Facilitators and Barriers to Adoption of a Successful Urban Telemedicine Model - Final Report

Purpose: The goal of this primary care, connected health initiative is replacement of inconvenient, inefficient traditional models of care, such as the emergency department (ED), through more convenient, high quality, less expensive care models that leverage information technology (IT). This project was designed to evaluate facilitators and barriers to implementation of the Health-e-Access (HeA), a health IT model with established feasibility, efficacy, effectiveness and efficiency in management of acute childhood illness, and to expand HeA implementation. Knowing facilitators and barriers to adoption of this disruptive innovation will help similar models become established more quickly and efficiently. Scope: Specific aims were to: (A) achieve substantial deployment and solidify sustainable business models for each of the 3 urban telemedicine service models; (B) identify facilitators and barriers; (C) monitor impact on utilization patterns; and (D) create and disseminate an implementation and sustainability toolkit. Methods: Three service models, in various stages of development and deployment, had evolved in use of HeA at the time of project initiation: (1) child care, (2) school, and (3) after-hours neighborhood. Each model is highly flexible in meeting patient needs, in part because HeA technology is web-based and includes mobile patient access units. Models served families in Rochester, NY, a mid-sized city with marked racial and ethnic disparities in socioeconomic and health status. Results: This project: expanded HeA broadly into the Rochester City School District and selected neighborhood centers; identified major facilitators and barriers; and demonstrated impact of the HeA models on utilization patterns, including more equitable access. An implementation toolkit was developed.