In the past decade telehealth has emerged as a major technological innovation within the medical community. Telehealth essentially refers to the administration of healthcare services to patients through electronic or digital channels. While telehealth was initially questioned as a reliable form of administering healthcare when it first emerged, it has increasingly gained acceptance among patients and physicians as a form of healthcare dissemination. Still, despite the growing acceptability of telehealth, evaluation programs increasingly need to be implemented to ensure these programs’ effectiveness and development. The present research constitutes a telehealth evaluation program that examines a user-technology interface through the effectiveness of its usability, decision-support system, and overall impact assessment.
Telehealth usability constitutes perhaps the most prominent area of importance involving the user-technology interface. Usability is an important feature of telehealth for a variety of reasons. Fruhling and Lee (2006) indicated that, particularly in rural patients, usability represented a critical means of gaining patient trust in the system. Gephart et. al. (2013) emphasized the importance of usability in relation to doctors and nurses. Of course, usability constitutes a broad field, even within the confines of telehealth, such that evaluating it comprehensively can be a challenging venture. Agha et. al. (2013) noted that among the primary important elements in relation to usability is that the system is tailored to specific users and their unique needs. For instance, if users using the telehealth technology were those with limited experience with computers or mobile devices (typically senior citizens), then elements such as strong color contrast, frequently repeated instructions, and greater feedback were all critical to ensure the effectiveness of the system. In order to evaluate the extent that this aspect of the telehealth system effective addressed users’ unique needs effectively, user experience testing will be carried out with both the patient population that intends to use the technology, as well as the physicians and nurses who will be facilitating these individuals in their use of this technology. The individuals will be asked to use the technology and their interaction with it will be recorded be an evaluator. Following this stage, users will be given semi-structured interviews regarding their use of the telehealth system in relation to whether or not they experienced any challenges.
Decision-support systems are another significant area to evaluate within telehealth. Decision-support systems refer to aspects of telehealth programs that provide tailored feedback to users based on their engagement with the system. Gephart et. al. (2013) indicated that decision-support systems were critical in aiding patients in a multitude of contexts. For example, this research considered one such system in which alerts were sent to patients based on information they provided in relation to heart rate and various other elements. The patients in this study all had a form of heart condition. The decision-support system facilitated these individuals in improving their quality of life, self care, and heart failure severity through statistically significant findings (Gephart et. al., 2013). In evaluating the effectiveness of decision-support systems in the telehealth program, a mixed-methods approach will be adopted. The qualitative portion of this evaluative approach will involve semi-structured interviews with patients regarding their perceptions on the effectiveness and usefulness of the decision-support system provided. The quantitative portion of the evaluation will involve evaluating whether or not patients that had a decision-support system for their telehealth outperformed a control population that did not have a decision-support system.
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Impact assessment constitutes another critical area that will be used in the evaluation of the telehealth program. Impact assessment is perhaps the most critical aspect of a user-technology interface because it constitutes the ultimate goal of the telehealth interface. As such, without involving an impact assessment in the evaluation approach, it’s possible to focus too intently on the process without gauging its true impact. Specifically, impact assessment constitutes a comprehensive undertaking that occurs in relation to a telehealth program to determine the ultimate impact of this program on the patient and the intended outcomes. Although impact assessment is concerned with the impact of the telehealth program and intervention, Agboola et. a. (2014) argued that the impact assessment process of telehealth evaluation should occur as soon as the problem being investigated is defined. Subsequently, the impact assessment will be directly tailored to the original intent of the telehealth intervention. In this respect, intermediate outcomes will be measured first. Agboola et. a. (2014) indicated that intermediate outcomes include elements such as, “increased knowledge, increased adherence to recommended treatments, behavior change, early detection, and treatment of symptoms.” However, the impact assessment will not stop with intermediate outcomes but will also address whether or not the intervention was successful. This approach will take into account overall goals such as intention of the treatment, but also recognize the convenience factor and whether or not telehealth facilitated treatment for individuals that otherwise would not have received this service. Both elements will be evaluated through randomized controlled trials. This will include patient populations that receive the telehealth intervention and those that don’t. The results will then be used to determine whether or not the telehealth user-interface was truly effective in providing quality of care. Ultimately, developing statistically significant results in relation to intermediate and overall outcomes for the telehealth system is critical in determining whether or not the user-interface is effective because it paradigmatically speaks to its essential purpose.
In conclusion, the present research has proposed a telehealth evaluation program that evaluates a telehealth user-technology interface based on usability, decision-support, and its overall impact assessment. In all of these instances, evaluation solutions have been proposed that will aid in determining the relative effectiveness of the user-interface component or user-interface as a whole. While evaluating these systems in terms of relative effectiveness is an important starting point, action needs to be taken based on the insights gained in this process. Subsequently, the evaluation of these three elements will be used in an iterative design process to develop the most effective system. Through such an approach it will be possible to ensure the telehealth system is the most effective one possible.
- Agboola, S., Hale, T. M., Masters, C., Kvedar, J., & Jethwani, K. (2014). “Real-world” practical evaluation strategies: a review of telehealth evaluation. JMIR research protocols, 3(4), e75.
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