Emergency and Eye Care Providers’ Perspectives on the Acceptance of Interprofessional Teleophthalmology.

Emergency and Eye Care Providers’ Perspectives on the Acceptance of Interprofessional Teleophthalmology. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Emergency and Eye Care Providers’ Perspectives on the Acceptance of Interprofessional Teleophthalmology. Assegid Roba, Gulzar Shah, Bettye Apenteng, William Mase This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8941200/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Teleophthalmology is well established for screening conditions such as retinal diseases, yet its use for synchronous interprofessional consultation in emergency departments (EDs) remains limited. This study examines how U.S. emergency and eye-care professionals viewed the challenges, opportunities, and overall acceptability of teleophthalmology for ED consultations. Methods We conducted a national cross-sectional web-based survey of emergency and eye-care providers across the United States in mid-2020. The survey assessed respondent demographics and organizational context, technology-acceptance constructs including perceived usefulness (PU) and intention to use (IU), perceived barriers and facilitators, and an open-ended item on implementation considerations. Analysis integrated descriptive statistics, subgroup comparisons, and inductive thematic analysis of free-text responses. Results Among 244 respondents, 35.2% reported prior experience with video-based telemedicine and 66.4% believed the COVID-19 pandemic would accelerate telemedicine adoption. The most frequently cited barriers were privacy and security concerns (61.9%), initial technology costs (60.6%), and resistance to workflow change (57.4%). Commonly identified facilitators included advancing technologies (59.4%), integration of telemedicine into medical and nursing education (59.0%), and easing of regulatory barriers (58.6%). Qualitative responses regarding teleophthalmology implementation in EDs reflected four sentiment profiles: positive (45.5%), cautiously optimistic (35.6%), and skeptical or negative (18.9%), with more favorable views associated with higher PU and IU scores. Conclusions Emergency and eye-care clinicians demonstrated clear readiness to adopt synchronous teleophthalmology for inter-provider consultations. Findings suggest that acceptance is shaped less by technical limitations than by persistent concerns about privacy, cost, and workflow integration. Pandemic-era policy shifts and growing telemedicine experience may facilitate broader adoption. Critical Care & Emergency Medicine Ophthalmology Teleophthalmology emergency eye care interprofessional consultation technology acceptance provider perspectives Figures Figure 1 INTRODUCTION Telehealth has moved from peripheral experimentation to a durable feature of modern care, driven by advances in networks and mobile devices, alongside policy attention to access and cost (Tuckson, Edmunds, & Hodgkins, 2017 ; van Dyk, 2014 ). Across clinical specialties, remote consultation has been associated with shorter time to decision making, fewer avoidable patient transfers, and a more equitable distribution of specialist expertise (Ekeland, Bowes, & Flottorp, 2012 ; Ackerman, Filart, Burgess, Lee, & Poropatich, 2010 ). Ophthalmology offers a particularly informative use case, as high resolution imaging is essential, yet on call specialist coverage remains uneven. This mismatch creates a gap that interprofessional teleconsultation can help address (Host, Turner, & Muir, 2018 ; Tan, Dobson, Bartnik, Muir, & Turner, 2017 ). While teleophthalmology is well established for retinal disease screening, its use for real time emergency department (ED) consultations between providers remains limited. Existing teleophthalmology research has focused largely on technical feasibility and the success of asynchronous care models. Most large scale implementations involve store and forward screening programs, such as diabetic retinopathy screening, where image interpretation can be efficiently centralized (Prathiba & Rema, 2011 ). In contrast, live teleophthalmology for ED consultation remains underused, despite its clear relevance to time sensitive conditions such as ocular trauma or suspected retinal detachment. In emergency settings, real time consultation allows ophthalmologists to guide the examination, support clinical decision making, and influence disposition without delay (Host et al., 2018 ; Tan et al., 2017 ). Hybrid models that combine store and forward imaging with live consultation have also shown promise (Prathiba & Rema, 2011 ; Tan et al., 2017 ). Given demonstrated diagnostic concordance and operational value for urgent eye complaints, the feasibility of live teleophthalmology is no longer the primary concern. Less well understood are the non-technical factors that limit routine adoption in emergency care. In ED settings, barriers commonly include workflow friction, such as responsibility for image acquisition and integration into triage, alongside medico legal concerns, cost, and professional culture (LeRouge & Garfield, 2013 ; van Dyk, 2014 ). The ED operates under high cognitive load and throughput pressure, conditions that amplify even minor disruptions in workflow. As a result, clinicians’ beliefs about usefulness and fit within existing processes often determine whether a pilot program becomes standard practice (Ekeland et al., 2012 ; LeRouge & Garfield, 2013 ). The policy shifts of 2020 temporarily lowered external barriers and increased awareness of telemedicine across care settings (Saleem et al., 2020 ; Sharma et al., 2020 ; Zachrison et al., 2020 ), but it remains unclear how clinicians interpreted this period and whether it translated into durable readiness for change (Tuckson et al., 2017 ). Directly examining provider perspectives helps distinguish short term adaptation from longer term acceptance and highlights implementation barriers that health system leaders can realistically address. The objective of this study was to characterize U.S. emergency and eye care professionals’ perceptions and overall acceptance of live teleophthalmology for interprofessional ED consultations. Specifically, the study aimed to identify commonly endorsed barriers and facilitators, describe individual and contextual factors associated with technology acceptance, and synthesize qualitative themes relevant to practical implementation. METHODS This study was a complementary part of a larger dissertation project evaluating the impact of transformational leadership constructs on the acceptance of teleophthalmology by emergency department professionals. The present report focuses on the descriptive and qualitative findings from the providers’ perspectives. Design and Participants. We conducted a national, cross-sectional, web-based survey (May–June 2020) targeting U.S. clinicians involved in emergency eye-care workflows. Eligible respondents included emergency physicians (EP); advanced practice providers (APPs, including nurse practitioners (NP) and physician assistants (PA)); emergency nurses (RN), technicians (TEC); and ophthalmologists (MD) and Doctor of Optometry (OD) who provide or receive ED teleconsultations. These roles were included because live ED teleophthalmology requires coordinated input from both ED teams and consulting specialists (Host, Turner, & Muir, 2018 ; Tan, Dobson, Bartnik, Muir, & Turner, 2017 ). A pragmatic, nonprobability approach was used as it aligns with telehealth evaluation guidance that emphasizes context and implementation in early-stage studies (Ekeland, Bowes, & Flottorp, 2012 ; van Dyk, 2014 ). Sampling and Recruitment. A purposive, nonprobability sampling strategy with quota controls was applied to include a diverse mix of providers. However, initial recruitment through email invitations, social media outreach, professional networks, and snowball referrals yielded limited participation as the COVID-19 pandemic constrained emergency providers’ availability. Consequently, a population of health professionals registered with a polling firm that conducts online and mobile surveys (Pollfish; https://www.pollfish.com ) was used as a proxy sampling frame. This pragmatic approach prioritized heterogeneity across roles and U.S. regions to reflect adoption barriers and facilitators under real-world conditions where formal sampling frames for interprofessional telehealth do not exist. Data Collection and Instruments. The self-administered questionnaire is provided as Supplementary Material (A-1: Survey Questionnaire). It comprised four parts: (1) demographics, individual factors, and organizational context; (2) technology-acceptance and transformational leadership constructs; (3) checklist items on perceived challenges and opportunities for live ED teleophthalmology; and (4) an open-ended prompt on how the technology should be introduced into ED workflow. Technology-acceptance items for perceived usefulness (PU) and intention to use (IU) were adapted from established theoretical models (Davis, 1989 ; Davis, Bagozzi, & Warshaw, 1989 ; Taylor & Todd, 1995 ; Venkatesh & Davis, 2000 ; Venkatesh et al., 2003 ; Thompson et al., 1991 ). Wording and examples were grounded in prior real-time teleophthalmology programs to ensure face validity for emergency use-cases (Host et al., 2018 ; Tan et al., 2017 ) and guided by telehealth adoption frameworks relevant to workflow and governance (LeRouge & Garfield, 2013 ; van Dyk, 2014 ). The core items addressing the study aims (Q16–Q20: prior telemedicine exposure; challenge checklist; opportunity checklist; perceived COVID-19 influence; and the open-ended implementation question) are included verbatim in this manuscript. Platform safeguards and manual review procedures minimized inattentive or fraudulent responses (e.g., short completion time, inconsistent answers). Key Terms. For this study, acceptance refers to individual-level attitudes toward teleophthalmology, measured as PU and IU following TAM/UTAUT frameworks (Davis, 1989 ; Venkatesh & Davis, 2000 ; Venkatesh et al., 2003 ). Adoption denotes organizational-level integration into ED workflows, influenced by factors like infrastructure, reimbursement, and staff readiness (Tuckson et al., 2017 ; van Dyk, 2014 ). Live teleophthalmology is defined as real-time, synchronous video consultation between ED teams and eye-care specialists, in contrast to store-and-forward models. Advanced practice providers (APPs) include nurse practitioners (NPs) and physician assistants (PAs), grouped together in analyses. Analysis. Primary outcomes were the frequencies of challenge and opportunity endorsements and the distributions of PU and IU. Secondary descriptors included individual factors (role, years in practice, prior video-based telemedicine experience) and organizational context (on-call availability, site type, ED volume, and telehealth infrastructure). These variables were selected for their relevance to perceived usefulness, normative pressures, and practical feasibility in clinical technology adoption (Davis, 1989 ; Venkatesh et al., 2003 ; LeRouge & Garfield, 2013 ). Closed-ended items were summarized descriptively (frequencies, percentages), with exploratory cross-tabulations by role, prior video experience, on-call availability, and site type. For the open-ended item, we conducted an inductive, constant-comparative thematic analysis to derive implementation-relevant themes (value/timeliness; quality/safety; workflow; equity; training; policy), consistent with pragmatic telehealth evaluation guidance (van Dyk, 2014 ). Ethical Considerations. The protocol received approval from the Institutional Review Board of Georgia Southern University. No personally identifiable information was collected. Participation was voluntary. Electronic informed consent preceded the survey launch. RESULTS A total of 244 clinicians completed the survey. The sample included emergency physicians (31.1%), emergency nurses/technicians (21.1%), nurse practitioners (18.4%), physician assistants (11.1%), and optometrists (19.3%). This role distribution approximated national workforce proportions and was consistent with the quota targets set at study design. Individual Factors. Roughly one-third of respondents (35.2%) reported prior experience with video-based telemedicine (Table 1 ). Additional patterns of exposure included telephone-only use before 2020 (17.6%), telephone or video visits first initiated during 2020 (27.4%), and no prior telemedicine exposure (19.7%). Clinicians with prior video-based telemedicine experience had higher mean scores for perceived usefulness (PU) and intention to use (IU) teleophthalmology than those without prior video experience. Differences by professional role were present but modest. Consultant-side clinicians, including ophthalmologists and optometrists, and some emergency physicians reported higher IU scores, while supporting staff, including nurses and technicians, reported lower mean IU scores. No meaningful differences were observed by age group or gender. Table 1 Individual characteristics and intention to use (IU) teleophthalmology among emergency eye-care providers, USA, 2020 (N = 244). Characteristics Group/Measure # % Usefulness (PU) Mean (SD) Intention (IU) Mean (SD) Gender Female 126 51.6% 3.45 (1.0) 3.66 (.99) Male 118 48.4% 3.56 (.93) 3.80 (.89) Generation 20–40 (Millennials, Gen-Y) 95 38.9% 3.58 (.85) 3.73 (.79) 40–54 (Gen-X) 107 43.9% 3.60 (1.04) 3.84 (1.01) 55+ (Baby-Boomers) 42 17.2% 3.20 (1.09) 3.52 (1.09) Race/Ethnicity Minorities 94 38.5% 3.56 (.99) 3.78 (.95) Whites 150 61.5% 3.50 (.96) 3.72 (.95) Consultation Side* Consulted (Eye Doctors) 47 19.3% 3.78 (.98) * 3.93 (.98) * Consulting (ED providers) 148 60.6% 3.58 (.91) 3.78 (.94) Supporting (Nurses & Techs) 49 20.1% 3.09 (1.04) 3.45 (1.07) Leadership Role* Medical Practice Only 122 50.0% 3.36 (1.01) 3.55 (.96) Directing / Managing Too 122 50.0% 3.69 (.91) * 3.93 (.90) * Video Telemedicine Experience* No 158 64.8% 3.43 (.99) 3.65 (.99) Yes 86 35.2% 3.67 (.91) * 3.91 (.84) * Qualitative Opinion * Positive 111 45.49% 3.72 (.90) * 3.91 (.80) ** Optimistic 87 35.66% 3.44 (1.1) 3.75 (1.04) Skeptical 28 11.48% 3.21 (1.1) 3.36 (1.00) Negative 18 7.38% 3.21 (.79) 3.28 (1.06) Note : Significant difference among subgroups * p < 0.05, **p < 0.01 (t-test for 2 means, one way ANOVA for multiple groups, equal variance) PU= Perceived Usefulness, IU= Intention To Use. Organizational Context. Most respondents practiced in urban hospitals, although on-site ophthalmology coverage was not universal. Higher PU and IU scores were observed in settings with on-call ophthalmology coverage, higher ocular emergency caseloads, and existing telemedicine systems in the ED (Table 2 ). Exploratory analyses did not indicate meaningful PU or IU differences by state policy environment, hospital location, or patient transfer rates. Table 2 Organizational context (on-call availability, site type, ED volume, telehealth infrastructure) and perceived usefulness/intention to use, USA, 2020 (N = 244). Characteristics Group/Measure # % Usefulness (PU) Mean (SD) Intention (IU) Mean (SD) State Policy on Telemedicine Restrictive 73 29.9% 3.44 (.99) 3.76 (.90) Moderate 49 20.1% 3.51 (1.06) 3.74 (.97) Progressive 122 50.0% 3.57 (.93) 3.74 (.97) Hospital Location Urban 162 66.4% 3.53 (.96) 3.81 (.91) Rural 82 33.6% 3.50 (1.0) 3.65 (1.00) Having On-Call Ophthalmologist* None 45 18.4% 3.10 (.94) 3.50 (1.20) Remote 112 45.9% 3.53 (.97) 3.66 (.98) On-site 88 35.7% 3.73 (.94)* 3.98 (.82) * Caseload ** (of ocular emergencies) Low (< 5 / month) 135 55.3% 3.27 (.97) 3.56 (.93) High (5+ /month) 109 44.7% 3.83 (.89)** 3.74 (.95)** Transfer Rate (cases/5 encounters) Low (< 3) 154 63.1% 3.47 (.95) 3.70 (.91) High (3+) 90 36.9% 3.60 (1.01) 3.82 (1.00) Telemedicine System in ED** None 58 23.8% 2.97 (1.0) 3.26 (1.00) Available 186 76.2% 3.69 (.90)** 3.90 (.88)** Note : * p < 0.05 ** p < 0.001 (t-test for 2 means, one way ANOVA for multiple groups, equal variance) PU= Perceived Usefulness, IU= Intention To Use Perceived Challenges and Opportunities. When asked about barriers to adopting live teleophthalmology in emergency departments, respondents most frequently cited privacy and security concerns (61.9%), the initial cost of technology (60.6%), and staff resistance to new workflows (57.4%). Other commonly noted challenges included medico-legal ambiguity, limitations in image quality, and uncertainty around consent and documentation procedures. Conversely, the leading opportunities reflected optimism about external and internal drivers of change. Advancing technologies were endorsed by 59.4% of respondents, incorporation of telemedicine into medical and nursing education by 59.0% and easing of regulatory restrictions by 58.6% (Fig. 1 ). Privacy and security issues ( p = 0.35) and the technology’s cost ( p = 0.026) were more critical challenges for physicians and doctors than other participants. Also, most doctors (64%) agreed that telemedicine education is one of the solutions. Otherwise, there was no difference among doctors and other health professionals in identifying opportunities and challenges. Compared to those from urban areas (43.2%), responders from rural hospitals (57%) were more likely to perceive limited acceptance by staff as a hindrance to telemedicine acceptance ( p = 0.037). No significant difference emerged in the pattern of selected opportunities and challenges among those exercising leadership roles compared without management responsibilities. Pandemic Impact on Telemedicine Use. More than one quarter of respondents (27.5%) reported initiating telemedicine use for virtual patient visits during the COVID-19 pandemic. When asked about the pandemic’s impact on telemedicine adoption, two-thirds of respondents (66.4%) reported that COVID-19 had “a great deal” or “a lot” of impact. An additional 26.0% reported a moderate impact, while 8.0% reported little or no impact. Provider Attitudes and Sentiment Profiles. Sentiment coding of open-ended responses to Q20 (“In general, what do you think about introducing teleophthalmology to emergency departments?”) identified four attitudinal categories: positive (45.5%), cautiously optimistic (35.6%), skeptical (11.5%), and negative (7.5%). These distributions were consistent with checklist findings, with more favorable sentiment associated with higher mean scores for perceived usefulness (PU) and intention to use (IU) (PU: F = 3.35, p = 0.02; IU: F = 4.2, p = 0.006; r = 0.19–0.22). Clinicians in the positive and cautiously optimistic groups emphasized teleophthalmology’s potential to improve timeliness and access, describing it as “a great idea… quick and easy, preventing unnecessary admissions” (Emergency Physician) and “a cost-saving tool that ensures 24/7 specialist access” (Nurse Practitioner). Others expressed conditional support, noting that teleophthalmology “helps decide whether to transfer or not” or “is better than no coverage at all.” Skeptical respondents raised concerns about diagnostic adequacy and reimbursement feasibility, including that “it would be difficult to perform a fundoscopic exam over a webcam” or that “insurers may not reimburse at parity.” Negative views, though infrequent, cited technical and medico-legal risks, such as “increased chance of misdiagnoses” and “the need for in-person exams in trauma cases.” Implementation Themes From Open-Ended Responses. Thematic analysis of open-ended responses identified six recurring implementation themes: value and timeliness, quality and safety, workflow design, equity and coverage, training and confidence, and policy or reimbursement considerations. Representative excerpts across the four sentiment categories are presented in Table 3 . Table 3 Attitudes Of Emergency and Eye Care Providers Towards Introducing Teleophthalmology Technology To Emergency Departments In The USA, 2020 Theme Excerpts Responder Positive (45.5%) “I think it would be a generally useful move that would increase efficiency.’ PA “Great idea - very efficient and effective. Plan to expand usage in the future.” EP “It is a great solution during COVID-19 and during normal times.” EP “It is a great idea and cost-saving for the patient.” NP “I think [it] is important because it can help with emergency procedures.” EP “I think in the long run, it is beneficial and may reduce wait times as well as triage headaches.” OPH “I think it would be useful and that all hospitals would need to use it. I like it, and some of my colleagues would like to try it someday.” OD Cautiously optimistic (conditional) (35.6%) “Depends on how many I can help.” PA “I think it can be useful in some situations, but it is never as good as an in-person visit.” NP “It is a tool and only a tool, but it adds flexibility to treatment.” EP “Very helpful, especially in rural areas!” OD “I think it is a great tool to have available in emergency rooms that may otherwise not have access to this type of service.” RN “It is good but needs much work to be used at its fullest potential.” RN Skeptical (11.5%) “I think it would make some improvements, but in our place, it might be more efficient to ship the patient.” NP “I am skeptical of how it will work.” EP “Pros and cons. Cannot examine the eye properly.” N.P “Impracticable but nice to have” RN Negative (7.5%) “It could increase misdiagnoses.” PA “It is difficult to do the eye exams, unfortunately.” EP “Better to see the injury in person.” NM Abbreviations : EP = Emergency Physician; PA = Physician Assistant; NP = Nurse Practitioner; RN = Registered Nurse; NM = Nurse Manager; OPH = Ophthalmologist; OD = Optometrist; DISCUSSION Our national snapshot of clinicians involved in emergency eye care in 2020 showed broad support for live teleophthalmology, with respondents anticipating benefits such as faster triage, fewer avoidable transfers, and more reliable after-hours coverage. At the same time, commonly cited barriers included privacy and security concerns, start-up costs, and staff resistance to workflow change. Acceptance varied by experience and context. Clinicians with prior video-based telemedicine experience reported higher perceived usefulness (PU) and intention to use (IU), consistent with the “experience effect” described in technology acceptance research (Davis, 1989 ; Venkatesh & Davis, 2000 ; Venkatesh et al., 2003 ; Taylor & Todd, 1995 ; Thompson, Higgins, & Howell, 1991 ). Qualitative responses highlighted recurring implementation themes related to clinical value, quality and safety, workflow fit, training, and governance, aligning with established telehealth adoption frameworks (Tuckson, Edmunds, & Hodgkins, 2017 ; van Dyk, 2014 ; LeRouge & Garfield, 2013 ; Ekeland, Bowes, & Flottorp, 2012 ). These findings reinforce evidence from the broader telehealth literature that adoption depends less on technological capability and more on implementation mechanics, including workflow integration, governance, and organizational support (Tuckson et al., 2017 ; van Dyk, 2014 ; Ekeland et al., 2012 ). Although prior ophthalmology studies have demonstrated diagnostic concordance for remote consultation, routine use in emergency settings remains uneven. Live teleophthalmology must perform under time pressure, where even minor workflow disruptions can undermine uptake (Host et al., 2018 ; Tan et al., 2017 ; Prathiba & Rema, 2011 ; LeRouge & Garfield, 2013 ). The observed experience effect suggests that brief, well-supported pilot implementations that allow ED teams to complete end-to-end consultations may be an effective strategy for building confidence and normalizing use. Implementation efforts should therefore prioritize workflow design, including clear consultation triggers and standardized order sets, alongside reliable connectivity to reduce failed or delayed consultations (Ackerman et al., 2010 ; LeRouge & Garfield, 2013 ). Clear governance structures, such as defined consent language, standard operating procedures for image storage, and liability guidance, may further reduce professional uncertainty that is often perceived as resistance. While policy changes during the COVID-19 pandemic lowered external barriers and increased familiarity with telemedicine (Saleem et al., 2020 ; Sharma et al., 2020 ; Zachrison et al., 2020 ), sustained adoption will depend on translating temporary regulatory flexibility into durable organizational and financing arrangements (van Dyk, 2014 ; LeRouge & Garfield, 2013 ). Attention to equity is also important to ensure that devices, training, and support are available across shifts and sites, minimizing access gaps (Tuckson et al., 2017 ; Ekeland et al., 2012 ). Limitations. This study benefits from a mixed sample of emergency and consulting eye-care clinicians and the integration of quantitative and qualitative data. Limitations include nonprobability sampling, reliance on self-reported measures, and a cross-sectional design reflecting a U.S. snapshot from 2020. Local variation in readiness and potential common-method bias should be considered when interpreting the findings. Nonetheless, convergence between quantitative patterns and qualitative themes supports the relevance of the implementation priorities identified. Conclusions. Clinicians in emergency eye care demonstrated cautious but clear readiness for live teleophthalmology. This optimism suggests that technical feasibility has largely been established and that remaining barriers are primarily organizational. Progress toward routine use is likely to depend on reducing workflow and governance friction rather than overcoming skepticism about the technology itself. Pandemic-era policy shifts and growing user experience provide momentum for health systems to move from pilot projects to broader integration. Future studies should examine real-world utilization and outcomes, including time to decision making, avoided transfers, user satisfaction, and the role of leadership in sustaining adoption. Declarations Funding and Disclosures No external funding was received for this study. The authors declare no conflicts of interest. Author Contributions: A. Roba conceptualized and led the study, including survey design, data analysis, and manuscript drafting. Drs. Mase, Apenteng, and Shah contributed to the study design, methodology, interpretation of findings, and critical revision of the manuscript. Dr. Shah provided overall guidance and oversight. Acknowledgments: The authors are very grateful to the clinicians who participated in the survey for their time and insights. We also thank Yousuf M. Khalifa, MD, and Hany H. Atallah, MD, of Emory University at Grady Memorial Hospital for their clinical perspectives, as well as Moges S. Ido, MD, PhD, of the Georgia Department of Health for statistical support. References Ackerman MJ, Filart R, Burgess LP, Lee I, Poropatich RK (2010) Developing next-generation telehealth tools and technologies: Patients, systems, and data perspectives. Telemedicine e-Health 16(1):93–95 Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77–101 Bruce BB, Lamirel C, Wright DW, Ward A, Heilpern KL, Biousse V, Newman NJ (2011) Non-mydriatic ocular fundus photography in the emergency department. N Engl J Med 364(4):387–389 Caffery LJ, Taylor M, Gole G, Smith AC (2019) Models of care in teleophthalmology: A scoping review. J Telemed Telecare 25(2):106–122 Cangur S, Ercan İ (2015) Comparison of model-fit indices used in structural equation modeling under multivariate normality. J Mod Appl Stat Methods 14(1):152–167 Carless SA, Wearing AJ, Mann L (2000) A short measure of transformational leadership. J Bus Psychol 14(3):389–405 Carrara GLR, Bernardes A, Balsanelli AP, Camelo SHH, Gabriel CS, Zanetti ACB (2017) Use of instruments to evaluate leadership in nursing and health services. Revista Gaúcha de Enfermagem, 38(3), e69038 Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS (2016) Epidemiology of eye-related emergency department visits. JAMA Ophthalmol 134(3):312–319 Davis FD (1989) Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q 13(3):319–340 Davis FD, Bagozzi RP, Warshaw PR (1989) User acceptance of computer technology: A comparison of two theoretical models. Manage Sci 35(8):982–1003 Ekeland AG, Bowes A, Flottorp S (2012) Methodologies for assessing telemedicine: A systematic review of reviews. Int J Med Informatics 81(1):1–11 Hall MA, McGraw D (2014) For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff 33(2):216–221 Host BK, Turner AW, Muir J (2018) Real-time teleophthalmology in rural Western Australia. Clin Experimental Optometry 101(1):129–134 Kruse CS, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M (2018) Evaluating barriers to adopting telemedicine worldwide: A systematic review. JMIR Med Inf, 6(2), e104 LeRouge C, Garfield MJ (2013) Crossing the telemedicine chasm: Have the U.S. barriers to widespread adoption of telemedicine been largely resolved? Int J Environ Res Public Health 10(12):6472–6484 Prathiba V, Rema M (2011) Teleophthalmology: A model for eye care delivery in rural areas of India. International Journal of Family Medicine, 2011, 683267 Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM (2012) Barriers to telemedicine: Survey of current users in acute care units. Telemedicine e-Health 18(1):48–53 Saleem SM, Pasquale LR, Sidoti PA, Tsai JC (2020) Virtual ophthalmology: Telemedicine in a COVID-19 era. J Eval Clin Pract 26(4):1099–1102 Schepers J, Wetzels M, de Ruyter K (2005) Leadership styles in technology acceptance: A test of a mediation model. Inf Manag 42(5):701–719 Schreiber JB, Nora A, Stage FK, Barlow EA, King J (2006) Reporting structural equation modeling and confirmatory factor analysis results: A review. J Educational Res 99(6):323–338 Sharma M, Jain N, Ranganathan L, Sharma N, Honavar SG (2020) Implementation of tele-ophthalmology during COVID-19 pandemic: Lessons learned. Telemedicine e-Health 26(9):1035–1041 Tan IJ, Dobson LP, Bartnik S, Muir J, Turner AW (2017) Real-time teleophthalmology versus face-to-face consultation: A systematic review. J Telemed Telecare 23(7):629–638 Taylor S, Todd P (1995) Understanding information technology usage: A test of competing models. Inform Syst Res 6(2):144–176 Thompson RL, Higgins CA, Howell JM (1991) Personal computing: Toward a conceptual model of utilization. MIS Q 15(1):125–143 Tuckson RV, Edmunds M, Hodgkins ML (2017) Telehealth. N Engl J Med 377(16):1585–1592 Valikodath NG, Leveque TK, Wang SY, Lee PP, Newman-Casey PA, Woodward MA (2016) Patient attitudes toward telemedicine in ophthalmology. JAMA Ophthalmol 134(3):318–325 van Dyk L (2014) A review of telehealth service implementation frameworks. Int J Environ Res Public Health 11(2):1279–1298 Venkatesh V, Bala H (2008) Technology acceptance model 3 and a research agenda on interventions. Decis Sci 39(2):273–315 Venkatesh V, Davis FD (2000) A theoretical extension of the technology acceptance model: Four longitudinal field studies. Manage Sci 46(2):186–204 Venkatesh V, Morris MG, Davis GB, Davis FD (2003) User acceptance of information technology: Toward a unified view. MIS Q 27(3):425–478 Ward MM, Jaana M, Natafgi N (2015) Systematic review of telemedicine applications in emergency rooms. Int J Med Informatics 84(9):601–616 Watzlaf V, Zhou L, Dealmeida DR, Hartman LM (2017) A systematic review of research studies examining telehealth privacy and security practices used by healthcare providers. Int J Telerehabilitation 