Telemedicine Encounter Quality: Comparing Patient and Provider

Perspectives of a Socio-Technical System

Cynthia LeRouge Alan Hevner Rosann Collins
St. Louis University University of South Florida University of South Florida
lerougec@slu.edu ahevner@coba.usf.edu rcollins@coba.usf.edu

Monica Garfield David Law
Bentley College Veterans Administration

mgarfield@bentley.edu david.law@med.gov.va

Abstract

The effectiveness of the telemedicine encounter is
dependent on the use of state-of-the-art technology and
the quality of the technology-based interactions. We
take a socio-technical approach to understanding
quality during telemedicine encounters. This approach
has not been well studied in telemedicine service
encounter research. To enrich understanding, we use a
multi-method (direct observation, interview, focus
group, survey) field study to collect and interpret a
rich set of data. We conduct this study from two
perspectives. First, we focus on the perceptions of the
medical providers (e.g. physicians) who directly use
the technology and are accountable for patient care.
We then compare provider perspectives to those of
patients, who act as indirect users of telemedicine
technology and are the ultimate consumers of health
care services provided via telemedicine. The result of
this field study is a comparative framework of quality
attributes for telemedicine service encounters that
prioritizes the attributes from the provider and patient
perspectives.

1. Introduction

“Quality is a fundamental challenge in our ever
changing society, particularly in the use of computers
and networks by all of us and within all sectors of
social and professional life” [1 p.1]. In health
informatics, the quality of a system can have a
significant impact on the health and well being of
people dependent on it.

Telemedicine is one type of health care system that is
used increasingly in many medical applications,

including direct patient care exams. “Telemedicine
involves the use of modern information technology,
especially two-way interactive audio/video
communications, computers, and telemetry, to deliver
health services to remote patients and to facilitate
information exchange between primary care physicians
and specialists at some distances from each other” [2
p.2]. Advances in technology and changes in medical
care delivery have enhanced the ability of telemedicine
to fulfill its purpose and need to develop effective high
quality telemedicine systems used in direct patient care
exams.

Unfortunately, in assessing process and product,
“…research on the effectiveness of telemedicine is
somewhat limited, although the work that has been
done thus far supports the hypothesis that, in general,
the technology is medically effective” [3 p.123]. There
is a need to explore which telemedicine factors have
constrained or limited telemedicine success.

Telemedicine systems have high criticality in that
each encounter of use has the desired outcome of
maintenance or improvement of human health.
Research indicates it is imperative to understand
quality to determine how to best manage service
encounters if a service organization is to produce
desired outcomes (e.g. satisfaction, loyalty, word of
mouth, sales, and profitability) [4]. Service encounters
are critical interactions between service providers and
recipients that demonstrate an organization’s capability
to fulfill its mission and shape consumers’ impressions
of the organization [5, 6].

This research uses one instantiation of
telemedicine, high bandwidth medical video
conferencing, which is arguably the most demanding
and complex form of telemedicine when deployed for
direct patient care (see Figure 1). High bandwidth

medical video conferencing is now used frequently to
connect patients (and perhaps supporting clinicians) at
one medical location to consulting clinicians at other
medical locations in the domains of dermatology,
cardiology, speech pathology, physical therapy, wound
care, neurology, drug screening, diabetic training, and
psychiatry.

Figure 1. High bandwidth telemedicine service

encounter (Adapted from LeRouge et al. [8])
1.1. Telemedicine encounter quality

To manage service encounters, it is necessary to

understand both how the quality-generating resources
should function (functional or process quality) as well
as what result they should achieve for the consumer
(outcome quality) [7]. The quality of technology-based
service encounters can be thought of as the expected
level of service provided by the company, technology,
employee, and, to some degree, the customer (e.g. as
direct or indirect user of the technology) to support the
completion of a successful interaction/transaction.
Telemedicine service encounters provide an interesting
instance of the nexus of service providers, service
recipients, the organization, and technology; as well as
the means for providing care to an individual patient by
the health organization over the life of the
patient/organization association (see Figure 2). Hence,
to effectively manage telemedicine as a means of
delivering medical service, we must understand both:
• Functional quality, which addresses personnel,

technology, physical environment, and customers
acting as quality-generating resources in the
telemedicine encounter process.

• Desired clinical encounter results including
diagnostic accuracy, diagnostic impact, and
therapeutic impact as well as other contributing
success factors including patient and direct user
(medical staff) satisfaction.

