Table S1.

Telemedicine quality attributes and definitions

Research team attribute	Practitioner team attribute	Definition
Technology (system) quality
Reliability	Reliability	The degree to which medical video conferencing equipment consistently connects and functions as designed.
Usefulness	Provider acceptance also part of usefulness (effective)	The degree to which, in general, stakeholders believe telemedicine devices function as intended and provide features (eg, camera freeze frame capability, wireless remote controls for cameras, and camera controls at the consultation site) that contribute to patient care in a clinical environment. This is a general perception that the equipment is effective for patient care and appropriate to the medical context.
Peripheral sophistication	Not detailed in equipment design	The degree to which technology that allows the extension of basic medical video conferencing equipment to specialized medical situations is available. Peripheral devices include electronic stethoscope, dermatology camera, retinal camera, nasopharyngoscope, and electronic electrocardiogram.
Performance	Not detailed in equipment design	The degree to which the telemedicine technology provides timely response to external stimuli to minimize delayed transmissions (eg, codec responsiveness to provide real-time delivery). Additionally, the speed of cameras to auto-focus and auto-iris (light adjustment) to suitable levels of image quality and the responsiveness of other input devices (eg, touch pads).
Ergonomic design	Not detailed in equipment design	The degree to which the technology is designed in a manner that affords ease in maneuvering and navigating medical video conferencing system equipment. Refers to the physical design of the equipment (eg, not bulky, accommodates hand span, not uncomfortable to use).
Affordability	Part of usefulness (efficiency)	The degree to which medical video conferencing provides a net positive relationship between the functional benefits of medical video conferencing and the resources (time, money, and space) consumed by the effort. Affordability issues include equipment costs, transmission costs, and patient reimbursement.
Information quality dimension
Audio clarity	Audio quality	The degree to which the technology provides sound quality comparable to similar communications occurring with all parties in one location. The distinctness of sound is compromised by choppy or muffled sound.
Image resolution	Image resolution	The degree to which the technology provides image resolution fidelity and precision for each still image. Image resolution quality is determined by the resolution of the camera receiving the image and the monitor projecting the image.
System feedback to patient	Appears to be part of equipment design definition	The degree to which the patient receives indicators from the technology that patient information was successfully received by the consulting doctor (eg, picture in picture on monitor feature used).
Motion handling	Motion handling	The degree to which the technology provides image refreshing at a rate that depicts comparatively real-time movement. Motion handling involves a smooth transition as images are updated. Motion handling quality is determined by the amount of pixelation, motion artifacts, and frame dropping that occurs during an encounter.
Adequate lighting	Lighting	The degree to which the amount and direction of lighting is appropriate to illuminating the patient examined and the physician at the consulting site without causing inappropriate shadows or discoloration.
Quiet/soundproof	Part of room design	The degree to which the acoustical environment provides sound control (ie, minimal noise interference) to improve both audio clarity and privacy in both the exam room and physician consulting room.
Support (service) quality
Scheduling support	Scheduling	The degree to which interactions between the scheduler and the multiple stakeholders facilitate integrating the schedules of multiple stakeholders (eg, patients, clinicians, technical staff). This implies the scheduler strives for efficiency in setting sequential appointments for clinicians. It also implies that the patient is apprised that they will have a telemedicine rather than in in-person encounter.
Patient education/telemedicine orientation	Orientation	The degree to which preliminary interaction occurs between the patient and a medical representative with the goal of facilitating patient comfort and understanding.
Privacy	Part of room design	The degree to which the exam room and physician consulting room are inaccessible to walk-in intrusion and visual or audible intrusion from walk-by traffic.
Technical support	Technical support	The degree to which interactions between medical video conferencing equipment operators and technology support personnel allow offloading technical issues from the clinician(s) to technology workers.
Suitable temperature	Part of room design	The degree to which the temperature accommodates both the equipment and patient comfort.
Facilitating décor	Room design	The degree to which the furnishings and other aspects of décor facilitate participant comfort in using the technology and in communicating during the encounter.
Use quality
Accommodates focus on primary objectives (patient care)	Not specifically addressed, but acknowledged the slips in this attribute were appropriate	The degree to which the technology permits the medical care provider to focus on patient care, rather than figuring out technology. The technology should not distract the provider (eg, doctor) and the consumer (eg, patient) from the tasks necessary to fulfill the objectives of the encounter. In essence, the equipment is subordinate to the exam process; it is merely a tool, not the focus.
Consultant telepresence	Telepresence	The degree to which the remote consultant is able to convey a ubiquitous, virtual presence (eg, eye contact, warm atmosphere, congenial atmosphere, interactive atmosphere). Telepresence may be thought of as “virtual bedside manner”.
Trained staff	Technical training	The degree to which users are able to operate equipment and understand the functions to facilitate the different clinical exams after a limited formal or informal initial learning period. Initial learning is supported by follow-up practice.
Medical team coordination	Caregivers’ relationship with each other and team presence	The extent to which the consulting doctor and other medical staff involved in the encounter work together like a team in conducting the telemedicine exam.
Clear future directives	Follow-up and end of visit instructions	The extent to which the consulting doctor instructs the patient regarding what to do after the encounter is over. Clear future directives include such things as medical instructions, who to contact in the future, will there be another telemedicine exam, will there be an in-person exam, and a status summary at the end of the encounter.
Conveys access/review of medical records	Records – practitioners agreed it was really the assurance that providers had reviewed records rather than just physically having the records	The extent to which the consulting doctor indicates to the patient that he/she has reviewed the patient’s records and has access to the records during the encounter.
Professionalism (clinician in patient room)	Qualifications	The extent to which the medical person in the room with the patient (eg, nurse practitioner) is professional and courteous toward the patient.
Mix with in-person exams	First visit in person	The degree to which relationship building and other data gathering during in-person meetings is needed to provide a necessary foundation for telemedicine encounter communications. The medical providers should assess the need for in-person meetings. The need may range from no meetings in person, only the first meeting in person, to intermittent in-person meetings.