As the opening speaker at the ITIS-ITAB'99 Conference, that took place in Amsterdam last April, figured Dr. Mary Moore, Dean of Library and Information Resources at the State University of Arkansas. Research studies show that the adoption of medical innovations in general and telemedicine in particular is influenced by a complex set of factors, involving socio-economic, demographic, psychological and communication related characteristics. Dr. Moore based her findings on scientific investigations, made by Everett Rogers with relation to the diffusion of innovations in general. These results applied to her own research on the early adoption of telemedicine, back in 1989, in the Texas Tech MEDNET project. Dr. Moore also presented the results of two other studies, analysing the attitude of paediatricians and anaesthesiologists towards innovative changes in their medical practice.
The Texas Tech MEDNET project was set up with $4 million of US federal funding in the western half of Texas where no large cities nor medical centres are located. In 1980, a medical centre was founded in Lubbock, later on followed by Odessa, El Paso, and Amarillo. Texas Tech MEDNET involved the implementation of interactive video sites to provide continuing education for patient care. By 1992, seventy sites were connected to supply qualitative health care to underserved patients and reduce the professional isolation of local physicians. The interactive video facility allowed to share resources and expertise in times of crisis and to contain costs by eliminating distant patient travels to the city hospital. The major disadvantages constituted the costs for the equipment, the inferior technical quality of the audio, the reimbursement issues and regulation restrictions, as well as the typically human resistance to change.
Empiric observations of the MEDNET user characteristics at two remote sites connected to the Lubbock medical centre, inspired Dr. Moore to the scientific research of physicians' adoption to medical innovation. While one remote site showed some very successful results, the other one amounted in a $250.000 failure. The users of the first site turned out to be recent medical graduates, who were assertive, energetic, gregarious, and affable, displaying an attitude that was humble and altruistic but self-confident at the same time. Acting as true opinion leaders, they also embodied the type of the aggressive lifelong learner. The American researcher, Everett Rogers, describes the diffusion of innovation as a dynamic process in which five adopter categories should be distinguished. The innovators, that represent 2.5% of the population, jump unto everything that is new; the early adopters (13.5%) are the real opinion leaders; the early majority (34%) form the target to market new products; the late majority (34%), and the laggards (16%) close the bell shaped curve.
Rogers typifies each category by means of socio-economic, personality, and communication variables. The early adopters are characterized by a greater intelligence, abstraction and rationality. They display higher aspirations for education, achievement and social mobility. They have greater empathy and a more information seeking behaviour. They act as cosmopolitans and show more social participation. To which extent can this typification be applied to adopters of medical innovation? In 1990, Weiss, Charney, and Baumgardner studied characteristics of paediatricians, motivated to change some aspect of their practice. Fineberg, Gabel, and Sosman carried out a similar study for anaesthesiologists in 1978. In both cases, the early adopters among medical professionals are younger of age, board-certified, read medical journals, but most of all, tend to rely on personal communication between colleagues for information on innovations. The importance of a physician's social network was already stressed in a study by Coleman, Katz, and Menzell in 1966.
In 1992, Dr. Mary Moore started her personal research on the application of interactive video for patient care, in order to analyse the information seeking and personality characteristics of rural family practitioners. The study also verified Rogers' theory in relation to telemedicine adoption by using the NEO-PI-Revised personality instrument, the Opinion Leadership Scale, as well as a detailed questionnaire. The study population was identified by telemedicine administrators and vendors. Three hundred packets were distributed, out of which 57 were returned. Only 38 related to rural practitioners, who as non-academics were operating in small communities and requesting telemedicine consultations. Their results were usable. The self-selected population and the self-reporting instruments form the major limitations of the study, that neither reports on changes over time, nor integrates late adopters, who were non-existent at the time.
The typical respondent was aged between 36 and 45, board-certified, active in a small hospital of 50 beds, in a community of less than 20.000 people. The major motivation to use telemedicine was inspired by the lack of a local speciality physician and the strong desire to serve the patient by retaining him or her locally. The average use of teleconsultation amounted to 7 hours per month, with a range from less than one hour to twenty hours per month. Most of the respondents had been using telemedicine for less than two years and half of them applied it within the first two weeks of installation. As for their information seeking behaviour, physicians reported to learn much from the 9 hours per week, spent on receiving or providing consultations and from the 8 hours per week of reading professional literature. It also appeared that 66% of the physicians had influenced a colleague to use telemedicine, and as such, had played the role of opinion leader.
As a recognized instrument of high reliability, the NEO-PI measures personal characteristics by taking into account five main factors of personality, being neuroticism or emotional maturity, extraversion, openness, agreeableness, and conscientiousness. Each factor includes six personality traits. General population scores have been normed on T scores, with the average at 50 and standard deviation of 10. The homogeneous group of physicians displayed a lower level of deviation than the overall population. Calculated against the population results, the physicians scored higher than the norm on openness to action, ideas, and values; competence; assertiveness; achievement; order; altruism; and activity. They performed lower than the norm on depression; anxiety; angry hostility; self-consciousness; vulnerability; modesty; openness to aesthetics and feelings; and tendermindedness. On the whole, physicians seem to be more emotionally stable.
In the research conducted by Dr. Moore, most of Rogers' generalizations were confirmed. The early adopters have a younger age or professional age and tend to attach great importance to information exchange with colleagues, via personal contact or through teleconsultation. It appears that opinion leaders not necessarily are frequent users of telemedicine nor are the early adopters. The emotional maturity among earlier adopters came as a surprise but might be explained by the fact that physicians more easily recognize questions with regard to emotional stability and as a result answer favourably, or it may be the case that rural practitioners in fact are more stable. Early adoption also is correlated with positive emotions. More research is still required involving later adopters, the late majority and those who refused to adopt telemedicine or discontinued usage. Other factors include the progressing technology, the environment, administrative issues, and the rewards and ease of use. For more information, you can check out Dr. Moore's home page at the Web site of the State University of Arkansas.