Critical success factors:

how to establish a successful

telehealth service
Accessibility
To receive this publication in an accessible format phone 03 9096 1405, using the National Relay Service 13 36 77
if required, or email: [email protected]

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, February, 2015

This work is licensed under a Creative Commons Attribution 3.0 licence (creativecommons.org/licenses/by/3.0/au).
It is a condition of this licence that you credit the State of Victoria as author.

ISBN 978-0-9924829-8-5

Available at http://www.health.vic.gov.au/telehealth

(1411002)
Contents
Introduction 1

Understanding telehealth 2

What is telehealth? 2

Why consider telehealth? 2

Types of telehealth services 2

Where to start 3

Critical success factors for successful telehealth 4

A clear purpose has been established 4

There is strong leadership and dedicated coordination 5

Key stakeholders and consumers recognise the benefits and are engaged 6

Project planning and a readiness assessment informs implementation 8

Technology and clinical service needs are well matched 10

A sustainable workforce model underpins the service 12

Change management is a focus 14

Clinical responsibility and governance protocols have been clearly articulated 16

A sustainable funding model is in place 18

Services are consumer-centred and consumers supported in adopting telehealth 20

There is ongoing review and evaluation 22

Involvement and collaboration across the sector 24

Feedback and contributions to this document 25

Contact details for Victorian agencies that can provide advice and assistance 26

Useful websites and further information about telehealth 27

References drawn on in developing critical success factors 28

Introduction
Telehealth is increasingly being used to support the Critical success factors
delivery of, and improve access to, clinically appropriate 1. A clear purpose has been established
and cost-effective consumer-centred care.
2. There is strong leadership and dedicated
A range of telehealth initiatives trialled across Victoria coordination
have demonstrated that the effective and efficient use 3. Key stakeholders and consumers recognise the
of telehealth can result in better access for consumers benefits and are engaged
as well as deliver services more efficiently. However, 4. Project planning and a readiness assessment
it has been challenging to build on these initiatives to guides implementation
develop system-wide telehealth services. 5. Technology and clinical service needs are well
matched
The diversity in projects and initiatives, target populations
6. A sustainable workforce model underpins the
and geographic and social landscapes in which telehealth
service
services have been established make it difficult for
7. Change management is a focus
clinicians, executives and administrators to identify
8. Clinical responsibility and governance
what is applicable and relevant when developing telehealth
protocols have been clearly articulated
services. While there is no ‘one size fits all’ approach
to telehealth implementation, the literature identifies 9. A sustainable funding model is in place
factors that strongly influence the success or failure of 10. Services are consumer-focused and consumers are
a telehealth service. supported in adopting telehealth
11. There is ongoing review and evaluation
Critical success factors: how to establish a successful
12. Involvement and collaboration across the sector
telehealth service aims to identify these factors to provide
health services with insight into the environmental A range of research reports and conference papers,
conditions that will increase the likely success rate of evaluations and the viewpoints of practitioners in the
telehealth services. It offers a practical resource that telehealth field have been drawn upon in synthesising
highlights the key issues identified as essential to building these critical success factors. Case studies highlight
a sustainable telehealth service, while drawing on some successful approaches to implementation and some
of the ‘sticking points’ that have hindered previous efforts. of the issues that have impacted on success.

The following are the identified critical success factors. In particular, the Department of Health & Human Services
As telehealth services proliferate, these will be added to thanks Dr Victoria Wade for her advice and sharing of
and amended as new implementation experiences identify her experiences and research. The Department also
other issues that can support or hinder the development appreciates the input and feedback received from
and expansion of telehealth services. representatives on the Telehealth Advisory Committee.

1
Understanding telehealth
What is telehealth? Why consider telehealth?
There is a range of terms used to describe Telehealth can be considered as an alternative
the delivery of health services using technology. or complementary model of service delivery:
Telehealth is commonly defined as the provision • For consumers and families, telehealth improves
of healthcare delivery or related processes (such access to specialist and primary cares services,
as education), when some of the participants reduces disruption eliminating the need to
are separated by distance and information and travel to access health services, improves choice
communication technologies (ICTs) are used to of practitioners and potentially reduces waiting times
overcome that distance. Common telehealth for health services. It can improve consumer outcomes
technologies include videoconferencing and through greater access to health services.
store and foreward technologies. • For health professionals and health services, telehealth
There are often distinctions between telemedicine reduces travel between locations and provides access
and telehealth, with the former limited to those being to specialist peer support. It enables practitioners to
delivered by physicians, and the latter by health conduct multidisciplinary care planning when healthcare
professionals in general, including nurses, pharmacists professionals are located across various services.
and allied health professionals. Telehealth is taken to It is used to deliver training and education options
include other aspects of healthcare such as disease and reduces rural practice isolation. The availability
management, prevention and health promotion. of telehealth services can improve the capacity for
services to recruit staff and retain health professionals.
The term telecare also has a broader application and
• For governments, telehealth services have the potential
can include the delivery of a range of care services
to improve access to special services, reduce the overall
using technologies.
cost of delivering services into rural and regional areas,
As the use of technology for the delivery of specialties deliver better services and improve health outcomes.
increases, new terms are also emerging. For example,
As technologies continue to improve and become more
teleophthalmology is a branch of telehealth that
widely available, telehealth also offers an opportunity for
delivers eye care through digital medical equipment
consumers to become more involved in their care and
and telecommunications technology. Teledentistry,
in health service planning. This shift from traditional
telepsychology and teledermatology are other terms
physician-centred practice to consumer-centred care
used to describe the delivery of specific health services
offers greater potential to improve the health outcomes
using technology. These are all subsets of telehealth.
of the population as consumers take on the responsibility
The application of telemedicine and/or telehealth for managing their health using telehealth such as home
to the home environment has introduced another monitoring technologies.
concept of telehomecare or home telehealth,
including home monitoring. Types of telehealth services
E-health is commonly used as an umbrella term that Telehealth is being used in a range of service models.
includes telehealth, electronic medical records, and other
The introduction of the Medicare Benefits Scheme (MBS)
components of health IT. The National E-health strategy
item numbers for telehealth has increased the use of
for Australia identifies E-health as both the essential
telehealth for specialist consultations directly to consumers
infrastructure underpinning information exchange and as
across a range of disciplines, including dermatology,
a key enabler and driver of improved health outcomes.
ophthalmology and diabetes management.
The commonality between all these services is that they
use technology to provide direct health services, share
information and link healthcare professionals.

