Putting positive planning into telemedicine projects

A new implementation tool helps practitioners design and build better bespoke remote healthcare programmes.

While the face-to-face consultation will never be replaced, online and phone-based healthcare is here to stay—even more so after the global COVID-19 pandemic that catalysed remote diagnosis. But designing successful telemedicine projects is notoriously complex with most initiatives failing during the founding stages. 

In an article in the journal Oxford Open Digital Health, Neha Verma and colleagues present a new easy-to-use chart-based checklist tool—Telemedicine Program Design Canvas (TPDC)—that brings clarity and a logical checklist approach to the process.

The TPDC allows doctors and healthcare workers to construct a programme that identifies strengths and likely pitfalls that can be adapted to suit patients and the wider community. To make sure it could be used in a variety of settings, the tool was developed over six mammoth 16- to 20-hour workshops, using healthcare stakeholders from three government organisations and three non-profit organisations. 

From the sessions, the researchers identified 14 key elements that need to be addressed when designing a new programme: the problem, ecosystem, patients, patient journey, patient engagement and trust, providers, provider training, provider engagement, channels, technology, medicines and diagnostics, desired outcomes, and costs and revenues. 

Process for the people

These 14 elements can then be grouped to guide conversations about implementation. For example, consider the problem and the ecosystem together. Is the community mainly urban or rural? In many low- and middle-income countries, rural phone and internet access may be limited so provision would need to be made to enable patients to participate in the programme.

Next comes the patients, patient journey, and patient engagement and trust: what particular strengths can be drawn on and what have patients been saying about their needs or previous programmes? 

After patients, consider the providers: are they specialists or generalists, and what can be done in terms of provider training and engagement?

With the patient and provider relationship examined, the TPDC looks to the medium and channels of communication. Which modes are most appropriate: web, apps, chat bots, or video? And how is the core technology in terms of software and hardware going to work reliably?

Finally, the tool looks at how tech and provider combine to deliver the diagnostics and treatments offered to patients. It also considers the desired outcomes because clear goal setting orientates the entire telehealth project. The very last step is to balance outcomes and treatment against overall costs and revenues. 

Putting the process into practice

The authors tested the new tool in two projects in rural India. The Visilant project used the TPDC tool to help achieve its aim to increase eye care to vulnerable populations through teleophthalmology. The MyTeleDoc project used the tool to help with its work connecting community health officers in government-run rural primary care clinics with specialists at secondary and tertiary health facilities.

The TPDC tool enabled each project to focus on their strengths and identify weaknesses, resulting in a more formulaic and less ad hoc approach to planning.

While the process is far from finished this is not the end of the conversation, as the article authors note. Many more projects will be needed to evaluate the efficacy of this approach.

However, with such a high failure rate for current remote healthcare projects there is a bridge to build between design and implementation of telehealth interventions, particularly for low and middle-income countries where people lack immediate access to onsite healthcare facilities. Providing a robust framework for the holistic design of such interventions, the TPDC is well-placed to help bridge this gap, enabling better comprehensive and iterative remote healthcare programme planning.

For more from Oxford Open Digital Health, check out our selection of scicomms content supporting our journal authors in spreading the word about their research.

_{Featured image by Karolina Grabowska (public domain)}