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

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

doi:10.1186/s12911-017-0576-4

Cited by 77Telemedicine and Telehealth ImplementationHealthcare Systems and TechnologyTechnology Use by Older Adults

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

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Alami, H., Gagnon, M. P., Wootton, R., Fortin, J. P., Zanaboni, P.·2017·BMC Medical Informatics and Decision Making

DOI 10.1186/s12911-017-0576-4PMC PMC5745591

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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.

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Authors reported that support and high-quality training were necessary to achieve widespread growth.
“Authors reported that support and high-quality training were necessary to achieve widespread growth [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [36]
Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 reviewed articles.
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [36]
Telehealth champions were typically clinical staff.
“Telehealth champions were typically clinical staff [2,34,36,41-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [36]
Absence of or ambiguity in reimbursement was a common contextual barrier that influenced wider spread of video consultations.
“Absence of or ambiguity in reimbursement was another common contextual barrier that influenced wider spread of video consultations [36].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [36]
At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all 13 reviewed studies.
“At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all studies (n=13) [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [36]

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Additional file 1 of Live video from bystanders’ smartphones to medical dispatchers in real emergencies
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Authors: Alami, H., Gagnon, M. P., Wootton, R., Fortin, J. P., & Zanaboni, P.
Affiliations: Hôpital Saint-François d'Assise (CA)
University Hospital of North Norway (NO)
Université Laval (CA)
Corresponding author: Zanaboni, P.
ORCID: Alami, H.
Wootton, R.
Fortin, J. P.
Zanaboni, P.
Venue: BMC Medical Informatics and Decision Making
Publisher: Springer Science and Business Media LLC
Published: 2017-12
Volume: 17
Issue: 1
Pages: 180-180
ISSN: 1472-6947 (ISSN-L)
DOI: 10.1186/s12911-017-0576-4
PMC: PMC5745591
OpenAlex: W2778428211
Cited by: 77
References: 60
Citations by year: 2026: 1 · 2025: 5 · 2024: 5 · 2023: 13 · 2022: 15 · 2021: 15 · 2020: 18 · 2019: 4 · 2018: 1
FWCI: 5.90
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders: Research Center on Healthcare and Services in Primary Care of Laval University (CERSSPL-UL)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Social Sciences › Demography › Technology Use by Older Adults
Keywords: telehealth utilization, telehealth implementation, multilevel determinants, digital health services, health care governance, outpatient visits
MeSH terms: Hospitals, Humans, Norway, Registries, Telemedicine

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

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