Health care standards (e.g. Joint Accreditation of
Healthcare Organizations) and telecommunication/
information system standards (e.g. International
Multimedia Telecommunications Consortium, Inc.)
provide general guidance with respect to outcome
quality. However, telemedicine research that provides
generalized standards of functional quality that
encompass the patient consultation experience are just
beginning to emerge [8]. To address this need, this
study focuses on functional quality associated with
telemedicine encounters.

The functional view of quality takes into
consideration the “unity of software including graphical
user interface (GUI), the hardware, embedded systems
for control and regulation of peripherally technical
processes and for communication with other IS, and,
last but not least, the associated social action system of
persons, who are acting with the technology and other
people” [9]. The recognition of technology-based
service encounters as complex engagements of a socio-
technical system is necessary to make significant
progress in addressing challenges regarding encounter
success in both research and practice. To date, there is
limited research that focuses on technology-based
encounters [10] and particularly on exploring social
and technical dimensions of quality in this context.
This is disappointing since health information systems
researchers indicate that successful health care
information systems will be those that: 1) match the
health care environment with respect to technical,
social, and organizational factors and 2) recognize the
most important issue is the perception of key
stakeholders [11].

Figure 2. Telemedicine service encounter

roles (Adapted from Bitner et al. [4])

1.2. Stakeholder perspectives

Quality within the telemedicine context requires
recognition that quality cannot be expressed in a
singular vernacular and no perspective alone provides a
complete definition. The patient and medical providers
serve as key participants throughout the encounter
process. The patient and provider may have differing
perspectives of the system (and perhaps quality) as they
work toward achieving multiple outcomes.

The provider perspective elucidates insight from the
central figure of responsibility and encounter activity.
Past research has demonstrated health-care
professionals have unique characteristics as a user
group, which may impact the nature and propriety of
commonly proposed antecedents to success in the
telemedicine context [12].

The patient perspective is needed from a business
perspective. Researchers note that improving quality
perceptions can help a healthcare organization attract
new customers and increase the number of repeat
customers and even small increases can have dramatic
effects on profits [13].

Collective exploration of multiple viewpoints is
critical to success when high-quality products and
services are a goal.

1.3. Research purpose

Quality attributes are not universal, but are context

specific and perhaps specific to stakeholder group. The
purpose of this research is to decompose the
telemedicine system quality construct in the form of a
quality model from the perspectives of both providers
and patients. Investigating high-end video conferencing
systems used for direct patient care should result in a
comprehensive model that encompasses the relevant
attributes for less critical contexts.

The quality model will provide research with an
organized set of characteristics (attributes) and the
relationships among them forming a foundation for
specifying telemedicine quality requirements and
evaluating quality. Furthermore, such a model
identifies the variables necessary to methodically study
the telemedicine process and develop associated
research tools.

For practitioners, explicit representation of the
quality attributes of technology-based systems from the
perspectives of both patients and providers provides
insights essential to implementation, utilization, and
common understanding. Additionally, without an
understanding of system quality in the telemedicine
environment, the potential for successful

implementation and utilization of telemedicine systems
as well as knowledge building is diminished.

Thus, we address the following research questions:
• What quality attributes contribute to telemedicine

encounter success from the provider perspective?
Patient perspective?

• Are there differences in relative importance among
attributes from the perspective of patients?
Providers? If so, which attributes are considered
most important to encounter success by each group?

• Do the quality perspectives of various users (patients
and medical providers) differ? If so, where do these
perspectives converge and diverge?

2. Research methodology

We adapt the process framework introduced by

Kanellis et al. [14, 15] (see Figure 3) using Klein and
Myers’ principles for interpretive research as
guidelines [16] in the design and execution of this
study. The Principle of Interaction between the
Researchers and the Subjects for qualitative studies
indicates that “the participants, just as much as the
researchers, can be seen as interpreters and analysts”
[16 p.74]. We highlight the role of telemedicine
stakeholders as interpreters and analysts in Figure 3
(gray boxes).