2
Videoconferencing is enabling specialists to work remotely Other initiatives that are underway include the use
with allied health services or local specialists to oversee of telehealth-enabled remote consumer monitoring.
the provision of care. As an example, the statewide Consumers are able to take their own vital signs
paediatric telehealth service, which is being rolled out and biometric measures that can be monitored by
across Victoria, is enabling regionally based paediatricians the health service with a 24-hour escalation process
and GPs to treat local consumers with support and for signs and symptoms of deterioration. This model
specialist advice from sub-specialists at The Royal of care captures a richer set of information than would
Children’s Hospital and Monash Children’s Hospital. be achieved if a consumer attended a consultation
This not only reduces the need for consumers and their and allows the consumer to customise and adjust
families to travel to receive sub-specialist care, it provides their healthcare based on this information.
regional practitioners access to knowledge and support
It is not the purpose of this document to identify the
from colleagues in other health services, which will improve
breadth of applications for telehealth in delivering health
their capacity to deliver care to their consumers.
services. There are a great number of examples that
In regional areas consumers that are presenting in can be found across specialist areas, consumer cohorts
emergency departments or patients that are deteriorating and in different settings that will inspire and provide
and require time-critical attention, such as those who useful examples of ways that telehealth can make
are diagnosed as having had a stroke are receiving advice an existing service more accessible or establish new
and treatment from specialists via videoconferencing. service models and capabilities.
Using telehealth in these environments is complex, as
the technology must be trustworthy and immediately Where to start
available to avoid time delays.
A first step is to contact agencies that can provide
Telehealth is also enabling multidisciplinary clinical assistance and advice on implementation and identify
discussions involving a range of specialists in the care other initiatives where possible synergies exist.
of a consumer. In Victoria, videoconferencing technology The Telehealth Unit in the Department is a good starting
is used to link clinicians to cancer multidisciplinary point to discuss your initiative and determine synergies
meetings (MDM) across Victoria to inform decision with other projects and opportunities to leverage from
making. These linkages include metropolitan clinicians existing initiatives.
into metropolitan MDMs, specialist diagnostics into
Across Victoria, many regional and sub-regional health
regional MDMs, region-wide MDMs for low volume
services have already put into place telehealth officers
cancers and GPs. This approach has been found
who can assist in identifying possible sources of advice
to be particularly successful in managing the overall
and assistance.
healthcare plan for consumers.
Each of the rural regions has a Rural Health Alliance (RHA)
Imaging-oriented services like teleradiology and, to a
that is responsible for managing the telecommunications
lesser extent, telepathology, have been successfully
infrastructure for information exchange needs for public
embedded in clinical environments and are now often
health services in the region. These organisations may
part of routine healthcare. Videoconference-enabled
provide advice on regional telehealth initiatives, existing
education is becoming a standard process to support
technology available in health services, and how the RHA
medical education and training.
can assist in implementation of a new telehealth initiative.

Medicare Locals have traditionally had a role in

supporting the adoption of telehealth across the primary
healthcare services, including GPs. As they transition
to become Primary Health Networks (PHNs) under new
Commonwealth arrangements, it is hoped that their role
in supporting telehealth implementation will be maintained.

3
Critical success factors for
successful telehealth
1. A clear purpose has been established
In developing a telehealth service model it is essential
to clarify the specific purpose of the service. Telehealth
services should not be adopted just because the The delivery of optimal stroke care in rural/regional
technology is available. Having a clear purpose will also Victoria is challenging for several reasons including
enable the service to be evaluated against what was a shortage of stroke care units; limited availability of
initially intended. stroke specialists; and time delays for consumers
due to long distances to access acute services.
Improvements in consumer outcomes should underpin
the implementation of a telehealth service. There may Intravenous thrombolysis (t-PA) as an acute treatment
be other objectives for a telehealth service as well, such of stroke greatly reduces disability. In 2011, only
as efficiencies or cost-savings. It is important that these 13 per cent of rural and regional hospitals used
are documented, although measuring these could be t-PA. Furthermore, the proportion of consumers
problematic. While there is evidence that telehealth can that present to regional hospitals that receive t-PA
have a positive impact on consumer access and care, continued to be very low, 2 per cent compared to
improvements in clinical outcomes and cost-savings international best practice of over 10 per cent.
are harder to measure.

It is important to specify the clinical uses the service will lead by the Florey Institute of Neuroscience and
be focused on, but also consider other services which Mental Health began in 2010, when the first pilot
might be delivered via telehealth. Service targets in terms project linked doctors at Bendigo Health to a
of volumes are a good mechanism to ensure that the network of specialist stroke neurologists in
service is targeted to specific outcomes. Melbourne to evaluate patients with acute stroke.

A pilot project offers an opportunity to understand and Key drivers for VST were to:
model uptake rates within a community and health improve rapid diagnosis, treatment and
service to ensure that the service will be viable and used organisation of care processes for acute stroke
to capacity. It will provide an opportunity to test and adjust ensure equity of stroke care received regardless
the approach without impacting too broadly, and will assist of geographic location
in determining whether the service can meet its objectives. ensure that effective thrombolytic therapy
Even with a pilot program, there must be a commitment
to embedding the practice.
Evaluation found that the VST pilot enhanced clinical
decision making regarding stroke care by providing
real time access to brain imaging, as well as high
Why is a telehealth service model being quality audio-visual communication to facilitate the
considered and what is it intended to achieve?
What is the problem that needs to be solved

How will telehealth contribute to the organisation’s Clinical Lead, Victorian Stroke Telehealth Project
The Florey Institute of Neuroscience & Mental Health
What outcomes are anticipated and how will
these be measured?
Have examples and evidence of effective
telehealth technologies used in similar contexts

4
2. There is strong leadership Governance structures need to reflect responsibility
for project functions. It may be appropriate to create
and dedicated coordination a governance group that includes high-level decision
Strong leadership and executive support are essential makers from across the organisation to oversee
to build an organisational culture that has capacity for implementation and promote integration.
change and improvement.
A dedicated telehealth coordinator who is empowered
The development of a telehealth initiative needs to align to manage and sustain telehealth initiatives, has the
with an organisation’s strategic plan, vision and mission. clinical and operational skills, can direct internal
It also needs to be grounded on a compelling business resourcing and has executive visibility to promote key
case and a commitment to supporting the change to milestones of the project will foster success.
existing processes.
A telehealth coordinator can work as an agent of
An internal champion, such as the CEO, will help ensure change across an organisation to drive implementation,
that telehealth is appropriately resourced and supported including process design, training support, managing the
through the organisation. development of policies and guidelines and negotiating
technical solutions associated with telehealth.

