Telehealth in a post-Katrina Gulf Coast - An ethnographic study

BACKGROUND. Since 2005, the Regional Coordinating Center for Hurricane Response (RCC) has engaged multiple collaborative partners, including the University of South Alabama (USA) towards developing autonomous and sustainable telehealth (TH) delivery models, with a focus on mental health services. To date, these models demonstrate varying levels of maturity and success. OBJECTIVE. This study sought to identify the processes and strategies, which led to successful TH engagement, implementation, and operation. This study also sought to identify barriers impacting TH success. METHODS. This qualitative, ethnographic study identified TH Key Informants (KI) among regulators, advocates, program administrators, technology experts, mental health providers and support personnel. Transcripts of recorded interviews were independently coded by three researchers using qualitative analysis software. Subsequent analyst discussions led to consensus in the interpretation of each transcribed interview. Results were summarized and returned to KI for validation. RESULTS. The 37 KI participants identified eight major elements and 20 key areas critical to TH development, as follows: funding (sources, sustainability), policy and regulation (reimbursement, licensure, liability), organizational workflow (policies, procedures, scheduling), administrator and staff attitudes (“Buy-in”, need for “champions” that convey enthusiasm and interest to staff), staffing (recruitment, training, appropriate time allocation), technology (hardware, connectivity, support), patient issues (comfort with technology, quality of service), and evaluation (metrics, methodology) CONCLUSIONS. Successful implementation of TH programs hinges on administrative commitment, adequate support, effective operational guidelines, appropriate implementation, and buy-in from all stakeholders.