Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study

Authors: H. Alami, M. P. Gagnon, R. Wootton, J. P. Fortin, P. Zanaboni

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

Login to get access

Abstract

Background

Norway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway.

Methods

We used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data.

Results

Telemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified.

Conclusions

This study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems.
Appendix
Available only for authorised users
Literature
1.
Ringard Å, Sagan A, Sperre Saunes I, Lindahl AK. Norway: health system review. Health Syst Transit. 2013;15(8):1–162.PubMed
2.
3.
Sørensen T, Dyb K, Rygh E, Salvesen R, Thomassen L. A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue. BMC Health Serv Res. 2014;14(1):643.CrossRefPubMedPubMedCentral
4.
Pettersen S. Hvordan kan radikale innovasjoner innen e-helse organiseres i norske sykehus? Bodø: Høgskolen i Bodø; 2010.
5.
Bergstrøm R, Heimly V. Information technology strategies for health and social care in Norway. Int J Circumpolar Health. 2004;63(4):336–48.CrossRefPubMed
6.
7.
Neby S. Institutional reform and governance in the Scandinavian hospital fields. The dynamics of and between change and control: PhD dissertation, Department of Administration and Organization Theory. Bergen: University of Bergen; 2009.
8.
Romøren TI, Torjesen DO, Landmark B. Promoting coordination in Norwegian health care Inter Int J Integr Care. 2011;11(Spec 10th Anniversary Ed):e127-e.
9.
Byrkjeflot H, Torjesen DO. Managerial innovation in health care. The introduction, translation and use of the American DRG system in the hospital sector in Norway and Denmark. Mysterion strategike og kaintotomia. Oslo: Novus Forlag; 2010. p. 130–48.
10.
Seim A, Løvaas L, Hagen TP. Hva kjennetegner virksomheter som kjøper private helseforsikringer? Tidsskrift for Den Norske Legeforening. 2007;127:2673–5.PubMed
11.
Baardseng T. Telemedicine and eHealth in Norway: administration and delivery of services. Int J Circumpolar Health. 2004;63(4):328–35.CrossRefPubMed
12.
13.
Johnsen JR. Health Systems in Transition: Norway. Copenhagen, WHO regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2006.
14.
Zanaboni P, Knarvik U, Wootton R. Adoption of routine telemedicine in Norway: the current picture. Glob Health Action. 2014;7(1):22801.CrossRef
15.
16.
O'Gorman LD, Hogenbirk JC, Warry W. Clinical telemedicine utilization in Ontario over the Ontario telemedicine network. Telemed J E Health. 2016;22(6):473–9.CrossRefPubMedPubMedCentral
17.
18.
Donnem T, Ervik B, Magnussen K, Andersen S, Pastow D, Andreassen S, Nørstad T, Helbekkmo N, Bremnes RM, Nordoy T. Bridging the distance: a prospective tele-oncology study in northern Norway. Support Care Cancer. 2012;20(9):2097–103.CrossRefPubMed
19.
Hartvigsen G, Pedersen S. Lessons learned from 25 years with telemedicine in northern Norway. In: NST report no 6–2015. Norwegian Centre for Integrated Care and Telemedicine. Tromsø: University Hospital of North Norway; 2015. p. 405.
20.
Hartvigsen G. Ten lessons for successful implementation of telemedicine Services in North Norway. Scandinavian conference on health informatics 2013; Copenhagen; Denmark; August 20; 2013: Linköping University Electronic Press.
21.
Bergstrøm R. National Health IT reform in Norway. Finn J eHealth eWelf. 2013;5(4):172–6.
22.
23.
Wade VA, Taylor AD, Kidd MR, Carati C. Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study. BMC Health Serv Res. 2016;16(1):183.CrossRefPubMedPubMedCentral
24.