For telehealth services involving more than one site, it is

suggested that a health worker or other staff member
As part of the Barwon South West Strengthening has responsibility for supporting the use of telehealth to
Health Services Collaboration, in 2013 Barwon manage practical issues at each site.
Health established a role to support development
Successful implementation of the program relies on a
of telehealth capability for evolving models of care
balance between top–down implementation of revised
across the region. The Regional Telehealth
business processes and governance frameworks with
Program Manager is the key contact for telehealth
bottom–up innovation that reflects and responds to the
promotion, initiatives and support for the 19 health
needs of clinicians and consumers.
service members as they elect to opt into telehealth.
The role is also responsible for developing seamless
and sustainable access to telehealth services across
the region. Has the project gained support from senior
leadership?
Telehealth features in the Barwon Health strategic
plan, which aligns closely with the business plan. Have internal champions been identified
Barwon Health’s CEO has been a leader in for the initiative?
advocating for telehealth, seeing it as an opportunity Is there recognition and support for change
to improve sustainable, consumer-centred healthcare from clinicians and executive?
linked to R3: right care, right time, right place. Does the project leader have good project
management skills to drive sustainable
In 2014, Barwon South West Telehealth held its first
implementation, integration and
Telehealth Awareness Week to bring together key
stakeholders to identify telehealth opportunities and
progress the development of a telehealth strategy.

5
3. Key stakeholders and Traditional communication tools, including progress
reports, website pages and posters, can highlight
consumers recognise the implementation progress and provide services with an
benefits and are engaged opportunity for involvement. Information should address
To be successful, any telehealth service requires the the factors that are likely to inhibit take-up from clinicians
support and engagement of key stakeholders and consumers.
throughout implementation. Feedback loops, such as surveys or feedback boxes for
It is essential that those delivering health services using consumers, promote engagement and offer an important
telehealth understand the benefits. Support for the service source of information upon which to make improvements.
will depend on the clinician’s confidence in the technology, Results of staff and consumer surveys should be regularly
their belief that telehealth will not add to their workload, compiled and distributed for discussion and to promote
and understanding that a telehealth consult will provide the ongoing improvement to service design. To be successful,
same or better value and quality of service to a consumer. staff and consumers need to feel confident that the
feedback is acted upon and that there is a commitment to
Creating a clear and compelling narrative that describes addressing issues that are raised.
the way the technology can help transform service delivery,
experience and outcomes will be important.

It is also important to explain how telehealth will integrate

with existing practices. Opportunities for engagement Have staff had the opportunity to be involved in
and feedback should be built into the establishment developing the project plan and considering the
and design phase. Clinicians and administrators need
to have input into the decision-making process, including Are there success stories that can build clinician
determining the most appropriate technologies, setting interest and support?
the policies and identifying evaluation measures. This is Have community or consumers been consulted
critical in creating a sense of ownership in the project in designing the service?
at a local level and contributes to project success. Have regular lines of communication been
established to keep all stakeholders well informed
Ensuring consumer engagement during the project is
of progress?
also important. Most health services are well connected
to their communities and many have consumer advisory Are feedback mechanisms in place to ensure the
committees or consumer representatives on committees. issues and considerations of staff and consumers
Telehealth is no different and should aim for consumer are captured and can be addressed?
representation in all levels of service development phases.

6
Strengthening success through engagement - Telehealth is being promoted to parents and families
The Royal Children’s Hospital (Melbourne) so they might initiate a discussion about telehealth
with their clinician. Promotional activities included TV
In 2012, The Royal Children’s Hospital in
and other local media stories, banners in Specialist
Melbourne commenced widespread implementation
Clinics, messages on in-house TV screens, links on
of telehealth across all clinical services. Most
the RCH internet and parent guide, brochures on
consultations are to families in their homes, typically for
display in Specialist Clinics and sent out with discharge
review appointments and with known patients. Most
summaries and Specialist Clinics letters.
specialties now offer at least some telehealth, with
around 60–80 consultations per month hospital-wide. Capitalising on the positive experiences of early
adopters, along with the clinical lead role, has been
The Family Advisory Council was consulted early on
vital in engaging clinicians. The approach to telehealth
and a Telehealth Steering Committee established,
rollout has been ‘local ownership’ - telehealth is
consisting of IT, two senior medical clinicians, the
‘owned’ by individuals and departments, rather than
executive sponsor, Director of Ambulatory Services,
the ‘telehealth unit’. Crucial to the engagement of
Specialist Clinics Manager, media producer, finance
clinicians has also been 1:1 support as needed –
and telehealth program manager.
increasingly this is now available from within Specialist
A telehealth website contains comprehensive Clinics.
resources for staff, including information on getting
For further information:
started, running a telehealth consultation, Medicare
Susan Jury
eligibility and billing, hospital procedures, practical
The Royal Children’s Hospital, Victoria
tips and medico-legal considerations.
Email: [email protected]
A participant feedback survey and a self-subscribing
emailing list were utilised to inform the development
of the service and have been invaluable in connecting
with stakeholders.

7
4. Project planning and a readiness
assessment informs implementation
Has a project plan been developed?
Developing a detailed project plan will assist in Has a telehealth readiness assessment been
articulating what the telehealth service is aiming to undertaken to understand the capacity for
achieve; establish project parameters, scope and timelines organisational, clinician and consumer adoption
and identify the risks and how these could be addressed.
As part of this, it is important to establish short and
Has an assessment of community health
long-term goals and the methods of measuring them.
needs been undertaken?
Robust data is also required as part of this project
planning phase. It is essential to gather detailed
information on current service provision and availability, Testing for readiness prior to implementation of a
demand patterns, consumer demographics and technical telehealth service saves time, money and energy. It can
capabilities. This will assist in identifying potential identify which clinicians, organisations and consumer
outcomes and establish a baseline against which to groups are able to support successful implementation.
measure success.1 A range of aspects of readiness need to be considered,
Project planning needs to encompass a readiness including organisational readiness, clinician and personnel
assessment to understand the extent to which the readiness, and community and consumer readiness.
organisation and the consumer community are ready It is essential to explore the resources that can support
to accept telehealth. Readiness for change considers this process. There is a range of toolkits, implementation
capacity for making change and the extent to which guides and other information available from government
individuals perceive the change as needed. Individual agencies, clinical networks and other organisations that
or organisational readiness to accept innovation may support the adoption of telehealth.
also be shaped by the readiness of others, indicating
the importance of leadership in implementing telehealth
innovations.

8
A number of tools and resources are available online
to assist in assessing readiness to implement a

The Telehealth Capacity Assessment Tool (TCAT)

developed by the National Frontier and Rural
Addiction Technology Transfer Centre Network in
the United States provides questions across six
key domains: organisational readiness, technology,
regulatory and policy, financing and reimbursement,
clinical and workforce.

