Evaluating Telemedicine Perception and Readiness among Healthcare Workers in Malaysia

Introduction

Increased access to healthcare is a priority for public healthcare services. Our study investigated healthcare workers’ (HCWs) perceptions and readiness to use telemedicine services.

Methodology

A self-administered online questionnaire was designed, validated, and disseminated among public HCWs in a single tertiary healthcare facility from a Malaysian northwestern state. Sections include sociodemographics, perception, and readiness domains. Descriptive and univariate statistics were used to determine correlation between selected parameters.

Results

A total of 288 HCWs participated: 66.3 percent agreed that new technology can be used alongside current practice. On core readiness, 29.1 percent would not consider telemedicine without prior physical interaction with patients. For clinical readiness, 56.6 percent would consider telemedicine services for clinical practice. All perception domains (except disadvantage) had significant positive correlations with readiness domains (r=0.12-0.57, p<0.05).

Conclusion

The perceptions and readiness of telemedicine among our public HCWs were suboptimal. Our findings denote potential limitation on cybersecurity and clinical practice gaps.

Keywords: telemedicine, health personnel, perception, technology, computer-assisted instruction

Introduction

Increased access to healthcare services to achieve the best health outcomes is essential for healthcare providers and patients. Apart from walk-in and appointment-based ambulatory care, the Ministry of Health Malaysia (MOHM) also provides alternatives to improve access to healthcare services, such as domiciliary care services and home medication review.¹

According to the World Health Organisation (WHO), telemedicine is defined as a tool that can improve patient outcomes by improving access to care and medical information through information and communications technology (ICT).² Telemedicine is also a clinical service that leverages ICT, video imaging and telecommunication linkages to enable healthcare workers to provide healthcare services at a distance.³ This enables patients from rural areas or with mobility problems to access clinicians virtually through telemedicine.

Background

Telemedicine can be conducted in several ways. For example, healthcare workers (HCWs) can perform the most basic service: a simple telephone or video call. Portable telemedicine kits such as electrocardiograms (ECGs) or vital signs monitors currently include a computer, laptop, or tablet. Detailed medical images captured by high-resolution digital cameras can be sent to specialists. Lastly, there is robust telemedicine software capable of storing clinical data and facilitating real-time video conferences. Based on a study conducted in the United States (US), telephone calls and electronic health records (EHR) can facilitate screening or treating a patient without needing in-person visits and improve the decision-making process among healthcare teams in ambulatory and emergency care.⁴

Telemedicine has been applied to almost all countries around the world. Although New Mexico has the sixth lowest population density in the US, a large percentage of the population still could not effectively access healthcare services.⁵ Even though telemedicine may be successfully implemented in certain regions of the world, unexpected barriers to adoption may still occur.⁵ This is reflected by a telemedicine readiness study in Uganda's public health facilities that concluded 70 percent of healthcare professionals were aware of telemedicine, but only 41 percent had used telemedicine services due to a lack of facilities.⁶

In a more local setting, the determinants of telemedicine acceptance in public hospitals in Malaysia were said to be: having computer self-efficiency; perception of usefulness; top management support; and government policies.⁷ A recent study among people in Sabah showed a high level of acceptance towards telemedicine.⁸
Through SWOT (strengths, weaknesses, opportunities, and threats) analysis⁹, some healthcare professionals identified that the coronavirus disease 2019 (COVID-19) pandemic had greater strength and opened more opportunities for more innovative healthcare delivery, although the infection carried a heavy threat to the healthcare system. Based on a systematic review of the roles of telemedicine during the COVID-19 pandemic1⁰, most studies stated that telemedicine is most beneficial in risk reduction in the transmission of SARS-CoV-2 by preventing direct physical contact between clinicians and patients, in turn reducing the presence of public from high-risk areas such as hospitals. Limited mobility due to the initial lockdown enforced by the Movement Control Order (MCO) made access to healthcare services slightly inconvenient, and numerous outpatient appointments had to be deferred.1¹ The MCO marked the nationwide movement restriction order imposed by the Malaysian government on March 18, 2020, as a means of breaking the chain of COVID-19 infection.1² The Malaysian Medical Council (MMC) also recognized telemedicine by releasing an advisory notice on telemedicine practice during the COVID-19 pandemic.¹³ Furthermore, since the pre-COVID-19 pandemic in May 2019, five public health clinics have pioneered virtual clinics in implementing telemedicine.

