Barriers to the up-take of telemedicine in Australia - a view from providers

INTRODUCTION: The continued poorer health status of rural and remote Australians when compared with their urban counterparts is cause for concern. The use of advanced technology to improve access to health care has the potential to assist in addressing this problem. Telemedicine is one example of such technology which has advanced rapidly in its capacity to increase access to healthcare services or provide previously unavailable services. The important anticipated benefits of greater access to healthcare services are improved health outcomes and more cost-effective delivery. METHODS: A national study was conducted to investigate the current perceived use and usefulness of telemedicine from the perspective of users and providers, and their views on how telemedicine could be expanded in Australia. In one component of this national study, the expert opinion of experienced providers of telemedicine services was elicited using a Grounded Theory approach and using semi-structured interviews which were analysed thematically. This article reports on the barriers to the up-take of telemedicine identified by this sub-sample. RESULTS: The primary barriers identified were: funding; time; infrastructure; equipment; skills; and preference for the traditional approach. While funding is a well-known barrier to the up-take of telemedicine, the extra time required for a telemedicine consultation has particular implications for the workload of rural doctors. The comparatively poor internet access available in rural Australia combines with difficulties accessing some items such as a computer, to make equipment an issue. Even though lack of equipment skills was identified as a barrier, the providers in this study reported that rural doctors are adept at using the telephone/teleconferencing and facsimile. A preference for a traditional approach can reflect a lack of interest in learning computer skills or difficulty acquiring this skill set. CONCLUSIONS: These results raise issues in the domains of policy, funding priorities, and education and training. This indicates an inter-related set of challenges that would require a targeted multifaceted approach to address. The results suggest that not using telemedicine is, in the current climate, a rational response--it is quicker, easier and more cost-effective not to use telemedicine.