title: Telemedicine in the acute health setting: A disruptive innovation for specialists (an example from stroke).
abstract: BACKGROUND
  Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine.
  
  
  METHODS
  Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation.
  
  
  RESULTS
  Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and >4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine.
  
  
  CONCLUSIONS
  Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine.
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Australia Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia kathleen.bagot@florey.edu.au.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Bagot
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Australia Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Vu
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Moss
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Australia Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Bladin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000458:organization & administration*; D019114:Remote Consultation / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration; D013038:Specialization; D020521:Stroke / Q000628:therapy*; D014739:Victoria
keywords: Remote consultation; disruptive innovation; teleconsulting; telemedicine