Table 3.

Key Themes and Representative Quotes from Physicians Regarding Perceived Usefulness and Ease of Use, Attitudes, Behavioral Intention to Use, and Future Recommendations for Using the Prototype Model System for Teleconsultation in Disaster Settings

THEME	REPRESENTATIVE QUOTES FROM PHYSICIANS
Usefulness
Access to teleconsultants can enhance bedside physician capabilities	“…the framework has enormous capability to add to my abilities, it's just great to have back up and expertise available” “…how quickly you connected with a consultant in something that is not your specialty, and you didn't have locally available was huge” “It would make me feel a little more comfortable that I wasn't grossly mis-stepping…in territory that I'm not familiar with.” “it's great to have that wider network available” “I found it most useful in the burn case out of all the cases because of the procedural piece of it.”
Video can enhance peer-to-peer interaction	“I was almost equally comfortable with the consultation being by telemedicine than in person.” “…the information was communicated very well back and forth” “it did seem really easy to communicate” “I'm not sure the best way of how to show the person on the other end of the line what's going on.” “Overall, it worked pretty well, and I felt like I was able to interact with the consultants and ask questions”
Video can interfere with bedside provider-to-patient interaction	“Technology treats my patient more as the museum objects to be displayed rather than interacting well with my patient” “I'm focusing more on the consultant than I am with what's going on with my patient” “…a little distracting from the clinical work” “Sometimes there's things that you want to say but don't want to panic the patient”
Video was necessary for remote procedural guidance	“I was instructing my colleague to actually go deeper with the escharotomy, and that sort of stuff can only be done with the video, moving images.” “…the images [are] key” “…quality was perfectly acceptable to do anything I need to do as a Senior Burn Surgeon shy of remotely operating instruments with telesurgery” “…the video was essential”
Ease of use
System was simple and easy to learn	“One of the challenges of these devices and interfaces is that you don't use it all the time, that you don't have the familiarity with it in a crisis situation” “It was very easy and intuitive to use” “…felt remarkably smooth given that complexity” “Reconnecting was easy” “there's a lot of things that, in a disaster situation, are not things that should be taking cognitive load” “It seemed like there was an enormous amount of complexity on the backend, which was not visible to me as frontline provider which is good. It's great that those aren't things I need to worry about so much”
Mobile, hands-free interface is preferred	“I like the mobility” “…having the ability to move around the different angles of the patient” “For extended conversations, it'd be nice to be able to do something else with my hands. Because if I'm holding it, I'm also focusing more on the consultant than I am with what's going on with my patient in case they start to decompensate” “there's a question about what you do for protective equipment and contamination, especially in a room [with] severe contact precautions” “The small size of the iPad itself, I don't know if that's considered as both a blessing and a curse”
Attitudes and behavioral intention to use
User attitudes and future intention to use	“I think it's critical and compulsory. I think that we have nowhere to turn, but to harness this.” “I think this is wonderful and I'd be an enthusiastic participant” “…I was actually pleasantly surprised.”
Recommendations for future use
Telehealth coordinator role needs clarification	“I'm unsure how much information to give to the coordinator” “More of an introduction, explain the roles, like I'm going to connect you with a consultant” “…a little bit more triage ability and knowing sort of the best way to use the resources would be helpful”
Estimating wait times could improve efficiency	“…if it's possible to have an estimate of how long you're going to be waiting for that. I could see that being a stressor in real time, in real life. Do you sit by the iPad or do you go see your next three patients?” “…some kind of estimate on time…”
Bandwidth sparing strategies are needed	“…bandwidth being a lot smaller and a lot more limiting. So again, having the option of just talking on a phone might be a way to free up some of that bandwidth when you don't need the video piece.” “…losing the video images and then going to still images and then losing the still images and still having the audio in the same platform, so to have some built-in graceful degradation would be very sensible” “I hope…under…austere conditions of a mass casualty with restriction in communications, that the bandwidth issue is not going to make this degree of quality not doable”
Interface audio/video quality should be improved	“It would be better to have higher resolution imaging capability” “I was only hearing about every, probably 50% of the words. The audio was in and out” “There were a couple times that I couldn't understand the physician” “It would be so great if there was some way to split the screen so that I see the monitor throughout the assessments.”