Telemedicine: 18 ways to prevent excess pilots

25 Jun

Tino MartíTino Martí, Health economist

Telemedicine services, like any other high value technological innovations tend to work well in controlled environments, such as a laboratory, where the most decisive variables are preset. These experiments are called ‘pilots’ and lead up to the spread of innovation. Pilots often present Hawthorne effect features, such as the result bias displayed when the observed is conscious of being observed and adopts the best behaviour accordingly. Under the spotlight, everything works well, but when the project expands, it often fails. The phenomenon is so common that the health authorities have abused the pilots as a means of implementation and currently there’s a lot of talk on pilotitis.

But what makes a project to exceed the pilot phase and become habitual? And what are the features of the projects that reach a large scale implementation? With these questions in mind and relying on the European Commission’s support, the Momentum project was launched in 2012. Its aim was to develop a guide to the successful implementation of telemedicine in Europe and last week they published the provisional list of 18 critical success factors identified by analyzing cases of success in telemedicine, understood as the relationship between professionals and patients who are not in the same place. These factors cover the following blocks:

  1. Strategy
  2. Organization and management
  3. Safety and Legality
  4. Technology and Infrastructure

The current version, far from being definitive, provides an initial guide comprising the elements to consider when introducing a new telemedicine service and aims to avoid stagnation in a pilot phase, whether the service comes from a public health organization or a private entrepreneurship.

These are the 18 critical success factors:

  1. Ensure you are culturally prepared for telemedicine;
  2. Make sure there is a clear leader;
  3. Identify a serious need;
  4. Gather the necessary resources for implementation and sustainability;
  5. Address the needs of the main customer;
  6. Involve health professionals and decision makers;
  7. Prepare and implement a business plan;
  8. Prepare and implement a change management plan;
  9. Place the patient at the centre of the service;
  10. Ensure the legality of the new service;
  11. Ask for advice from security and privacy experts;
  12. Apply safety and legality guidelines;
  13. Make sure that the service users are aware of the privacy issues;
  14. Make sure that the informatics and eHealth infrastructures meet your needs;
  15. Ensure that the technology is user friendly;
  16. Have a good maintenance system;
  17. Follow good practice guidelines in trade relations;
  18. Ensure that the technology has the potential to become scalable (“think big”)

As an open list, it accepts amendments until the final version scheduled for later this year. At the current stage, legal aspects weigh more than the functional ones, which goes to show the difficulties in introducing these type of services. In my opinion, legality, far from being a guarantee, is an educated act of passive resistance that one should manage in the most pragmatic way the circumstances allow.

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