title: Dilemma of applying telehealth for overseas organ transplantation: comparison on perspectives of health professionals and e-health information and communication technologists in Taiwan.
abstract: BACKGROUND
  Telehealth is one of the avenues of e-health; it is a voice, image, or document delivery system via the internet and aims to assist patients to prevent disease and to promote health, diagnosis, self-care, and treatment. The purpose of using telehealth for overseas organ transplantation (OOT) was debated. This study aimed to explore the dilemma in applying telehealth for OOT patients from the perspectives of health professionals and e-health information and communication technologists (eh-ICTs) in Taiwan.
  
  
  METHODS
  An exploratory qualitative method was used, with a purposive sample of OT health professionals (OTHP) and eh-ICTs in Taiwan. Qualitative data were collected by face-to-face semistructured interviews, and were analyzed by content analysis.
  
  
  RESULTS
  Fifty subjects including 10 OT surgeons (OTS), 30 registered nurses (RNs), and 10 eh-ICTs participated in this study. Five dilemmas were identified: (1) medical law violation (80%, n = 40 of 50; 100% OTS [n = 10 of 10], 67% RNs [n = 20 of 30], 100% eh-ICTs [n = 10 of 10]); (2) integrating telecommunication and medical systems for OOT (74%, n = 37 of 50; 90% OTS [n = 9 of 10], 73% RNs [n = 22 of 30], 60% eh-ICTs [n = 6 of 10]); (3) the inconsistent caring protocols among medical parties (68%, n = 34 of 50; 80% OTS [n = 8 of 10], 70% RNs [n = 21 of 30], 50% eh-ICTs [n = 5 of 10]); (4) the uncertainty in quality of care in overseas medical institutes (62%, n = 31 of 50; 80% OTS [n = 8 of 10], 60% RNs [n = 18 of 30], 50% eh-ICTs [n = 5 of 10]); and (5) the uncertainty in cost-effectiveness (36%, n = 18 of 50; 60% OTS [n = 6 of 10], 17% RNs [n = 5 of 30], 70% eh-ICTs [n = 7 of 10]).
  
  
  CONCLUSIONS
  The use of telehealth for OOT is in its infancy. A systematic curriculum with advanced pilots targeted to develop telehealth for OOT will be needed for mutual communication between OTHPs and eh-ICTs in the near future.
authors.affiliation: Department of Medical Research & Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chayi, Taiwan.
authors.forename: F Jin
authors.initials: FJ
authors.lastname: Shih
authors.affiliation: Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan. Electronic address: fujong@gmail.com.
authors.forename: F Jong
authors.initials: FJ
authors.lastname: Shih
authors.affiliation: Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Pan
authors.affiliation: School of Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: H M
authors.initials: HM
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: wangp@ntu.edu.tw.
authors.forename: S-S
authors.initials: SS
authors.lastname: Wang
mesh_terms: D022126:Access to Information; D000328:Adult; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000191:economics; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D057286:Electronic Health Records; D017048:Health Care Costs; D066275:Health Information Exchange; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D007391:International Cooperation; D008498:Medical Record Linkage / Q000379:methods; D057193:Medical Tourism / Q000191:economics; D008875:Middle Aged; D009726:Nurses; D016377:Organ Transplantation / Q000191:economics / Q000451:nursing; D010820:Physicians; D011787:Quality of Health Care; D013624:Taiwan; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome