Strategies for assessing telemedicine that could prove its effectiveness

Telemedicine is constantly bringing innovations and solutions, but is still not completely extended or integrated in the healthcare systems. One of the reasons is that it is often believed that there is little evidence of it being effective, in fact studies and evaluations of the impact of this practice are still scarce.

For this reason, a report recently published in JMIR Publications considers the dilemma and analyses the studies performed up to now, to detect challenges and possible analysis models for future projects. The authors of the study analysed frequently used frameworks and strategies of evaluation applied to a real case, and detected strengths and weaknesses.

Difficulties in assessing telemedicine

They thus realised that the classical assessment strategies cannot be effectively applied to telemedicine. Traditionally, the impact is determined through systematic, random and rigorous studies. The studies made of telemedicine are highly varied and include very different pilot projects of different levels of quality (both the project and its assessment). It was therefore found that the problems arising in assessing telemedicine programs can generally be classified into three groups:

Practical focus and assessment of the impact of telemedicine

In this sense, the authors of the study highlight the importance of faithfully following a protocol throughout the whole process of the project. Considering only the basic phases in the development of a project, this process model was created to draw up and assess a telemedicine project:

1. The diversity of telemedicine projects, as they can be focused on resolving all kinds of problems in the health system: healthcare, service provision, clinical interventions, strategies… This makes it difficult to establish parameters that can be used as indicators in assessing telemedicine.
   1. Traditional assessment designs, such as the random controlled tests (RCTs), are often not very practical when applied to assessing telemedicine: they are costly, difficult to perform and long.
   2. Telemedicine programs are complex and dynamic and the traditional frameworks of assessment do not pick up on them satisfactorily.
2. Implementation:
   1. Technology and operations: The actions carried out in this phase will be guided by the goal and design made before. The right technology has to be selected and assessed as a whole with the rest of the project.
   2. Adoption and assimilation: This phase in telemedicine is critical, especially if the project is aimed at the principal stakeholders (patients and providers). With respect to the patient, consideration must be given to the degree of digital literacy, the design of the application, its simplicity and functionality. As for the provider, the integration with the existing process will be assessed, its assimilation by the staff, the integration of the medical record and the ease of application. The techniques for improving patient assimilation are personalisation, offering rewards or economic incentives, playfulness and integration with the social networks.
3. Assessment of the impact: Measuring the results both during and after implementing the project. It is recommended that each telemedicine program should have an assessment process designed for each of its phases, bearing in mind the specific features of the program.

The study therefore recommends practical methods that apply multiple processes and consider all phases. It considers both the assessment of the project throughout all of the stages (instead of only the final stage) and the preliminary planning. The preliminary planning must include all stakeholders so that they might identify the goals of the program and the actions that have to be taken in each phase, which brings two important benefits: the personalisation of telemedicine, a process that is still growing and can be adapted from the outset to the needs of the patient, and; the commitment of the users, as the more they participate in the planning process, the more committed they will be to the program throughout its implementation.