Figure 2. Evaluation of telemedicine

encounter quality (Adapted from Kanellis et al.
[15])

2.1. Dimensional framework

An adaptation of the respecified DeLone and
McLean IS Success Model [17], which supports a
socio-technical analysis of systems and acknowledges
quality as an antecedent to success, is used in this
research to guide theory building. The Telemedicine
Service Encounter Relationships model (see Figure 2)
implies that medical video conferencing is essentially a
communication system used for virtual collaboration to
deliver medical care. Constructs in the DeLone and
McLean model (service quality, system quality,
information quality, use, user satisfaction, individual
impact, and organizational impact) reflect the
communication system levels. Figure 4 represents the
adapted version of the IS Success Model used for this
study, with functional quality dimensions that parallel
intended dimensions for the telemedicine quality model
shaded.

Figure 4: Reformulated IS success model
(Adapted from DeLone and McLean [17])

In keeping with the need for contextual specification,

the definitions of the quality dimension constructs used
for this study have been refined to reflect the concerns
and assumptions of stakeholders (providers) based on:
• Direct observation (40 hours) of medical video

conferencing rooms, functional equipment, and
videoconference sessions for representations of
quality attributes and issues

• Review of archived video and photographic images
of telemedicine encounters and rooms

• Open-ended survey of 84 telemedicine patients
• Unstructured interviews with an originator of the

model as well as telemedicine researchers inside
and outside of the United States

Following are definitions of the dimensions of
functional quality reflecting both the stakeholder and
researcher concerns and assumptions that we use to
inspire and organize inquiry into specific telemedicine
encounter quality attributes.

System (Technology) Quality – In this study,
technology quality attributes are those features of
medical video conferencing equipment and
telecommunication processes utilized for medical video
conferencing encounters.

Information Quality – In a telemedicine encounter,
information quality specifically includes the
characteristics of information that allow the participants
to take appropriate action concerning patient care and
facilitate diagnosis. Telemedicine information quality
attributes should include attributes that facilitate
capturing appropriate input for collaborative
communication (e.g. aspects of the physical
environment) as well as providing appropriate
technology transmission output.

Support (Service) Quality – We address service
quality from the perspective of the support provided for
use of a telemedicine system during the encounter used
in information systems literature, which is most
appropriate to the purpose of this study and consistent
with the IS domain. In looking at the telemedicine
system, service quality can be defined as the human
infrastructure and physical environment provided by
the organization that support user comfort and system
use.

Use Quality – Given the nature of this study and
current concerns regarding the use construct among the
IS community [18], it is our position that use quality,
rather than a generalized definition of use has the
greatest impact on net benefits in the telemedicine
context and that a standard of use must be upheld for a
successful encounter. Use quality synergizes
technology with process and cognitive ability. We
define use quality in this study as informed and
effective communication and deployment of technology
by direct users (medical staff) during the medical video
conferencing encounter that facilitates desired
outcomes.

This framework provides only a precursory
understanding of the quality construct. There is no
universal set of quality attributes for any of the
suggested dimensions as quality is both multi-faceted
and domain-specific. Researchers reiterate the need for
domain specification of the DeLone and McLean
model to facilitate insight, theory building and
application [19, 20]. Furthermore, providing services
using technology creates a level of complexity that
requires the criteria used for evaluating an IS to emerge
from investigating first and foremost the context and

from understanding the concerns of the stakeholder
groups [21].

2.2. Attribute identification and importance

Iterative data collection and interpretation was used

to develop a detailed understanding of the
interdependent meaning of each dimension of quality
through the specification of quality attributes. Detailed
research procedures reflecting the adapted framework
are presented in Table 1. Specifically, we used direct

observation, expert panel interviews (including
telemedicine clinicians, administrators, support
personnel, researchers), and validating survey to
elucidate the provider perspective. To parallel, we used
open-ended survey, focus groups (expertise derived
from collective assessment of sporadic encounters), to
elucidate patient perspectives. The model validating
surveys completed by both groups also served to
collect data related to the perceived importance of each
attribute identified by each respective stakeholder
group.

Table 1. Research design

Research Step from Field Study Model Research Methods and Procedures in Multi-method Approach

Determination of the concerns and perceptions
of the researcher

• Evolved through personal insight and awareness of IS, telemedicine,
software engineering, quality, health informatics and marketing
literatures.

Concerns and assumptions of the stakeholders
(providers)

• Direct observation
• Open-ended patient survey
• Unstructured interviews
• Secondary data (e.g. archived telemedicine video) review

Identification and clarification of any possible
epistemological differences

• Reconciliation of concerns and assumptions in cooperation with
stakeholders.

