This paper provides a conceptual framework for the evaluation of telehealth implementations in Australia, and also provides an evidence base that illustrates the current state of telehealth evaluation on an international scale.
This paper was produced as part of a one year study, funded by the University of Melbourne interdisciplinary seed grant. This paper will firstly provide a conceptual framework that incorporates the key dimensions, criteria and measures that need to be considered in the evaluation of telehealth implementations in Australia.
Telehealth evaluation can be considered to be the examination of the effectiveness, appropriateness and cost of a telehealth service, by answering four fundamental questions 1) does the intervention work; 2) for whom; 3) at what cost and 4) how does it compare with the alternatives? In helping to address these questions for telehealth evaluation in the Australian context, this framework is linked back to a national, validated health performance framework. The AIHW framework was also used to form a link between the evaluation criteria and measures described in international literature, to health performance indicators. This resulting conceptual framework will be modified and validated with 3 to 5 case studies involving interviews, focus groups with key stakeholders involved in telehealth implementations. This framework will make it more efficient to undertake evaluation of any Australian telehealth implementation, to produce more widely applicable findings, to share these and to improve practice based on the collective results. This paper will be of interest to decision makers, coordinators of telehealth programs or others who are either involved in or concerned about the evaluation of telehealth implementations in Australia. It is a timely and valuable resource, especially in light of the recent recommendations put forth by the Health Innovation and Reform Council, Department of Health, Victoria.
This paper also provides an evidence base that illustrates the current state of telehealth evaluation on an international scale. A systematic review of systematic reviews on telehealth implementations and evaluations indicates that:
The research around telehealth evaluation is plenty. Some focus on telehealth outcomes in particular specialties, some on specific outcomes such as cost-effectiveness, and others on frameworks and guidelines to support telehealth evaluation.
Telehealth evaluation can be complex with a great many potential inputs, outputs, outcomes and stakeholders. This may be one reason for a lack of established telehealth evaluation protocols, which in turn has hindered decision-making to implement wide scale initiatives.
- There is no standardisation of definitions, criteria, measures across the literature leading to ambiguity and confusion.
- There is no link between the telehealth evaluation criteria and health performance indicators. Therefore, the overall impact of telehealth on the healthcare system cannot be judged.
- The methodologies for conducting telehealth evaluations are not consistent.
The paper is divided into three sections. Section 1 provides an overview of the literature, method and proposed framework. Section 2 provides the proposed framework for telehealth evaluation. Section 3 describes the results of grouping the various criteria and measures mentioned in the literature. This paper also has two Appendices. Appendix A should be used to support the reading of Section 3. Appendix B provides an annotated bibliography of the papers reviewed, as well as further information on the literature.