9(2):39–59 Wedekind L, Sainani K, Pershing S (2016) Supply and perceived demand for teleophthalmology in triage and consultations in California emergency departments. JAMA Ophthalmol 134(5):537–543 Weintraub P, McKee M (2019) Leadership for innovation in healthcare: An exploration. Int J Health Policy Manage 8(3):138–144 West SG, Taylor AB, Wu W (2012) Model fit and model selection in structural equation modeling. In: Hoyle RH (ed) Handbook of structural equation modeling. Guilford Press, pp 209–231 Whitten PS, Mackert MS (2005) Addressing telehealth’s foremost barrier: Provider as initial gatekeeper. Int J Technol Assess Health Care 21(4):517–521 Witmer MT, Margo CE (2009) Analysis of ophthalmology workforce and delivery of emergency department eye care in Florida. Arch Ophthalmol 127(11):1522–1527 Yogesan K, Kumar S, Goldschmidt L, Cuadros J (eds) (2006) Tele-ophthalmology. Springer Zachrison KS, Boggs KM, Hayden EM, Espinola JA, Camargo CA Jr. (2017) Understanding barriers to telemedicine implementation in the emergency department. Mayo Clinic Proceedings, 92(6), 894–900 Zachrison KS, Gupta N, Nadel ES et al (2020) Rapid telehealth expansion in a large academic emergency department during the COVID-19 pandemic. NEJM Catalyst Innovations Care Delivery, 1(4) Zailani S, Gilani MS, Jafarzadeh Z, Iranmanesh M (2014) Determinants of telemedicine adoption by hospitals in Malaysia: A SEM approach. PLoS ONE, 9(7), e103017 Zhang D, Shi L, Ido MS, Green DE, Li Y, Su D, Hess DC (2019) Impact of participation in a telestroke network on clinical outcomes. Circulation: Cardiovasc Qual Outcomes, 12(1), e005147 Zhang X, Han X, Dang Y, Meng F, Guo X, Lin J (2017) User acceptance of mobile health services from users’ perspectives. Inform Health Soc Care 42(2):194–206 Additional Declarations The authors declare no competing interests. Supplementary Files SpplementaryEDProvidersPerspective.docx Supplementary Material A-1: Survey Questionnaire Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8941200","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595277887,"identity":"56b4bcfb-3b81-4b2f-adb0-151af2054fe8","order_by":0,"name":"Assegid Roba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYBADHobjDQzMJGo5c4BELQwMNxKI1MLfv/jxxx8VtTJ8N98Yfi6osGHgb+9OwKtF4sYzM2meM8d5JG/nGEvPOJPGIHHm7AYC7jlgxszYdozH4HaOgTRv22EGA4lc/Frkbxz//PHnP6CWm2eMfxOlxeB8j4EEb0MNj8ENHjPibDG8wVMmzXPsAI/kmbQya54zaTwE/SJ3/vjmjz9q6uz5jh/efJunwkaOv72XgPclEkDkYSDmMACxePArBwH+AyCyDojZHxBWPQpGwSgYBSMSAAAiRUtoxXxnXQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-7661-3856","institution":"Grady Health Systems","correspondingAuthor":true,"prefix":"","firstName":"Assegid","middleName":"","lastName":"Roba","suffix":""},{"id":595281224,"identity":"8931aa84-7c63-45c1-b1f0-a0d18c8876f5","order_by":1,"name":"Gulzar Shah","email":"","orcid":"https://orcid.org/0000-0002-8390-1730","institution":"Georgia Suthern University","correspondingAuthor":false,"prefix":"","firstName":"Gulzar","middleName":"","lastName":"Shah","suffix":""},{"id":595281225,"identity":"a86763de-7950-4313-bc1f-aacfc0e1da26","order_by":2,"name":"Bettye Apenteng","email":"","orcid":"","institution":"Georgia Suthern University","correspondingAuthor":false,"prefix":"","firstName":"Bettye","middleName":"","lastName":"Apenteng","suffix":""},{"id":595281226,"identity":"1df343a5-0fe7-4b32-86fe-e1c1c9a19705","order_by":3,"name":"William Mase","email":"","orcid":"","institution":"Georgia Suthern University","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"","lastName":"Mase","suffix":""}],"badges":[],"createdAt":"2026-02-22 19:50:00","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8941200/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8941200/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103332583,"identity":"02bb58c5-89fa-493a-9e8b-905e682439fa","added_by":"auto","created_at":"2026-02-24 14:07:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38449,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePercent endorsement of perceived challenges and opportunities for adopting live emergency teleophthalmology among emergency and eye-care providers, USA, 2020 (N = 244).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8941200/v1/e38dcdf8bd0cf00bf1b3ee12.png"},{"id":103507171,"identity":"fd07eb09-c336-4a46-8b41-6c13fe8e692a","added_by":"auto","created_at":"2026-02-26 13:40:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1005318,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8941200/v1/4586ab5c-ffec-44e0-93f8-dd4c89441357.pdf"},{"id":103332582,"identity":"18097349-b2d4-452d-b2b9-7dc16b2194cf","added_by":"auto","created_at":"2026-02-24 14:07:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46851,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Material A-1: Survey Questionnaire\u003c/p\u003e","description":"","filename":"SpplementaryEDProvidersPerspective.docx","url":"https://assets-eu.researchsquare.com/files/rs-8941200/v1/5e37285d9c5ffe22741ef16e.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eEmergency and Eye Care Providers’ Perspectives on the Acceptance of Interprofessional Teleophthalmology.\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTelehealth has moved from peripheral experimentation to a durable feature of modern care, driven by advances in networks and mobile devices, alongside policy attention to access and cost (Tuckson, Edmunds, \u0026amp; Hodgkins, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Across clinical specialties, remote consultation has been associated with shorter time to decision making, fewer avoidable patient transfers, and a more equitable distribution of specialist expertise (Ekeland, Bowes, \u0026amp; Flottorp, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Ackerman, Filart, Burgess, Lee, \u0026amp; Poropatich, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Ophthalmology offers a particularly informative use case, as high resolution imaging is essential, yet on call specialist coverage remains uneven. This mismatch creates a gap that interprofessional teleconsultation can help address (Host, Turner, \u0026amp; Muir, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tan, Dobson, Bartnik, Muir, \u0026amp; Turner, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). While teleophthalmology is well established for retinal disease screening, its use for real time emergency department (ED) consultations between providers remains limited.\u003c/p\u003e \u003cp\u003eExisting teleophthalmology research has focused largely on technical feasibility and the success of asynchronous care models. Most large scale implementations involve store and forward screening programs, such as diabetic retinopathy screening, where image interpretation can be efficiently centralized (Prathiba \u0026amp; Rema, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). In contrast, live teleophthalmology for ED consultation remains underused, despite its clear relevance to time sensitive conditions such as ocular trauma or suspected retinal detachment. In emergency settings, real time consultation allows ophthalmologists to guide the examination, support clinical decision making, and influence disposition without delay (Host et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tan et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Hybrid models that combine store and forward imaging with live consultation have also shown promise (Prathiba \u0026amp; Rema, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Tan et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Given demonstrated diagnostic concordance and operational value for urgent eye complaints, the feasibility of live teleophthalmology is no longer the primary concern.\u003c/p\u003e \u003cp\u003eLess well understood are the non-technical factors that limit routine adoption in emergency care. In ED settings, barriers commonly include workflow friction, such as responsibility for image acquisition and integration into triage, alongside medico legal concerns, cost, and professional culture (LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The ED operates under high cognitive load and throughput pressure, conditions that amplify even minor disruptions in workflow. As a result, clinicians\u0026rsquo; beliefs about usefulness and fit within existing processes often determine whether a pilot program becomes standard practice (Ekeland et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The policy shifts of 2020 temporarily lowered external barriers and increased awareness of telemedicine across care settings (Saleem et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sharma et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zachrison et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), but it remains unclear how clinicians interpreted this period and whether it translated into durable readiness for change (Tuckson et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Directly examining provider perspectives helps distinguish short term adaptation from longer term acceptance and highlights implementation barriers that health system leaders can realistically address.\u003c/p\u003e \u003cp\u003eThe objective of this study was to characterize U.S. emergency and eye care professionals\u0026rsquo; perceptions and overall acceptance of live teleophthalmology for interprofessional ED consultations. Specifically, the study aimed to identify commonly endorsed barriers and facilitators, describe individual and contextual factors associated with technology acceptance, and synthesize qualitative themes relevant to practical implementation.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis study was a complementary part of a larger dissertation project evaluating the impact of transformational leadership constructs on the acceptance of teleophthalmology by emergency department professionals. The present report focuses on the descriptive and qualitative findings from the providers\u0026rsquo; perspectives.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDesign and Participants.