Using Telemedicine in Practice: Implications for Workforce Development




digital health, skills, telemedicine, workforce


The aim of this article is to present a discussion of the impact of telemedicine on professional practice, and the implications for the workforce. Telemedicine, or the use of video-conferencing for remote consultations between clinician(s) and patients, is now a mature technology. Many pilot studies have taken place, generally showing positive benefits to patients. There is emerging evidence that the impact on staff is more mixed; with concerns about changes to job role, skills development, and poor understanding of the organisational benefits. Evidence also highlights enablers of successful telemedicine implementation, including senior leadership, peer motivation, understanding of patient benefits, and time for safe experimentation. Following a review of qualitative data from four case study telemedicine projects undertaken within the authors’ research group, evidence from published literature is discussed. The four projects explore telemedicine services provided between an acute hospital service and nursing homes (remote assessment of swallowing difficulties), an acute hospital service and home (video-link to renal patients undergoing home dialysis), between a specialist teaching hospital service and a district general hospital (fetal abnormalities ultrasound telemedicine clinic), and a survey of mental health professionals across acute and community services within a locality. The introduction of telemedicine at scale requires an organisational and system-level approach that recognises the specific challenges and issues for the workforce. Education and training need to be provided at all levels. In conclusion: there are significant opportunities to realise the benefits of remote consultations, to improve the patient experience and staff productivity, if workforce issues are addressed.

Author Biography

Alison Marshall, University of Cumbria

I am Professor of Health Technology and Innovation at the University of Cumbria. I have a background in technology and product development, having worked within and with academia in getting research 'from bench to boardroom' for around twenty years. I was a director of a medical electronics start-up company and before coming to the University of Cumbria developed and led industrial partnerships for research and knowledge transfer at the University of Leeds. My research interests are in technology adoption and involving users in technology development in healthcare. I am currently undertaking research into the barriers and issues in adoption of telehealth, consultancy work for a number of NHS and private sector organisations, teaching on the Digital Health and Social Care course and working with app developers and other technology companies to support them in demonstrating evidence and benefits to health customers.


Armfield, N.R., Donovan, T., and Smith, A.C. (2010) ‘Clinicians' perceptions of telemedicine for remote neonatal consultation’. Studies in Health Technology and Informatics, 161, 1–9

Bell, R.C., Yager, P.H., Clark, M.E., Roumiantsev, S., Venancio, H.L., Chipman, D.W., . . . Noviski, N.N. (2016) ‘Telemedicine versus face-to-face evaluations by respiratory therapists of mechanically ventilated neonates and children: A pilot study’. Respiratory Care, 61 (2), 149–154

Bidmead, E. and Marshall, A. (Forthcoming) ‘Staff user stakeholder perceptions in a fetal telemedicine case study’.

Bidmead, E., Reid, T., Marshall, A., and Southern, V. (2015) ‘“Teleswallowing”: A case study of remote swallowing assessment’. Clinical Governance: An International Journal, 20 (3), 155–168

Brewster, L., Mountain, G., Wessels, B., Kelly, C., and Hawley, M. (2014) ‘Factors affecting front line staff acceptance of telehealth technologies: A mixed‐method systematic review’. Journal of Advanced Nursing, 70 (1), 21–33

Buck, S. (2009) ‘Nine human factors contributing to the user acceptance of telemedicine applications: A cognitive-emotional approach’. Journal of Telemedicine and Telecare, 15 (2), 55–58

Davis, F.D. (1989) ‘Perceived usefulness, perceived ease of use, and user acceptance of information technology’. MIS Quarterly, 13 (3), 319–340

Ditchburn, J.-L. and Marshall, A. (2017) ‘Renal telemedicine through video-as-a-service delivered to patients on home dialysis: A qualitative study on the renal care team members’ experience’. Journal of Renal Care, 43 (3), 175–182

Dorsey, E.R. and Topol, E.J. (2016) ‘State of telehealth’. New England Journal of Medicine, 375 (2), 154–161

Downes, M.J., Mervin, M.C., Byrnes, J.M., and Scuffham, P.A. (2015) ‘Telemedicine for general practice: A systematic review protocol’. Systematic Reviews [online] 4 (1), 1

Ekeland, A.G., Bowes, A., and Flottorp, S. (2010) ‘Effectiveness of telemedicine: A systematic review of reviews’. International Journal of Medical Informatics, 79 (11), 736–771

French, B., Day, E., Watkins, C., McLoughlin, A., Fitzgerald, J., Leathley, M., . . . Lightbody, C. (2013) ‘The challenges of implementing a telestroke network: A systematic review and case study’. BMC Medical Informatics and Decision Making [online] 13, 125

Greenhalgh, T., Singlehurst, D., and Stones, R. (2014) ‘Rethinking resistance to “big IT”: A sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies Health Services and Delivery Research, 2 (39), 1–86

Jayasinghe, D., Crowder, R.M., and Wills, G. (2016) ‘Model for the adoption of telemedicine in Sri Lanka’. Sage Open [online] 6 (3)

Joseph, V., West, R.M., Shickle, D., Keen, J., and Clamp, S. (2011) ‘Key challenges in the development and implementation of telehealth projects’. Journal of Telemedicine and Telecare, 17 (2), 71–77

LeRouge, C., Garfield, M.J., and Collins, R.W. (2012) ‘Telemedicine: Technology mediated service relationship, encounter, or something else?’ International Journal of Medical Informatics, 81 (9), 622–636