Establishment of a research framework from a
reconciled perspective

• Identification and adaptation of suitable success model congruent with
reconciled perspective

Development of a quality model appropriate to
context

• Expert-panel interviews
• Patient focus groups
• Researcher coding and analysis of expert panel interview and focus

group transcripts.
• Mapping of constructs to research framework.

Communication and feedback between
stakeholders and researcher

• Telemedicine stakeholders participation in research design process (e.g.
review of questions and protocols)

• Stakeholder participation in focus group moderation
• Probes during the focus group and interview inquiry process.
• Stakeholder interpretive development of quality attribute codes from

provider expert panel and patient focus group transcripts
Validation of quality model • Validating survey to expert-panel members

• Validating survey to focus group members
• Comparison of stakeholder interpretation of quality attributes to

researcher interpretation
Analysis and interpretation of results by
stakeholders and researchers

• Interpretive analysis of focus group and expert panel data by
stakeholders.

• Interpretive analysis of focus group and expert panel data by researchers.
• Delphi panel to assess control opportunities.
• Stakeholder reviews of research results with researchers to inspire action

in practice.
Possible activity by stakeholders to change the
environment

• Possible development/modification of telemedicine protocols
• Possible development/modification of patient education literature
• Possible development/modification of telemedicine training process

Conclusions, theory building and determine of
need to revisit assumptions or revise or extend
model.

• Expressed through conclusions, limitations, and future work.

3. Discussion of results

The research results of this study are tri-fold: (1) the
telemedicine service encounter quality model, (2)
identification of the differences between patient and
provider in which quality attributes are identified, and
(3) understanding what aspects of the telemedicine
service encounter are more important to each
perspective.

Effects of the research design developed for this
study may also be considered results. The goals of
integrating practicing stakeholder analysis and
interpretation at multiple stages in the research process
included expanding the depth of research insight as
well as enriching the relevance of this study. It seems
both goals have been achieved. Stakeholder efforts to
change the telemedicine environment can indicate
relevance. Activities by organizations participating in
this study to change the telemedicine environment
include the development of patient orientation
materials, provider training content, and strategic
planning guidelines based upon data from this study.

3.1. Telemedicine service encounter quality
model

We present the resulting model in Appendix A. A

full presentation of the model can be found in [22]. The
comparative model embodies the complexity of
technology-based service encounters and differences in
the attribute list identified by each stakeholder group.
The range of attributes identified by both patients and
providers attests to the need for socio-technical
conceptualization of the telemedicine encounter
phenomenon by both research and practice when
considering the provider perspective, patient
perspective, or both.

We find many commonalities in identified functional
quality attributes among all dimensions of quality
(technology quality, use quality, information quality,
and use quality) between patients and providers.
However, differences were noted. We look to role
theory to explain the differences indicated by each
group. There are two viewpoints of roles in this context
– user roles and consumer/professional service provider
roles. Telemedicine providers (e.g. medical staff) act as
the “front line” and direct users in staging and
executing the encounter. Providers, as direct users,
singularly identified (or escalated the importance of)
some attributes of encounter quality that may not be
readily apparent to consumers of medical care who are
only indirect users of technology. Likewise, provider
identification of some single-group attributes may be

attributed to their in-depth understanding of the factors
necessary to address the clinical need of the patient.

Conversely, the patient acting as indirect user of the
technology is somewhat of an independent observer to
the orchestration and actions of direct users (e.g.
clinicians in the room with the patient and remote
consultants) and seems to note issues not readily
observable by those engaged in direct use of the
technology and leading the communication process.
Furthermore, in their role as consumers of medical
services, patients may be more attuned to facility and
human factors in forming their perceptions of quality
since it is extremely difficult for health care consumers
to gauge clinical outcomes given their lack of expertise
[13].

3.2. Differences in quality attribute
perspectives

To elaborate on the differences between groups, we

further discuss single-group attributes (attributes
identified by only one group) and differences in the
perceived importance of attributes. We find 15 single-
group attributes in the model. We address each of the
single group attributes in the context of the quality
dimension they were mapped to.

