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Cited by 38Telemedicine and Telehealth ImplementationDental Research and COVID-19Healthcare during COVID-19 Pandemic

Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study

Open access
Liu, Jialin, Liu, Siru, Zheng, Tao, Bi, Yongdong·2021·JMIR Medical Informatics
DOI 10.2196/26463PMC PMC8171288

Published version of a preprint

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Abstract

Background: Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non–COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. Objective: The purpose of this study was to understand physicians’ attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. Methods: We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. Results: Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents’ hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. Conclusions: Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 2020 survey of 129 Chinese physicians enrolled in a clinical informatics PhD program, most hospitals had telemedicine systems but physicians used them infrequently, while willingness to use telemedicine during and after COVID-19 was high. The main concern and barrier was the inability to perform an in-person physical examination.

Key findings

  • Among 148 surveyed physicians, 129 responded (87.2%); mean age was 35.6 (SD 3.9) years and 51.9% (67/129) were female. A total of 94.6% (122/129) of respondents’ hospitals had adopted telemedicine, but 34.1% (44/129) had never used it and only 9.3% (12/129) used it frequently (≥1 time/week).
  • Willingness to use telemedicine was high: 91.5% (118/129) during the COVID-19 pandemic and 88.4% (114/129) after it; 60.5% (78/129) considered telemedicine suitable for their specialty during the pandemic.
  • The biggest concern was inability to complete an in-person physical examination (101/129, 78.3%), and 58.9% (76/129) agreed that inability to examine patients would hinder clinical decision making. Other concerns included poor communication with patients (32/129, 24.8%), unstable telemedicine systems (30/129, 23.3%), and no assurance of patient medical safety (23/129, 17.8%).
  • In open-ended comments from 127/129 respondents, barriers included inability to examine patients personally (48/127, 37.8%), insufficient infrastructure (40/127, 31.5%), and patient data quality issues (28/127, 22.1%); the most cited incentive was performance measures (60/127, 47.2%).

Methods

  • A qualitative survey study conducted from October 17 to 25, 2020, surveying all 148 physicians attending the clinical informatics PhD program at West China Medical School, Sichuan University, China. Respondents came from 57 hospitals in 16 provinces; 54 were 3A-level, two 3B-level, and one 2A-level.
  • The questionnaire had three sections: demographic/clinical characteristics, 7-point Likert-scale statements on telemedicine perspectives and usage, and open-ended questions. It was administered face-to-face after physicians spent more than 3 hours on telemedicine coursework.
  • Open-ended responses were analyzed by qualitative content analysis with independent review by two reviewers and adjudication by a third. Likert responses were summarized as percentages and means with SDs; P values were calculated for specialty differences in usability and willingness, with two-sided P≤.01 considered significant.

Limitations

  • The paper states respondent bias inherent to survey-based studies; the survey included only Chinese physicians, so incentive effects may differ in other countries due to cultural differences; and the limited sample size and descriptive design may not reflect all physicians in each hospital.
  • The paper also notes difficulty in collecting opinions through large random sampling because of limited telemedicine use and knowledge among general physicians, and that participants were clinical informatics PhD physicians, mostly involved with hospital management, younger (23–48 years), from highest-level hospitals, and more familiar with telemedicine and digital technology.
  • Evident from the text: this was a convenience sample of physicians in one PhD program, not a representative sample of Chinese physicians; several specialty analyses had very small subsamples (e.g., n=5), and the study reports attitudes and associations rather than causal effects.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/26463

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 38 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    32% (27/85) of physicians believed that telemedicine had a decision support system.

    “A total of 32% (27/85) of physicians believed that telemedicine had a decision support system (Table 2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    91.5% (118/129) of respondents would be willing to adopt telemedicine during the COVID-19 pandemic (mean 5.7, SD 1.02).

    “A total of 91.5% (118/129) of respondents would be willing to adopt telemedicine during the COVID-19 pandemic (mean 5.7, SD 1.02).”
    • Also stated in: § Results · plain
      “A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively.”
    Quote in the paperSubstantial claim
  • Findingown data

    45.0% (58/129) of physicians used a telemedicine system occasionally (≤1 time/month).