Clinicians' perceptions of telemedicine are primarily connected to their willingness to adopt the technology into clinical practice. Readiness on telemedicine conveys the organization's leadership in understanding and changing management plans to adapt. Furthermore, the equipment must be located where it is convenient to be used. In addition, clinical decision-making, functioning, and telemedicine processes require administrative policies and procedures. These include standardized, well-defined, easy-to-use mechanisms for the referral and transfer of patients, record keeping, and prerogative to use telemedicine at receiving and referring sites.¹⁴

In Malaysia, local studies on telemedicine among healthcare professionals are scarce, and earlier data showed that only a minority accepted the reduction in physical communication through telemedicine.1⁵ This lack of acceptance may be due to how vital direct interaction with patients is,1⁶ technological limitations, Internet challenges, lack of trust, feelings that the tools are impersonal or prone to error, and other reasons. There is, otherwise, no published study looking at both perception and readiness for telemedicine among clinicians and how far have they experienced and implemented telemedicine. Hence, this study aimed to investigate public HCWs’ perceptions and readiness to use telemedicine services in a single tertiary healthcare facility in a northwestern state of Malaysia.

Methods

Design

This was a cross-sectional study involving the development, validation, and distribution of an English language self-administered online questionnaire conducted from August to September 2021.

Selection of sites and participants

Sites included three groups of government healthcare facilities located within the vicinity of the small state of Perlis. This included the state hospital, health clinics under the district health office, and the state health department. The questionnaire was distributed among “telemedicine aware” public healthcare workers in the state of Perlis, Malaysia. “Telemedicine aware” are those who are aware of telemedicine’s existence but have not used it. “Telemedicine naïve” individuals were excluded to answer the objective of this study. Our study further included health professionals who had basic information technology (IT) usage and who were directly involved in patient care: medical doctors, nurses, pharmacists, therapists, psychologists, counselors, and dieticians. The stated inclusion criteria were included in the consent section, and only those fulfilling all criteria were allowed to answer the questionnaire.

Procedures

The questionnaire was content validated by a selected panel of experts consisting of IT savvy medical doctors, pharmacists, and ICT officers working in Perlis State Health Department, Kangar District Health Office, and Hospital Tuanku Fauziah, Perlis, to provide input on the content suitability with the Malaysian healthcare system. Sentences were reworded to make them more comprehensible. The questionnaire was then pilot tested among 10 public healthcare workers working in the neighbouring state of Kedah. It took 15–20 minutes to complete the questionnaire, which was distributed through instant messaging and official workplace email. An implied consent section was incorporated in the first section of the online form.

Measurement

Perception and readiness of telemedicine was measured using a self-administered, web-based questionnaire. The questionnaire consisted of three sections:

• Sociodemographics
• Perception domains: advantages (7 items), disadvantages (8 items), necessity (6 items), ease of use (6 items), security (6 items)
• Readiness domains: core (10 items), e-learning (3 items], clinical (3 items), overall (1-item)

Perception toward telemedicine was evaluated based on the advantages and disadvantages of telemedicine application, the necessity of using telemedicine, ease of use of the information and communication technologies in clinical practice, and telemedicine technology security. Core readiness refers to the extent of full readiness to switch to telemedicine as a solution to displeasing current healthcare service provision.1⁷ Core readiness consists of 10 questions: Q1-4 on the integration of telemedicine, Q5-7 on comfort with telemedicine, and Q8-10 on process workflow. Negative (reverse) items included core readiness items 8-10, in which ”Strongly Disagree” or ”Disagree” responses were taken as positive attitudes, and the corresponding data were transformed. Readiness for e-learning refers to an individual’s readiness to adopt a digital mode of learning via electronic devices,1⁸ and clinical readiness is readiness to provide clinical services via telemedicine.1⁹

The perception domains were adapted from Ayatollahi et al. (2015),2⁰ while readiness domains were adapted from Kiberu et al. (2019).²¹ Perception and readiness remained on a five-point Likert scale. The total score was the mean sum of all the items in the domain. The cut-off point for positive perception and readiness was any score greater than the mean score.

