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RPM) for the Care of Senior Population Portland State University PDXScholar Dissertations and Theses Dissertations and Theses 7-17-2020 Exploring Policies and Strategies for the Diffusion of Remote Patient Monitoring (RPM) for the Care of Senior Population Hamad Asri Alanazi Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the Engineering Commons Let us know how access to this document benefits ou.y Recommended Citation Alanazi, Hamad Asri, "Exploring Policies and Strategies for the Diffusion of Remote Patient Monitoring (RPM) for the Care of Senior Population" (2020). Dissertations and Theses. Paper 5505. https://doi.org/10.15760/etd.7379 This Dissertation is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. Exploring Policies and Strategies for the Diffusion of Remote Patient Monitoring (RPM) for the Care of Senior Population by Hamad Asri Alanazi A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Technology Management Dissertation Committee: Tugrul U. Daim, Chair David Sibell Ramin Neshati Robert R. Harmon Portland State University 2020 Abstract Telemedicine offers great promise in addressing some of the healthcare challenges such as the increase of healthcare expenditure, a growing population and a projected physician shortage; telemedicine is increasingly being included in the discussion of medicine’s future. Telemedicine offers the capabilities to deliver healthcare across distances at reduced costs while maintaining or even increasing the quality of treatment and services. The objective of this research is to develop a model to evaluate alternative solutions to increase the adoption of RPM for the senior population. Also, the research provides a systematic approach for a comprehensive assessment of teleconsultation adoption, develop a decision model to assess the effectiveness of telemedicine policy targeted to increase teleconsultation adoption, evaluate and prioritize current teleconsultation adoption barriers and measure their relative contribution to this adoption, and evaluate and prioritize the alternative solutions and measure their relative contribution to this adoption. Criteria used in this assessment depend on four perspectives that are perceived by decision makers as important for the adoption process. These perspectives are: financial, technical, logistical, and cultural. The research implemented the hierarchical decision model (HDM) to construct a generalized adoption assessment framework. The HDM is used in order to measure the teleconsultation adoption barriers limiting its advantages, and to identify the best alternatives to help its diffusion. i Experts’ qualitative judgments were collected and quantified using the pair- wise comparison method. The final rankings and effectiveness of alternative solutions with respect to the mission were identified. The results of this research identified financial barriers as the most influential perspective and that standard processes for reimbursement and multi-state license for telemedicine are the two most effective criteria to accomplish that. The research also applied sensitivity analysis and scenario analysis to identify the effect of perspectives on priority changes on determining the most effective alternative for this perspective. The results showed that standard processes for reimbursement and multi-state license for telemedicine were found to be the two most effective alternatives among the alternative solutions. The research model and outcome can serve as a roadmap in the adoption of teleconsultation or any type of telemedicine. Based on the overall research findings, decision makers can apply specific alternative instruments to support adoption efforts for any given scenario and perspectives emphasis. ii Dedication The memory of my parents To my brothers Salem Farhan, and Mohammed; and my four sisters who believed in me and encouraged me without you all, I would never be here. To my wonderful wife, Nadiyah, who stood by my side for bad and for good and supported me. To my lovely children, Abdulaziz, Abdulrahman, Watan, Saud, and Lina, who were the perfect children that anyone could wish for. iii Acknowledgements I sincerely acknowledge the many individuals who have provided motivation, encouragement, and guidance throughout this research effort. I would like to express my gratitude to my advisor, Professor Tugrul U. Daim for his guidance, mentorship, patience, understanding, and encouragement in the challenges of this research process. He has always been there with valuable insights which played a significant role in my Ph.D. journey. I would like to express my deep appreciation to my dissertation committee members, Dr. David Sibell, Dr. Ramin Neshati, and Dr. Robert R. Harmon for their constructive suggestions and continuous support over the past years as I moved from the research idea to completed research. I would like to thank all faculty members, staff, and friends in the department of Engineering and Technology Management (ETM) who had been like my second family during the years I spent here. I would like to thank all of the research participants and experts for their time and effort spent on the questionnaires and feedback. I would like to express my heartfelt gratitude for, my driving force, my brothers Salem, Farhan, and Mohammed; and my four sisters, and without their help, support, and encouragement I will not complete my Ph.D. journey. iv I believe that words not enough to express my great gratitude for the role and help of my lovely wife, Nadiyah during my Ph.D. research. I am especially indebted to her for being extremely understanding, supporting me patiently, and raising our lovely Children, Abdulaziz, Abdulrahman, Watan, Saud, and Lina, without enough help from me during years of my studies and hardship. Her unconditional support fueled my success. v TABLE OF CONTENTS ABSTRACT................................................................................................................... iI DEDICATION ........................................................................................................... IIIiii ACKNOWLEDGEMENTS ........................................................................................ IViv LIST OF TABLES ...................................................................................................... XIxi LIST OF FIGURES ................................................................................................. XIIIxiii CHAPTER 1: INTRODUCTION ................................................................................. 1 1.1 The Increase of Health Expenditure ................................................................. 2 1.2 A Growing United States Population ................................................................ 3 1.3 A Projected Physician Shortage ........................................................................ 4 2 CHAPTER 2: LITERATURE REVIEW ............................................................. 6 2.1 Health Information Technology (HIT). ............................................................ 6 2.2 Cultural Change in Healthcare Industry ........................................................ 14 2.3 Telemedicine .................................................................................................... 17 2.3.1 Definition of Telemedicine ............................................................................ 18 2.3.2 History of Telemedicine ................................................................................ 19 2.3.3 Types of Telemedicine ................................................................................... 23 2.3.4 Modes of Operation ....................................................................................... 25 2.3.5 Delivery Mediums ......................................................................................... 26 2.3.6 Telemedicine applications .............................................................................. 27 2.4 Teleconsultation ............................................................................................... 29 2.4.1 Types of Teleconsultation .............................................................................. 30 2.4.2 Advantages of Teleconsultation ..................................................................... 32 2.4.3 Teleconsultation for older patients ................................................................. 33 2.4.4 Teleconsultation Technology ......................................................................... 35 2.4.5 Remote Patient Monitoring (RPM) for older patients ..................................... 46 2.5 Successful Telemedicine Applications ............................................................. 50 2.5.1 Teleradiology................................................................................................. 50 2.5.2 Home Care .................................................................................................... 52 vi 2.5.3 Health Care for Prisoners ............................................................................... 53 2.5.4 Rural Telepsychiatry ...................................................................................... 54 2.5.5 Postsurgical Intensive care in an Urban Nursing Home
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