An Innovation Ahead of its Time Understanding the Factors Influencing Patient Acceptance of Walk-In Telemedicine Services

Introduction

In the United States (U.S.), the healthcare industry lags other service industries in applying Information Technology to business practices. Healthcare spending in the U.S. continues to outpace gross domestic product (GDP), comprising nearly $2.5 trillion, or 17.3 percent, of GDP in 2009 and is projected to rise to nearly 20 percent of GDP by 2019 (Truffer et al., 2010). With the healthcare economy rapidly growing but suffering from pervasive organizational inefficiencies, there is vast opportunity for implementing technological innovations to meet the demands of both industry and consumers, reduce overall costs, and provide widespread access to healthcare at affordable rates.

One particular area of concern is patients’ increased use of emergency departments for nonurgent conditions. While this trend contributes to the rising costs of healthcare, patients often choose this option because their primary care physician is not readily accessible or because they do not have a usual source of care (Afilalo et al., 2004; Howard et al., 2005). Proposed solutions to this problem include walk-in urgent care clinics and emergency department fast tracks, often staffed by nurse practitioners and physician assistants (Howard et al., 2005). Another potential solution is a walk-in clinic for minor conditions that uses telemedicine (telecommunication systems to facilitate healthcare consultations between individuals remotely) to connect patients to healthcare providers. Advantages of a telemedicine walk-in clinic include fewer required staffing resources compared to a traditional walk-in clinic and the potential to provide patients, particularly those in rural areas, greater access to routine healthcare services.

Thus, the current study investigates this new application of telemedicine that provides healthcare services for minor ailments to walk-in patients via a teleconferencing retail health clinic. Though telemedicine has been practiced for over forty years in the U.S., it has mainly been implemented in specialized areas of medicine (Brennan, Holtz, Chumbler, Kobb, & Rabinowitz, 2008; Mair & Whitten, 2000; Williams, May, & Esmail, 2001). The first walk-in telemedicine clinic in the U.S. that operated as a retail clinic was the Health e-Station, which opened in 2006 in Georgia but subsequently closed its services. Designed primarily to promote patient empowerment and improve access to healthcare during off-hours, the Health e-Station was open late hours and on weekends—i.e., during times when primary care providers are generally unavailable. A similar model of a walk-in telemedicine clinic opened in six Wal-Marts in Houston, Texas in 2008 (Merrill 2008) but subsequently closed in the first quarter of 2009. Given the difficulty in sustaining a walk-in telemedicine service model, it is important to investigate the factors that would lead to patient adoption of walk-in telemedicine services.

A typical walk-in telemedicine visit involves patient interaction with a trained healthcare provider (e.g., a nurse or paramedic), who connects the patient to an available physician via videoconferencing and operates the instruments to perform the patient examination. The videoconferencing technology transmits images and sounds taken from the patient examination to the physician and permits real-time interaction, via video and audio, between the physician and patient. Moreover, typically, the patient is able to view the transmitted images on a display monitor in the examination room. Proponents of walk-in telemedicine clinics argue that their main advantages over emergency rooms are their lower cost for services and quicker access to healthcare providers.