Sample Size calculation

Sample size estimation was calculated using the population proportion formula.²² Preliminary data indicate that the prevalence of the “telemedicine aware” group was 0.286.2¹ Therefore, in a local population size of healthcare workers provided by the Human Resource Unit, Perlis State Health Department, of approximately 3,000 individuals, with a pre-set type I error probability and precision at 0.05, a minimum sample size of 285 was required.

Statistical Analysis

The data analysis was performed using IBM SPSS Statistics for Windows (Version 20.0). Descriptive statistics were employed for all variables. Domains of perception and readiness were analyzed by Spearman’s correlation.

Ethical Consideration

This study was registered with the National Medical Research Register (NMRR-21-134-58360) and approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia.

Results

A total of 288 healthcare workers in the state of Perlis, Malaysia completed the survey (Table 1) who were “telemedicine aware”. The respondents had a mean age of 36 and work experience of 11 years. Most respondents were female (78.1 percent), Bumiputera, i.e., Malaysian of indigenous Malay origin (87.5 percent), diploma holders (50.3 percent), allied health professionals and nurses (50 percent) working in the district health office or health clinics (55.6 percent).

Across the domains of perception toward telemedicine (Table 2), “disadvantages” subdomain scored the lowest (Mean score: 25±6.1 out of 40 points). Only a small number of HCWs agreed that telemedicine technology causes psychological harm to the patients (Mean score: 3±1.0), reduces the efficiency of patient care (Mean score: 3±1.0), and breaches patient privacy (Mean score: 3±1.0). Respondents had the most positive perception on the security aspect of telemedicine (Total score percentage: 80 percent). Most respondents agreed that telemedicine technology requires a secured network for access to medical information (Mean score: 4±0.9) and to avoid data breaches (Mean score: 4±0.9). In addition, a majority agreed (Mean score: 4±0.9) that telemedicine technology needs legal clarity such as patient consent. A sizable number of respondents agreed (31.6 percent) and strongly agreed (4.5 percent) that telemedicine technology reduces the efficiency of patient care. Similarly, 36.4 percent perceived telemedicine could lead to greater malpractice among clinicians as a certain degree of professional skills or learning could not be achieved thoroughly. On the perception of the necessity of telemedicine technology, 55.2 percent perceived telemedicine technology as a requirement for patient care. Most respondents agreed (66.3 percent) that new telemedicine technology can be used alongside current clinical practice. This result also aligned with the perception that telemedicine can provide doctors instant access to patient information (62.9 percent). The majority believed that software's user-friendliness (55.2 percent) matters more than the system's quality (50.7 percent) in encouraging usage. Some 64.9 percent of our respondents acknowledged that telemedicine would change the referral process. Similarly, most agreed that telemedicine improves productivity (54.8 percent), but less than half agreed it reduced clinicians’ errors (43.4 percent).

The mean score of core readiness was the lowest at 64 percent compared to other readiness domains (Table 3). On integrating telemedicine, 29.1 percent would not consider using telemedicine without prior physical interaction with the patient. However, most respondents were still comfortable with telemedicine, with 62.1 percent agreeing it is worth investing.

The overall readiness to use telemedicine was moderately correlated (Table 4) with the advantages that telemedicine has to offer (r=0.523, p<0.01) but correlated with telemedicine security at a low level (r=0.225, p<0.01).

Discussion

This was a cross-sectional study to determine the perception and readiness toward telemedicine among HCWs in a single tertiary healthcare facility in a suburban state of northwestern Malaysia. The domains of perception illustrating the highest and lowest total mean scores meant that these were the main issues of focus as they may either facilitate or hinder the implementation of telemedicine in this population. Our study determined that our HCWs were generally ambivalent on the concept of telemedicine as part of clinical patient care, partly due to security concerns. Though overall readiness was high, the core readiness domain scored the lowest, indicating insufficient quantitative evidence that the population was fully ready for telemedicine use in the clinical setting.