\u003c/b\u003e We conducted a national, cross-sectional, web-based survey (May\u0026ndash;June 2020) targeting U.S. clinicians involved in emergency eye-care workflows. Eligible respondents included emergency physicians (EP); advanced practice providers (APPs, including nurse practitioners (NP) and physician assistants (PA)); emergency nurses (RN), technicians (TEC); and ophthalmologists (MD) and Doctor of Optometry (OD) who provide or receive ED teleconsultations. These roles were included because live ED teleophthalmology requires coordinated input from both ED teams and consulting specialists (Host, Turner, \u0026amp; Muir, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tan, Dobson, Bartnik, Muir, \u0026amp; Turner, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). A pragmatic, nonprobability approach was used as it aligns with telehealth evaluation guidance that emphasizes context and implementation in early-stage studies (Ekeland, Bowes, \u0026amp; Flottorp, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSampling and Recruitment.\u003c/b\u003e A purposive, nonprobability sampling strategy with quota controls was applied to include a diverse mix of providers. However, initial recruitment through email invitations, social media outreach, professional networks, and snowball referrals yielded limited participation as the COVID-19 pandemic constrained emergency providers\u0026rsquo; availability. Consequently, a population of health professionals registered with a polling firm that conducts online and mobile surveys (Pollfish; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pollfish.com\u003c/span\u003e\u003cspan address=\"https://www.pollfish.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used as a proxy sampling frame. This pragmatic approach prioritized heterogeneity across roles and U.S. regions to reflect adoption barriers and facilitators under real-world conditions where formal sampling frames for interprofessional telehealth do not exist.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection and Instruments.\u003c/b\u003e The self-administered questionnaire is provided as Supplementary Material (A-1: Survey Questionnaire). It comprised four parts: (1) demographics, individual factors, and organizational context; (2) technology-acceptance and transformational leadership constructs; (3) checklist items on perceived challenges and opportunities for live ED teleophthalmology; and (4) an open-ended prompt on how the technology should be introduced into ED workflow.\u003c/p\u003e \u003cp\u003eTechnology-acceptance items for perceived usefulness (PU) and intention to use (IU) were adapted from established theoretical models (Davis, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Davis, Bagozzi, \u0026amp; Warshaw, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Taylor \u0026amp; Todd, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Venkatesh \u0026amp; Davis, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Venkatesh et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Thompson et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). Wording and examples were grounded in prior real-time teleophthalmology programs to ensure face validity for emergency use-cases (Host et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tan et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and guided by telehealth adoption frameworks relevant to workflow and governance (LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe core items addressing the study aims (Q16\u0026ndash;Q20: prior telemedicine exposure; challenge checklist; opportunity checklist; perceived COVID-19 influence; and the open-ended implementation question) are included verbatim in this manuscript. Platform safeguards and manual review procedures minimized inattentive or fraudulent responses (e.g., short completion time, inconsistent answers).\u003c/p\u003e \u003cp\u003e \u003cb\u003eKey Terms.\u003c/b\u003e For this study, acceptance refers to individual-level attitudes toward teleophthalmology, measured as PU and IU following TAM/UTAUT frameworks (Davis, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Venkatesh \u0026amp; Davis, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Venkatesh et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Adoption denotes organizational-level integration into ED workflows, influenced by factors like infrastructure, reimbursement, and staff readiness (Tuckson et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Live teleophthalmology is defined as real-time, synchronous video consultation between ED teams and eye-care specialists, in contrast to store-and-forward models. Advanced practice providers (APPs) include nurse practitioners (NPs) and physician assistants (PAs), grouped together in analyses.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis.\u003c/b\u003e Primary outcomes were the frequencies of challenge and opportunity endorsements and the distributions of PU and IU. Secondary descriptors included individual factors (role, years in practice, prior video-based telemedicine experience) and organizational context (on-call availability, site type, ED volume, and telehealth infrastructure). These variables were selected for their relevance to perceived usefulness, normative pressures, and practical feasibility in clinical technology adoption (Davis, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Venkatesh et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClosed-ended items were summarized descriptively (frequencies, percentages), with exploratory cross-tabulations by role, prior video experience, on-call availability, and site type. For the open-ended item, we conducted an inductive, constant-comparative thematic analysis to derive implementation-relevant themes (value/timeliness; quality/safety; workflow; equity; training; policy), consistent with pragmatic telehealth evaluation guidance (van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cb\u003eEthical Considerations.\u003c/b\u003e The protocol received approval from the Institutional Review Board of Georgia Southern University. No personally identifiable information was collected. Participation was voluntary. Electronic informed consent preceded the survey launch.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 244 clinicians completed the survey. The sample included emergency physicians (31.1%), emergency nurses/technicians (21.1%), nurse practitioners (18.4%), physician assistants (11.1%), and optometrists (19.3%). This role distribution approximated national workforce proportions and was consistent with the quota targets set at study design.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIndividual Factors.\u003c/b\u003e Roughly one-third of respondents (35.2%) reported prior experience with video-based telemedicine (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additional patterns of exposure included telephone-only use before 2020 (17.6%), telephone or video visits first initiated during 2020 (27.4%), and no prior telemedicine exposure (19.7%). Clinicians with prior video-based telemedicine experience had higher mean scores for perceived usefulness (PU) and intention to use (IU) teleophthalmology than those without prior video experience. Differences by professional role were present but modest. Consultant-side clinicians, including ophthalmologists and optometrists, and some emergency physicians reported higher IU scores, while supporting staff, including nurses and technicians, reported lower mean IU scores. No meaningful differences were observed by age group or gender.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndividual characteristics and intention to use (IU) teleophthalmology among emergency eye-care providers, USA, 2020 (N\u0026thinsp;=\u0026thinsp;244).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup/Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUsefulness (PU)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntention (IU) Mean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.45 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.66 (.99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.56 (.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.80 (.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eGeneration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;40 (Millennials, Gen-Y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.58 (.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.73 (.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;54 (Gen-X)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.60 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.84 (1.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55+ (Baby-Boomers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.20 (1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.52 (1.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinorities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.56 (.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.78 (.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.50 (.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.72 (.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eConsultation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eSide*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsulted (Eye Doctors)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.78 (.98) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.93 (.98) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsulting (ED providers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.58 (.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.78 (.94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupporting (Nurses \u0026amp; Techs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.09 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.45 (1.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLeadership Role*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Practice Only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.36 (1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.55 (.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDirecting / Managing Too\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.69 (.91) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.93 (.90) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eVideo Telemedicine Experience*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.43 (.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.65 (.99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.67 (.91) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.91 (.84) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eQualitative\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eOpinion *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.72 (.90) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.91 (.80) **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOptimistic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.44 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.75 (1.