System (Technology) Quality – Providers identified
all single group attributes related to technology quality.
Providers solely identified technology attributes
(specifically interoperability, rational design,
convenience, and security), which would be most
apparent to direct users. In fact, these attributes may be
“hidden” from the patient, indirect user. Given that
patient personal information is at stake, it is of some
surprise that patients did not also identify concerns
regarding security. It would seem such factors such as
HIPPA regulations prompt the inclusion of security by
providers. We speculate patient omission of this
attribute may be perhaps attributed to a lack of
understanding of potential security infringements or
conversely feelings of exposure of self and information
for viewing and discussion that may during the course
of any medical exam.

Information Quality – Providers, as medical
caregivers, identified the attributes of room layout and
adequate space which impact their ability to provide
service. Patients, as consumers, may not be aware of
the importance of these items to the medical care
process. Patients singly identified system feedback to
patient, which may indicate a desire for participation
and assurance in the exam process.

Service (Support) Quality – Coordinator support is
the only support quality attribute singly identified. As
indirect users, patients may not interact with a

telemedicine coordinator and furthermore may be
unaware of the orchestration and management
necessary to provide telemedicine.

Use Quality – Patients in their role as consumers
singly identified use quality attributes, which
emphasized the service they would expect of any
medical exam (i.e. clear future directives and
professionalism in room). Furthermore, patients
identified attributes that would provide more
“consumer comfort” (i.e. conveys access/review of
patient records and mix with in-person exams). Finally,
as independent observers of team interactions, medical
team coordination may be more apparent to patients
then to those engaging in the coordination process.

In looking at provider and in particular the consulting
clinician (often a doctor), as the person in-charge of
conducting the exam and having to change work
processes, it is logical that providers would be able to
identify the need for adaptability. The mention of this
attribute seems to provide some indication that the
ultimate objective is that patients perceive no change or
detriment to the care that would be provided in an in-
person exam process.

In order to explore more fully the nature of these
differences, we discuss how patients and providers rank
the importance of the quality attributes.

3.3. Assessment of attribute importance

An understanding of the importance of individual

attributes can facilitate the creation and interpretation
of formative measures for each dimension of
telemedicine quality as well as provide guidance in
balancing situational constraints in quality management
efforts. Moreover, assessments of importance further
illuminate commonalities and differences between
patient and provider perspectives.

As with the range of attributes identified by both
patients and providers, the importance assessment of
individual attributes attests to the need for socio-
technical conceptualization of the telemedicine
encounter phenomenon by both research and practice
(see Appendix B). It is of note that the “top” attributes
(mean above 3.5 on a four point scale) for both groups
contain both social (e.g. professionalism – clinician in
room for patients and coordinator support for
providers) and technical attributes (e.g. peripheral
sophistication for patients and interoperability for
providers). However, aside from audio clarity and
image resolution, which seems to designate the
fundamentals needed to engage in this communication
process, the mix of “top” attributes is clearly different
for patients and providers. Each group included
attributes unique to their group in their “top” listing

(e.g. team coordination and clear future directives for
patients – interoperability and coordinator support for
providers). Furthermore, each group’s “top” attribute
seems to reflect why they are engaging in this
technology service encounter. Patients want
instructions and guidance regarding their health
provided via a means that addresses the challenges of
distance. Providers want to provide reliable service via
distance.

For the most part, physical environment attributes
seem to be on the lower end (under 3 points on a four
point scale) for both groups (e.g. facilitating décor and
suitable temperature). It seems both groups recognize
comfort is desirable but may be willing to sacrifice
some comfort to gain telemedicine conveniences.

By comparing the differences in how patients and
providers rank the quality attributes in importance, we
see that patients’ rankings evidence a central concern
for how information about their health is communicated
to them at a distance, while providers’ rankings show a
focus on the reliability of the health service they
provide via telemedicine. Differences in importance
distributions reiterate the result that patients’ and
providers’ view of the telemedicine system is distinct,
and based on whether they are indirect or direct users
of the system. The differences between patient and
provider perspectives in which quality attributes are
identified and their relative importance underscores the
need to measure the quality perceptions of both groups.

4. Conclusions and future directions

This research indicates a telemedicine encounter is

an orchestrated process with a complex list of quality
requirements spanning across technology, physical
environment and human resources. The principal
contribution of this paper is an organized model of
quality attributes for a medical video conferencing
system that compares and contrasts the perspective of
key telemedicine encounter stakeholders to further
understand telemedicine encounter success. This study
shows that though there is common ground regarding
functional quality among the principles participating in
the encounter process (e.g. patients and providers),
each of these constituencies perceives quality from a
unique vantage in fulfilling roles that seems to
introduce differences in perception.

