Telemedicine implementation: WHO's eleven steps

Telemedicine implementation, in the World Health Organization's 2022 guide, runs to eleven steps in three phases, from forming a team to planning for continuous improvement. Together, the steps lead towards a costed implementation plan. WHO wrote the guide for policy decision-makers and for those who design and oversee telemedicine implementations.

WHO recommends telemedicine to complement health services, not to replace them. It sets one condition: patient safety, privacy, traceability, accountability and security must be open to monitoring. The guide also treats telemedicine as part of the package of health-care services, never as a separate intervention.

Knowing what counts as telemedicine, and which step comes first, lets a hospital plan its service in the right order.

What telemedicine is

WHO's definition describes telemedicine as the delivery of health-care services where distance is a critical factor. Health-care professionals deliver it using information and communication technologies. The information they exchange serves the diagnosis, treatment and prevention of disease and injuries.

At its heart, the guide says, telemedicine is the provision of remote health-care services through digital tools. It forms one part of telehealth, a broader term. Telehealth also covers distance education and other uses of technology that support health-care services.

The guide also records the benefits telemedicine has shown. Among them are fewer unnecessary clinical visits, more timely care and wider access for underserved communities.

The three modes of telemedicine

The guide describes three ways of delivering a telemedicine service.

1. Store and forward. Health data and images go digitally to a health worker, usually a specialist, for analysis at a later time. Dermatology, radiology and ophthalmology have used it.
2. Interactive services. Two or more people in clinical practice communicate to help diagnose and treat patients who would otherwise lack timely access to specialist care.
3. Remote patient monitoring, also known as telemonitoring. Health workers follow a patient's condition remotely through connected medical devices and sensors, often for chronic conditions.

Telemedicine may also connect patients with health workers, which the guide calls client-to-provider telemedicine. Alternatively, it may connect health workers with one another, which it calls provider-to-provider telemedicine.

Its common uses follow from these. First, teleconsultation brings remote clinical services to patients. Second, in tele-expertise, a health worker seeks a second opinion or guidance from a specialist. Tele-triage, finally, speeds up emergency decisions by sending health parameters for remote consultation.

WHO's recommendations on telemedicine

WHO's guideline gives a recommendation for each of the two kinds. For client-to-provider telemedicine, WHO recommends its use to complement, rather than replace, the delivery of health services. That use belongs only where patient safety, privacy, traceability, accountability and security are open to monitoring.

Similarly, for provider-to-provider telemedicine, WHO recommends its use under the same condition of monitoring. In this sense, monitoring includes standard operating procedures, known as SOPs. They describe protocols for patient consent, for data protection and storage, and for verifying provider licensing and credentials.

Telemedicine implementation in eleven steps

WHO's guide arranges the work in three phases. Each phase holds its own steps, eleven in all, in the order a programme meets them.

1. Situational assessment. Step 1 forms the team and establishes goals. Step 2 defines the programme's context and key targets. Step 3 maps the digital systems already in use, and step 4 assesses the enabling environment.
2. Plan the implementation. Step 5 determines how the telemedicine system will operate. Step 6 enforces mechanisms for patient and health worker safety and protection. Step 7 establishes SOPs, and step 8 invests in patient engagement and in gender, equity and rights. Step 9 develops a budget.
3. Monitoring and evaluation, and continuous improvements. Step 10 determines the goals for monitoring and evaluation. Step 11 plans for continuous improvements and adaptive management.

Planning how a telemedicine service will run

The first key step, in the guide's words, is to establish a team and determine the overall objectives and expected goals of the programme. Mapping what exists then documents the digital systems already in use. As a result, it can show gaps, and tools worth reusing or expanding.

Then come functional requirements. They detail what the digital system needs to do to support the health system's processes and tasks. Meanwhile, change management should begin early in the planning.

Likewise, user testing has a clear aim in the guide. The technology should not harm the relationship between the patient and the health worker. The budget, too, looks beyond the initial capital expenditure, because it allows for the costs of implementation and maintenance as well.

Richnovex helps hospitals put smart healthcare solutions into daily use, as its work with hospitals sets out. The work covers the exact workflows, technical specifications and structures the solution needs, and its implementation and system integration. It also covers the training, performance monitoring and maintenance that follow go-live.

Measuring and improving a telemedicine service

The third and last phase, in turn, sets the goals for monitoring and evaluation. For instance, one of the guide's illustrative indicators is the percentage of all health services or encounters performed using telemedicine.

Beyond the indicators, the guide also asks for a culture of data use. That culture allows the programme to adapt in response to how people use the telemedicine service.

Telemedicine implementation belongs inside routine care

In short, WHO's guide treats telemedicine as part of the package of health-care services, not as a separate intervention. Its eleven steps carry a programme from situational assessment to a costed implementation plan, and on to continuous improvement.

Sources

1. World Health Organization, Consolidated telemedicine implementation guide (2022): who.int, the guide