Abstract
AimTelemedicine is a promising solution to extend traditional health care services. Even though mainly discussed during the past two decades, its roots go back into the past century and even further, considering the use of bonfires to warn other villages of diseases. Insights from historical cases can therefore be useful for the ongoing discussion regarding the successful implementation of telemedicine.Subject and MethodsWe analyzed three historical telemedicine cases (varying regarding time and place) and extracted their success factors and barriers as well as assessed their maturity by using the Telemedicine Community Readiness Model (TCRM). Evidence-based categories of success factors and barriers as well as the TCRM’s dimensions were used as deductive categories to analyze the study material’s content.ResultsThe analysis showed that the readiness for telemedicine is higher when the technology is the only option to access health care services. In all three cases, core readiness played a central role. However, the health sector, existing technology, and finance were barriers present at all times, while during pandemics, some barriers are only temporarily removed, for example, by putting legal issues on hold. The analyzed cases were all on lower levels of maturity as they mainly represent pilot tests or exceptional circumstances.ConclusionResults indicate the important core functions in telemedicine initiatives as well as the diversity of their circumstances. Insights from such historical meta-perspectives can, for example, help to strengthen the sustainability of the increased use of telemedicine during the COVID-19 pandemic and scale up current telemedicine projects.
Highlights
Telemedicine is by no means an invention of the twenty-first century but has roots that go back thousands of years to the use of bonfires to warn other villages of diseases (Bashshur and Shannon 2009)
The second aim is to define the maturity level of the historical cases based on the criteria of the Telemedicine Community Readiness Model (TCRM) (Care4Saxony 2020; Otto et al 2020b), which is a generic concept of readiness for telemedicine in communities
Barriers persist despite core readiness being present, as the STARPAHC project demonstrates: In remote and thinly populated areas, remote consultation of patients is certainly useful; funding for any telemedicine system must be ensured beyond the pilot project phase and sustained even when a major stakeholder drops out of the project (Huang et al 2017; Otto and Harst 2019)
Summary
Telemedicine is by no means an invention of the twenty-first century but has roots that go back thousands of years to the use of bonfires to warn other villages of diseases (Bashshur and Shannon 2009). Telemedicine can be understood as “the conveyance of health information using the best technology available” (Hurst 2016), always with the final means to bring care to those in need of it (Sood et al 2007) With telemedicine being such a historical concept, looking into the past can provide important insights for its successful implementation in the present as well as the future. A systematic overview of implementation barriers for telemedicine initiatives, which summarized existing reviews, found 98 barriers for telemedicine implementation (Otto and Harst 2019) These barriers include 11 factors triggering the barriers: patients and health care providers, their culture and the patient’s disease, the health sector, standards/guidelines, legal framework, finance, organization, and methodology as well as the technology applied. Barriers resulting from the involvement of different people, processes, or objects can prevent successful implementation and the subsequent scaleup of telemedicine projects
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