Telemedicine represents a broad range of medical applications
including education and distance learning, diagnosis, treatment and
prevention of disease, exchanging of information with healthcare
providers and consumers, research, and evaluation. These functions and
more can be accomplished and performed from a distance when a robust
information communication infrastructure is deployed. This article is an
exploratory study that seeks to determine the levels of telemedicine
usage utilizing technology acceptance model (TAM) as its theoretical
Keywords: Technology Acceptance model, e-Commerce; e-Readiness,
Diffusion, Tele-Health Networks, Telemedicine, Hard Technologies,
Hospital Primary Care Networks.
In the civilian world, telemedicine has made many advances around
the world. Canada has continued a steady approach to telemedicine as a
way of delivering health care services to its geographically dispersed
and culturally diverse population (McDonald-Rencz, Cradduck, and
Parker-Taillon, 2004 ; Cloutier, 2004). The government of the United
Kingdom continues to support numerous Telemedicine initiatives across a
wide range of eHealth care services. France has also used Telemedicine
and robotics to facilitate surgical procedures. In the U.S. many rural
communities are using a variety of telemedicine application to deliver
health care services. For example, the U.S. Department of Agriculture
recently approved $128 Million for distance learning associated with
Telemedicine (USDA Press Release, April 11, 2007).
The roots of telemedicine go back centuries, when medical care was
limited to the radius in which the physician was available to deliver
medical services. Thus, as the distance between patient and physician
played a large role in driving the costs of healthcare, and the volume
of healthcare service delivery, it soon became apparent that patients
and providers had to be co-located in order to optimize the delivery of
health care services. With the advent of the telephone, medical
communications was accomplished. The telephone system became the vehicle
or the medium that enabled physicians to provide medical information to
Within the last seventy-five years, in which numerous wars were
fought (WWI, WWII, Korea and Vietnam) wide spread use of radio also
enabled the transfer of medical information and services across the
battle field, and between forward battle positions and field hospitals.
Widespread use and acceptance of, and diffusion of a broad range of
different technologies have certainly facilitated the growth and
delivery of medical services on the battle field.
The key aspect of telemedicine is the use of electronic signals to
transfer information from one site to another. At the core of any
successful telemedicine initiative then is a robust telecommunications
infrastructure that facilitates delivery of health care services. Hence,
the delivery of healthcare services is no longer limited by the location
of patients and service providers, but it may be linked to the level of
technology diffusion or acceptance in the areas where the patient is
located. The question then to be addressed is: "are levels of
telemedicine practice directly linked to levels of technology acceptance
or diffusion in those areas where telemedicine is practiced?" To
address this question, we will compare the evolution and practice of
telemedicine in France and the U.S. The primary objective of this study
is to assess the use of telemedicine in France and the U.S utilizing the
technology acceptance model (TAM).
We begin with a brief definition of Telemedicine and list examples
of different types of Telemedicine systems. We follow this by a
description of Technology Acceptance. The paper then provides a brief
but comprehensive description of the French Health Care System.
Attention is given to its organization and finance. Selected
Telemedicine applications in the U.S. are then discussed. Since this
paper makes a comparison between Telemedicine in France and the U.S.,
the paper provides a short discussion on the differences and
similarities between the French and the U.S. telemedicine programs. Some
suggestions are presented to explain the different approaches to
Telemedicine in both countries, within the context of technology
acceptance model. Telemedicine trends in both countries are then
discussed. The final section of this paper will seek to address what
changes might have to be made to realize comparable Telemedicine system
deployment. Areas for further research are also identified.
The following are some of the key definitions and terms used in
Telemedicine: Telemedicine can be defined broadly as the use of
telecommunications technology to provide medical information and
services (Zundel, 1996). Some Telemedicine applications or systems that
are in service today include: Tele-Radiology, Tele-Pathology,
Tele-Ophthalmology, Tele-Ultrasound, and Tele-Education. Figure 1
provides a pictorial representation of components associated with
[FIGURE 1 OMITTED]
Tele-Health: Tele-health is the use of communications and
information technology to deliver health and health care services and
information over large and small distances. (Picot and Cradduck, 2000).