Using the TCAT, organisations can identify their

strengths and weaknesses—where they are meeting
essential components and where they do not—as
well as define activities that can strengthen the
organisation’s ability to refocus programs and
continually improve the quality of their telehealth
efforts. In addition, the TCAT can be used as a
measurement tool over time to allow the organisation
to assess its increased competency and capacity in
the areas that support telehealth initiatives.

TCAT is available at: http://www.attcnetwork.org/

The New South Wales Agency for Clinical

Innovation (ACI) Rural Telehealth Working Group has
also developed a readiness tool. This tool includes
organisational, workplace, practitioner, technical and
consumer/community readiness. Answering a series
of questions will result in an assessment of factors
that will impact on the use of telehealth and/or
barriers to implementation.

The self-completion aspect of these tools can also

foster a sense of ownership that can improve the
success of telehealth services.

The ACI readiness tool is available at: http://

www.aci.health.nsw.gov.au/ data/assets/
pdf_file/0004/242878/Guidelines-for-the-use-of-

NSW.pdf

9
5. Technology and clinical service
needs are well matched
The Statewide Expanding Paediatric Telehealth
To implement a telehealth service, technological products
Project commissioned the Australian Centre for
or services required can be broadly categorised as:
Health Innovation to develop a video evaluation tool
• infrastructure: telecommunications connectivity, that could be used by health services to aid video
data and information exchange
• videoconferencing solutions and peripheral devices To facilitate the decision-making process, an
• support technologies: sharing, session record keeping, evaluation tool for cloud-based video solutions
billing, software integration. appropriate for telehealth video consultations
There are examples of telehealth services being
delivered using tablets and less sophisticated technologies. The evaluation tool uses a series of questions to
While these offer advantages of ubiquity, there are elicit the purpose, scope and capability required and
issues with standards, updates and quality that need identifies a range of technology options that will be
to be considered. potentially appropriate to support the service, taking
In designing a technological solution for a specific clinical into consideration sustainability and affordability. It
need it is important to undertake a ‘fit for purpose’ also asks the respondent to consider future growth
approach. This will reduce the risks associated with and service improvements that might be required
an overinvestment in technology and ensure that the over the medium-term to ensure the technical
technical capabilities match the service requirements. options will not limit future service requirements.
The technology to be used must not place further burden Ultimately, the tool guides health services of varying
on healthcare professionals, but rather support them to sizes in the selection of cloud-based video solutions
work in a more efficient and effective way. In all situations,
the technology must be easy to use, able to establish
fast and reliable connections and decrease interruptions The tool is available from the Department website:
to communications. http://www.aci.health.nsw.gov.au/ data/assets/
pdf_file/0004/242878/Guidelines-for-the-use-of-
A first step is to determine whether the existing
infrastructure is capable of meeting the clinical needs NSW.pdf
or if additional investment is required. In many situations
health services have a level of ICT infrastructure in place
that can be adapted to specific clinical needs and deliver
the capability required to support a similar initiative.

The focus should not be only on the specific needs of

the health service instigating the services. Telehealth
systems may be proprietary or standards based.
Proprietary systems have limited interoperability and
may only connect with a system using the same software.
Standards-based systems have been developed using
agreed communication protocols to enable communication
with other standards-based systems, independent of
the manufacturer. A general rule of thumb is to adopt
standards-based solutions as this will foster interoperability
between different platforms and technologies.

10
In considering the most appropriate technical solution,
it is also important to determine scalability and the
capacity of the technology to adapt as the service
requirements change.

Prior to deciding which technology will support the service,

it is important to ensure that there is adequate technical
support available. A range of telehealth providers now
offer an advisory/technical support service to maintain
and test the connections and the technology regularly
and troubleshoot when problems are encountered.

It is essential to ensure that once the technology is in

place that there is ample opportunity to use it regularly
to ensure familiarity and build trust.

Does the proposed clinical service lend itself

to a telehealth service model?
Has advice been sought on the types of telehealth
technologies that are available and an assessment
been made of which is most suitable?
Is the proposed technology interoperable with
end sites?
Who will be responsible for product issues and

11
6. A sustainable workforce model
underpins the service
Is there an adequate workforce base to support
Telehealth services will enable all health services to the demand for telehealth services?
provide their community with access to a broader range What technical and administrative resources
of health services. While there may be opportunities are required to support the service?
for workforce efficiencies through the use of telehealth, How will any additional impacts on the health
it is important to ensure that workforce needs are service or clinicians be monitored and managed?
adequately assessed, and appropriately resourced.
It is likely that a different mix of skills will be required.
Metropolitan services that are providing specialist
consultations will need to consider the additional
workload that providing a telehealth service may
generate. Similarly, the workforce capabilities in
those services supporting patients receiving specialist
services via telehealth may change.

Underestimating the additional resourcing required to

support implementation, particularly in the establishment
phase, has been identified as a common cause of
telehealth failure, in particular, the under-estimation
of the personnel requirements.

Telehealth consultations may take longer than traditional

face-to-face services, due to the need to direct other staff
to perform tasks at a distance. The mix of skills required
may also change when incorporating telehealth.

To support a dedicated clinical workforce delivering

services via telehealth, other resource requirements must
be considered, including administrative and technical skills.

Another consideration is the support required by patients

who are receiving care remotely. An appropriately skilled
workforce must be available at both ends of a telehealth
service. Clinicians may require nursing or medical staff
to support the patient and ensure the clinician has access
to the required information.

New roles may be established, or the requisite skills of

existing staff may change. It is essential that skill needs
are clearly identified and that roles are clearly articulated.

