The sustainability of a telehealth programme is one measure of its success. However, the term sustainable telehealth has almost become an oxymoron. Many telehealth programmes are initiated in good faith and are based upon well founded principles. Unfortunately, the initial funding cycle is rarely long enough to enable the programme to reach maturity and become integrated into the health-care system. Telehealth does not critically depend on technology; change management is much more important and it takes time for personnel to adopt new modes of practice. In addition, a telehealth programme needs a threshold number of installations before it can be deemed fully operational. In many cases an evaluation carried out at the conclusion of the pilot phase will fail to recognize the initial goals. As a consequence, the criteria used to justify further financial support are often at odds with the original goals and aspirations of the project initiators, and this leads to dissatisfaction by all parties concerned.

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A Canadian project (the National Initiative for Telehealth Guidelines) was established to develop telehealth guidelines that would be used by health professionals, by telehealth providers as benchmarks for standards of service and by accrediting agencies for accreditation criteria. An environmental scan was conducted, which focused on organizational, human resource, clinical and technological issues. A literature review, a stakeholder survey (245 mail-outs, 84 complete responses) and 48 key informant interviews were conducted. A framework of guidelines was developed and published as a preliminary step towards pan-Canadian policies. Interim recommendations were that organizations and jurisdictions might consider formal agreements to specify: (1) organizational interoperability; (2) technical interoperability; (3) personnel requirements; (4) quality and continuity-of-care responsibilities; (5) telehealth services; (6) remuneration; and (7) quality assurance processes. An additional recommendation was that flexible mechanisms were needed to ensure that accreditation criteria will be realistic and achievable in the context of rapid changes in technology, service integration and delivery, as well as in the context of operating telehealth services in remote or underserved areas.