    “45.0% (58/129) used one occasionally (≤1 time/month)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Only 9.3% (12/129) of physicians used a telemedicine system frequently (≥1 time/week).

    “only 9.3% (12/129) used one frequently (≥1 time/week).”
    • Also stated in: § Current Use of Telemedicine · plain
      “only 9.3% (12/129) used one frequently (≥1 time/week).”
    Quote in the paperNot a substantial claim
  • Findingown data

    94.6% (122/129) of respondents' hospitals had adopted a telemedicine system.

    “A total of 94.6% (122/129) of respondents’ hospitals had adopted a telemedicine system”
    • Also stated in: § Current Use of Telemedicine · plain
      “Among the 129 respondents, 94.6% (122/129) of the respondents’ hospitals adopted a telemedicine system.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 26

  • May combine two claims.

    Findingown data

    Regarding willingness to adopt telemedicine, radiologists had the highest mean score (6.4, SD 0.80) and ophthalmologists had the lowest mean score (4.6, SD 0.49).

    “Regarding willingness to adopt telemedicine, radiologists had the highest mean value (mean 6.4, SD 0.80) and ophthalmologists had the lowest mean value (mean 4.6, SD 0.49).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For each specialty, the P values for differences between usability and willingness scores were greater than .01.

    “For each specialty, we calculated P values to determine the statistical significance of the differences between the scores of usability and willingness (P>.01).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years).

    “The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years)”
    • Also stated in: § Physician Demographics and Characteristics · plain
      “The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the group with telemedicine-appropriate specialties, obstetrics and gynecology had the highest mean suitability score (6.3, SD 0.97) and dermatology had the lowest mean suitability score (4.2, SD 0.75).

    “In the group with telemedicine-appropriate specialties, obstetrics and gynecology had the highest mean value (mean 6.3, SD 0.97) and dermatology had the lowest mean value (mean 4.2, SD 0.75).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    67 of 129 respondents (51.9%) were female.

    “67 out of 129 respondents (51.9%) were female”
    • Also stated in: § Physician Demographics and Characteristics · plain
      “Out of 129 respondents, 67 (51.9%) were females and 62 (48.1%) were males.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Increased telemedicine publicity was suggested as an incentive by 14/127 (11.0%) of commenting physicians.

    “Physicians believed that telemedicine could be promoted through the following incentives: performance measures (60/127, 47.2%), increased telemedicine equipment (22/127, 17.3%), policy support (21/127, 16.5%), financial support (19/127, 15.0%), technical support (18/127, 14.2%), increased training (18/127, 14.2%), and increased telemedicine publicity (14/127, 11.0%) (Table 7).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was approved by the Institutional Review Board at West China Medical School, Sichuan University (IRB17-75).

    “This study was approved by the Institutional Review Board at West China Medical School, Sichuan University (IRB17-75).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Physicians' willingness or unwillingness to use telemedicine is a well-known factor in facilitating or inhibiting telemedicine acceptance.

    “Physicians’ willingness or unwillingness to use telemedicine is a well-known factor in facilitating or inhibiting telemedicine acceptance [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Hospitals can replace some routine medical services with telemedicine to improve the efficiency of their health care system.

    “To better mitigate and manage the spread of COVID-19, hospitals can replace some routine medical services with telemedicine to improve the efficiency of their health care system [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    This study is subject to respondent bias inherent in all survey-based studies.

    “First, this is a survey-based study and is subject to respondent bias inherent in all survey-based studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The challenges to telemedicine may be due to regulation, incentives, training, malpractice insurance, security and confidentiality of patient data, and telemedicine technology.

    “These challenges may be due to regulation, incentives involving telemedicine, effective telemedicine training, malpractice insurance coverage for telemedicine, security and confidentiality of patient data, and telemedicine technology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The questionnaire was derived from the literature on telemedicine satisfaction and experts in telemedicine.

    “The questionnaire was derived from the literature on telemedicine satisfaction and experts in telemedicine [23-28].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [23] source

      Not checked in the free run.

    • cites [24] source

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

    • cites [26] Hu, PJ, 1999, Top Health Inf Manage

      Not checked in the free run.

