JMIR Publications

ABSTRACT

Background:

Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up between a major academic hospital in partnership with five other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during Endoscopic Retrograde Cholangio-Pancreatografy (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system level outcomes, causes of which are not well understood.

Objective:

We were interested in factors related to usability and user experience of the telemedicine service which might come to affect adoption. We therefore wanted to investigate perceptions and responses to use and/or anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures are used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures.

Methods:

We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures.

Results:

142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111/140 (79.3%) of the cases. Specific examples are that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, 11 referrals and in 11 cases, combinations of these outcomes. Pre-procedure beliefs about the usefulness of teleguidance were generally lower than post-procedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%).

Conclusions:

Users’ satisfaction with teleguidance surpassed their initial expectations, mainly by contributing to non-technical aspects of performance, through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes. Clinical Trial: N/A