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkeptical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.21 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.36 (1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.21 (.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.28 (1.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: \u003cem\u003eSignificant difference among subgroups * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (t-test for 2 means, one way ANOVA for multiple groups, equal variance) PU= Perceived Usefulness, IU= Intention To Use.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eOrganizational Context.\u003c/b\u003e Most respondents practiced in urban hospitals, although on-site ophthalmology coverage was not universal. Higher PU and IU scores were observed in settings with on-call ophthalmology coverage, higher ocular emergency caseloads, and existing telemedicine systems in the ED (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Exploratory analyses did not indicate meaningful PU or IU differences by state policy environment, hospital location, or patient transfer rates.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOrganizational context (on-call availability, site type, ED volume, telehealth infrastructure) and perceived usefulness/intention to use, USA, 2020 (N\u0026thinsp;=\u0026thinsp;244).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup/Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUsefulness (PU)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntention (IU)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eState Policy on\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTelemedicine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRestrictive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.44 (.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.76 (.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.51 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.74 (.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgressive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.57 (.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.74 (.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHospital\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.53 (.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.81 (.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.50 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.65 (1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHaving On-Call\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eOphthalmologist*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.10 (.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.50 (1.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemote\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.53 (.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.66 (.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOn-site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.73 (.94)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.98 (.82) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCaseload **\u003c/b\u003e (of ocular emergencies)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (\u0026lt;\u0026thinsp;5 / month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.27 (.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.56 (.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh (5+ /month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.83 (.89)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.74 (.95)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTransfer Rate\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(cases/5 encounters)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (\u0026lt;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.47 (.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.70 (.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh (3+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.60 (1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.82 (1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTelemedicine System\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ein ED**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.97 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.26 (1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.69 (.90)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.90 (.88)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (t-test for 2 means, one way ANOVA for multiple groups, equal variance) PU= Perceived Usefulness, IU= Intention To Use\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePerceived Challenges and Opportunities.\u003c/b\u003e When asked about barriers to adopting live teleophthalmology in emergency departments, respondents most frequently cited privacy and security concerns (61.9%), the initial cost of technology (60.6%), and staff resistance to new workflows (57.4%). Other commonly noted challenges included medico-legal ambiguity, limitations in image quality, and uncertainty around consent and documentation procedures. Conversely, the leading opportunities reflected optimism about external and internal drivers of change. Advancing technologies were endorsed by 59.4% of respondents, incorporation of telemedicine into medical and nursing education by 59.0% and easing of regulatory restrictions by 58.6% (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrivacy and security issues (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.35) and the technology\u0026rsquo;s cost (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026) were more critical challenges for physicians and doctors than other participants. Also, most doctors (64%) agreed that telemedicine education is one of the solutions. Otherwise, there was no difference among doctors and other health professionals in identifying opportunities and challenges. Compared to those from urban areas (43.2%), responders from rural hospitals (57%) were more likely to perceive limited acceptance by staff as a hindrance to telemedicine acceptance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037). No significant difference emerged in the pattern of selected opportunities and challenges among those exercising leadership roles compared without management responsibilities.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePandemic Impact on Telemedicine Use.\u003c/b\u003e More than one quarter of respondents (27.5%) reported initiating telemedicine use for virtual patient visits during the COVID-19 pandemic. When asked about the pandemic\u0026rsquo;s impact on telemedicine adoption, two-thirds of respondents (66.4%) reported that COVID-19 had \u0026ldquo;a great deal\u0026rdquo; or \u0026ldquo;a lot\u0026rdquo; of impact. An additional 26.0% reported a moderate impact, while 8.0% reported little or no impact.\u003c/p\u003e \u003cp\u003e \u003cb\u003eProvider Attitudes and Sentiment Profiles.\u003c/b\u003e Sentiment coding of open-ended responses to Q20 (\u0026ldquo;In general, what do you think about introducing teleophthalmology to emergency departments?\u0026rdquo;) identified four attitudinal categories: positive (45.5%), cautiously optimistic (35.6%), skeptical (11.5%), and negative (7.5%). These distributions were consistent with checklist findings, with more favorable sentiment associated with higher mean scores for perceived usefulness (PU) and intention to use (IU) (PU: F\u0026thinsp;=\u0026thinsp;3.35, p\u0026thinsp;=\u0026thinsp;0.02; IU: F\u0026thinsp;=\u0026thinsp;4.2, p\u0026thinsp;=\u0026thinsp;0.006; r\u0026thinsp;=\u0026thinsp;0.19\u0026ndash;0.22).\u003c/p\u003e \u003cp\u003eClinicians in the positive and cautiously optimistic groups emphasized teleophthalmology\u0026rsquo;s potential to improve timeliness and access, describing it as \u0026ldquo;a great idea\u0026hellip; quick and easy, preventing unnecessary admissions\u0026rdquo; (Emergency Physician) and \u0026ldquo;a cost-saving tool that ensures 24/7 specialist access\u0026rdquo; (Nurse Practitioner). Others expressed conditional support, noting that teleophthalmology \u0026ldquo;helps decide whether to transfer or not\u0026rdquo; or \u0026ldquo;is better than no coverage at all.\u0026rdquo; Skeptical respondents raised concerns about diagnostic adequacy and reimbursement feasibility, including that \u0026ldquo;it would be difficult to perform a fundoscopic exam over a webcam\u0026rdquo; or that \u0026ldquo;insurers may not reimburse at parity.\u0026rdquo; Negative views, though infrequent, cited technical and medico-legal risks, such as \u0026ldquo;increased chance of misdiagnoses\u0026rdquo; and \u0026ldquo;the need for in-person exams in trauma cases.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplementation Themes From Open-Ended Responses.\u003c/b\u003e Thematic analysis of open-ended responses identified six recurring implementation themes: value and timeliness, quality and safety, workflow design, equity and coverage, training and confidence, and policy or reimbursement considerations. Representative excerpts across the four sentiment categories are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes Of Emergency and Eye Care Providers Towards Introducing Teleophthalmology Technology To Emergency Departments In The USA, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcerpts\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResponder\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003ePositive\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think it would be a generally useful move that would increase efficiency.\u0026rsquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Great idea - very efficient and effective. Plan to expand usage in the future.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;It is a great solution during COVID-19 and during normal times.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;It is a great idea and cost-saving for the patient.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think [it] is important because it can help with emergency procedures.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think in the long run, it is beneficial and may reduce wait times as well as triage headaches.