International Journal of Telemedicine and Applications As speciﬁc steps in the process are identiﬁed, probe as to which steps are considered for the best and which have been for the worse. (5) What in your opinion could improve this process (in general)? Please elaborate. I am now beginning to get a sense of the unique issues faced in your practice. (1) Now, what if you had the opportunity to change ONE thing in your practice to improve this process of making referrals/providing consult services, do you have any thoughts on what those change would be? Now, I would like you to go back to the initial scenario which you may or may not ﬁnd typical presenting at your clinic (INSERT CASE SCENARIO—varied based on PCP or specialist OF PATIENT IN PRIMARY CARE/SPECIALTY CARE SETTING PRESENTING WITH SYMPTOMS NECES- SITATING NEED FOR SPECIALTY CARE SERVICE REFER- RALS/CARE AT SFGH). Now, imagine, it is 10am and your patients “present with these same symptoms necessitating a referral to specialty care service, BUT now you are now able to VIDEOCONFER- ENCE in and consult with the PCP/Specialists/Fellow all at the same time. (1) How would this change the process in your clinic/ site? Please elaborate. (2) Can you walk me through some of the changes? (3) Do you like this change? (4) What do you NOT like about this change? As speciﬁc steps in the process are identiﬁed, probe as to which steps are considered for the best and which will worsen with this new approach. (5) Can you think of any barriers to implementing such a telemedicine program at your clinic site? (6) What are your thoughts on: (A) Maintenance of the equipment for the pro- gram? Please elaborate. (B) Maintaining a medical record? Please elaborate. (C) Reimbursement? Please elaborate. Speciﬁc to primary care providers: (1) If you had the opportunity of collaborating with and were provided access to any type of telemedicine services, if available, with the specialists at SFGH, do you have any thoughts on what some of those services would look like? Speciﬁc to the specialists: (1) If you had the opportunity of collaborating with or were provided access to any type of telemedicine services, if available, with the Primary Care Provider’s in the outpatient setting, do you have any thoughts on what some of those services would look like? 13 Thank you very much for your time and an engaging discussion. This has been an interesting learning experience for me. We hope to use this information to ultimately make improvements in the delivery of specialty care to uninsured and Medicaid patients, and your contribution to this pursuit is greatly appreciated. You will be receiving an email from my PI, Dr Hal Yee in the next couple weeks or so. Please do respond to the survey by rating your selections on types of telemedicine services you would ﬁnd most useful in your practice. Once again, if you have any questions about this research study or any questions asked, feel free to contact me Ken Russell Coelho, directly at (415) 206-8539 or by e-mail: ken.coelho@ucsf.edu and/or my faculty advisor/Principal Investigator, Dr. Hal Yee, at (415) 206-4808 or by email: hyee@medsfgh.ucsf.edu. Have a great day! Interview guide adapted from the Telecommunica- tions and Information Policy Institute document, Needs and Assets Assessment tool, University of Texas-Austin (http://www.utexas.edu/research/tipi/research/needs assest assestments.pdf) Accessed on March 9th 2010. Abbreviations APN: Advanced Practice Nurse CHR: Committee on Human Research CIDP: Committee on Interdisciplinary Practice COPC: Community Oriented Primary Care CNO: Chief Nursing Oﬃcer CNS: Certiﬁed Nurs e Specialist CNL: Certiﬁed Nurse Leader EMR: Electronic Medical Record FHC: Family Health Center GMC: General Medical Clinic GI: Gastroenterology HMO: Health Maintenance Organization HSF: Healthy San Francisco LCR: Lifetime Clinical Record MEA: Medical Evaluations Assistant NEC: Nursing Executive Committee PCP: Primary Care Provider SFGH: San Francisco General Hospital SFDPH: San Francisco Department of Public Health UCSF: University of California, San Francisco VMI: Videoconferencing medical interpretation. Acknowledgments Author would like to thank Dr. John Ziegler, Dr. Hal Yee, Dr. Wayne Steward and Dr. Mary Sutphen for their outstanding faculty mentorship and Roland Pickens, Iman Nazeeri- Simmons and Sue Schwartz for their strategic expertise on the SFDPH system. Author would also like to thank Dr. Phillip Prager for his useful comments during the review process. No funding was sought in the creation of this work.