Miller EA. Solving the disjuncture between research and practice: telehealth trends in the 21st century. Health Policy. 2007;82(2):133–41.CrossRefPubMed
25.
Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013;347:f6753.CrossRefPubMed
26.
27.
Morse J. In: Denzin N, Lincoln Y, editors. Designing funded qualitative research. Handbook of qualitative research. Newbury Park: Sage Publications; 1994. p. 220–35.
28.
Kommunal- og moderniseringsdepartementet, Distriktsindeksen 2015 - metode, datakilder og kvalitetssikring. Oslo; 2015.
29.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psycho. 2006;3(2):77–101.CrossRef
30.
Alami H, Fortin JP, Gagnon MP, Pollender H, Têtu B, Tanguay F. The challenges of a complex and innovative telehealth project: a qualitative evaluation of the eastern Quebec Telepathology network. Int J Health Policy Manag. 2017;6:1-12.
31.
Thurmond VA. The point of triangulation. J Nursing Scholarsh. 2001;33(3):253–8.CrossRef
32.
Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. The sustainability of healthcare innovations: a concept analysis. J Adv Nurs. 2015;71(7):1484–98.CrossRefPubMed
33.
Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook: sage; 1994.
34.
35.
Norwegian Ministry of Health and Care Services. The coordination reform. Proper treatment—at the right place and right time. Oslo: Norwegian Ministry of Health and Care Services (report no. 47 (2008–2009) Oslo: Helse- og omsorgsdepartementet; 2009.
36.
37.
38.
Nohr LE, Nymark M, Zmenja M. Report on identified legal issues of the Baltic eHealth project. Baltic eHealth2005. Tromsø: Norwegian Centre for Telemedicine; 2007.
39.
Larsen F, Gjerdrum E, Obstfelder A, Lundvoll L. Implementing telemedicine services in northern Norway: barriers and facilitators. J Telemed Telecare. 2003;9(suppl 1):17–8.CrossRef
40.
41.
42.
Charitou CD, Markides CC. Responses to disruptive strategic innovation. MIT Sloan Manag Rev. 2002;44(2):55–64.
43.
Dyb K, Andreassen HK. Telemedicin: Et maktperspektiv. Tidsskrift for Forskning i Sygdom og Samfund. 2014;21:37–55.
44.
Henderson R. The innovator's dilemma as a problem of organizational competence. J Prod Innov Manage. 2006;23(1):5–11.CrossRef
45.
Alami H, Lamothe L, Fortin J-P, Gagnon MP. L’implantation de la télésanté et la pérennité de son utilisation au Canada: quelques leçons à retenir. European Research in Telemedicine/La Recherche Européenne en Télémédecine. 2016;5(4):105–17.CrossRef
46.
Kane GC, Palmer D, Phillips AN, Kiron D. Is your business ready for a digital future? MIT Sloan management review. 2015;56(4):37.
47.
Rogers EM. The diffusion of innovation 5th edition. New York: Free Press; 2003.
48.
49.
Cassiman S. Le Management de Transition vers la Soutenabilité. Ed Wolters Kluwer Belgium. 2011.
50.
51.
Campbell RJ. Change management in health care. Health Care Manag. 2008;27(1):23–39.
52.
Kotter JP. Leading change: why transformational efforts fail. Harv Bus Rev. 1995;73(2):59–2.
53.
Neufeld JD, Doarn CR. Telemedicine spending by Medicare: a snapshot from 2012. Telemed J E Health. 2015;21(8):686–93.CrossRefPubMed
54.
55.
Christensen C, Grossman J, Hwang J. The Innovator's prescription: a disruptive solution for health care. New York: McGraw-Hill; 2009.
56.
Chaudoir SR, Dugan AG, Barr CH. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci. 2013;8(1):22.CrossRefPubMedPubMedCentral
57.
58.
Légaré É, Vincent C, Lehoux P, Anderson D, Kairy D, Gagnon MP, et al. Telehealth readiness assessment tools. J Telemed Telecare. 2010;16(3):107–9.CrossRefPubMed
59.
Khoja S, Scott RE, Casebeer AL, Mohsin M, Ishaq A, Gilani S. E-health readiness assessment tools for healthcare institutions in developing countries. Telemed J E Health. 2007;13(4):425–32.CrossRefPubMed
