Institutionalizing Telemedicine Applications: The Challenge of Legitimizing Decision-Making

Abstract

During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness.We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale.We discuss (1) three main requirements— rationality, fairness, and efficiency—that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications—benefits and sustainability.According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators’ perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.

Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial

“…Mean costs for the health care system provide another informative measure for policy decisions and confirm that the remote device monitoring might become an institutionalized service [33]. Our analysis showed that the mean annual cost for the management of the patients in the remote arm was €167.23 lower than that in the standard arm (€1962.78 versus €2130.01; P =.80).…”

A Systematic Review of the Technology Acceptance Model in Health Informatics

“…The rapid development of worldwide Internet infrastructures has facilitated development of systems in this domain. Telemedicine applications have in particular allowed to introduce new organizational structures in health services 40 and consequently led to an interest in the use of the TAM to facilitate the organizational adaptation. Health care policy makers are still debating why institutionalizing telemedicine applications on a large scale has been so difficult, 53 and why health care professionals are often averse or indifferent to telemedicine applications.…”

“…Health care policy makers are still debating why institutionalizing telemedicine applications on a large scale has been so difficult, 53 and why health care professionals are often averse or indifferent to telemedicine applications. 40,54 We believe that user rejection is one of the important factors in institutionalizing various types of telemedicine applications. Therefore, it is important to examine the effective factors in accepting telemedicine applications by health care professionals.…”

“…Several major technologies like mobile and telemedicine have variety of applications. 40,41 In a separate phase, the technologies and applications as a subset of major technological contexts and characteristics of each tested model for user groups were identified by three authors together. Finally, the publications in the list were classified into three categories according to their aim and content:…”

Delivering telemedicine interventions in chronic respiratory disease

“…Standard practice guidelines for the amount of self-management activity and changes to individual care plans based on these readings parallel traditional care; however, the lack of clarity in supporting clinician decision-making may be, in large part, why healthcare professionals are often averse or indifferent to adopting telemedicine applications [19]. Decisions related to the extension of the most promising telemedicine applications are complex and should include multiple stakeholders such as practitioners, healthcare regulators and governments [20]. Key elements for monitoring patients with CRD via telemedicine are shown in figure 3.…”