    • cites [27] source

      Not checked in the free run.

    • cites [28] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The adoption of telemedicine systems depends on physicians' and patients' satisfaction with the use of the telemedicine service.

    “some studies noted that the adoption of telemedicine systems depends on physicians’ and patients’ satisfaction with the use of the telemedicine service [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Remote patient monitoring equipment need to be automatically synchronized to the patient's chart so that physicians can instantly obtain patient data.

    “In order to maximize the benefits of utilizing telemedicine technology, technologies including remote patient monitoring equipment need to be automatically synchronized to the patient’s chart, so that physicians can instantly obtain patient data [47].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The results of the study were confirmed by all researchers in the team.

    “Lastly, the results of the study were confirmed by all researchers in the team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Major health organizations around the world, including the World Health Organization, the US Centers for Disease Control and Prevention, and the American Medical Association, have advocated for the use of telemedicine during the COVID-19 pandemic and have taken steps to promote its use.

    “Major health organizations around the world, including the World Health Organization, the US Centers for Disease Control and Prevention, and the American Medical Association, have advocated for the use of telemedicine during the COVID-19 pandemic and have taken steps to promote its use [17-19].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [17] Healthcare facilities: Managing operations during the COVID-19 pandemicCenters for Disease Control and Prevention20212020-11-26https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html

      Not checked in the free run.

    • cites [18] HarrisPAAMA applauds Medicare telemedicine policy change during pandemicAmerican Medical Association202003172020-11-25https://www.ama-assn.org/press-center/ama-statements/ama-applauds-medicare-telemedicine-policy-change-during-pandemic

      Not checked in the free run.

    • cites [19] Maintaining essential health services: New operational guidance for the COVID-19 contextWorld Health Organization202006012020-11-20https://www.who.int/news/item/01-06-2020-maintaining-essential-health-services-new-operational-guidance-for-the-covid-19-context

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A pilot test of the questionnaire was conducted within the research group.

    “We conducted a pilot test within our research group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Integration of telemedicine with current health system workflows and connection to the electronic health record is an important aspect in the application of telemedicine.

    “An important aspect in the application of telemedicine will be the integration of telemedicine with the current health system workflows and the connection to the electronic health record [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The challenges to telemedicine are in line with the findings of other studies.

    “These are in line with the findings of the other studies [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The COVID-19 pandemic has drastically impacted global health care and dramatically changed the practice of health care.

    “The COVID-19 pandemic has drastically impacted global health care and dramatically changed the practice of health care [1,2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [2] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Free-text answers were summarized and assessed independently by two reviewers using a standardized evaluation process.

    “Free-text answers were summarized and assessed independently by two reviewers using a standardized evaluation process.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Research team members repeatedly and independently read the answer summaries and validated the accuracy and meaning of the contents.

    “The research team members repeatedly and independently read the answer summaries and validated the accuracy and meaning of the contents.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A third reviewer reviewed by adjudication in cases of disagreement.

    “A third reviewer reviewed by adjudication in cases of disagreement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The knowledge and perception of health care professionals affect telemedicine adoption.

    “There are studies that indicate that the knowledge and perception of health care professionals affect telemedicine adoption [34,35].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [34] Ayatollahi, H, 2015, Perspect Health Inf Manag

      Not checked in the free run.

    • cites [35] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The survey was only about Chinese physicians, so incentive effects may differ in other countries due to cultural differences.

    “Second, the survey was only about Chinese physicians. Incentive effects may differ in other countries due to cultural differences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The overall response rate was very high (87.2%) and included a variety of clinical specialties.

    “In addition, the overall response rate was very high (87.2%) and included a variety of clinical specialties.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The relatively younger physicians (23 to 48 years old) from the highest-level hospitals represented those who might be more familiar with telemedicine and digital technology.

    “The relatively younger physicians (23 to 48 years old) from the highest-level hospitals represented those who might be more familiar with telemedicine and digital technology.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is difficult to collect opinions through large random sampling given the limited use of telemedicine in China and the lack of knowledge about telemedicine among general physicians.

