Author: Matt Waldman


Elena Karahanna
MIS professor Elena Karahanna’s initial interest in telemedicine stemmed from an NBC News report on a startup called Health e-Station that offered doctor consultations via webcam. Her idea earned her a Terry-Sanford Research Award, and the resulting pap

Imagine that you’re on a business trip, and on the eve of a big presentation you get sick. Coming down with fever, a sore throat, or a sinus infection while on the road is not a pleasant thought, but it’s a common occurrence for business travelers. Instead of riding it out and suffering the consequences, imagine you could drive to an all-night clinic at a local shopping center and consult with a physician who could prescribe treatment that might give you immediate physical relief — and save your presentation.

And it could all be handled via webcam.

Until recently, this scenario was a pipe dream. But in the fall of 2006, a first-of-its-kind, walk-in clinic providing telemedicine services opened at a Kroger shopping center in Peachtree City, Ga. When management information systems professor Elena Karahanna came across an NBC News video about Health e-Station, she thought it would make an excellent research study.

Karahanna was right. Her idea earned her a Terry-Sanford Research Award, and the resulting paper co-authored with doctoral student Christina Serrano, “e-Healthcare: An Exploratory Study of Patient Acceptance of Walk-in Telemedicine Services for Minor Conditions,” was accepted by the International Journal of Health Information Systems and Informatics. The research determines what drives a patient’s decision to accept this new health care model and discusses what telemedicine will need to do to remain a viable option in the marketplace.

“One of the success factors for these facilities is patient adoption,” says Karahanna, who explains that despite technological advancements in the U.S. health care industry it trails other service industries when applying information technology to its business practices. “If the customer doesn’t use the service and they don’t adopt it, it’s going under.”

Open weeknights from 4 p.m. to 8:30 a.m. and 24 hours on the weekends, Health e-Station epitomized telemedicine in practice. A trained staff technician used a videoconferencing system to connect with a physician and then, functioning as a stand-in for the physician, performed a physical examination of the patient. Although clinics like Health e-Station are a new way of using telemedicine, the concept actually has a 40-year history in the United States.

“The existing types of telemedicine consultations have been very specialized,” says Serrano, who explained it was reserved for niche areas such as dermatology and psychiatric consults. “It is the move to a retail model of health care that we have seen with vision centers that is very appealing.”

Karahanna and Serrano showed 29 people of various demographic backgrounds an online video about Health e-Station that included a patient examination at the facility and a discussion of its pros and cons. After watching the video they interviewed the people individually to determine their perceptions of the service.

The results indicate that patients would use the service if they feel confident in the accuracy of the diagnosis, cost, convenience, and whether it is covered by their insurance. Concerns include questions about the reliability and security of sending sensitive images and information over the web and the apprehension that the technology isn’t rich enough to transmit auditory, visual, tactile, and olfactory sensory cues.

“One of the issues was that physicians were not reimbursed for their time from insurance companies if they were consulting with patients electronically via the web, through web cameras, or via e-mail,” says Karahanna, who explained that the telemedicine portion of the Health e-Station clinic closed during the study. But since then, several telemedicine centers have sprung up, including six Wal-Mart clinics in Houston. “But now that model has changed and they are now able to get reimbursed.”

According to Serrano, both Cigna and Aetna recently announced they will reimburse physicians for electronic consultations for minor conditions. “That’s even via the web and that is something that has been proliferating. There are web solutions like Relay Health, American Well, and Hello Health that both physicians and patients can use. They log in, describe their symptoms, get matched with a physician, and web chat with them or send e-mails.”

Karahanna and Serrano believe the demand for self-service by a consumer-driven society combined with the advancements in technology may steer health care back to its roots — to a time when physicians came to the patient. The difference is that these contemporary house calls may be handled through web-enabled technology. This back-to-the-future concept for health care might have been nothing more than a passing fascination for Karahanna if it weren’t for the Terry-Sanford Research Award, which provides financial support to research projects with great promise for publication in top academic journals.

“I think it enables people to work on different kinds of projects that they might not have had the time to work on otherwise,” says Karahanna. “And that’s a huge benefit.”