Table 3.

Design Elements of Telemedicine Potentially Enhancing Impact on Patients and Families

DOMAIN	DEFINITION	QUOTES
Technology
Quality of technology	Ability of the technology to transmit high-quality images and sound	I'd want to know that their video technology is … advanced enough … the images they're seeing aren't those crackled, grainy pictures; that they're getting a very clear picture.
Reliability of technology	Consistency with which the technology is available and functioning	Something not going through, or, you know, just having difficulty with technology maybe not cooperating in your favor on a given day, like the Wi-Fi is down, or something like that.
Privacy of technology	Security and confidentiality of transmissions	I think probably the same thing most parents would want to know: how secure is the line?
Policies/protocols
Timeliness	Timeliness of telemedicine visit; timeliness of communication about scheduling telemedicine visit	And I'll schedule an appointment, and it will be for a week or so down the line, you know, if they can—“The soonest we can get you in is in a week.” I would have loved to have been able to connect—like, even if it's like a FaceTime, or something like that—through videoconferencing.
		That you get a response quickly.
Transparency of processes	Availability of information about scheduling processes, workflow processes, continuity	What their response time is going to be, how fast are they going to get back to me? Like I could even see avoiding an emergency room visit.
Access without travel	Ability to connect at home or work	To just be able to say, “Hey, here's very quick. [name]'s in bed. You know, I can take you up to see her, and this is what's going on. What do you think we should do?” I would have loved to have been able to do that.
Reliability of processes	Confidence that care (including prescriptions, follow-up tasks) will be completed during visit	I mean what all you have to go through to be able to do it. … It's like the Internet stuff just isn't well for me … because me doing all the online or the over the phone, stuff sometimes don't get done.
Guidelines for when to use	Clarity of indications for using telemedicine	I think outlining the parameters and letting people know … what that type of technology would be used for is huge. So if I could go on [hospital web]site and think, say, ok, my child needs to see, I want to switch over to their endocrinology department, let's say. What is acceptable to be using the videoconferencing versus what is expected as an office visit?
Continuity with provider	Ability to connect with usual subspecialist or usual team	Is it going to be our doctor who knows our son's game plan or is it going to be a resident who's like having a fun day figuring things out?
Cost	Costs to the patient/family	I would be worried about if it would be … like the cost of it and if it was covered by insurance.
Culture
Subspecialist buy-in	Subspecialist commitment to making telemedicine available	I would want to know that that particular specialist or doctor or whoever was 100 percent on board with that because I wouldn't want to say, “Oh, yeah, this is great,” and we'll go all into it and be all for it and sign up for it, and then have a particular doctor that's just not really into it, not really keeping with it, and not, you know…kind of like false hope. So if it's something that will be put in place, then it should be something that all the doctors are very hands on with and actually use and implement in their care with the parents and everything.
Patient/parent choice	Ability of parent/patient to continue in-person care when preferred	I would like to think that this is something that is going to be a part of the care, not is going to become the norm. So that would bother me, because I think it's still important to be able to have that option to come in and have your child seen, versus, “Oh, I think if we just do a conference call we're fine.” I don't, I'd like to see, you know—I don't know. That would just be a concern of mine.