Framework for Evaluating and Developing Sustainable Telehealth Programs

Zhang, Yunxi; Chandra, Saurabh; Peña, Maria T; Lal, Lincy S.; Summers, Richard L.; Swint, J. Michael

doi:10.1089/tmj.2022.0407

Cited by 11 publications

(16 citation statements)

References 11 publications

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“…The financing model for digital therapeutics was considered highly influential with respect to their uptake in the health care system [ 12 , 65 , 81 , 87 , 127 , 139 , 162 , 170 , 203 , 205 , 212 , 229 , 230 , 232 ]. In the included literature, eleven distinct financing models for digital therapeutics were identified: (1) periodical subscription (Germany and the United Kingdom), (2) 1-time license fee (Germany), (3) part of bundle packages with other (nondigital) therapeutics (the United States), (4) financing through (innovation) grants, subsidies, or fundraisers (the Netherlands and Germany), (5) sponsor-based agreements in which the digital therapeutic is sponsored by a large platform or institution (eg, Alzheimer Netherlands sponsors a digital health intervention for Dutch patients with dementia at no charge to caregivers), (6) public-private partnerships (eg, a private actor helps develop the local digital health infrastructure on the condition that their digital therapeutic is added in the local health care inventory), (7) inclusion in data plans, (8) performance-based contracts (the United States), (9) risk-benefit sharing contracts (the United States), (10) part of employment benefit plans, and (11) pay-as-you-go arrangements [ 12 , 65 , 86 , 87 , 127 , 143 , 162 , 170 , 203 , 205 , 212 , 229 , 230 , 232 , 239 ]. In addition, some form of reimbursement parity (eg, service or payment parity) with traditional biomedical therapeutics was considered important [ 68 , 70 , 119 , 123 , 153 , 169 , 206 , 238 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, some form of reimbursement parity (eg, service or payment parity) with traditional biomedical therapeutics was considered important [ 68 , 70 , 119 , 123 , 153 , 169 , 206 , 238 ]. Incentives for the uptake of digital therapeutics were also identified as an important means of bolstering the development of a reimbursement pathway for digital therapeutics (eg, dedicated funding or financial compensation for offsetting the high fixed costs of implementing digital therapeutics in practice) [ 1 , 19 , 62 , 87 , 122 , 126 , 133 , 140 , 143 , 145 , 169 , 174 , 187 , 188 , 200 , 218 , 225 , 227 , 231 ]. An important aspect of these incentives is the development of reimbursement codes for digital therapeutics [ 2 , 53 , 99 , 148 , 153 , 169 , 170 , 212 ].…”

Section: Resultsmentioning

confidence: 99%

“…As they reduce the need for patients to travel to health care facilities, they are both environmentally friendly and can reduce the risk of hospital-borne infections [ 120 , 139 , 165 , 171 , 180 , 185 ]. When designed and deployed adequately, digital therapeutics can also contribute to the reduction of health inequalities; however, when designed poorly or without the consideration of the potential for the digital exclusion of groups with lower levels of digital literacy, they have the potential to exacerbate health inequalities [ 47 , 53 , 68 , 70 , 81 , 95 , 99 , 100 , 102 , 107 , 120 , 127 , 132 , 139 , 140 , 142 , 143 , 173 , 182 , 210 , 218 , 221 , 242 ]. Finally, digital therapeutics can aid in the generation and analysis of meaningful real-world (health) data through their integration with electronic health records [ 5 , 136 , 231 , 273 ], enable the use of cloud-based diagnostics and (big data) analyses [ 48 , 72 , 223 ], and be continuously developed and improved through iterative user feedback [ 201 ].…”

Section: Resultsmentioning

confidence: 99%

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Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

van Kessel,

Roman-Urrestarazu,

Anderson

et al. 2023

J Med Internet Res

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Background Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. Objective In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. Methods A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. Results We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. Conclusions The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system’s readiness for digital therapeutics.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

van Kessel,

Roman-Urrestarazu,

Anderson

et al. 2023

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…In countries with a developed and institutionalized patient movement, including the Czech Republic, it is patient organizations that can represent the community level. Other authors, for example Zhang et al ( 46 ), point out that telemedicine stakeholders should strengthen intersectoral collaboration to incorporate population preferences and entrench the service in the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

Development of telemedicine in the Czech Republic from patients’ and other key stakeholders’ perspective

