Investigating the Integration of Telemedicine into Clinicians’ Workflow: A Review of Methods

Abstract

Telemedicine has received recent attention as a means to improve care access for chronically ill patients and underserved communities. However, new health information technologies like telemedicine change health providers’ practices, management, and environment. These changes, if not well addressed, can cause dissatisfaction and disruption, negatively impacting time efficiency, quality of care, and patient safety. This scoping literature review seeks to identify the methods used to study integration of telemedicine into clinicians’ workflow. Scoping reviews identify gaps and provide direction for future research and areas of improvement. Peer-reviewed, original empirical studies related to workflow in the context of telemedicine integration were identified through a comprehensive search of MEDLINE (Ovid). The search identified 147 articles, which were screened based on title and abstract. The remaining articles were thoroughly reviewed and assessed for eligibility. Fifteen articles were included. Three approaches to study telemedicine integration in clinical workflow predominate the academic literature: First, quantitative data analysis techniques applied to time studies, time-motion studies, and surveys and interviews; second, qualitative data analysis techniques applied to interviews, surveys, and observational studies; and third, mixed methods to assess telehealth integration. Literature identifies time-saving as a significant benefit of telemedicine. However, physicians, nurses and other relevant stakeholders have concerns that cannot necessarily be measured in terms of time. Additional research is needed to address other dimensions of clinical workflow, collect holistic perspectives of integration issues from stakeholders, and connect those issues to the specific components of the telemedicine system to prioritize in process improvement.