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOPH\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think it would be useful and that all hospitals would need to use it. I like it, and some of my colleagues would like to try it someday.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eCautiously optimistic (conditional)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Depends on how many I can help.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think it can be useful in some situations, but it is never as good as an in-person visit.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;It is a tool and only a tool, but it adds flexibility to treatment.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Very helpful, especially in rural areas!\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think it is a great tool to have available in emergency rooms that may otherwise not have access to this type of service.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;It is good but needs much work to be used at its fullest potential.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eSkeptical\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I think it would make some improvements, but in our place, it might be more efficient to ship the patient.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I am skeptical of how it will work.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Pros and cons. Cannot examine the eye properly.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN.P\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Impracticable but nice to have\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNegative\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;It could increase misdiagnoses.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;It is difficult to do the eye exams, unfortunately.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;Better to see the injury in person.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNM\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: \u003cem\u003eEP\u0026thinsp;=\u0026thinsp;Emergency Physician; PA\u0026thinsp;=\u0026thinsp;Physician Assistant; NP\u0026thinsp;=\u0026thinsp;Nurse Practitioner; RN\u0026thinsp;=\u0026thinsp;Registered Nurse; NM\u0026thinsp;=\u0026thinsp;Nurse Manager; OPH\u0026thinsp;=\u0026thinsp;Ophthalmologist; OD\u0026thinsp;=\u0026thinsp;Optometrist;\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur national snapshot of clinicians involved in emergency eye care in 2020 showed broad support for live teleophthalmology, with respondents anticipating benefits such as faster triage, fewer avoidable transfers, and more reliable after-hours coverage. At the same time, commonly cited barriers included privacy and security concerns, start-up costs, and staff resistance to workflow change. Acceptance varied by experience and context. Clinicians with prior video-based telemedicine experience reported higher perceived usefulness (PU) and intention to use (IU), consistent with the \u0026ldquo;experience effect\u0026rdquo; described in technology acceptance research (Davis, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Venkatesh \u0026amp; Davis, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Venkatesh et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Taylor \u0026amp; Todd, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Thompson, Higgins, \u0026amp; Howell, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). Qualitative responses highlighted recurring implementation themes related to clinical value, quality and safety, workflow fit, training, and governance, aligning with established telehealth adoption frameworks (Tuckson, Edmunds, \u0026amp; Hodgkins, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Ekeland, Bowes, \u0026amp; Flottorp, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese findings reinforce evidence from the broader telehealth literature that adoption depends less on technological capability and more on implementation mechanics, including workflow integration, governance, and organizational support (Tuckson et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ekeland et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Although prior ophthalmology studies have demonstrated diagnostic concordance for remote consultation, routine use in emergency settings remains uneven. Live teleophthalmology must perform under time pressure, where even minor workflow disruptions can undermine uptake (Host et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tan et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Prathiba \u0026amp; Rema, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The observed experience effect suggests that brief, well-supported pilot implementations that allow ED teams to complete end-to-end consultations may be an effective strategy for building confidence and normalizing use.\u003c/p\u003e \u003cp\u003eImplementation efforts should therefore prioritize workflow design, including clear consultation triggers and standardized order sets, alongside reliable connectivity to reduce failed or delayed consultations (Ackerman et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Clear governance structures, such as defined consent language, standard operating procedures for image storage, and liability guidance, may further reduce professional uncertainty that is often perceived as resistance. While policy changes during the COVID-19 pandemic lowered external barriers and increased familiarity with telemedicine (Saleem et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sharma et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zachrison et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), sustained adoption will depend on translating temporary regulatory flexibility into durable organizational and financing arrangements (van Dyk, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; LeRouge \u0026amp; Garfield, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Attention to equity is also important to ensure that devices, training, and support are available across shifts and sites, minimizing access gaps (Tuckson et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ekeland et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations.\u003c/b\u003e This study benefits from a mixed sample of emergency and consulting eye-care clinicians and the integration of quantitative and qualitative data. Limitations include nonprobability sampling, reliance on self-reported measures, and a cross-sectional design reflecting a U.S. snapshot from 2020. Local variation in readiness and potential common-method bias should be considered when interpreting the findings. Nonetheless, convergence between quantitative patterns and qualitative themes supports the relevance of the implementation priorities identified.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions.\u003c/b\u003e Clinicians in emergency eye care demonstrated cautious but clear readiness for live teleophthalmology. This optimism suggests that technical feasibility has largely been established and that remaining barriers are primarily organizational. Progress toward routine use is likely to depend on reducing workflow and governance friction rather than overcoming skepticism about the technology itself. Pandemic-era policy shifts and growing user experience provide momentum for health systems to move from pilot projects to broader integration. Future studies should examine real-world utilization and outcomes, including time to decision making, avoided transfers, user satisfaction, and the role of leadership in sustaining adoption.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding and Disclosures\u003c/h2\u003e \u003cp\u003e \u003cb\u003e\u003c/b\u003eNo external funding was received for this study. The authors declare no conflicts of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contributions:\u003c/h2\u003e \u003cp\u003eA. Roba conceptualized and led the study, including survey design, data analysis, and manuscript drafting. Drs. Mase, Apenteng, and Shah contributed to the study design, methodology, interpretation of findings, and critical revision of the manuscript. Dr. Shah provided overall guidance and oversight.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThe authors are very grateful to the clinicians who participated in the survey for their time and insights. We also thank Yousuf M. Khalifa, MD, and Hany H. Atallah, MD, of Emory University at Grady Memorial Hospital for their clinical perspectives, as well as Moges S. Ido, MD, PhD, of the Georgia Department of Health for statistical support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAckerman MJ, Filart R, Burgess LP, Lee I, Poropatich RK (2010) Developing next-generation telehealth tools and technologies: Patients, systems, and data perspectives. Telemedicine e-Health 16(1):93\u0026ndash;95\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77\u0026ndash;101\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruce BB, Lamirel C, Wright DW, Ward A, Heilpern KL, Biousse V, Newman NJ (2011) Non-mydriatic ocular fundus photography in the emergency department. N Engl J Med 364(4):387\u0026ndash;389\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaffery LJ, Taylor M, Gole G, Smith AC (2019) Models of care in teleophthalmology: A scoping review. J Telemed Telecare 25(2):106\u0026ndash;122\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCangur S, Ercan İ (2015) Comparison of model-fit indices used in structural equation modeling under multivariate normality. J Mod Appl Stat Methods 14(1):152\u0026ndash;167\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarless SA, Wearing AJ, Mann L (2000) A short measure of transformational leadership. J Bus Psychol 14(3):389\u0026ndash;405\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrara GLR, Bernardes A, Balsanelli AP, Camelo SHH, Gabriel CS, Zanetti ACB (2017) Use of instruments to evaluate leadership in nursing and health services. Revista Ga\u0026uacute;cha de Enfermagem, 38(3), e69038\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChanna R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS (2016) Epidemiology of eye-related emergency department visits. JAMA Ophthalmol 134(3):312\u0026ndash;319\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis FD (1989) Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q 13(3):319\u0026ndash;340\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis FD, Bagozzi RP, Warshaw PR (1989) User acceptance of computer technology: A comparison of two theoretical models. Manage Sci 35(8):982\u0026ndash;1003\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkeland AG, Bowes A, Flottorp S (2012) Methodologies for assessing telemedicine: A systematic review of reviews. Int J Med Informatics 81(1):1\u0026ndash;11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall MA, McGraw D (2014) For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff 33(2):216\u0026ndash;221\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHost BK, Turner AW, Muir J (2018) Real-time teleophthalmology in rural Western Australia. Clin Experimental Optometry 101(1):129\u0026ndash;134\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKruse CS, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M (2018) Evaluating barriers to adopting telemedicine worldwide: A systematic review. JMIR Med Inf, 6(2), e104\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeRouge C, Garfield MJ (2013) Crossing the telemedicine chasm: Have the U.S. barriers to widespread adoption of telemedicine been largely resolved? Int J Environ Res Public Health 10(12):6472\u0026ndash;6484\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrathiba V, Rema M (2011) Teleophthalmology: A model for eye care delivery in rural areas of India. International Journal of Family Medicine, 2011, 683267\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogove HJ, McArthur D, Demaerschalk BM, Vespa PM (2012) Barriers to telemedicine: Survey of current users in acute care units. Telemedicine e-Health 18(1):48\u0026ndash;53\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaleem SM, Pasquale LR, Sidoti PA, Tsai JC (2020) Virtual ophthalmology: Telemedicine in a COVID-19 era. J Eval Clin Pract 26(4):1099\u0026ndash;1102\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchepers J, Wetzels M, de Ruyter K (2005) Leadership styles in technology acceptance: A test of a mediation model. Inf Manag 42(5):701\u0026ndash;719\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchreiber JB, Nora A, Stage FK, Barlow EA, King J (2006) Reporting structural equation modeling and confirmatory factor analysis results: A review. J Educational Res 99(6):323\u0026ndash;338\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma M, Jain N, Ranganathan L, Sharma N, Honavar SG (2020) Implementation of tele-ophthalmology during COVID-19 pandemic: Lessons learned. Telemedicine e-Health 26(9):1035\u0026ndash;1041\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan IJ, Dobson LP, Bartnik S, Muir J, Turner AW (2017) Real-time teleophthalmology versus face-to-face consultation: A systematic review. J Telemed Telecare 23(7):629\u0026ndash;638\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor S, Todd P (1995) Understanding information technology usage: A test of competing models. Inform Syst Res 6(2):144\u0026ndash;176\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson RL, Higgins CA, Howell JM (1991) Personal computing: Toward a conceptual model of utilization. MIS Q 15(1):125\u0026ndash;143\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuckson RV, Edmunds M, Hodgkins ML (2017) Telehealth. N Engl J Med 377(16):1585\u0026ndash;1592\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValikodath NG, Leveque TK, Wang SY, Lee PP, Newman-Casey PA, Woodward MA (2016) Patient attitudes toward telemedicine in ophthalmology. JAMA Ophthalmol 134(3):318\u0026ndash;325\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Dyk L (2014) A review of telehealth service implementation frameworks. Int J Environ Res Public Health 11(2):1279\u0026ndash;1298\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesh V, Bala H (2008) Technology acceptance model 3 and a research agenda on interventions. Decis Sci 39(2):273\u0026ndash;315\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesh V, Davis FD (2000) A theoretical extension of the technology acceptance model: Four longitudinal field studies. Manage Sci 46(2):186\u0026ndash;204\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesh V, Morris MG, Davis GB, Davis FD (2003) User acceptance of information technology: Toward a unified view. MIS Q 27(3):425\u0026ndash;478\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWard MM, Jaana M, Natafgi N (2015) Systematic review of telemedicine applications in emergency rooms. Int J Med Informatics 84(9):601\u0026ndash;616\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatzlaf V, Zhou L, Dealmeida DR, Hartman LM (2017) A systematic review of research studies examining telehealth privacy and security practices used by healthcare providers. Int J Telerehabilitation 9(2):39\u0026ndash;59\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWedekind L, Sainani K, Pershing S (2016) Supply and perceived demand for teleophthalmology in triage and consultations in California emergency departments. JAMA Ophthalmol 134(5):537\u0026ndash;543\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeintraub P, McKee M (2019) Leadership for innovation in healthcare: An exploration. Int J Health Policy Manage 8(3):138\u0026ndash;144\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWest SG, Taylor AB, Wu W (2012) Model fit and model selection in structural equation modeling. In: Hoyle RH (ed) Handbook of structural equation modeling. Guilford Press, pp 209\u0026ndash;231\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitten PS, Mackert MS (2005) Addressing telehealth\u0026rsquo;s foremost barrier: Provider as initial gatekeeper. Int J Technol Assess Health Care 21(4):517\u0026ndash;521\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWitmer MT, Margo CE (2009) Analysis of ophthalmology workforce and delivery of emergency department eye care in Florida. Arch Ophthalmol 127(11):1522\u0026ndash;1527\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYogesan K, Kumar S, Goldschmidt L, Cuadros J (eds) (2006) Tele-ophthalmology. Springer\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZachrison KS, Boggs KM, Hayden EM, Espinola JA, Camargo CA Jr. (2017) Understanding barriers to telemedicine implementation in the emergency department. Mayo Clinic Proceedings, 92(6), 894\u0026ndash;900\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZachrison KS, Gupta N, Nadel ES et al (2020) Rapid telehealth expansion in a large academic emergency department during the COVID-19 pandemic. NEJM Catalyst Innovations Care Delivery, 1(4)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZailani S, Gilani MS, Jafarzadeh Z, Iranmanesh M (2014) Determinants of telemedicine adoption by hospitals in Malaysia: A SEM approach. PLoS ONE, 9(7), e103017\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang D, Shi L, Ido MS, Green DE, Li Y, Su D, Hess DC (2019) Impact of participation in a telestroke network on clinical outcomes. Circulation: Cardiovasc Qual Outcomes, 12(1), e005147\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Han X, Dang Y, Meng F, Guo X, Lin J (2017) User acceptance of mobile health services from users\u0026rsquo; perspectives. Inform Health Soc Care 42(2):194\u0026ndash;206\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Georgia Southern University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Teleophthalmology, emergency eye care, interprofessional consultation, technology acceptance, provider perspectives","lastPublishedDoi":"10.21203/rs.3.rs-8941200/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8941200/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTeleophthalmology is well established for screening conditions such as retinal diseases, yet its use for synchronous interprofessional consultation in emergency departments (EDs) remains limited. This study examines how U.S. emergency and eye-care professionals viewed the challenges, opportunities, and overall acceptability of teleophthalmology for ED consultations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a national cross-sectional web-based survey of emergency and eye-care providers across the United States in mid-2020. The survey assessed respondent demographics and organizational context, technology-acceptance constructs including perceived usefulness (PU) and intention to use (IU), perceived barriers and facilitators, and an open-ended item on implementation considerations. Analysis integrated descriptive statistics, subgroup comparisons, and inductive thematic analysis of free-text responses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 244 respondents, 35.2% reported prior experience with video-based telemedicine and 66.4% believed the COVID-19 pandemic would accelerate telemedicine adoption. The most frequently cited barriers were privacy and security concerns (61.9%), initial technology costs (60.6%), and resistance to workflow change (57.4%). Commonly identified facilitators included advancing technologies (59.4%), integration of telemedicine into medical and nursing education (59.0%), and easing of regulatory barriers (58.6%). Qualitative responses regarding teleophthalmology implementation in EDs reflected four sentiment profiles: positive (45.5%), cautiously optimistic (35.6%), and skeptical or negative (18.9%), with more favorable views associated with higher PU and IU scores.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEmergency and eye-care clinicians demonstrated clear readiness to adopt synchronous teleophthalmology for inter-provider consultations. Findings suggest that acceptance is shaped less by technical limitations than by persistent concerns about privacy, cost, and workflow integration. Pandemic-era policy shifts and growing telemedicine experience may facilitate broader adoption.\u003c/p\u003e","manuscriptTitle":"Emergency and Eye Care Providers’ Perspectives on the Acceptance of Interprofessional Teleophthalmology.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 14:07:39","doi":"10.21203/rs.3.rs-8941200/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1fa49e2-f23d-4bde-82d2-f882b51a6bdd","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63341799,"name":"Critical Care \u0026 Emergency Medicine"},{"id":63341800,"name":"Ophthalmology"}],"tags":[],"updatedAt":"2026-02-24T14:07:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 14:07:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8941200","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8941200","identity":"rs-8941200","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}