The Telemedicine Community Readiness Model (TCRM)
The Telemedicine Community Readiness Model (TCRM) helps actors in communities to determine the current requirements for a successful telemedicine implementation. Communities can be connected locally (e.g. regions or health networks) or through a common interest (e.g. a common disease).
Telemedicine is defined by three characteristics. It describes i) the provision of health care services for patients by health care providers ii) over a distance iii) through the use of information and communication technology. Only if all three characteristics are fulfilled this constitutes telemedicine.
The TCRM is based on barriers and success factors for telemedicine identified in the literature as well as research results regarding the influence of communities and regarding existing maturity models .
Using three dimensions, the status quo can be determined on six levels (see illustration). To assess the status quo, the status of existing telemedicine initiatives is relevant as well as how many members of the community are involved and what evidence has already been generated.
Depending on the status quo of the community, improvement measures are suggested, which can help to increase the use of telemedicine initiatives in the long term. This should enable to realise the full benefits of telemedicine initiatives.
All improvement measures are listed below according to the individual levels.
|Basic technical/ infrastructural requirements are clear to those planning telemedicine initiatives||Knowing all the technical/ infrastructural requirements from the beginning of the telemedicine initiative onwards is difficult. In the first place, it is important to know the basic requirements that need to be set up (e.g. internet and/or telephone line)|
|Involvement of stakeholders (decision makers, users, etc.) in the development of telemedicine initiatives||User-centred design processes should involve potential users – in this case, e.g., patients, citizens, healthcare professionals|
|Provision of essential technical infrastructure||Basic hardware and/or software for delivering telemedicine services needs to be provided (e.g. iPad, a SIM card)|
|Definition of a holistic objective for telemedicine implementation in the community||A vision for telemedicine in the community should include all the relevant stakeholders and topics in the community itself|
|Compliance with regulatory requirements||All regulatory requirements need to be clear and to be followed (e.g. regarding jurisdiction, liability)|
|Compliance with ethical guidelines||Guidelines for ethics and governance exist, are known, and are followed|
|Securing risk management||Probability of occurrence and extent of damage for possible risks need to be known and adequately addressed|
|Securing a written form for contractual arrangements||All arrangements are recorded to track agreements (written contracts)|
|Provision of awareness campaigns for the existence of telemedicine initiatives to expand knowledge about them||NutzerInnen müssen Users need to know about the existence of telemedicine initiatives, otherwise they cannot use themer die Existenz von Telemedizininitiativen aufgeklärt sein, sonst können sie diese nicht nutzen|
|Definition of a step-by-step implementation plan for telemedicine in the community||Continuous operationalisation of the holistic objective, including the definition of processes, responsibilities, and members of the workforce|
|Definition of requirements, aims and outcomes for telemedicine initiatives in the community||Expectations for implementing telemedicine initiatives in the community are defined and in line with the community objectives and the implementation plan|
|Definition of hierarchical structures, which can be adapted for telemedicine responsibilities||This is a prerequisite for the assignment of responsibilities so that things can move forward (the structures should preferably be documented in a written format)|
|Securing an information management transparent to all stakeholders ||Provision of sufficient information to actively address people's worries and anxieties|
|Harmonisation of guidelines for decision making in the community with the community climate and the beliefs of the community||It is possible to undertake hierarchical decision making while avoiding the potential for conflict and still ensuring consensus; if decision making violates community values, parallel structures would need to be created, which would hinder efficiency and lead to stubbornness|
|Provision of awareness campaigns about the existence of telemedicine initiatives, which also include the users´ peers as target group||Users of telemedicine initiatives often value the opinions and judgement of people close to them|
|Provision of a forum for communication, (inter- and intra-group) cooperation, data management, and the creation of trust among stakeholders who are mutually dependent on each other||Cooperation of the actors involved is directly supported and made transparent to all the persons involved (according to community climate and beliefs)|
|Provision of adequate financial resources for telemedicine initiatives||The focus on financial resources is explicitly on community resources, i.e. the community is expected to support the telemedicine initiatives financially when other funding is insufficient|
|Definition of one or more person(s) as responsible for telemedicine, to whom authority is allocated to||Based on the existing hierarchical structures, there are clear decision-making competencies (which should be allotted to existing personnel to avoid parallel structures and to bundle knowledge/competence)|
|All technical/ infrastructural requirements are clear to those planning telemedicine initiatives||At this point, all requirements need to be clear to provide the best possible TI|
|Provision of awareness campaigns of benefits of telemedicine (based on effectiveness studies||Having information only about the existence of telemedicine is not enough for its long-term use. Their benefits should also be communicated and shown as soon as possible.|
|Provision of adequate human resources by the community||The focus on human resources is explicitly on community resources, i.e. the community is expected to support the telemedicine initiatives by providing human resources when existing human resources are insufficient|
|Definition of a sustainable scaling up strategy||Continuous implementation of the vision in the existing system should be combined with a realistic implementation strategy|
|Compliance with culturally appropriate communication so that all potential end users are reached equally||Equal access should be ensured by including all potential users and having a supportive community climate|
|Provision of programs to diminish existing inequalities in healthcare and to increase (health/digital) literacy||Equal access to using the existing telemedicine initiatives should be ensured for all members of the community (inequalities can result from, e.g., education, socio-economic factors, demographics, or health and employment status)|
|Provision of training and qualification for all relevant stakeholders||The aim is to increase competence, ability and comfort when using telemedicine and improve (e-) health literacy for all stakeholders|
|Securing continuous improvement/ performance management (including supportive policies)||Telemedicine initiatives should not be left without further support. Once the initiatives are up-and-running, uniform rules for all telemedicine initiatives in the community need to be in place and monitored regularly|
|Provision of structural programmes to ensure that an adequate number of people is available in the workforce and equipped with the necessary skills and knowledge||Proprietary programmes for the development of well-trained workforces exist in order to ensure long-term sustainable use|
|Securing that telemedicine initiatives and further existing IT infrastructure are interoperable||The telemedicine initiatives are not isolated solutions that can die off quickly. Rather, they are based on an all-encompassing platform that has different components|