Těšinová,

Dobiášová,

Dušek

et al. 2023

Front. Public Health

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Telemedicine is a way to improve healthcare outcomes with greater efficiency for both patients and care providers. The great potential of digital technologies also lies in strengthening the patient-centered approach. The early successes and benefits of telemedicine in the Czech Republic, amplified by the COVID-19, have contributed to the fact that wider implementation of telemedicine is already generally supported at the expert and public levels. Our research focuses on the identification of key issues in the implementation of telemedicine and the challenges of telemedicine in the future, from the perspective of patients and other stakeholders. The study is based on a qualitative research approach, combining focus groups with key stakeholders, patient panels and expert panels (2021–2022). The lack of rules and uncoordinated development of various activities proved to be the main barriers to the integration of telemedicine in the health system. This regulatory uncertainty can generate a number of problems in the patient–doctor relationship in practice, including ethical ones, and can also lead to inequalities in access to healthcare and affect the overall quality of care provided. Furthermore, it has been shown that patients’ interests in the implementation of telemedicine are: 1. a predictable and reliable framework that guarantees them certainty and security in the provision of telemedicine services, 2. telemedicine solutions that increase the availability and efficiency of the care provided while bringing comfort, and 3. user-friendly and simple solutions. At the same time, patients want to understand the new environment and be active participants in the process of digital innovation, including the practical implementation of telemedicine. The research team has developed recommendations for further developments in the implementation of telemedicine that reflect the patient’s interest and can be implemented at three levels – the health system, institutional, and community level. In countries with a well-developed and institutionalized patient movement, the community level can be represented by patient organizations, thus becoming the link between telemedicine policy making and implementation at the individual level of healthcare provision. For the further development of telemedicine, the development of a national strategy involving all key stakeholders, including patients, in the implementation has proven essential.

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“…These frameworks have been designed to guide and facilitate the assessment of specific dimensions of telehealth programs. For example, Zhang et al [15] designed a framework to guide the development and evaluation of sustainable telehealth programs. Curfman et al [16] developed an economic framework focusing on measuring the value of pediatric telehealth.…”

Section: Overviewmentioning

confidence: 99%

Telehealth Evaluation in the United States: Protocol for a Scoping Review

Zhang,

Lin,

Lal

et al. 2024

JMIR Res Protoc

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Background The rapid expansion of telehealth services, driven by the COVID-19 pandemic, necessitates systematic evaluation to guarantee the quality, effectiveness, and cost-effectiveness of telehealth services and programs in the United States. While numerous evaluation frameworks have emerged, crafted by various stakeholders, their comprehensiveness is limited, and the overall state of telehealth evaluation remains unclear. Objective The overarching goal of this scoping review is to create a comprehensive overview of telehealth evaluation, incorporating perspectives from multiple stakeholder categories. Specifically, we aim to (1) map the existing landscape of telehealth evaluation, (2) identify key concepts for evaluation, (3) synthesize existing evaluation frameworks, and (4) identify measurements and assessments considered in the United States. Methods We will conduct this scoping review in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). This scoping review will consider documents, including reviews, reports, and white papers, published since January 1, 2019. It will focus on evaluation frameworks and associated measurements of telehealth services and programs in the US health care system, developed by telehealth stakeholders, professional organizations, and authoritative sources, excluding those developed by individual researchers, to collect data that reflect the collective expertise and consensus of experts within the respective professional group. Results The data extracted from selected documents will be synthesized using tools such as tables and figures. Visual aids like Venn diagrams will be used to illustrate the relationships between the evaluation frameworks from various sources. A narrative summary will be crafted to further describe how the results align with the review objectives, facilitating a comprehensive overview of the findings. This scoping review is expected to conclude by August 2024. Conclusions By addressing critical gaps in telehealth evaluation, this scoping review protocol lays the foundation for a comprehensive and multistakeholder assessment of telehealth services and programs. Its findings will inform policy makers, health care providers, researchers, and other stakeholders in advancing the quality, effectiveness, and cost-effectiveness of telehealth in the US health care system. Trial Registration OSF Registries osf.io/aytus; https://osf.io/aytus International Registered Report Identifier (IRRID) DERR1-10.2196/55209

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Framework for Evaluating and Developing Sustainable Telehealth Programs

Cited by 11 publications

References 11 publications

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

Development of telemedicine in the Czech Republic from patients’ and other key stakeholders’ perspective

Telehealth Evaluation in the United States: Protocol for a Scoping Review

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