a unique attempt to understand the barriers and motivational factors related to the utilization of telemedicine.
  
  
  OBJECTIVE
  A survey of emergency and critical care remote presence telemedicine users was conducted to determine the factors that motivate and the barriers that impede the acceptance and maintenance of a robotic telemedicine (RTM) program.
  
  
  METHODS
  The majority of the survey users were in the Emergency Department or in the Intensive Care Unit.
  
  
  METHODS
  E-mail invitations were sent to 483 individuals representing 63 healthcare institutions and groups in North America and Europe. Respondents were directed to a Web-based survey. The survey consisted of 96 separate questions, addressing user familiarity and 5-point Likert scales, addressing issues spanning the conceptual and practical issues surrounding adoption of telemedicine.
  
  
  RESULTS
  A total of 106 surveys were completed, representing an individual response rate of 21.9% but an institutional response rate of 60.3%. More than two-thirds of the respondents were physicians who participated in active RTM programs. Across seven different topics related to barriers to implementing RTM, the majority of all respondents indicated that cultural issues did not constitute meaningful hurdles, technological matters were generally favorable, and that most personnel were agreeable to both achieving the buy-in to start an RTM program and to maintaining RTM once started. However, respondents proclaimed that RTM's success was still hampered by licensing, credentialing, and malpractice protection, as well as costs, billing, and reimbursement issues. Achieving immediate patient access, overcoming service gaps, improving quality, providing clinical support, maintaining patient satisfaction, and adhering to practice guidelines were viewed as significant motives for RTM implementation.
  
  
  CONCLUSIONS
  The leading applications of RTM included emergency response and consultation. The patients, physicians, nurses, nor hospital executives served as barriers to implementation. However, licensing, costs for technology, and reimbursement for RTM continue to impede progress.
authors.affiliation: C₃O Medical Group, Ojai, California 94024, USA. hrogove@c3omedicalgroup.com
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Rogove
authors.forename: David
authors.initials: D
authors.lastname: McArthur
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D003469:Culture; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D012371:Robotics / Q000458:organization & administration* / Q000706:statistics & numerical data; D017216:Telemedicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States