Tele-Medicine Teaching and Education: Where instructors or professors of
medicine can use medical image repositories to search for interesting
cases, based on diagnosis or anatomical region but also on visual
similarity, to present to their students.
Tele-Medicine Information: Where medical information, including
image, extracted from a repository of a hospital or clinic, and a wealth
of other valuable medical applications in diagnostics, research, and
education, may be made available via the World Wide Web.
Hospital Primary Care Networks: Primary or base network center that
generates the information needed for specialty referral and
consultation, information for decision support and refinement of patient
care plans, to facilitate orderly delivery of health care services to
E-Readiness: The evaluation that is undertaken by a country or
community to determine its level of readiness for global electronic
commerce. (Oxley & Yeung, 2001; APEC, 2001; McConnell & Docktor,
Hard Technologies: This may include equipment, factories, tools and
other electrical and mechanical devices that are part of the
technological infrastructure of a country.
Information Communication Technologies Infrastructure: A
combination of various telecommunications media and computer equipment
that are interconnected to facilitate electronic transmission of data
Technology Adaptation: A process in which the original technology
has been modified to meet or address the specific needs in a local
Technology Adoption: Technology is chosen by an organizational,
corporate, or governmental level, as the standard application solution.
It is a process in which senior members of the organization make the
decision to adopt a particular technology as an organizational solution
for a particular issue or set of issues.
Transportation Modality: A variety of ways that a country, or
society, may employ to transport goods or information. These include:
Pipelines, Railways, Air, Sea, Land/Roads, and Telecommunications
(digital or analog).
2. TECHNOLOGY ACCEPTANCE MODEL (TAM)
The Technology Acceptance Model (TAM) (Davis, 1986, 1989) is an
adaptation of the Theory of Reasoned Action (TRA) (Fishbein and Ajzen,
1975; Ajzen and Fishbein, 1980). According to Davis (1986, 1989) the
positive perception of technology's (1) ease of use, (2)
usefulness, and (3) attitudes towards technology usage are important
determinants of the intention to use a given technology. Technology
acceptance, in this case, Telemedicine, may be determined or measured by
the End-Users' willingness to embrace and utilize a new or
adaptation of existing technologies for specific application to
telemedicine, in preference to an old technology (Davis, 1989). Figure 2
is a representation of the original TAM.
[FIGURE 2 OMITTED]
Davis (1989) observed that the user's experience with a
particular technology is also a major contributing external factor, and
that other external factors should be studied extensively in the future.
However, some of these factors are yet to be fully investigated,
particularly technology diffusion, or tele-density as a platform for
Telemedicine. Figure 3 is a representation of Davis' modified TAM
(TAM2) that shows the potential influence attributed to external
variables. Using TAM2, and focusing on a number of inter- and
extra-organizational variables, Igbaria, Zinatelli, Cragg, and Cavaye
(1997) made a number of interesting discoveries relative to computing
utilization. For them the external components were (a) internal
computing support, (b) internal computing training, (c) management
support, (d) external computing support, and (e) external computing
training. They illustrated that these external factors do influence the
degree of technology adoption and acceptance. Among other findings, it
was determined that "external support has a direct positive effect
on perceived ease of use and perceived usefulness". They went on to
state that external support combined with management support are
important factors that can contribute to effective personal computing
[FIGURE 3 OMITTED]
3. OVERVIEW OF THE FRANCE HEALTH CARE SYSTEM
Modern France has one of the "universal" health care
systems in the world and is a leader among European nations. It offers a
"high quality services and is easily accessible at the same
time". Arguably, the modern French Health Care systems emerged out
of the political and social dynamics of World War II, as France
transitioned from a colonial power to European Union builder. According
to Green and Irvine, (2001) "France has a reputation for state
direction and protectionism, but the French healthcare system is based
on a compromise between two conflicting ideologies, egalitarianism [in
which every one has equal access to healthcare; and liberalism--in which
personal choices and competition still exist]".