Furthermore, this study provides research with a
specified articulation of the use quality construct.
Additionally, the research process itself may be
considered a contribution. Research designs, such as
the one operationalized in this study, emphasize that

relevance can be enhanced and meaning enriched by
involving practitioners in rigorous research efforts.

This model provides practice with an organized
representation of fundamental knowledge required to
manage telemedicine services and create measures to
monitor appropriate progress over time and ultimately
to facilitate telemedicine success as indicated by
clinical, profit-orientated, or other outcomes.

This research provides the foundation for further
construct and theory development. The model also
highlights formative measures (social/human as well as
technical) to be considered in studies that test
relationships among quality constructs and with
telemedicine outcomes. Future research could use this
model in developing measurement instruments related
to medical teleconferencing quality to assess the impact
of these quality attributes on the various dimensions of
telemedicine success.

Effort are underway to expand this study by : 1)
determining control factors (entity most in control and
when attribute is most controllable during the
encounter process) related to each of the quality
attributes and 2) broadening this U.S. based study to
other countries to determine the need to adapt the
model in light of cultural and information technology
infrastructure differences.

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Appendix A. Telemedicine Service Encounter Quality Model

Appendix B. Results of Validation Process: Ranking of Attributes

Ranked according to highest mean, then lowest standard deviation

Quality Attribute Patient
Mean

Patient
SD

Quality Attribute Provider
Mean

Provider
SD

Clear Future Directives 3.762 0.700 Reliability 3.917 0.289
Audio Clarity 3.714 0.463 Audio Clarity 3.750 0.452
Telemedicine Trained Staff 3.619 0.498 Technical Support 3.667 0.492
Peripheral Sophistication 3.619 0.740 Image Resolution 3.583 0.515
Medical Team Coordination 3.571 0.507 Synchronization 3.583 0.515
Image Resolution 3.571 0.598 Interoperability 3.583 0.669
Professionalism Ğ Clinician
in Room

3.524 0.512 Coordinator Support 3.583 0.793

Patient

Education/Telemedicine
Orientation

3.524 0.512 Focus on Patient Care 3.500 0.522

Conveys Access/Review of
Medical Records

3.524 0.602 Motion Handling 3.500 0.522

Consultant Telepresence 3.476 0.512 Usefulness 3.417 0.515
Adequate Lighting 3.429 0.676 Scheduling Support 3.417 0.669
Scheduling Support 3.381 0.498 Consultant Telepresence 3.333 0.492
Technical Support 3.381 0.590 Adaptability 3.333 0.492
Reliability 3.381 0.865 Adequate Lighting 3.333 0.651
Focus on Patient Care 3.333 0.483 Telemedicine-Trained Staff 3.333 0.651

Privacy 3.286 0.644 Privacy 3.333 0.651
Usefulness 3.286 0.717 Rational Design 3.333 0.651
Affordability 3.263 0.806 Patient

Education/Telemedicine
Orientation

3.333 0.778

Quiet/Soundproof 3.190 0.814 Performance 3.167 0.577
Motion Handling 3.095 0.625 Quiet/Soundproof 3.167 0.718

Mix with In-Person Exams 3.050 0.510 Affordability 3.083 0.669
Convenience 3.083 0.900

Ergonomic Design 3.000 0.707 Room Layout 3.000 0.426
System Feedback to Patient 2.810 1.123 Peripheral Sophistication 3.000 0.739
Suitable Temperature 2.619 0.590 Ergonomic Design 2.917 0.515
Facilitating D�cor 2.476 0.814 Adequate Space 2.833 0.718
Performance 2.381 1.024 Security 2.750 0.754
Convenience N/A N/A Facilitating D�cor 2.667 0.492

Coordinator Support N/A N/A Suitable Temperature 2.583 0.669
Security N/A N/A Clear Future Directives

N/A N/A

Adequate Space N/A N/A Team Coordination N/A N/A
Interoperability N/A N/A Conveys Access/Review of

Medical Records
N/A N/A

Rational Design N/A N/A Professionalism Ğ Clinician
in Room

N/A N/A

Synchronization N/A N/A Mix with In-Person Exams N/A N/A

Adaptability N/A N/A Room Layout N/A N/A
Room Layout N/A N/A System Feedback to Patient N/A N/A

Patients Providers