Looking to the future, the increasing adoption of telehealth

may change our workforce needs, bringing a greater
emphasis on public health and workforce mobility and
flexibility. These issues need to be considered in workforce
design, planning and training

12
Ensuring an appropriate workforce • all new patients could be seen first via
- Townsville Cancer Centre videoconferencing
• patients from Mt Isa did not need to travel to
In 2007, the Department of Medical Oncology of the
Townsville unless requested by the patients or
Townsville Cancer Centre (TCC), the tertiary cancer the treating teams
centre for northern Queensland (Australia), established • all solid chemotherapy regimens could be
the Townsville Teleoncology Network (TTN) over a vast administered in Mt Isa
geographical area. A key part of the implementation • all admitted inpatients were seen by medical
was building capacity to provide services via telehealth oncologists in ward rounds via videoconferencing.
in Mt Isa, 900 km away. As the complexity of services provided at rural sites
Prior to the introduction of the TTN in Mt Isa, cancer increased, the number of medical, nursing and
patients were managed by the emergency department allied health practitioners at providing and rural sites
at Mt Isa Hospital. There were two nurses who had increased. Reflecting on implementation of the model,
some competency in administering chemotherapy. one of the main reasons for success was the expansion
All patients had to travel to Townsville for their first and capacity building of remote sites to accommodate
consultation, services from TCC. Providing additional levels of
for reviews and for the first doses of chemotherapy. resources and support, along with implementation
of quality improvement activities, resulted in increased
In establishing the delivery of services from Mt Isa,
buy-in from the rural sites.
nurses at Mt Isa Hospital were given extra training
to treat patients. Each case discussion via video link For further information:
also served as an opportunity for continuing medical Sabe Sabesan
education for rural doctors. Director of Medical Oncology/Senior Staff Specialist
Queensland Health
Once the service was running well, the following
Email: [email protected]
changes in process were able to be implemented:

13
7. Change management is a focus
Implementation of telehealth can confront staff with
How will change be sustained over time?
unfamiliar and unpredictable technologies; the need
Have targeted training programs for clinicians
to develop new skills, new protocols and workplace
and nurses been established?
practice; and fears associated with privacy and security
How will the health service ensure that staff
of consultations.
are aware and fully competent in the use of
The importance of continuing change management the technology over time?
cannot be under estimated. In most cases, failing to Have existing clinical and administrative processes
commit to a robust and structured change management been mapped and the impact of the telehealth
program can either lead to a telehealth program not service on these been assessed?
getting off the ground or not able to be sustained.
A change management plan should be completed
A key part of change management is bringing staff as part of the planning phase (see page 22)
along for the journey. Training and information sessions
to engage with clinicians and other staff will enable the
issues to be negotiated and resolved early. The change
management process should acknowledge the capacities
and perceptions of people within the organisation
and actively engage them in the process of change.
Identifying a telehealth contact at a local level can assist
in coordinating training, encourage uptake and support
behaviour change.

Training can be delivered in-house through the

development of a train-the-trainer approach, where
key personnel are trained to deliver ongoing training
in telehealth services. This will ensure that training
can be delivered locally and respond to specific health
service needs. It will also build local expertise and skills.
Timing is often as important as content.

Incorporating telehealth training into position descriptions

and key performance indicators (KPIs) will help embed
telehealth into normal practice. Many organisations
have also introduced accreditation for clinicians providing
services via telehealth, which reflects the value of the
training to staff. The University of Queensland has
developed an accredited telehealth training program
that attracts continuing professional development (CPD)
points. The training package is targeted to general
practitioners but can be used by a range of professionals
and can be counted towards CPD.

14
Change management to support successful nursing staff at all participating sites to highlight
telehealth adoption – the experience of the Virtual technical improvements and distribute other materials
Trauma and Critical Care Unit telehealth project to support use of ViTCCU, including protocols and
clinical processes.
The Virtual Trauma and Critical Care Unit (ViTCCU)
telehealth project was implemented by the Loddon Training was provided to staff at each of the health
Mallee Rural Health (LMRHA) in 2008 to deliver services involved in the project at the provider and
specialist trauma and critical care support to regional receiver ends and a manual was developed to
hospitals using telehealth technologies. Under the support training. Targeted training and familiarisation
model, major Melbourne hospitals provided specialist activities were also undertaken with regional
clinical support to assist with the diagnosis and general practitioners (GPs) to raise awareness and
stabilisation of patients and enable local, ongoing understanding of the aims of ViTCCU.
treatment of some patients in regional hospitals.
A clinical working party (CWP) was established with
In the early stages, clinicians were reluctant to representation from all participating hospitals. During
accept new models of care and there was lower the implementation phase of the project the CWP
than expected support from regional GPs. supported the development of processes to tailor the
To overcome these obstacles, a range of change use of ViTCCU to meet the needs of the participating
management initiatives were put in place to increase agencies. The CWP also marketed and promoted the
awareness, promote use and embed the changed project with members of the group championing the
models of care. use of ViTCCU within their organisations.

A specialist roadshow was undertaken, with clinicians Formal evaluation of the trial found improvements
from the metropolitan hospitals visiting the participating in patient care and a 10 per cent reduction in
regional hospitals. This approach offered regional unnecessary ambulance transfers. The use of
clinicians an opportunity to engage with those ViTCCU is now embedded as a model of care
clinicians providing the care remotely and built across the Loddon Mallee and has been deployed
respect. The regional sites were able to understand at Bendigo Hospital to underpin the Victorian Stroke
the expertise of those providing care remotely and Telemedicine (VST) project.
how this would be beneficial for improving patient
For further information:
outcomes. It also promoted an appreciation of the
Bruce Winzar
different working environments.
Chief Information Officer
An interactive webpage was developed and regular Bendigo Health
newsletter updates distributed to clinicians and Email: [email protected]

15
8. Clinical responsibility and Protocols that identify roles and responsibilities of different
organisations and how interactions between sites are
governance protocols have managed are required to manage risk and reassure
been clearly articulated consumers. Where possible, standard protocols for use
It is generally accepted that introducing or adapting of equipment, examinations and documentation should
service models requires a redesign of existing practice be developed and should follow the protocols for non-
and process to enable integration and ensure that a telehealth delivery as much as possible. There must be
telehealth service becomes a routine part of service mechanisms in place to assure quality and accountability.
delivery. Current service models and processes need Consumers need to be confident that their privacy
to be assessed to determine the extent to which they is adequately protected and systems are secure.
will support the adoption of telehealth. It is important to establish rigorous security measures
to reduce risks of data breaches.

Clinical governance guidelines – Geelong • a medico-legal guideline that outlines key legal
Hospital Intensive Care Telehealth Project considerations when providing clinical support
using telehealth
In 2013, the Department funded a collaborative
telehealth project to facilitate the provision of • a clinical governance in telehealth guideline.
specialist care for critically ill patients in intensive The project has developed other tools, including
care units (ICU) and urgent care centres (UCC) a clinical audit guideline and an education
across the Barwon-South Western region. evaluation form.
Specialist advice is provided via videoconference The sharing of protocols and guidelines has assisted in
from the Alfred and the Royal Children’s Hospitals standardising best practice and decreasing the burden
to the Geelong Hospital ICU. Geelong Hospital ICU of telehealth implementation. The Geelong Hospital ICU
provides support to other ICUs and UCCs in the is available as both a resource and a demonstration site
region, including Hamilton and Warrnambool. and is committed to supporting other health services to
To ensure that the clinicians conducting telehealth change their work flow practices.
consultations have the necessary support and An evaluation of the project has indicated that the
skills, the Telehealth Statewide Reference Group routine use of telehealth has the potential to facilitate
was convened for the 12-month project period early, appropriate identification of patients and improve
with responsibility for developing and disseminating referral pathways and patient care in a critical setting.
information to support the implementation phase. It also found that using telehealth may enhance regional
This has now been replaced by the Geelong Hospital and remote professional recruitment and retention
Telehealth Special Interest Group (TSIG). by reducing isolation and providing improved access
A suite of guidelines and protocols to assist with to specialists.
using telehealth have been developed, including: Guidelines developed as part of the project are being
• a remote site telehealth guideline that identifies shared across all ICU sites and are available from the
the process to initiate a telehealth consultation Department website: http://www.health.vic.gov.au/
with a specialist for support or advice telehealth