In France, every employed individual, regardless of the level of
employment, is covered by a national health insurance plan known as
securite sociale (Social Security). Coverage extends to spouses and
children too. People who are not entitled to securite sociale are
required to take out special coverage, known as assurance personelle
(Personal Insurance). However, many people also choose to purchase
additional insurance to complement or supplement their existing national
health insurance plan. Thus the French health care system is a unique
blend of private and public delivery of Health Care services. Rodwin and
Pen (2004) argue that "French policymakers typically view their
National Health Insurance system as a realistic compromise between
Britain's National Health Service, which they believe requires too
much rationing and offers insufficient choice, and the mosaic of
subsystems in the United States, which they consider socially
irresponsible because 15 percent of the population younger than 65 years
of age has no health insurance".
The French health care system is mainly financed by social
insurance but there is also a significant supplementary insurance. About
two-thirds of hospital beds are in the public sector with the remainder
split between the for-profit and non-profit private sectors. Along with
much of the developed world, the French authorities have been trying to
control government spending. While France has a universal public health
insurance system, the coverage it provides is incomplete and the vast
majority of the French population has private complementary health
insurance, (Buchmueller and Couffinhal, 2004). Private coverage accounts
for 12% of total health spending. Given the extent of private coverage
and its importance as a source of financing care, an understanding of
private health insurance is essential for understanding France's
health system and the policy challenges it faces.
3.1 Telemedicine Systems in France
Early French experiences with telemedicine go back to the mid
1940's. It was during that time that the Centre of Maritime Health
Care offered a variety of consultation services which represented their
initial foray into telemedicine (Sosa-Iudicissa, Wootton, and
Ferrer-Roca, 2001). During the 1960's, France experienced
significant growth in the use of telephone and radiophone consultations
for health care purposes. This growth led to the creation of the SAMU
(Service d'Aide Medical d'Urgence) in 1968 and the SAMUR
(Service Mobile d'Urgence et Reanimation), which represented
important milestones in the history of telemedicine in France. While
these organizations did not regulate Telemedicine, they created the
framework that enabled Telemedicine in France to have advanced to the
degree that it has today. By 1970, fifteen regional health centers were
electronically interconnected. In 1984, definitions and regulations
concerns about medical private records were established. Standards were
also established for telephone numbers assigned for medical services,
law enforcement, fire and rescue, and other emergency response agencies.
Since the late 1990's to date, France, being one of the
co-founder of the European Community, implemented a number of programs
that have catapulted France into the forefront of Telemedicine, not only
in Europe but worldwide. France adopted the recommendation of the
European Community to implement a single European emergency call number,
viz. 112, so that each member county will now have a common emergency
number. This is somewhat similar to the 911 emergency number in the U.S.
An important milestone was created in 1989 in which the European
Institute of Telemedicine, in Toulouse, became heavily involved in a
number of European and international telemedicine projects. Some of
these projects included: (a) teaching health care professionals using
appropriate telecommunication systems; (b) research designed with a view
to harmonize training schemes or research programs for telemedicine. (c)
Surgical procedures using remotely controlled robots; (d) automated and
multi-user-oriented pooling of digital orthopedic procedures (Lareng,
France has taken many steps to extend telemedicine applications.
According to Moore (2002), a team of French and American doctors and
engineers used and controlled a robotic system to operate and remove a
gall bladder on a patient in a Strasbourg, a France hospital. Also in
2001/2002 an agreement was signed between the Medical Director in French
Guiana and the French National Center for Space Studies to establish a
Medical Tele-consultation system to cover remote areas in French Guiana.