A sizable number of respondents (31.6 percent agreed and 4.5 percent strongly agreed) that telemedicine technology reduces the efficiency of patient care. Indeed, certain diseases and disorders do require a face-to-face physical examination and cannot be diagnosed virtually via telemedicine. In the worst-case scenario, improper medical consultation may even result in injury, damage, or even loss of life, according to a study by Kiberu et al. (2019) that affirmed telemedicine was associated with technological flaws.²¹ A doctor may potentially deliver wrong referrals of specific medical services to patients as telemedicine might limit the primary medical examination, resulting in improper diagnosis. According to an investigation lead by the Consolidated Risk Insurance Company (CRICO), a leading medical professional liability insurance provider in the United States, 66 percent of telemedicine-related claims received between 2014 and 2018 were diagnosis-related.2³

Generally, human-related factors such as users’ perception and readiness toward telemedicine technology greatly influence the use of information technology in healthcare organizations. Therefore, many strategies must be considered to implement this technology substantially including human-related factors, infrastructures, accessibility, and security. A similar study by Judi et al. (2009) inveterate that a secure telemedicine network in keeping patient information and documentation confidential is crucial to public and providers’ acceptance of the technology.2⁴ A recent systematic analysis suggested that certain security techniques, such as watermarking, cryptography, and steganography, are important methods of medical image security.2⁵ The findings of studies looking into the security aspects of telemedicine is therefore important to specifically address the issue of cybersecurity in the local setting. Regions of the same country may have technological advancement of varied levels, and this will further determine the type of security needed in their local clinical setting. For the population that were assessed in this study, there is no available centralized EHR system.

On the benefits of telemedicine technology, 70.8 percent of respondents perceived that telemedicine minimizes needless travel expenditures for patients. In this sense, the impression of utility has a favourable influence on telemedicine adoption. A study by Bagayoko et al. (2013) showed that telemedicine technology could improve healthcare professionals' recruitment, satisfaction, and retention of patients in rural areas.2⁶ However, infrastructure development should be seriously considered to allow limitless accessibility to technology, particularly in geographically deprived regions.

For clinical readiness, 56.6 percent of our respondents would consider using telemedicine services for clinical practice. Numerous studies have shown how system attributes determine the system usage. For instance, Saig-Rubió et al. (2014) discovered that the factor influencing telemedicine usage was ICT's perceived ease of usability.2⁷ According to Chang et al. (2009), telemedicine can increase its effectiveness if it is simple to use.²⁸ Overall readiness domain in our study scored a mean of 4 out of 5, with more than half (51.4 percent) of respondents agreeing that HCWs are ready to integrate telemedicine into routine clinical practice. Furthermore, 53.1 percent of our respondents agreed that telemedicine could bridge the clinical skills gap as telemedicine helps provide better long-term care to patients. Hence, one conclusion is that telemedicine is necessary for healthcare providers.

Regarding e-learning readiness, 73.6 percent agreed telemedicine enhances e-learning. A study has further demonstrated that people generally acknowledged the benefits of telemedicine in e-learning and were prepared to use it.²¹ These findings are also in line with the literature, which supports that e-learning is crucial in training and maintaining the skills of the HCWs.²⁹

When evaluating the core readiness toward telemedicine, the results showed that HCWs were mostly concerned about how telemedicine would affect workflow, work practice, and referral processes. In terms of workflow and work practice, adjustments must be made to incorporate new technology in the work process. Before this may happen, a lot of user training must be done. With reference to the result of this study, the HCWs did not optimally perceive telemedicine as easy to use (Percentage score: 70 percent). Another concern was that telemedicine would change the referral process. Some changes in law would be required for referrals to private health care facilities.

With regards to correlation between perception and readiness toward telemedicine usage among HCWs, all perception domain except “disadvantage” subdomain had significant positive correlations with readiness domain. Positive perceptions (except on disadvantage elements) increased readiness among healthcare workers. However, despite the perceived disadvantages of telemedicine, they do not significantly affect the readiness of HCWs toward telemedicine. The overall readiness to use telemedicine had significant positive correlation with telemedicine security, but at a low level (r=0.225, p<0.01). This result may indicate that security is a concern among the HCWs we surveyed. The security of medical information handling should be inspected prior to implementation of telemedicine in this population.

Limitation

Our study was limited in its methodological approach. The questionnaire was distributed via email and text messaging. Despite its easy accessibility and ease of use, it may also limit participation as workplace emails were typically accessed during working hours, which may not be convenient. A concern that was discussed was the possibility of incorrect diagnosis. However, this study did not examine different classes of treatment, which makes it a study limitation. Future studies should be conducted to bridge this knowledge gap.

