The use of research in telehealth implementations | | |

Recent advances in, and increasing availability and utilisation of technology are presenting opportunities to provide greater access to services for those who live in regional and remote locations. This is particularly the case in health, where specialist services are usually limited to metropolitan areas. Those who live in regional or remote locations are therefore often required to travel long distances to gain access to these services (Wootton, 1998 and WHO 2010).

Telehealth has many perceived benefits including the potential for enhancing access, quality, efficiency, and cost-effectiveness (Craig and Patterson, 2005). Additionally, evidence suggests many socioeconomic benefits to patients, families, health practitioners and the health system, including enhanced patient-provider communication and educational opportunities (Wootton, 1998 and Jennett et al. 2003). This is particularly useful for communities traditionally underserved – those in remote or rural areas with few health services and staff – as telehealth lessons the barriers of distance and time to specialised services.

While technology exists that facilitates the provision of these specialist services - unfortunately they are not always utilised with many projects not proceeding beyond the pilot phase (Klecun-Dabrowska, 2003) and even worse, according to one estimate, three quarters of healthcare ICT implementations are considered failures (Littlejohns et al, 2003). Often the reasons for this lack of sustainability extend beyond purely technical reasons, to the social, organisational and political (Sanderson, 2007).

It is for this reason that with any new telehealth implementation a thorough evaluation of the current literature and research should be undertaken to identify the key success factors and critical issues that have presented in other implementations across the world. Fortunately there is a growing body of evidence regarding health IT implementation to draw from and use to create a successful outcome for new telehealth projects (Box et al, 2010 and WHO, 2010). While the majority of this research is focused in single hospitals or clinics, or projects in a subset of a larger health system, some common themes have emerged which should be taken into consideration when implementing any telehealth project.

Of note, organisational and cultural factors often offset perceived technology-based barriers.
Joseph et al. (2011) have identified seven key challenges facing telehealth implementations; if an organisation can address these early in the lifecycle of the project it will have a better chance of long term success: 1. Staff
Adoption of a bottom-up approach in which local stakeholders; healthcare providers in particular, are consulted early in the process to identify areas of clinical need that may be addressed by the new telehealth solution. By involving the healthcare providers and users of the technology in the early consultation and design this creates a sense of ownership of the solution and ultimately the users of the technology have contributed to design a solution that meets the needs they identified (Box et al, 2010). Recruitment of clinical champions once the solution is up and running is considered vital to reduce scepticism about the new technology. This has been shown to increase user acceptance and adoption.

2. Project management
A lack of a dedicated project manager and underestimating the amount of time staff need to dedicate to a telehealth project has been a reoccurring issue in failed projects. For successful outcomes a dedicated team is necessary (Joseph et al. 2011). 3. Patients and provision of support
It is essential to recruit patients with a willingness to use the telehealth solutions and provide adequate ongoing support and training. Patients need to find the solutions easy to use and see that this creates benefits for them (Joseph et al. 2011). 4. Technology
A thorough evaluation of interoperability of the technology to be used needs to occur. The telehealth units need to be compatible with the networks at both the base area the remote area and potentially in patient’s homes. If home monitoring devices are to be used the users need training on how to set them up correctly. Long term maintenance and support of the technology needs to be evaluated as to the time and cost involved (Joseph et al. 2011). 5. Partnerships
It is essential to have a good partnership between the different service locations and departments that will be involved. It is essential that they have mutual goals and beliefs in what the services will achieve and work together to have standard processes for delivering the services. If this partnership does not happen the project is bound to fail (Joseph et al. 2011). 6. Funding
Recurrent funding is needed to keep telehealth projects running and to evolve with new innovations. Research and evaluation are key to this to provide evidence of success (Joseph et al. 2011). 7. Strategic plan
Strong executive leadership, including vision and long-term strategic planning is essential for success, many telehealth projects are limited to around one year’s duration, however these often lack sustainability. It is essential to have a strategic plan for at least three to five years in the future (Joseph et al. 2011). Strategic planning coupled with implementation leadership from key physicians is particularly vital to the success and sustainability of telehealth services. In addition, strategic collaborations between technical, clinical, and organizational entities throughout implementation are essential (Box et al, 2010).
Wootton (1998) summarises the critical issues that will need to be addressed in future strategies to continue to see telehealth reach its potential and perceived benefits, these include a commitment: to encourage and provide funding for telemedicine research; to develop a plan for implementation (once clinical effectiveness and cost-effectiveness have been demonstrated); to assess the major structural changes required within organizations to incorporate this method of delivering health care; to develop a process for training, formulation of practice guidelines, quality control and continuing audit. Although these were identified over a decade ago they are still relevant and necessary for further sustainability and success. These strategies can only happen if those responsible for commissioning and implementing telehealth continue to use the current research to evaluate and put into practice the lessons learnt to ensure maximisation of benefit and avoid further waste of scarce health resources (Littlejohns et al, 2003 and WHO 2010).

References

Box TL, McDonell M, Helfrich CD, Jesse RL, Fihn SD, et al. (2010) Strategies from a nationwide health information technology implementation: the VA CART story. J Gen Intern Med 25(S1): 72076

Craig, J., & Patterson, V. (2005). Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare, 11(1), 3-9. Retrieved from http://ezproxy.utas.edu.au/login?url=http://search.proquest.com/docview/210708401?accountid=14245

Jennett, P A; L Affleck Hall; Hailey, D; Ohinmaa, A; et al. (2003). The socio-economic impact of telehealth: A systematic review. Journal of Telemedicine and Telecare, 9(6), 311-320.
Joseph V., West R.M., Shickle D., Keen J. & Clamp S. (2011) Key challenges in the development and implementation of telehealth projects. Journal of Telemedicine and Telecare 17(2), 71–77.
Klecun-Dabrowska, E. (2003) Telehealth in the UK: A critical perspective, Proceedings of the 2nd European Conference on Research Methodology for Business and Management Studies

P. Littlejohns, J. C. Wyatt, and L. Garvican, (2007) Evaluating computerised health information systems: hard lessons still to be learnt, British Medical Journal, 326, 860-863

Sanderson, P. (2007). Designing and evaluating healthcare ICT innovation: A cognitive engineering view. Proceedings of the Third International Conference on Information Technology in Healthcare--Sociotechnical Systems. Sydney, 28-30 August, 2007. [Invited keynote address]

Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth 2010. Global Observatory for eHealth. Series 2. World Health Organization (WHO)

Wootton R. (1998) Telemedicine in the National Health Service. J Roy Sac Med, 91:614-21