Marshall, A. (2013) ‘Designing telemedicine apps that health commissioners will adopt’. Proceedings of the 14th Conference of Open Innovations Association FRUCT, Finland November 2013 [online] IEEE 63–68. available from [19 February 2018]

May, C.R. and Finch, T. (2009) ‘Implementing, embedding, and integrating practices: An outline of Normalization Process Theory’. Sociology, 43, 535–554

May, C.R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., . . . Montori, V.M. (2009) ‘Development of a theory of implementation and integration: Normalization Process Theory’. Implementation Science [online] 4, 29

Moeckli, J., Cram, P., Cunningham, C., and Reisinger, H.S. (2013) ‘Staff acceptance of a telemedicine intensive care unit program: A qualitative study’. Journal of Critical Care, 28 (6), 890–901

Mullen-Fortino, M., DiMartino, J., Entrikin, L., Mulliner, S., Hanson, C.W., and Kahn, J.M. (2012) ‘Bedside nurses’ perceptions of intensive care unit telemedicine’. American Journal of Critical Care, 21 (1), 24–32

NHS England (2014) Five Year Forward View [online] available from [5 February 2018]

NHS Scotland (2015) e-Health Strategy 2014-2017 [online] available from [5 February 2018]

Odeh, B., Kayyali, R., Nabhani-Gebara, S.N., and Philip, N. (2014) ‘Implementing a telehealth service: Nurses’ perceptions and experiences’. British Journal of Nursing, 23 (21) 1133–1137

Peddle, K. (2007) ‘Telehealth in context: Socio-technical barriers to telehealth use in Labrador, Canada’. Computer Supported Cooperative Work (CSCW), 16 (6), 595–614

Rogers, E.M. (1995) Diffusion of Innovations. 4th edn. New York, NY: Free Press

Saliba, V., Legido-Quigley, H., Hallik, R., Aaviksoo, A., Car, J., and McKee, M. (2012) ‘Telemedicine across borders: A systematic review of factors that hinder or support implementation’. International Journal of Medical Informatics, 81 (12), 793–809

Segar, J., Rogers, A., Salisbury, C., and Thomas, C. (2013) ‘Roles and identities in transition: Boundaries of work and inter‐professional relationships at the interface between telehealth and primary care’. Health & Social Care in the Community, 21 (6), 606–613

Smith, A.C. and Maeder, A.J. (2010) Global Telehealth: Selected Papers from Global Telehealth 2010 (GT2010): 15th International Conference of The International Society for Telemedicine and EHealth and 1st National Conference of the Australasian Telehealth Society [online] Amsterdam: IOS Press, eBook Collection (EBSCOhost) [6 December 2016]

Sørensen, T., Dyb, K., Rygh, E., Salvesen, R., and Thomassen, L. (2014) ‘A qualitative description of telemedicine for acute stroke care in Norway: Technology is not the issue’. BMC Health Services Research [online] 14, 643

Taylor, J., Coates, E., Brewster, L., Mountain, G., Wessels, B., and Hawley, M.S. (2015) ‘Examining the use of telehealth in community nursing: Identifying the factors affecting frontline staff acceptance and telehealth adoption’. Journal of Advanced Nursing, 71 (2), 326–337

University of Cumbria for the Cumbria Rural Health Forum (2016) Digital Technology for Mental Health Survey of Mental Health Professionals in Cumbria, March 2016. [online] available from [5 February 2018]

Venkatesh, V., Morris, M.G., Davis, G.B., and Davis, F.D. (2003) ‘User acceptance of information technology: Toward a unified view’. MIS Quarterly, 27 (3), 425–478

Verhoeven, F., van Gemert-Pijnen, L., Dijkstra, K., Nijland, N., Seydel, E., and Steehouder, M. (2007) ‘The contribution of teleconsultation and videoconferencing to diabetes care: A systematic literature review’. Journal of Medical Internet Research [online] 9 (5), e37,

Volpe, T., Boydell, K.M., and Pignatiello, A. (2013) ‘Attracting child psychiatrists to a televideo consultation service: The TeleLink experience’. International Journal of Telemedicine and Applications [online] 2013, 146858

Vuononvirta, T., Timonen, M., Keinänen-Kiukaanniemi, S., Timonen, O., Ylitalo, K., Kanste, O., and Taanila, A. (2009) ‘The attitudes of multiprofessional teams to telehealth adoption in northern Finland health centres’. Journal of Telemedicine and Telecare, 15 (6), 290–296

Vuononvirta, T., Timonen, M., Keinänen-Kiukaanniemi, S., Timonen, O., Ylitalo, K., Kanste, O., and Taanila, A. (2011) ‘The compatibility of telehealth with health-care delivery’. Journal of Telemedicine and Telecare, 17 (4), 190-194

Wade, V., Eliott, J., Karnon, J., and Elshaug, A.G. (2010) ‘A qualitative study of sustainability and vulnerability in Australian telehealth services’. Studies in Health Technology and Informatics, 161, 190–201

Young, L.B., Chan, P.S., and Cram, P. (2011) ‘Staff acceptance of tele-ICU coverage: A systematic review’. Chest Journal, 139 (2), 279–288

Zanaboni, P. and Wootton, R. (2012) ‘Adoption of telemedicine: From pilot stage to routine delivery’. BMC Medical Informatics and Decision Making [online] 12, 1




How to Cite

Marshall, A., & Bidmead, E. (2018). Using Telemedicine in Practice: Implications for Workforce Development. International Journal of Practice-Based Learning in Health and Social Care, 6(2), 111–124.