Conclusion

The perceptions and readiness among our HCWs in Perlis toward telemedicine were suboptimal. Despite the potential of telemedicine as a beneficial tool for many medical and surgical consultations, psychological counselling, medical reports generation and storage, laboratory updates, medication refills and communication with other facilities, it does not replace HCWs’ hands-on expertise. The limitation in cybersecurity and clinical practice gaps requires further improvement and modification to sustain its use.

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Tables

Table 1. Sociodemographic characteristics of respondents (n=288)

Characteristics	n	%
Age (years old)	36±8.1a
Gender
Male	63	21.9
Female	225	78.1
Ethnicity
Bumiputera	252	87.5
Non-Bumiputera	36	12.5
Highest education level
Diploma	145	50.3
Degree	121	42.0
Master	20	6.9
PhD	2	0.7
Occupation
Specialist/Consultant	10	3.5
Medical officer	35	12.2
Houseman officer	9	3.1
Dental officer	44	15.3
Pharmacist	36	12.5
Nurse	71	24.7
Medical assistant	10	3.5
Allied health professionals	73	25.3
Working place
District health office/health clinics	160	55.6
Hospital	112	38.9
State health department	16	5.6
Working area
Clinical	253	87.8
Non-clinical	35	12.2
Working Experience (in years)	11±8.2a

Note:⁸ Presented as mean±standard deviation.

 

Table 2. Perception of telemedicine technology among respondents (n=288)