"Since 2000, CNES, MEDES (for MEDEcine Spatiale--Space medicine)
and the Centre Hospitalier Andree Rosemon de Cayenne (CHC) have been
working together on the contribution of Space systems to public health
matters in French Guiana.
Given all that France has accomplished in the area of Telemedicine,
it is inconceivable that further advancements will be tempered only by
advances in medical technology. With France being a technological leader
in Europe and the world, with wide spread technology acceptance in
France and adoption in French colonies, it is possible that France may
first test some of these technologies in the colonies before wide spread
implementation on the continent.
4. THE U.S. HEALTH CARE SYSTEM
Perhaps, driven by the "market-oriented economy of the U.S.,
the U.S health Care System is a "blend of public and private
involvement in the delivery of health care services" (Shi and
Singh, 2004). This blend of health care systems delivers a combination
of services that result in:
* A multiplicity of financial arrangements
* Numerous insurance agencies that employ a variety of mechanism to
hedge against risks
* Multiple payers that make their own determinations regarding how
much to pay for each service
* A large array of setting for each service
* Numerous consulting firms that offer their expertise in planning,
cost containment, quality of service, and restructuring.
There are ten basic characteristics that make the American health
care system unique. These characteristics are listed as follows:
1. There is no central agency that governs the system
2. Access to the health care system is selectively determined by
the level of insurance coverage.
3. Health care services are delivered within an imperfect market
(where for example the patient is severely at a disadvantage with
respect to many dynamics that occur within the health care system)
4. The insurers act as a intermediary between the financing and
5. The existence of multiple payers makes the system cumbersome
6. Balancing of power between various entities makes it difficult
for any one entity to have a dominate position
7. Legal risks influence how providers deliver their services
8. Development of new technologies create a demand for their use
9. New service setting have evolved along a continuum of health
care (from preventative to end-of-life care)
10. Quality and standards are now looked upon as integral
components of the health care system
According to Shi and Singh (2004), there is little standardization
within the U. S. health care system; thus we are confronted with a
system that is fragmented where the various components fit together in a
very loose manner. The health care system in the U.S is financed through
(1) Voluntary payers--for those who can afford to pay for health care
services; (2) A Multi-payer system that include premiums or general
taxes. At this level there are health care insurance services that
provide coverage for most employees and their immediate dependants; and
(3) Government sponsored (Medicare and Medicaid)--where many that are
"under-insured" or "un-insured" rely mainly on this
netting to cover basic health care services.
4.1 Telemedicine Systems in the U.S.
In the U.S. Telemedicine has its root back in the 1960's when
technology acceptance (particularly Electronic Data Processing systems)
began to influence almost every area of society and business processes
in general. In the 1970's telemedicine received a tremendous boost
from manned space-flight program when Lockheed Missile and Space (now
Lockheed Martin) and National Aeronautics and Space Administration
(NASA) doctors demonstrated that they provide health care services to
people with severe health problems, but who had difficulties accessing
health care services. In 1990, Maritime Health Services (MHS), based in
Seattle, Washington, initiated a program that allowed medical officers
on board fishing trawlers to communicate directly with shore-based
physicians as needed, around the clock (Zundel, 1996). In an effort to
overcome time and distance barriers, National Aeronautics and Space
Administration (NASA) doctors demonstrated that "physiological
functions for astronauts in space could be monitored successfully by
physicians on earth, NASA's scientists, engineers, and contractors
developed sophisticated biomedical telemetry and telecommunications
systems for biomedical applications" (Zundel, 1996).
Thus, as electronic data systems proliferated throughout the
1970's, 1980's, 1990's and into the 21st century, and
with technology becoming more user friendly, accepted and reliable,
medical and health telemedicine usage is becoming more accepted in the
It may be argued that there are many Telemedicine applications and
initiatives that are currently underway in the U.S. that spawn the range
of health care applications from Robotic Surgery to basically providing
health care information via some hand-held telecommunications devices.
