Chronic illnesses associated with aging are one of the greatest issues in our modem society. Moreover, the rising cost of medical and health care expenses caused by chronic illnesses is a burden to both individuals and nations alike. One innovative method being discussed to reduce rising medical and healthcare costs, telemedicine service, has been rapidly growing for the past 10 years in South Korea. Telemedicine service has the latent potential to enhance the efficiency, safety, and quality of treating patients.
Telemedicine service in South Korea initially started as a pilot project by Seoul National University Hospital and Yeoncheon-gun Healthcare Center in 1988. Since then, many university hospitals have conducted telemedicine projects with governmental support. Diverse numbers of other related projects have been carried out in the public sector beginning in 2006. However, the acceptance of telemedicine service in real healthcare settings has been slow in South Korea. Telemedicine service has been faced with many challenges, which have made it difficult for a full-scale market to form.
In this dissertation, several approaches are adopted to explore this issue. The first approach investigates the development of a Telemedicine Service Acceptance Model for physicians by extending the Technology Acceptance Model with inclusion of new constructs: the individual, regulatory, and clinical factors. The structural equation modeling technique is used to evaluate the empirical validity and causal relationship of the model, which uses data collected from a survey from 183 physicians. The results indicate that the perceived usefulness directly impacts the behavioral intention to use the service, and the perceived ease of use directly impacts both the perceived usefulness and the behavioral intention to use. In addition, perceived incentive shows to be directly related with the behavioral intention to use. Individual factors, such as self-efficacy, have a significant positive impact on the perceived ease of use. The accessibility of medical records, as a clinical factor, directly impacts the perceived usefulness. The first approach is able to demonstrate that the newly developed model can feasibly explain the adoption patterns of telemedicine services. The results offer both implications and recommendations to motivate telemedicine service acceptance by physicians.
The second approach investigates the development of a Telemedicine Service Acceptance Model for chronically ill patients based on the unified theory of acceptance and use of technology (UTAUT), the innovation diffusion theory (IDT), and perceived risk theory. Data collected from a survey of 118 chronically ill patients is analyzed using partial least squares (PLS). The results indicate that compatibility and demonstrability of the results for individual factors directly have effects on the performance expectancy. This result confirms that, to chronically ill patients, it is important to deliver service outcomes to telemedicine providers or others after using the service. This study reveals the performance expectancy as a second-order constructs, including: clinical quality improvement, clinical accessibility and clinical intimacy improvement. Our results confirm that there is a causal relationship between the effort expectancy and performance expectancy. The results indicate that the social influence conditions are revealed as implementation factors that have positive effects on the behavioral intentions to use. The second approach does not reveal any evidence supporting the importance of facilitating conditions in telemedicine service. Finally, the second approach shows that chronically ill patients separately perceived risks related to technology, providers, and services. However, it is revealed that only the perceived provider risk has an impact on clinical performance expectancy. The second approach is able to provide a realistic implication by deriving a variable that explains the peculiarity of the medical environment and verifies that the newly drawn model is fit for the level of telemedicine service development in South Korea. Moreover, it can provide a useful model for other countries where telemedicine service levels have the same development rate as South Korea.
The last approach looks into the health lifestyle pattern of consumers with chronic illness and healthy people over the age of 40. The last approach attempts to propose a customized service strategy to increase telemedicine service usage. Association rule mining and rule induction method (C5.0) are used as the analysis methods for the last approach. Two analysis results are compared, analyzed and integrated in order to derive customized service patterns. From the results, the last approach draws six rules. The health lifestyles of chronically ill patients can be divided into three types: taste-seeking style, exercise-seeking style and meal-managing style. The healthy people group also can be divided into three types: heavy-drinker style, exercise-managing style and wellbeing-oriented style.
The last approach can provide understanding and insight of consumers and derives a core strategic rule. Moreover, the last approach can provide a practical guideline for the design and development of a service model for telemedicine service created by service providers and policy makers.