No.	Items	n (%)					Score
		Very Little	Little	No effect	Large	Very Large	Mean ±SD	%
Advantages (Maximum score: 35)							26±4.8	74.3
1.	To what extent are you familiar with the benefits of telemedicine?	18 (6.3)	27 (9.4)	121 (42.0)	94 (32.6)	28 (9.7)
2.	To what extent is telemedicine effective in reducing unnecessary patients’ transportation costs?	5 (1.7)	1 (0.3)	78 (27.1)	134 (46.5)	70 (24.3)
3.	To what extent is telemedicine effective in reducing the costs of patient care in hospitals?	5 (1.7)	4 (1.4)	100 (34.7)	124 (43.1)	55 (19.1)
4.	To what extent will telemedicine influence users' satisfaction?	7 (2.4)	13 (4.5)	132 (45.8)	101 (35.1)	35 (12.2)
5.	To what extent will telemedicine technology save clinicians' time?	6 (2.1)	12 (4.2)	83 (28.8)	129 (44.8)	58 (20.1)
6.	To what extent will telemedicine technology provide faster and better medical care?	6 (2.1)	15 (5.2)	99 (34.4)	110 (38.2)	58 (20.1)
7.	In your opinion, how effective will telemedicine technology improve patient care?	7 (2.4)	15 (5.2)	96 (33.3)	125 (43.4)	45 (15.6)
Disadvantages (Maximum score: 40)							25±6.1	62.5
1.	To what extent may telemedicine technology disrupt a doctor-patient relationship?	18 (6.3)	35 (12.2)	122 (42.4)	93 (32.3)	20 (6.9)	3±0.9
2.	To what extent will telemedicine reduce the effectiveness of patient care?	20 (6.9)	40 (13.9)	124 (43.1)	91 (31.6)	13 (4.5)	3±0.9
3.	In your opinion, could telemedicine technology cause psychological harm to the patient?	34 (11.8)	56 (19.4)	126 (43.8)	62 (21.5)	10 (3.5)	3±1.0
4.	To what extent will telemedicine technology breach patient privacy?	25 (8.7)	51 (17.7)	116 (40.3)	85 (29.5)	11 (3.8)	3±1.0
5.	To what extent will telemedicine technology reduce the efficiency of patient care?	25 (8.7)	47 (16.3)	128 (44.4)	76 (26.4)	12 (4.2)	3±1.0
6.	To what extent may telemedicine technology result in unauthorized access to patient medical information?	17 (5.9)	43 (14.9)	113 (39.2)	93 (32.3)	22 (7.6)	3±1.0
7.	To what extent may telemedicine technology increase the expenses of a hospital?	26 (9.0)	48 (16.7)	120 (41.7)	80 (27.8)	14 (4.9)	3±1.0
8.	To what extent may telemedicine technology increase malpractice in healthcare?	20 (6.9)	36 (12.5)	127 (44.1)	85 (29.5)	20 (6.9)	3±1.0
Necessity (Maximum score: 30)							22±4.1	73.3
1.	To what extent is telemedicine technology necessary for patient care?	3 (1.0)	15 (5.2)	111 (38.5)	121 (42.0)	38 (13.2)
2.	To what extent can telemedicine provide timely healthcare service to patients?	3 (1.0)	17 (5.9)	104 (36.1)	122 (42.4)	42 (14.6)
3.	To what extent should new technology be used along with the current practice?	3 (1.0)	9 (3.1)	85 (29.5)	127 (44.1)	64 (22.2)
4.	To what extent will telemedicine be able to provide services to the underprivileged and those in remote areas?	12 (4.2)	24 (8.3)	113 (39.2)	87 (30.2)	52 (18.1)
5.	To what extent can telemedicine technology provide doctors with instant access to patient information?	3 (1.0)	9 (3.1)	95 (33.0)	127 (44.1)	54 (18.8)
6.	To what extent are national standards essential for telemedicine technology implementation?	7 (2.4)	21 (7.3)	115 (39.9)	105 (36.5)	40 (13.9)
Ease of use (Maximum score: 30)							21±4.2	70.0
1.	To what extent does the ease of use of telemedicine technology make it practical for the clinical staff?	5 (1.7)	21 (7.3)	116 (40.3)	113 (39.2)	33 (11.5)
2.	To what extent does user friendly software ease the clinicians to apply telemedicine technology?	5 (1.7)	18 (6.3)	106 (36.8)	118 (41.0)	41 (14.2)
3.	To what extent does easy-to-use telemedicine technology increase the efficiency of clinical users?	4 (1.4)	15 (5.2)	111 (38.5)	115 (39.9)	43 (14.9)
4.	To what extent does ease of use of telemedicine technology reduce clinicians' errors?	9 (3.1)	24 (8.3)	130 (45.1)	99 (34.4)	26 (9.0)
5.	To what extent does ease of use of telemedicine technology facilitate its learning?	3 (1.0)	10 (3.5)	128 (44.4)	110 (38.2)	37 (12.8)
6.	To what extent does ease of use of telemedicine increase clinicians' skills?	7 (2.4)	36 (12.5)	148 (51.4)	77 (26.7)	20 (6.9)
Security (Total score: 30)							24±4.7	80.0
1.	To what extent is authorised access necessary for the use of telemedicine?	3 (1.0)	8 (2.8)	105 (36.5)	100 (34.7)	72 (25.0)	4±0.9
2.	To what extent are security policies and guidelines necessary for the use of telemedicine technology?	5 (1.7)	8 (2.8)	88 (30.6)	105 (36.5)	82 (28.5)	4±0.9
3.	To what extent does telemedicine need to be supported by all healthcare community?	3 (1.0)	5 (1.7)	92 (31.9)	110 (38.2)	78 (27.1)	4±0.9
4	To what extent does telemedicine technology require a secured network for access to medical information?	3 (1.0)	2 (0.7)	85 (29.5)	83 (28.8)	115 (39.9)	4±0.9
5.	To what extent does telemedicine technology require legal clarification (e.g., consent) for patients?	4 (1.4)	3 (1.0)	87 (30.2)	92 (31.9)	102 (35.4)	4±0.9
6.	To what extent should a secured network be created to prevent breaching of data confidentiality when using telemedicine?	3 (1.0)	6 (2.1)	90 (31.3)	84 (29.2)	105 (36.5)	4±0.9

 

Table 3. Readiness to adapt telemedicine among respondents (n=288)

