Attachment B - Cognitive Protocol

Attachment B: Telemedicine Cognitive Interview Protocol

Telemedicine Protocol

Early Stage Scoping / Cognitive Interviews

11.27.18

Research Questions:

• Do respondents understand what information they are being asked to provide with these questions?

• Do respondents understand the terminology used in the questions?

• Are respondents able to answer the questions that are being asked?

• Is the requested information available in respondents’ records?

• Are the instructions helpful to respondents?

• Are respondents familiar with telemedicine?

• Can they define telemedicine and telehealth?

  • Do they distinguish between the two?

• Do respondents use remote patient monitoring?

• Can they define remote patient monitoring?

• Do respondents use two-way live video interaction with patients?

  • Can they define what is meant by two-way live video interaction?

• Do respondents use peer-to-peer or inter-professional internet consults between practitioners?

  • Can they explain peer-to-peer internet consults between practitioners?

• Do respondents use store-and-forward transmission of patient records?

  • Can they define store-and-forward transmission of patient records?

• Do they plan on starting or expanding the use of telemedicine services?

• Do they track telemedicine services?

  • If so, how? What are those mechanisms?

Expected Length of Interview: 20-30 minutes

Materials Needed:

• Draft question and SAS form

General probes that may be used throughout the interview:

• Reflect back on respondent’s answer: “you said…”

• In your own words, what is this question asking?

• How did you arrive at this number/answer this question?

• What records (if any) did you look at? What line or lines were of interest?

• Specifically, what did you include in this number? What did you exclude?

• Would you consult other people to obtain this answer?

INTRODUCTION

• Explain purpose of meeting: Thank you very much for your time. Let me start by telling you a little about what we will be doing today. We are getting feedback on a new question that will be added to the Services Annual Survey. We would like to get your input on the new question, in order to make it as clear and easy to complete as possible. Any information you provide will be kept confidential

[Have respondent sign consent form if meeting in person. If they decline recording, note on the consent form that they declined recording and have them sign.]

ABOUT THE RESPONDENT

First, I’d like to learn a bit about you, and your role here at the company.

• What is your job title?

• What is your role in completing government surveys?

• How much experience do you have completing the Services Annual Survey?

• What has your experience completing the Services Annual Survey been like?

• Do you work with anyone else in your company to get the data for the Services Annual Survey?

  • How are those other people involved?

  • How many people are involved?

Now I’d like to learn a little about your company.

• Can you give us a brief description of what your company does?

• What kind of services do you provide?

EARLY STAGE SCOPING QUESTIONS

Thank you very much for that background information! Now, I would like to transition to the main topic of today’s interview.

Terminology

I would like to introduce you to some terms. For each of these terms, please define them in your own words, within the context of your company. It may also be helpful for you to provide us with examples, if any come to mind.

• Telemedicine

• Telehealth

• Telemedicine may include:

  • Remote patient monitoring

  • 2-Way live video interaction with patients

  • Peer-to-peer internet consultations between practitioners

  • Store-and-forward transmissions of patient records

• The first term is Telemedicine. What does that mean to you?

• The second term is Telehealth. What does that mean to you?

• What do the other telemedicine related terms mean to you? (Remote patient monitoring; 2-Way live video interaction; Peer-to-peer internet consultations; Store-and-forward transmissions)

• In your mind, are there any major differences between these terms? If yes, can you explain them to us?

• Are there any other terms that you may use that you consider synonyms to these terms?

In Practice

• Can you give me some examples of how telemedicine is used in your company?

• Does your establishment use telemedicine or telehealth?

• [IF NO] Does your establishment plan on starting to use these services?

• How are telemedicine visitations expensed at your company?

• Are telemedicine visitations expensed differently than other related expenses?

• Does your establishment do interprofessional internet consultations, wherein practitioners communicate through a live streaming service?

  • Is this billed?

  • Do you count this as a visit?

• Is your video service a subscription that must be renewed?

  • Is this an acquired or leased purchase?

• Are there associated costs with the use of telemedicine (e.g., training, installation, maintenance, programming, safety precautions, etc.)?

  • Are you able to separate out these costs?

• Who do you purchase the telemedicine equipment from?

Record Keeping

• In your financial records, are you able to identify:

  • Billable visits that use remote telemedicine/telehealth as their method of communication?

  • Costs and values of any telemedicine related equipment?

    • Are you able to separate that out from the costs and values of other equipment?

• Does your company keep these records at the company level? The establishment level? Some other level?

• If you are not able to access these records, does someone else have access to them, or are they simply not kept?

COGNITIVE INTERVIEW QUESTIONS

Now I’d like to introduce you to the question that we have drafted.

Please, take a look at the document with the question text I emailed to you earlier.

• In your own words, what is this question asking you?

• How would you go about answering this Yes/No question, if you were to receive it?

• Do you have this information in your records?

• [If Variation One] Do you have a ballpark figure for what this percentage might be?

  • How might you come up with an answer to this question?

• [If Variation One] If this question were included in the actual survey, would you be able to retrieve the data that’s being asked for at the company level?

  • Is there anything difficult about retrieving this data?

  • Would you need to reach out to others to help answer this question? Who?

• How long would it take you to answer this question?

• Did you review the definitional text before answering the question?

• Does this match the definition you provided earlier? If not, how is it different?

  • Are there any types of Telemedicine that your company has, according to how you defined it earlier, that you believe this definition is telling you to exclude? What are they?

• Review definition with respondent, getting their feedback on each of the 4 examples.

• Would you like any additional clarifications/definitions in the introductory text?

Wrap-up

We are almost done, and I just have a few wrap-up questions.

• Do you think this question would be easy to answer, difficult to answer, or somewhere in between? Why?

• Is there anything else we haven’t touched on today, that you think is relevant?

• Do you have any questions for us?

Thank you very much for your time today!