60.
Nøhr C, Villumsen S, Ahrenkiel SB, Hulbæk L. Monitoring telemedicine implementation in Denmark. MedInfo. 2015:497–500.
61.
Jang-Jaccard J, Nepal S, Alem L, Li J. Barriers for delivering telehealth in rural Australia: a review based on Australian trials and studies. Telemed J E Health. 2014;20(5):496–504.CrossRefPubMed
62.
63.
Hudson HE. Rural telemedicine: lessons from Alaska for developing regions. Telemed J E Health. 2005;11(4):460–7.CrossRefPubMed
64.
Carroll M, Horton MB. Telehealth and Indian healthcare: moving to scale and sustainability. Telemed J E Health. 2013;19(5):377–9.CrossRefPubMed
65.
Darkins A. The growth of telehealth services in the veterans health administration between 1994 and 2014: a study in the diffusion of innovation. Telemed J E Health. 2014;20(9):761–8.CrossRefPubMed
66.
Soriano Marcolino M, Minelli Figueira R. Pereira Afonso dos Santos J, Silva Cardoso C, Luiz Ribeiro a, Alkmim MB. The experience of a sustainable large scale Brazilian telehealth network. Telemed J E Health. 2016;22(11):899–908.CrossRefPubMed
67.
Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform. 2010;79(11):736–71.CrossRefPubMed
68.
Scott RE, Mars M. Principles and framework for eHealth strategy development. J Med Internet Res. 2013;15(7)
69.
70.
Khoja S, Durrani H, Scott RE, Sajwani A, Piryani U. Conceptual framework for development of comprehensive e-health evaluation tool. Telemed J E Health. 2013;19(1):48–53.CrossRefPubMed
71.
Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: toward a unified view. MIS Q. 2003:425–78.
72.
Hicks L, Boles K. A comprehensive model for evaluating telemedicine. Stud Health Technol Inform. 2003;106:3–13.
73.
Broens TH, Huis in’t Veld RM, Vollenbroek-Hutten MM, Hermens HJ, van Halteren AT, Nieuwenhuis LJ. Determinants of successful telemedicine implementations: a literature study. J Telemed Telecare. 2007;13(6):303–9.CrossRefPubMed
74.
Lau F, Price M, Keshavjee K. From benefits evaluation to clinical adoption: making sense of health information system success in Canada. Healthc Q. 2011;14(1):39–45.CrossRefPubMed
75.
Wade V, Gray L, Carati C. Theoretical frameworks in telemedicine research. J Telemed Telecare. 2017;23(1):181–7.CrossRefPubMed
76.
Fortin JP, Gagnon MP, Lamothe L. Evaluation of health care information and communication technologies: a framework to support decision making. Proceedings of the IADIS International Conference e-Society; Avila, July 18–21,2004.
Metadata
Title
Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study
Authors
H. Alami
M. P. Gagnon
R. Wootton
J. P. Fortin
P. Zanaboni
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-017-0576-4

Other articles of this Issue 1/2017

BMC Medical Informatics and Decision Making 1/2017 Go to the issue

Research article

Electronic Health Record Portal Adoption: a cross country analysis

Technical advance

Secure and scalable deduplication of horizontally partitioned health data for privacy-preserving distributed statistical computation

Research article

The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial

Research article

Early recognition of multiple sclerosis using natural language processing of the electronic health record

Research article

Social media in public health: an analysis of national health authorities and leading causes of death in Spanish-speaking Latin American and Caribbean countries

Erratum

Erratum to: An information and communication technology-based centralized clinical trial to determine the efficacy and safety of insulin dose adjustment education based on a smartphone personal health record application: a randomized controlled trial