However there are three basic areas of telemedicine that are worthy
listing: (a) NASA's Telemedicine applications with terrestrial
based applications; (b) Telemedicine application in Disaster Response;
and (c) Telemedicine in the area of Home Health Care.
NASA Telemedicine Applications: One of the early proponents and
users of Telemedicine systems was NASA. Starting in the early
1970's and continuing through to day, NASA has been testing and
implementing telemedicine capabilities. Nicogossian, Pober, and Roy
(2001) noted that NASA has carried out the majority of terrestrial
telemedicine activities in collaboration with other organizations that
included: (a) U.S department of Health and Human Services; (b) the
Indian Health Service; (c) Medical Informatics and Technology
Applications Consortium Commercial Space Center located at the Virginia
Commonwealth University; (d) East-West Space Science Center (EWSSC) and
the (e) Uniformed Services University of the Health Science; and (f)
U.S. Department of Education.
Telemedicine in Disaster Response: In the area of Disaster
Medicine, NASA was also the first to use telecommunication technologies
to furnish disaster aid following the 1985 earthquake disaster in Mexico
City. NASA has also teamed up with the USSR to create a "Space
Bridge Project to provide consultation in the areas of neurology,
orthopedics, psychiatry, infections disease, and general surgery
(Garshnek, and Burkle, 1999).
Telemedicine in Home Health Care: According to Lisetti and LeRouge
(2004) Home health Care in the U.S. is "the fastest-growing section
of the health care market in the United States". "According to
the National Association for Home Care, more than 20,000 medical
professionals provided approximately 7.6 million people in the U.S. home
care services for acute illness, long-term health conditions, permanent
disability, or terminal illness [National Association of systems, vital
sign monitoring devices, video conferencing, medication reminder
systems, web-based systems and interactive communications systems
(synchronous or asynchronous).
To address these health care services, three common forms of
interactive healthcare communication system were used: (1) A Video
Tele-health System that consists of a videophone, telephone with
speakerphone, and electronic peripheral devices including a blood
pressure cuff and pulse monitor, stethoscope-sending unit, and
thermometer; (2) In Home Messaging Device that connects to a
patient's existing home telephone line and allows patients to view
questions and reminders from their health care provider; and (3) Health
Care Chat Line that allows patients to log into a private Internet site
from their home computer at a designated time. In this way a private
synchronous communication conversation/discussion may be accomplished
with their physician or clinician.
Telemedicine: Rural America Healthcare Delivery: In a report that
described healthcare challenges and opportunities in Rural America,
Matthews and Woodwell (2005) noted that Telemedicine was in the
forefront of delivering state of the art health care services across
America's rural communities. Recognizing that the appropriate
telecommunication and information infrastructure is vital for successful
delivery of telemedicine in these rural communities, it was noted that
several communities have taken the lead in accepting the key
technologies to make delivery of telemedicine services a reality.
For example to stimulate the economic activity, Garrett County,
Md., in cooperation, with the local community college has implemented
high-speed Internet access to the region's businesses and
individuals through the Garrett Rural Information Cooperative. Local
community health care providers are exploiting this capability to
facilitate delivery of a variety of IT health care related services.
Similarly, the state of Georgia has one of the largest telemedicine
systems. This network that was started in 1987, now involves 60 sites,
including rural community hospitals, an ambulatory center, a public
health facility, and correctional institutions. Along with interactive
patient consultation, the system enables rural physicians to acquire
continuing medical education. A future goal of the project is to examine
patients with chronic illness via interactive cable television in their
homes. Originally financed through telephone company rate overcharges,
the system has been expanded and maintained through the joint efforts of
the phone companies, a medical college, and the Governor's office
(Matthews and Woodwell 2005). Also in Georgia, in November 1991, the
Medical College of Georgia introduced an alternative healthcare
system-telemedicine in the State of Georgia. Utilizing an interactive
voice and video telecommunication system integrated with biomedical
diagnostic instrumentation, the telemedicine system allows a physician
at a specialty referral hospital to examine a patient at a rural
location. By electronically transporting the expertise at the referral
hospital, the Telemedicine healthcare delivery system encompasses the
* Providing immediate access to specialty consultation;
* Retaining the patient at the rural community hospital;
* Reducing delays in providing acute care;
* Maintaining continuity of care with the patient's primary
* Providing effective continuing medical education (distance
* Expanding medical capability as well as the ability to supervise
non-physician healthcare personnel;
* Decreasing healthcare costs.