    “However, considering the limited use of telemedicine in China and the lack of knowledge about telemedicine among general physicians, it is difficult to collect opinions through large random sampling.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Telemedicine use in China is limited and general physicians lack knowledge about telemedicine.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The responses were collected from 55 hospitals in Eastern, Central, and Western China, representing various clinical subspecialties.

    “The responses were collected from 55 hospitals in Eastern, Central, and Western China, as it was a study representing various clinical subspecialties.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Although telemedicine cannot yet be used universally for all health care needs and cannot fully replace in-person physical examinations, physicians' willingness to use telemedicine was high.

    “The results of this survey indicate that, although telemedicine cannot yet be used universally for all health care needs and cannot fully replace in-person physical examinations, physicians’ willingness to use telemedicine was high.”
    Quote in the paperSubstantial claim
30 of 30

  • The paper relies on this without support.

    Physicians' perspectives on telemedicine visits have not been fully investigated.

    “However, physicians’ perspectives on telemedicine visits have not been fully investigated.”

  • The paper relies on this without support.

    The surveyed physicians had high levels of informatics literacy and a certain understanding of information technology and telemedicine at their hospitals.

    “They had high levels of informatics literacy and a certain understanding of information technology and telemedicine at their hospitals.”

  • The paper relies on this without support.

    The telemedicine training course increased physicians’ awareness of, knowledge about, and attitudes toward telemedicine.

    “The telemedicine training course increased physicians’ awareness of, knowledge about, and attitudes toward telemedicine.”

  • The paper relies on this without support.

    Whether in the learning stage or late in their careers, physicians want to carefully examine each patient personally.

    “Whether in the learning stage or late in their careers, physicians want to carefully examine each patient personally.”

  • The paper relies on this without support.

    The survey questions were inherently pragmatic, and the responses faithfully reflected the physicians’ sentiments.

    “The survey questions we asked were inherently pragmatic, and the responses to these questions faithfully reflected the physicians’ sentiments.”

  • The paper relies on this without support.

    Telemedicine use in China is limited and general physicians lack knowledge about telemedicine.

    “considering the limited use of telemedicine in China and the lack of knowledge about telemedicine among general physicians”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Hospital levels are reversed in Table 1

    Minor

    The results text says that, among the 55 responding hospitals, two were 3B-level and one was 2A-level. Table 1 assigns those counts to the opposite levels.

  • Specialties with five physicians appear despite stated cutoff

    Minor

    The discussion says only specialties with more than five participating physicians were analyzed, but Table 3 includes and analyzes specialties with five, including dermatology.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. 10.4338/aci-2009-12-r-0020 · DOI
  2. HarrisPAAMA applauds Medicare telemedicine policy change during pandemicAmerican Medical Association202003172020-11-25https://www.ama-assn.org/press-center/ama-statements/ama-applauds-medicare-telemedicine-policy-change-during-pandemic
  3. Hu, PJ, 1999, Top Health Inf Manage, 19, 20
  4. 10.1177/1460458219892162 · DOI · Paper page
  5. Ayatollahi, H, 2015, Perspect Health Inf Manag, 12, 1c
  6. 10.2196/16407 · DOI · Paper page
  7. Pong, RW, 2000, Health Law Rev, 9, 3

Cited by

Sorted by citations

Related

Authors
Liu, J., Liu, S., Zheng, T., & Bi, Y.
Affiliations
  • Sichuan University (CN)
  • University of Utah (US)
Corresponding author
Liu, Jialin
ORCID
Venue
JMIR Medical Informatics
Publisher
JMIR Publications Inc.
Published
2021-06-01
Volume
9
Issue
6
Pages
e26463
ISSN
2291-9694 (ISSN-L)
DOI
10.2196/26463
PMC
PMC8171288
OpenAlex
W3158238102
Cited by
38
References
41
Citations by year
2025: 5 · 2024: 8 · 2023: 8 · 2022: 14 · 2021: 3
FWCI
7.15
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Medical Informatics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
  • Physical Sciences › Computer Science › Information Systems › Healthcare during COVID-19 Pandemic
Keywords
telemedicine, COVID-19 pandemic, physician attitudes, telehealth adoption, health system pressure, telehealth reimbursement

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