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February 14, 2026Journal of the American Medical Informatics Association1 citations

Conceptualizing and measuring integration of telehealth and in-person services from the provider’s perspective: development of the integration of telehealth and in-person services (ITIPS) survey

CSChristopher M. SheaUniversity of North Carolina at Chapel Hill STSharita Renée ThomasUniversity of North Carolina at Chapel Hill SKSaif KhairatUniversity of North Carolina at Chapel Hill

Key Points

The study aims to develop a survey to measure the integration of telehealth and in-person services from the perspective of healthcare providers.
Conducted semi-structured interviews to identify indicators of telehealth integration.
Utilized a modified-Delphi approach with two rounds of Qualtrics surveys to refine the survey instrument.
Engaged some participants in all phases while others contributed through either interviews or surveys.
Identified multiple indicators related to modality decisions, workflows, and influencing factors for telehealth integration.
Developed a 22-item survey measuring telehealth integration extent in practice environments.
Included 31 items assessing factors affecting telehealth integration.

Abstract

Abstract Objective Hybrid in-person and telehealth work environments are now common among health care providers. When in-person and telehealth services are not well integrated, provider workload could increase, negatively affecting provider satisfaction and burnout and hindering implementation of interventions aimed at improving quality. A lack of measures of telehealth integration has hindered studies of such impacts. This article presents the Integration of Telehealth and In-Person Services (ITIPS) survey, developed to assess telehealth integration and its facilitators from the provider’s perspective. The ITIPS survey represents a meaningful step toward measuring integration in hybrid healthcare environments, including indicators of the extent of telehealth integration and factors promoting telehealth integration. Materials and Methods Using an exploratory sequential mixed-methods design, this study included semi-structured interviews and a participant-driven, modified-Delphi survey development approach consisting of 2 rounds of Qualtrics surveys to obtain participant feedback. Some participants engaged in all phases, whereas others participated either in interviews or in the modified Delphi surveys. Results Interviews identified multiple indicators of telehealth integration related to decisions about the visit modality, provider and staff workflows, as well as influencing factors such as leadership priorities related to quality and access, physical space, scheduling systems, and staff support. Our study yielded a survey with 22 items measuring the extent of telehealth integration in a practice environment and 31 items assessing factors influencing the level of telehealth integration. Conclusion This study presents the ITIPS survey, which has undergone assessments for content validity and is ready for psychometric assessment for additional types of validity.

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