The impact of this system in the State of Georgia has been
significant. Thirty (30) sites are currently operational in the state
while more than 50 additional sites are planned. (State of
Georgia--Rural Healthcare Plan, 2000)
While there are many Telemedicine initiatives currently underway,
there are a few concerns that could limit the how deeply Telemedicine
will penetrate the Health care profession.
* There is the concern that many rural communities, while desirous
of participating in telemedicine health care service, may not have
assess and connectivity to an appropriate ICT infrastructure that is
capable of supporting needed services. Therefore it is necessary that
these communities first invest in developing an appropriate ICT
infrastructure (The Lewin Group, Inc., 2000)
* There is the concern that the introduction of new technology
carries with it a degree of uncertainty on the part of system operators.
Without the assurance of a robust information communications technology
infrastructure, users will inevitably experience severe disruptions that
will render systems inoperable (The Lewin Group, Inc., 2000)
* Third, there is the area of cost and reimbursement. At what
rate(s) should the health care service provider, (those that uses
telemedicine to augment delivery of health care services) be paid?
Should they be paid or reimbursed at the normal rate when there is human
intervention, versus a different rate when there is limited human
intervention in a clinical procedure?
* Grisbey and Saunders (1998) observed that some limitations are
linked to the concerns associated with liability and malpractice. There
is the concern that using more telemedicine may further expose them to
malpractice lawsuits. This situation may be compounded by interstate
variability in the handling of malpractice claims.
* Finally, in the U.S. the process followed by the Food and Drug
Administration may take close to ten years before medical technologies
are brought into general use. According to Sorrel (2006) U.S. medical
devices could take over three years while in France the process is much
shorter. Kaplan et al (2004) explained that while the two countries may
have a rigorous approach to certification of medical technologies, the
U.S. approach is built upon the efficacy of the devices, while the
French (European) approach is more focus on safety.
Thus deployment of telemedicine services is limited due to a
variety of constraints. While rural communities are steadily making the
necessary telecommunication investments to facilitate delivery if
telemedicine services, the slow rate of device approval by the Food and
Drug Administration is also a restraining factor. The uncertainty of
reimbursement rates is also a restraining factor.
5. TRENDS AND FUTURE
There is a steady trend toward further use of telemedicine. While
usage of telemedicine has rapidly increased over that last twenty years,
it is still being used in a limited way. One may argue that this limited
use may be attributed to some of the limitations discussed above.
However it is expected that when cost-effective business models are used
there will be more rapid growth in telemedicine usage. For example,
currently a considerable amount of federal, state and private funding
have been allocated to supported telemedicine in recent years; however
legislators (federal, regional, and state policymakers) are struggling
with "crafting" appropriate policies that will facilitate a
more wide-spread and deeper telemedicine usage. While in the past
research on the effectiveness of telemedicine might have been somewhat
limited, it is safe to argue that NASA, the U.S. Army (in connection
with evacuating wounded soldiers from the battle filed), and the private
sector will continue to demand further telemedicine healthcare usage.
However, the slow approval rate of technology in this area is likely to
restrict the rate and levels of implementation.
