Sustainability-the Holy Grail of telehealth?

Abstract

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.

Sustainable Rural Telehealth Innovation: A Public Health Case Study

“…However, telehealth innovations invariably struggle to sustain after initial sponsorship ends (Sanders and Bashshur 1995; Wright 1999; Stachura 2001; Cradduck 2002). Sustainability is the long‐term ability of a system to respond to external pressures, and to adapt to external constraints without detriment to its functioning (Whittaker et al 2004).…”

“…Sustainability of telehealth is affected by existing structures and processes of the health care delivery system, policy frameworks, communication and technology costs, and physician and patient acceptance (Sanders, Salter, and Stachura 1996). A telehealth service is sustainable when it is “no longer considered a special case, but has been absorbed into routine healthcare delivery” (Cradduck 2002) and this requires its integration “among members of the relevant social system” (Rogers 2003), including managers, staff, and specialists at partnering institutions.…”

“…Thus, telehealth can become an “alternative healthcare delivery system” (Bashshur, Reardon, and Shannon 2000). However, most telehealth innovations struggle to survive beyond the pilot stage, despite being medically and technically viable solutions (Sanders and Bashshur 1995; Wright 1999; Cradduck 2002). The objective of this study is, therefore, to contribute to health services research by examining how rural public health institutions can sustainably adopt telehealth innovations.…”

Telepractice: The Australian Experience in an International Context

“…Singh, Mathiassen, Stchura, and Astapova (2010) report that telepractice innovations often struggle to endure after initial sponsorship (e.g., grants) end. The advice offered by Cradduck (2002) states that a telepractice service is considered sustainable when it is ''no longer considered a special case, but has been absorbed into routine health care delivery'' (p. 8). To accomplish this, each professional discipline involved in the effort needs to participate in planning and evaluating the telepractice services being offered.…”

Exploring Trust-Based Service Value Chain Framework in Tele-healthcare Services

“…Christensen, et al [7] pointed out that medical technologies have been helping hospitals and doctors solve the most complex problems instead of creating customers' value. However, most tele-healthcare services are struggling to survive beyond the pilot or trial project stage with reimbursement, far from being a service business model, despite offering medically and technically viable solutions [8,9,34,45]. Thus, it is imperative to include the development and testing of business models while implementing tele-healthcare services.…”