New Study Ties Telehealth Success to Staff Education, Support

A telehealth program implemented in 2017 at a California independent living facility didn’t help reduce hospitalizations – because staff were opposed to using the technology.

That’s the conclusion drawn from a University of Connecticut study recently published in the Journal of Medical Internet Research. The study, led by Kelsi Carolan, PhD, of UConn’s School of Social Work, found that front-line staff felt the telemedicine technology not only added complexity to their jobs, but interfered with their decision-making.

“EMT-trained safety staff did not perceive telemedicine as a valuable tool, viewing it as undermining their autonomy in decision making and increasing their workload,” Carolan and her colleagues reported. “Reducing resident transports to the ED was not a goal embraced by safety staff, who described approaching all calls with the assumption that transport would likely be necessary.”

The study highlights an often overlooked barrier to telehealth adoption: pushback from those tasked with using it in the healthcare setting. If staff aren’t using connected health tools because they don’t understand the benefits, those benefits won’t be seen.

The problem lies not only in teaching staff how to use the technology, but having them understand what it can and can’t do. It also points to the need by management to include staff in the planning process before a telehealth program is implemented.

In their study, Carolan and her colleagues looked at call logs from a 950-patient senior living community in California in 2017-18, and compared that to two other sites run by the same company. The first site had launched a telemedicine platform in 2017 that was designed to help care workers triage patients, giving them a virtual link to an emergency medicine physician to identify those needing transport. The idea was to give on-site staff more resources to treat patients and reduce costly hospitalizations.

Staff, however, had different ideas about how the platform should be used.

“Safety staff felt that the program’s goal to deter ED visits was the wrong goal and that telemedicine would better address minor medical concerns at the on-site clinic,” the study noted. In interviews, staff felt that they could make their own triage decisions, and that telehealth didn’t change the outcome, only making it more complicated.

“Safety staff also reported that residents were reluctant to use telemedicine,” the study added. “One safety staff member said, ‘Honestly, they don’t directly request it, and I think a lot of that has to do with they don’t want to change from the old-school days of actually seeing a doctor.' … Another staff member agreed, saying, ‘...when I do offer it to residents, they only want to see their doctor and then they want to be in person ... to talk to someone who knows them personally.' One participant described this perceived reluctance as a lack of comfort with receiving medical care through an unfamiliar medium.”

When interviewed for the study, residents had a more positive view of telehealth.

“In contrast to staff perceptions, resident focus group participants described multiple benefits of using telemedicine,” Carolan and her colleagues wrote. “Residents expressed a strong interest in avoiding trips to the ED whenever possible, mentioning the long wait times, financial costs, and potential health risks of ED visits. Residents interviewed identified avoiding an ED visit as a primary benefit of using the telemedicine intervention.”

The study concluded that the failure to see benefits in this case isn’t necessarily the fault of the technology, but in how staff reacted to it.

“Minimal research has explored the feasibility and acceptability of telemedicine interventions involving first responders as frontline providers,” Carolan and her colleagues wrote. “The intervention facility’s senior management considered EMT-trained safety staff as an advantage, as staff would be able to effectively assist the remote physician. However, the safety staff viewed the intervention as undermining their autonomy. Traditionally, prehospital first responders are trained to provide minimal treatment to stabilize patients for emergency transport, with successful transfer to the ED as the goal. EMTs embracing reduced ED transport as a goal would require a significant shift in professional mentality and culture.”

“Staff may have benefitted from further education on identifying potentially avoidable transfers, the harm to residents of unnecessary transfers, and the opportunity to work and learn in cooperation with remote physicians,” they concluded.