No.		Items	n (%)					Score
			Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Mean ±SD	%
Core (Maximum score: 50)								32±4.7	64.0
1.		In your opinion, telemedicine will help reduce patients’ hospital/clinic visits	2 (0.7)	6 (2.1)	57 (19.8)	119 (41.3)	104 (36.1)	4±0.8
2.		Would you prefer to use telemedicine over traditional mode of care?	4 (1.4)	23 (8.0)	107 (37.2)	101 (35.1)	53 (18.4)	4±0.9
3.		Would you consider using telemedicine even without prior physical interaction with the patient?	26 (9.0)	58 (20.1)	93 (32.3)	75 (26.0)	36 (12.5)	3±1.1
4.		In your opinion, telemedicine would solve healthcare workers' shortage	23 (8.0)	24 (8.3)	104 (36.1)	90 (31.3)	47 (16.3)	3±1.1
5.		In your opinion, telemedicine is more cost-effective as compared to traditional mode of care	4 (1.4)	25 (8.7)	115 (39.9)	98 (34.0)	46 (16.0)	4±0.9
6.		In your opinion, it is worth investing in telemedicine infrastructure	2 (0.7)	6 (2.1)	101 (35.1)	115 (39.9)	64 (22.2)	4±0.8
7.		In your opinion, telemedicine is an effective service for emergency cases	20 (6.9)	35 (12.2)	99 (34.4)	78 (27.1)	56 (19.4)	3±1.1
8.		In your opinion, telemedicine affects normal process workflow*	8 (2.8)	21 (7.3)	126 (43.8)	97 (33.7)	36 (12.5)	3±0.9
9.		In your opinion, telemedicine will change work practices*	7 (2.4)	9 (3.1)	88 (30.6)	123 (42.7)	61 (21.2)	2±0.9
10.		In your opinion, telemedicine will change referral process*	4 (1.4)	9 (3.1)	88 (30.6)	125 (43.4)	62 (21.5)	2±0.9
e-Learning (Maximum score: 15)								11±2.2	73.3
1.	In your opinion, telemedicine enhances e-learning (e.g., CME)		2 (0.7)	4 (1.4)	70 (24.3)	114 (39.6)	98 (34.0)
2.	In your opinion, healthcare workers are ready to adopt e-learning		2 (0.7)	15 (5.2)	94 (32.6)	102 (35.4)	75 (26.0)
3.	In your opinion, telemedicine can bridge clinical skills gap		4 (1.4)	19 (6.6)	112 (38.9)	100 (34.7)	53 (18.4)
Clinical (Maximum score: 15)								11±2.4	73.3
1.	Would you consider the use of telemedicine service for clinical practice?		6 (2.1)	20 (6.9)	99 (34.4)	110 (38.2)	53 (18.4)
2.	Are you confident on patients’ outcomes as a result of e-prescription or e-consultation?		7 (2.4)	24 (8.3)	118 (41.0)	103 (35.8)	36 (12.5)
3.	In your opinion, telemedicine will improve patients’ clinical outcome		6 (2.1)	12 (4.2)	142 (49.3)	93 (32.3)	35 (12.2)
Overall (Maximum score: 5)								4±0.9	80.0
1.	In your opinion, healthcare workers are ready to integrate telemedicine in routine clinical practice		6 (2.1)	22 (7.6)	112 (38.9)	104 (36.1)	44 (15.3)	4±0.9

Note: *”Strongly Disagree” or ”Disagree” responses were taken as positive attitude toward item.

 

Table 4. Correlation coefficients (r) of perception and readiness domains

Readiness Perception	r
	Core	e-Learning	Clinical	Overall
Advantages	0.546**	0.564**	0.570**	0.523**
Disadvantages	-0.090	-0.063	-0.072	-0.096
Necessity	0.397**	0.464**	0.479**	0.435**
Ease of use	0.407**	0.514**	0.488**	0.479**
Security	0.124*	0.445**	0.255**	0.225**

Note: **,* Correlation is significant at p<0.01 and p<0.05, respectively.

 

Author Biographies

Wei Chern Ang, MPharm (Hons.), MEc, is a senior pharmacist in the Clinical Research Centre and the Department of Pharmacy of Hospital Tuanku Fauziah, Perlis, Ministry of Health Malaysia.

Karniza Khalid, MBBS, MMedSc, (karniza.khalid@moh.gov.my) is a senior medical officer at the Special Protein Unit, Specialised Diagnostic Centre, Institute for Medical Research, National Institutes of Health, Kuala Lumpur, Ministry of Health Malaysia. She was previously the Deputy of the Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Malaysia.

Siti Zulaiha Che Hat, Dip. (Nursing), BNS, is a senior registered nurse in the Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Ministry of Health Malaysia.

Amalina Anuar, MBBS, is a senior medical officer in the Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Ministry of Health Malaysia.