103 THE STORE-AND-FORWARD TELEMEDICINE SERVICE USER-SATISFACTION QUESTIONNAIRE INTRODUCTION Telemedicine includes store-and-forward (asynchronous) or real-time (synchronous) digital communication in clinical practice and enables referring health care providers (HCPs) to diagnose and possibly treat patients with advice of remote HCPs (i.e., medical specialists). Due to the proven cost-effectiveness and care quality of store-and-forward telemedicine, these services now permeate a wide variety of fields, e.g. cardiology, pulmonology, mental health, ophthalmology, and dermatology [1-6]. As this wider adoption of store-and-forward services accelerates, particularly post-coronavirus disease 2019 (COVID-19), it will become essential to understand HCPs’ satisfaction with aspects of digital solutions offered by telemedicine organizations in order to guarantee telemedicine service quality and ongoing success. Prior constructed HCPs’ satisfaction telemedicine questionnaires often focus on comfort, observed privacy, ease of use, technical quality of sound and images, and lack details on validation and development [7,8]. It is well appreciated that telemedicine is not just a technological device or platform implementation process but concerns changes at various levels: technological, human, organizational, economical, cultural, and legal [9]. Factors impacting adoption and long-term continuation of telemedicine services are for example (a) telemedicine platform technology (perceived ease of use or usefulness, reliability, maintenance, serviceable equipment), (b) appropriate, up-to-date training and (technical) support of HCPs, (c) implementation policy (bottom-up vs. top-down), (d) organizational infrastructure (organization stability, integration workflow, resources, culture, and management), (e) interaction and communication strategies of telemedicine organization with HCPs and among HCPs, (f) financing (insurance eligibility, reimbursement of care, and equipment costs) [10-17]. All these factors may affect HCPs’ satisfaction with and motivation to use and to continue telemedicine use. HCPs’ dissatisfaction or negative experiences can influence their commitment to a telemedicine organization or may result in abandonment of the platform [18]. Therefore, involved and satisfied referring and performing HCPs are crucial for the adoption and sustainability of telemedicine services [18,19]. Different types of intermediate telemedicine organizations have set up technical telemedicine platforms with some also offering liability and financial insurance policies as covered policies for HCPs. In the Netherlands, the largest store-and-forward health care organization that contracts HCPs to perform telemedicine services through a platform is Ksyos [20]. For Ksyos (a privately owned health provider) it is likewise crucial to continuously ensure the quality of its telemedicine services and to have insight into aspects that contribute to successful deployment as these services expand. However, telemedicine services are not monitored on a structural basis, and information on the service quality of telemedicine vendors and platforms is still unavailable [14,15]. 6
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