THE UNIVERSITY OF NORTHERN VIRGINIA HECA 553 – Special topics in Health Care Administration INSTRUCTOR – JUDE E. EDWARD, D. B. A. From: Milind Raval (ID-108 00 1235) TELEMEDICINE USAGE IN FRANCE AND THE U. S: AN EXPLORATORY INVESTIGATION USING THE TECHNOLOGY ACCEPTANCE MODEL 1. INTRODUCTION Today, telemedicine has made many advances around the world. Different countries have continued steady approach to telemedicine like Canada, U. K. , France, and USA. Key aspect of telemedicine is the use of electronic signals to transfer information from one site to another.

When medical care was limited to the radius in which the physician was available to deliver medical services, telephone became vehicle for healthcare service delivery. Radio also enabled during WW1, WW2, Korea & Vietnam. Outline of the case study: a) Definitions. b) Technology Acceptance Model (TAM). c) Overview of the France healthcare system. d) The U. S. healthcare system. e) Trends and future. f) Conclusion and areas of further research. g) References. 2. BODY/ANALYSIS/DISCUSSION a) Definitions

The following are some of the key definitions and terms used in this article. Tele-Health, Tele-Medicine, Teaching and Education, Tele-Medicine Information, Hospital Primary Care Networks, E-Readiness, Hard Technologies, Information Communication Technologies Infrastructure, Technology Adaptation, Technology Adoption, Transportation Modality. b) Technology Acceptance Model (TAM) The Technology Acceptance Model (TAM) (Davis, 1986, 1989) is an adaptation of the Theory of Reasoned Action (TRA) (Fishbein and Ajzen, 1975; Ajzen and Fishbein, 1980).

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Initially Telemedicine, may be determined or measured by the End-Users’ willingness to embrace and utilize a new or adaptation of existing technologies for specific application to telemedicine, in preference to an old technology (Davis, 1989). And later on focusing on a number of inter- and extra-organizational variables, Igbaria, Zinatelli, Cragg, and Cavaye (1997) made a number of interesting discoveries relative to computing utilization. For them the external components were (a) internal computing support, (b) internal computing training, (c) management support, (d) external computing support, and (e) external computing training. ) Overview of the France healthcare system Modern France has one of the“universal” health care systems in the world and is a leader among European nations. It offers a “high quality services and is easily accessible at the same time”. In France, every employed individual, regardless of the level of employment, is covered by a national health insurance plan known as securite sociale (Social Security). The French health care system is mainly financed by social insurance but there is also a significant supplementary insurance. C. 1 Telemedicine Systems in France

During the 1960’s, France experienced significant growth in the use of telephone and radiophone consultations for health care purposes. This growth led to the creation of the SAMU (Service d? Aide Medical d? Urgence) in 1968 and the SAMUR (Service Mobile d? Urgence et Reanimation), which represented important milestones in the history of telemedicine in France. Since the late 1990’s to date, France, being one of the co-founder of the European Community, implemented a number of programs that have catapulted France into the forefront of Telemedicine, not only in Europe but worldwide.

France has taken many steps to extend telemedicine applications. Given all that France has accomplished in the area of Telemedicine, it is inconceivable that further advancements will be tempered only by advances in medical technology. d) The U. S. healthcare system. Perhaps, driven by the “market-oriented economy of the U. S. , the U. S health Care System is a “blend of public and private involvement in the delivery of health care services” (Shi and Singh, 2004). The health care system in the U.

S is financed through (1) Voluntary payers – for those who can afford to pay for health care services; (2) A Multi-payer system that includes premiums or general taxes. At this level there are health care insurance services that provide coverage for most employees and their immediate dependants; and (3) Government sponsored (Medicare and Medicaid) – where many that are “under-insured” or “un-insured” rely mainly on this netting to cover basic health care services. D. 1 Telemedicine Systems in the U. S.

In the 1970’s telemedicine received a tremendous boost from manned space-flight program when Lockheed Missile and Space (now Lockheed Martin) and National Aeronautics and Space Administration (NASA) doctors demonstrated that they provide health care services to people with severe health problems, but who had difficulties accessing health care services. In 1990, Maritime Health Services (MHS), based in Seattle, Washington, initiated a program that allowed medical officers on board fishing trawlers to communicate directly with shore-based physicians as needed, around the clock (Zundel, 1996).

However there are three basic areas of telemedicine that are worthy listing: (a) NASA’s Telemedicine applications with terrestrial based applications; (b) Telemedicine application in Disaster Response; and (c) Telemedicine in the area of Home Health Care. 3. YOUR THOUGHTS & RECOMMENDATIONS As per our article, French has better telemedicine service than USA because French takes short time to approval of new technology and USA more focus on efficacy of device while French focus on safety.

In rural area of USA, telecommunication and information infrastructure is requiring for success delivery of telemedicine, Georgia State is best example of that. So, in USA, try to make fast approval of new medical device and technology. Also, some other recommendations are * Teaching health care professionals using appropriate telecommunication systems * Research designed with a view to harmonize training schemes or research programs for telemedicine * Raise the special fund to develop telemedicine * Develop better communication network in rural area and teach people how to use them. Telemedicine is best way to transfer medical service in rural area and isolated communities. * Connect all hospitals and allow to access each other patient’s treatment 4. AREAS OF ADDITIONAL RESEARCH Use of Telemedicine as an extension of a doctor’s medical practice is more readily accepted in France, where there are no credentialing issues. A doctor may physically be located in Paris while he remotely guides surgical procedures in other parts of France without having to acquire appropriate credentials in that remote area. Credentialing of civilian health care personnel is easily overcome. Further research is necessary in this area.

France, and Europe in general, will continue to make greater strides in the deploying telemedicine application more than the U. S. due in part to the shorter time it takes to approve medical technologies. Further research is necessary in this area. 5. REFERENCES Ajzen, Icek and Fishbein, Martin, Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research, Addison-Wesley, Reading, Massachusetts, 1975. Ajzen, Icek and Fishbein, Martin, Understanding Attitudes and Predicting Social Behavior, Prentice-Hall,Inc. , Englewood Cliffs, NJ, 1980. Asia-Pacific Economic Corporation (APEC) Readiness Initiative (2001).

E-commerce readiness Assessment Guide; www. wcommerce. gov/apec Buchmueller, Thomas C. , and Couffinhal, A, Private Health Insurance in France; Unclassified Organisation de Cooperation et de Developpement Economiques ; Organisation for Economic Co-operation and Development, Mar-2004 Bahloul, Marie-FranAoise and Laly, S. , Medical Teleconsultation in french guiana a first for France CNES and Cayenne Hospital sign national agreement; June, 2001; Centre National d’Etudes Spatiales (CNES) : http://www. spaceref. com/news/viewpr. html? pid=5388 Cloutier, Alain, “Telehealth and Canada: A Good Fit”, Telemedicine Journal and eHealth, Vol.

X (1), 2004, 1-2. Davis, Fred D. A Technology Acceptance Model for Empirically Testing New End-User, Information System: Theory and Results”, Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Mass. , 1986. Davis, Fred D. , “Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology”. MIS Quarterly, Vol. XIII (3), 1989, 319 – 340. Garshnek, Victoria. and Burkle, Frederick M, “Telemedicine Applied to Disaster Medicine and Humanitarian Responses History and Future”. Proceedings of the 32nd Hawaii International Conference on Systems Science, 1999


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