title: Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil.
abstract: In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units.
  
  
  
  We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject.
  
  
  
  We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described.
  
  
  
  The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Carlos Henrique Amaral
authors.initials: CHA
authors.lastname: de Souza
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Renata Albaladejo
authors.initials: RA
authors.lastname: Morbeck
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Milton
authors.initials: M
authors.lastname: Steinman
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Cora Pereira
authors.initials: CP
authors.lastname: Hors
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Mario Maia
authors.initials: MM
authors.lastname: Bracco
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Kozasa
authors.affiliation: Hospital Israelita Albert Einstein , São Paulo, SP, Brazil .
authors.forename: Eliseth Ribeiro
authors.initials: ER
authors.lastname: Leão
mesh_terms: D001291:Attitude of Health Personnel; D001938:Brazil; D002983:Clinical Competence; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D010819:Physician's Role; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*
keywords: barriers; e-Health; telehealth; telemedicine