Telemedicine Adoption at Grand Hospital: Strategy & Barriers

Grand Hospital: Organizational Overview

Located in a rural region of the Midwestern United States, Grand Hospital is a relatively small yet well-staffed medical center comprising 209 beds, serving a diverse geographic community. Grand Hospital is a community nonprofit that offers a broad range of services, including inpatient and outpatient care, employing approximately 1,600 individuals — the majority being full-time employees (1,250 employees) alongside 225 practitioners. Grand Hospital operates on a budget that often exceeds $130 million and has a net asset base of $150 million. It is also well managed from a financial standpoint, having earned an A credit rating from Moody's, Standard & Poor's, and Fitch Ratings.

Despite its rural location, the hospital has over 100 comparable medical facilities within close geographic proximity. Grand Hospital currently serves approximately 11,000 inpatients and 160,000 outpatients, addressing more than 36% of the primary service area's demand for hospital services. The hospital is also financing a $57 million expansion to serve the community more responsively. Given the density of competition in its core market, Grand Hospital is struggling to recruit qualified physicians for an increasingly large workload.

All of these factors contribute to a greater need for more effective information systems management. The current IT infrastructure includes: patient registration and revenue management; an electronic medical record with computerized physician order entry; imaging via a PACS system; and laboratory and pharmacy management. The potential for telemedicine to transform Grand Hospital — making it more effective at anticipating and meeting patients' needs — is clear, given how diverse, distributed, and disparate these systems are today. Transitioning from a traditional clinical practice to one that is more automated requires an exceptional level of effort in change management planning, execution, and follow-through, as many roles and responsibilities in healthcare organizations evolve substantially over time as a result (Josey & Gustke, 1999).

Impact of Early IT Adoption on Telemedicine Readiness

Grand Hospital will experience both strengths and weaknesses as it moves from traditional on-premise healthcare information technologies to telemedicine solutions. A key technological strength is the unified architecture already in place to support the multiple systems currently running in the hospital. On-premise and legacy systems often establish useful information taxonomies that can support better data management and the extrapolation of reporting requirements beyond the limitations of decades-old system architectures (Josey & Gustke, 1999).

An additional benefit of having already implemented healthcare information system technologies is that Grand Hospital is staffed with experienced IT professionals who are accustomed to aligning IT systems to the unique requirements of internal staff, physicians, administrators, and changing patient needs. A third benefit is the flexibility this gives Grand Hospital in replacing the most obsolete and antiquated systems it has relied upon. Additionally, the concept of transitioning to a cloud-based system capable of managing the hospital's diverse information needs becomes more feasible with this foundation already in place. Compliance and security requirements will remain ongoing concerns, and the selection of telemedicine providers will need careful evaluation.

Perhaps the most significant advantage of early adoption is that fear of new technology is likely to be considerably lower at Grand Hospital than at healthcare organizations just beginning their informatics journey. Staff who have navigated previous technology transitions are better prepared to engage with telemedicine as a natural extension of the systems they already use (Lockamy & Smith, 2009).

Barriers to Telemedicine in Radiology, Behavioral Health, and Intensive Care

The most significant barriers to successful telemedicine adoption will be cultural rather than technological. The most challenging aspects of implementing a telemedicine solution involve getting administrators, nurses, physicians, and staff to adopt and trust the new system to meet their information needs (Josey & Gustke, 1999). Change management strategies will ultimately determine whether any telemedicine system's effectiveness is measurable and significant enough to warrant further investment (Lockamy & Smith, 2009).

Beyond change management, there is also the challenge of integrating legacy systems and providing a unified approach to measuring overall system performance from the patient's perspective. Technological integration barriers are particularly significant in institutions that have historically prioritized internal processes over patient-centered outcomes (Paul, Pearlson, & McDaniel, 1999). For many healthcare providers, the de facto primary customers are insurance companies and other payment processors rather than patients themselves. The most successful telehealth systems, however, concentrate first on patient needs and align all internal processes to that objective (Coughlan, Eatock, & Eldabi, 2006). Rather than aligning IT systems primarily to the financial and reporting needs of the provider, the best-performing telemedicine solutions continuously strive to drive greater value and a better patient experience (Paul, Pearlson, & McDaniel, 1999).

Benchmarking patient satisfaction is therefore critically important, as it serves as a reliable indicator of how well a telemedicine solution is meeting — and ideally exceeding — patient expectations. Among the three specialty areas under consideration, radiology is likely the easiest to transition to telemedicine, as teleradiology is already a well-established practice with mature technology and workflow standards. Intensive care presents moderate complexity due to monitoring requirements, while behavioral health poses the greatest challenges because of the relational and privacy-sensitive nature of mental health services.