• a telehealth retrieval service guideline to define the For further information:

process for initiating a retrieval by Adult Retrieval Gerry Keeley
Victoria (ARV) or Paediatric Emergency Transport Regional Project Coordinator – ICU
Service (PETS) and to also consider a retrieval [email protected]
service telehealth consultation;

16
Tools and services that support telehealth consultations
should be used where possible, including simplified
scheduling, measurement, documentation and billing
protocols and systems.

Clinical forums are a mechanism for the development

of telehealth clinical governance arrangements, clinical
standards, ethics and quality assurance.

The Australian College for Rural and Remote Medicine

(ACCRM) received Commonwealth Government funding
to develop a Telehealth Standards Framework and range
of support materials to assist medical practitioners,
patients and health facility staff in adopting telehealth,
including the clinical usage aspects and clinical process.

Have clinical protocols been developed to guide

the use of telehealth across the organisation?
Who will be responsible for overseeing adherence
to these and what governance arrangements will
be in place?
The ACCRM telehealth standards framework
identifies a range of technical and clinical
processes that will support implemenation of

org.au/telehealth-standards)

17
9. A sustainable funding Healthy, Happy in the Home telehealth initiative
– a sustainable model, Royal District Nursing
model is in place Service (RDNS)
The financial sustainability of any service is essential to
In 2012, the RDNS trialled a new service model
ensure long-term success.
using remote videoconferencing facilities between
In Australia, some telehealth services provided by private RDNS Customer Service Centre (CSC) and
specialists are provided by private specialists are eligible approximately 50 client homes for the purpose of
for reimbursement under the Medicare Benefits Scheme safe self-medicine management and monitoring.
(MBS) video consultation items numbers. The telehealth
The key purpose of the project was to develop an
item numbers that were introduced into the MBS in 2012
acceptable complementary service to daily face-
enable private specialists to bill for telehealth services
to-face visits for medicines management for RDNS
provided to regional consumers who meet specific criteria.
patients, with the potential of providing the patient
Should a GP also be supporting a consumer, an MBS
with greater flexibility and independence. The project
reimbursement is available for that GP. There are numerous
also sought to test whether a telehealth service
limitations to be aware of and it is important to review
could deliver increased productivity for RDNS and
eligibility criteria.
enable them to deliver cost-effective quality care to
Many telehealth initiatives are funded through seed or more patients.
grant funding. For these services to become business as
Implementing a successful model of service delivery
usual and sustainable, funding models need to ensure that
required resourcing in terms of staff administration.
the cost of providing the service can be recovered through
There were also set-up infrastructure costs and
a reimbursement mechanism or through cost savings
ongoing technology costs. These additional costs
generated. With telehealth this is a difficult task as the
were offset through increased productivity and
savings primarily accrue to the consumer rather than the
reductions in the per-patient costs of the program,
provider, with direct savings being more difficult to quantify.
associated with reductions in travel time and costs
Services interested in establishing telehealth programs are (or example, motor vehicle expenses). The time
encouraged to undertake a cost benefit analysis to assist saved also increased nursing productivity and
in understanding the costs and potential cost savings that enabled more patients to be serviced through the
can be realised through a telehealth service. This provides program with existing nursing staff.
a rational basis to consider the merit of investment and
Since the completion of the operational stages of
identify potential options to redirect funding from other
the telehealth project, RDNS has sought to establish
program areas as a result of financial savings achieved
whether the telehealth service delivery model is a
through telehealth services.
financially viable method of care that can be self-
Evidence of costs and potential savings through investing sustaining beyond the funding period.
in telehealth models is mixed. Some studies show that
Overall, the use of telehealth to provide medication
a telehealth service will reduce the costs of providing
management to the patients included in the trial
services and therefore be a sound business investment.
resulted in an overall benefit to patients and the
For example, tele-stroke services introduced in the United
RDNS nursing workforce. With the increase in
States were shown to be cost-effective for rural hospitals
patient volumes, the Healthy, Happy in the Home
that don’t have full-time neurologists on staff. Other
Model of Care could become a standard service
telehealth models have shown cost savings through the
delivery method of care for Australians in need.
use of a regional practitioner who is not a doctor (for
example, a nurse or an allied health professional) linking Further information:
in with the specialist remotely. This reduces the need Mat Tyler
(and cost) of having a medical specialist at the patient Royal District Nursing Service
end of the consult. Email: [email protected]

18
In competitive healthcare environments, deploying
telehealth services may result in increased market
share and, as a result, increased revenue from billing
for consultations.

Other measures that may be quantified in determining

the overall cost impact of using telehealth could include
emergency department use, hospitalisations and
readmissions, costs of providing outreach services
and workforce productivity measures.

There may also be cost implications for the broader

economy when considering telehealth alternatives.
This could include reductions in costs to consumers
for travel and accommodation associated with receiving
specialist healthcare at a distance and increases in overall
productivity as a consequence of reductions in time spent
out of the workforce for medical reasons.

Quantifying the benefits of a telehealth service in these

terms may assist in identifying alternative revenue sources
or support for funding.

Most importantly, it is essential to address these

sustainability issues at the beginning of the project,
rather than considering this when the project funding
is coming to an end. The length of time before the
project reaches a sufficient level of maturity for it to be
sustainable and become integrated into service delivery
should also be considered.

How will this project be funded?

Have the costs, revenues and risks to create
sustainable business models been analysed and
documented?
Is the service eligible for funding under MBS
telehealth? The MBS telehealth website provides
further details about eligibility (http://www.
mbsonline.gov.au/telehealth)
How will the service attract a sustainable

The Mid-Atlantic Telehealth Resource Centre offers

resources to assist in developing a business case
for telehealth and information about the potential
cost savings from telehealth initiatives (http://
matrc.org/return-on-investment-roi).