6. CONCLUSION AND AREAS FOR FURTHER RESEARCH
There are many areas of telemedicine that both France and the U.S.
are exploiting. In the U.S., NASA and the U.S. Army appears to have
spearheaded the use and application by bringing medical treatments to
the frontline or in combat zones. Telemedicine has also had significant
usage in disaster response as well, particularly when the U.S. military
is deployed in those disaster areas. However electronic credentialing of
civilian health care professional to work in those areas has been a
challenge. Recognizing that "credentialing" of health care
professional is a central component that facilitate telemedicine, and
with "credentialing" being done at the state level, expanded
telemedicine utilization across state boundaries are thus limited. To
date, neither the federal or state governments have agreed on a generic
electronic format for health care credentialing. However, using
Telemedicine as an extension of a doctor's medical practice is more
readily accepted in France, where there are no credentialing issues. A
doctor may physically be located in Paris while he remotely guides
surgical procedures in other parts of France without having to acquire
appropriate credentials in that remote area. Credentialing of civilian
health care personnel is easily overcome. Further research is necessary
in this area.
Both the U.S. and France have, and are continuing to adapt
technologies that were developed for their respective space programs for
telemedicine. France is leveraging and adapting their satellite and
Robotic technologies to deliver telemedicine capabilities to remote
areas, while the U.S. seems to be focusing on rural health care needs.
However it is very likely that France, and Europe in general, will
continue to make greater strides in the deploying telemedicine
application more than the U.S. due in part to the shorter time it takes
to approve medical technologies. Further research is necessary in this
Finally, this paper began with the notion that the levels of
technology acceptance were a factor or a contributor to the wide-spread
use of Telemedicine. While France is less "wired" (France has
41% teledensity) than the U.S., (the U.S. has 64% teledensity),
telemedicine utilization in France appears to have had deeper
penetration in the area of surgical procedures using remotely controlled
robots. On the other hand, the U.S. appears to be taking a cautionary
approach in this area. While French telemedicine capabilities have
extended into such areas as clinical robotic procedures; telemedicine in
the U.S. apparently tends to focus on clinical and patient informatics.
France has taken steps to further deliver health care professionals a
variety of teaching and educational instructions using appropriate
telecommunication systems; in the U.S. some states are further along in
this area than others. France is also continuing to design research with
a view to harmonizing training schemes or research programs for
telemedicine; while the U.S. remains a leader in medical technology
research. France appears eager to use emerging technologies to deliver
telemedicine services to rural and underdeveloped areas; whereas rural
areas in the U.S. must first make the necessary ICT infrastructural
investment before gaining access to telemedicine services that are
readily available in nearby metropolitan areas.
This is a research in progress. Therefore, we intend to provide a
justification of the strength to TAM model and try to support its
appropriateness as a suitable and consistent measure of technology
acceptance in telemedicine. We intend to determine if significant
differences exist between France and the U.S. We are in the process of
developing an instrument that can operationalize the dependent variable,
that is telemedicine usage and allow us to investigate the following
* Is there a relationship between France/U.S perceptions of
usefulness and usage of Telemedicine?
* Is there a relationship between France/U.S perceptions of ease of
use and usage of Telemedicine?
These questions were developed based upon TAM. Empirical research
is needed to test the propositions and the results will be provided in a
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Jude E. Edwards, Capitol College, Laurel, Maryland, USA
Leila A. Halawi, Bethune-Cookman University, Daytona Beach,
Dr. Jude E. Edwards earned his DBA--International, at Nova
Southeastern University, Ft. Lauderdale, FL in 2003. He is an Adj. Prof.
for Capitol College and Columbia Union College in their MBA programs. He
also teaches online for South University. He has over 25 years of
experience in IT and business development (ten years with Lockheed
Martin). His current research includes Informatics and Knowledge
Management in Health Care. He is an international conference presenter.
Dr. Leila A. Halawi earned her DBA--IT, at Nova Southeastern
University, Ft. Lauderdale, Fl. in 2005. She is an assistant professor
of business administration in the school of business at Bethune-Cookman
University. She is also an Adj. Prof. at the University of Tampa. Her
current research includes knowledge management, data mining, information
systems success and strategy, and ethical impacts of information
technology. She is frequently invited to present her research at
national and international conferences.