19
10. Services are consumer- Training programs, information sheets and troubleshooting
guides that assist consumers as they familiarise
centred and consumers are themselves with the equipment are options that will
supported in adopting build consumer capability and also assist in stimulating
telehealth demand for telehealth options.

Telehealth services need to be usable, useful, effective,

reliable and affordable for all involved.
Have the end-users’ technological capability and
Success will still depend on the uptake and acceptance
acceptance of technologies been assessed?
by the consumer community, which in turn demands
Have issues of cultural responsiveness been
improvements in accessibility and quality of services.
considered in the design of the service and
As part of the engagement process consumers need
to be equipped and supported to use the technology Is there training and support provided to assist
and reassured that service quality will be retained when end-users in using the telehealth service?
providing the service remotely.

Different levels of support will be required for different

groups of consumers. It is necessary to consider the
population the service is being targeted at when
designing the approach. For example, there is some
correlation between age of consumers and acceptance
of new technologies. Research has found that older adults
or consumers who feel anxiety, apprehension or less
control over computers or who are physically, cognitively
or perceptually limited would have more difficulty using
the technology. Other factors such as gender, education
level and computing experience will also be important
in understanding consumer capability and acceptance
of telehealth. In designing a service, a key step will be
to understand the technical capability as well as the
physical, psychological and social needs of consumers
that the service is being designed for and, if necessary,
providing the skills to improve use and build rapport with
the technology. Consumer-end support should also be
considered to ensure that consumers have access to
immediate assistance should they require it.

20
Impacts on end-user adoption among older
adults - learning from the research

Research conducted to better understand the

factors that impact on the uptake of telehealth
services, in particular home monitoring health
services, among older adults found that there
were a number of factors that influence.

The simplicity and intuitiveness of graphical user

interfaces, price of the technologies and technical
support were identified in the research as the most
important factors determining the success of the
initial adoption of home telehealth services.

Research found that older users have specific

concerns regarding access to their personal health
data by an unauthorised person and the need to
control authorisation for third-party access. Those
involved in the study also expressed the need to be
able to limit access by closer family members.

Social influence was another important predictor.

The physician was reported as an important
source of information and recommendations by
the physician and other healthcare professionals
were identified as an important factor that influences
whether consumers decide to use a telehealth service.

The research aimed to identify some practical

considerations to promote adoption of telehealth.
The influence of computer anxiety requires
consideration of different visual equipment that
focuses on functionality. The presence of secure
mechanisms must also be clearly visible to create
a trustworthy environment. It suggested that
providers should focus on technology support
for existing processes, which may encourage the
adoption of more advanced services later.

While this research was specific to the use of home

telehealth services, it identifies the various factors
that need to be considered in developing a telehealth
service for different consumer cohorts and possible
approaches to improve uptake among specific groups.

Source: Cimperman, M. et al (2012) Older Adults

Perceptions of Home Telehealth Services. Available
at: http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3787386/

21
11. There is ongoing A unified approach to telehealth evaluation
for Australia
review and evaluation
In 2013 the Institute for a Broadband Enabled
Establishing evaluation processes during a trial
Society (IBES) developed a conceptual framework
or implementation will guide rollout, identify future
that incorporates the key dimensions, criteria
challenges and assist in determining how to
and measures that should be considered in the
overcome barriers as they arise.
evaluation of telehealth implementations in Australia.
Evaluation of projects is also essential to inform
The framework identifies four key criteria against
ongoing implementation and assess the effectiveness,
which the project should be measured: patient
appropriateness and cost of a telehealth service.
control, the clinical quality of care, organisation
Establishing an evaluation process early will ensure sustainability and technology capacity/capability.
that foundational data collection mechanisms are
Dimensions of the evaluation are linked to the
in place to enable an effective evaluation outcome.
Australian Institute of Health and Welfare National
Action should be taken in the planning phase to
Health Performance Framework, which provides
develop an evaluation framework.
precise health performance indicators. The technical
Telehealth evaluation can be complex with many dimensions of the framework are linked to the
potential inputs, outputs, outcomes and stakeholders. technical standards put forth by the Australian
It is important to identify which criteria are more important College of Remote and Rural Medicine (ACCRM).
and how they should be measured. Success and failure
This framework provides a starting point to
of an initiative needs to consider the goals of the program
undertake evaluation of any Australian telehealth
over the short, medium and long terms. Short-term
implementation, to produce more widely applicable
goals of a service may be quite different from long-term
findings, to share these and to improve practice
goals, which needs to be factored into the evaluation.
based on the collective results.
For example, a goal of a project in the short-term may
be to improve access to services for a population. This framework provides just one option for
This may lead to increased demand for services and undertaking comparable evaluations into telehealth
higher costs associated with providing these services. projects. It is available from:
Financial sustainability may not be realised in the short http://www.broadband.unimelb.edu.au/resources/
term while processes are being developed and refined. white-paper/2013/Evaluation-of-Telehealth-
However it may be a long-term goal that can be achieved Implementations-in-Australia.pdf
as the service evolves and is embedded into practice.
A broader assessment of effectiveness needs to be
considered, although it is far more complex. This
goes beyond the individual aspects of how a service is
Is there an evaluation process in place?
achieving its objectives to consider whether the initiative
What data is going to be captured?
is achieving broader health outcomes and priorities for
Has an evaluation plan been developed?
the sector. Evaluation measures to assess this could
include whether the telehealth service is providing What measures are being used and have baseline
greater access to speciality services in a geographical measures been established and data collected?
area and/or contributing to improved health outcomes How will results be reported to the sector?
for specific consumer groups.

22
The effectiveness of a telehealth service against sector-
wide priorities or government targets will provide a sound
evidence base to illustrate the benefits of telehealth.

The results of telehealth projects should be shared and

subjected to peer review. It should be a core principle
for any telehealth system that ideas, methods, outcomes
and further research questions should be documented
and published.

There is a great deal of information sharing in the

telehealth field at present, with several academic journals,
an increasing number of international and national
conferences, and many dedicated telehealth websites.

The act of publication, teaching and sharing knowledge

and expertise is very important in building the evidence
around healthcare reform. In addition to the value it
delivers to others, the activity of writing or presenting the
telehealth experience and lessons learnt creates a level
of self-awareness, self-discipline and self-assessment
that might not otherwise exist. Programs presenting or
publishing their results at least once per year appear to
do significantly better than those that do not.

23
12. Involvement and collaboration Several organisations across Australia are driving the
adoption of telehealth and supporting executives,
across the sector clinicians, administrators and other stakeholders to
Success of a telehealth initiative hinges on collaboration collaborate and support the adoption of telehealth
and support across the sector. Commitment from more broadly. The efforts of these groups to ensure that
the executive, clinicians and nurses, administrators and telehealth remains on the agenda and that the results from
consumers is needed to make telehealth successful. telehealth initiatives and the learnings from implementation
Health system support is needed to ensure telehealth are shared and provide policy and practice improvements
is seen as an acceptable alternative to current service are essential.
models.

Shared responsibility across the system will build trust

and eliminate personal barriers and concerns that
Has an environmental assessment been
telehealth will challenge and disrupt the traditional
undertaken to determine other projects across
delivery of health services.
the sector that could be leveraged?
Aspects of telehealth that appear to be inhibiting uptake Are there any other projects within the organisation
include perceptions from regional clinicians that telehealth or clinical speciality that provide opportunities for
will diminish their role and that consumers may bypass partnerships?
local services. There have also been concerns raised
that the potential of telehealth will mean that specialists
no longer travel beyond metropolitan settings, thereby
reducing access to specialist advice and support that
currently comes through specialist outreach programs.

While these concerns may be genuine for health services

and individual clinicians, it is essential that these issues
are worked through collaboratively across the sector to
ensure that the potential for telehealth to improve service
delivery and access for consumers is realised.

Sector-wide collaboration will also reduce duplication

of effort and competition between services for limited
resources. Consideration should be given across the
sector to how new telehealth initiatives can be leveraged
from and used more broadly across a range of services.
The use of telehealth infrastructure across organisations
and clinical specialties will contribute to greater cost-
efficiencies.

The Department recommends leveraging from existing

projects to ensure that the current investment in telehealth
services achieve maximum impact rather than continuing
to fund local pockets of innovation that do not support
each other or have scope to expand. It is important that
the sector continues to identify opportunities for sharing
existing investments and building on current initiatives.

24
Feedback and contributions to this document
The Department is keen to continue to improve this
document and complement it with other resources that will
assist health services in implementing telehealth services.

Feedback and contributions to this document and the

development of other resources can be provided to:

Department of Health & Human Services Telehealth Unit

Phone: 03 9096 1405
Email: [email protected]

25
Contact details for Victorian agencies
that can provide advice and assistance
Department of Health & Human Services
Telehealth Unit
Phone: 03 9096 1405
Email: [email protected]
Website: www.health.vic.gov.au/telehelath

Barwon Region
Barwon-South West Telehealth Program
Phone: 03 4215 5660
Email: barwonhealth.org.au
Website: www.bswtelehealth.org.au

Gippsland
Gippsland Rural Health Alliance
Phone: 03 5136 5000
Website: www.gha.net.au

Grampians
Grampians Rural Health Alliance
Phone: 03 5136 5000
Website: www.grha.com.au

Hume
Hume Rural Health Alliance
Phone: 03 5832 8300
Email: [email protected]
Website: www.hrha.net.au

Loddon Mallee
Loddon Mallee Rural Health Alliance
http://www.lmrha.org.au/

26
Useful websites and further information
about telehealth
Australasian Telehealth Society
http://aths.org.au/

Australian College of Rural and Remote

Medicine (ACRRM)
http://www.ehealth.acrrm.org.au

Australian Medicare Local Alliance

http://www.amlalliance.com.au/

Australian Nursing Midwifery Federation

http://anmf.org.au/pages/telehealth

Department of Health and Ageing - MBS online

Telehealth information
http://www.mbsonline.gov.au/telehealth

How to Make Telehealth Work: Defining

Telehealth Processes and Procedures
http://www.e-unicare.com.au/wp-content/
uploads/2014/10/unicare_ebook_edition_2.pdf

New South Wales Agency for Clinical

Innovation Readiness Tool
http://www.aci.health.nsw.gov.au/ data/assets/pdf_
file/0004/242878/Guidelines-for-the-use-of-Telehealth-for-
Clinical-and-non-Clinical-Settings-in-NSW.pdf

Nursing and Midwifery Telehealth Consortia

http://www.apna.asn.au/scripts/cgiip.exe/
WService=APNA/ccms.r?PageId=11973

Royal Australian College of General

Practitioners (RACGP)
http://www.racgp.org.au/yourpractice/e-health/telehealth/

Telehealth Capacity Assessment Tool

http://www.attcnetwork.org/regcentres/productDocs/20/
NFAR_TCAT_web.pdf

University of Queensland
Education and Training in Clinical Telehealth
http://www.uq.edu.au/coh/clinical-telehealth

27
References drawn on in developing critical
success factors
Calvin K.L. Or, Ben-Tzion Karsh, A systematic review Janet P, Yeo M, Pauls M & Graham J. Organizational
of patient acceptance of consumer health information readiness for telemedicine: implications for successes
technology, J Am Med Inform Assoc. 2009 Jul-Aug; 16(4): and failure. Journal of Telemedicine and Telecare 2003; 9
550–560. (Suppl. 2): S2:27–30

Cradduck, T.D. Sustainability – the holy grail of telehealth? Jennett P.A., Gagnon, M.P., Brandstadt, H.K., Preparing
Journal of Telehealth and Telecare 2002 8:7, http:// for Success: Readiness models for Rural Telehealth,
jt.sagepub.com/content/8/suppl_2/7 accessed August 2014, <http://www.jpgmonline.com/
article.asp?issn=0022-3859;year=2005;volume=51;issue=
Desai, N. The 10 Secrets of Telehealth Success, Hands On
4;spage=279;epage=285;aulast=Jennett>
Telehealth, accessed July 2014, <www.handsontelehealth.
com> Judi H, Razak A, Sha ari N, Mohomah H. Feasability and
critical success factors in implementing telemedicine. 2009
Edwards, J. The Potential and Reality of Telemedicine.
Information Technology Journal 8 (3):326-332
Gartner Consulting, accessed 09/09/2013, <http://
www.gartner.com/technology/research/hype- Koch, S, Year of publication? Home telehealth-Current
cycles/?fnl=search> state and future trends, Centre for eHealth, place of
publication?
European Momentum for Mainstreaming Telemedicine
Deployment in Daily Practice (Momentum) 2014, Kodukula, S. Evaluation of critical success factors for
Empowering patients and supporting widespread telemedicine implementation, International Journal of
deployment of telemedicine services – List of Computer Applications (0975 – 8887), Vol 12– No.10,
Critical Success Factors, accessed August 2014, January 2011
<http://www.knowledge.scot.nhs.uk/media/CLT/
Monash University 2011, Potential telehealth benefits of
ResourceUploads/4050440/Momentum_18_critical_
high speed broadband, accessed June 2014, <http://
success_factors_v01_6may2014[1].pdf>
www.digitalpeel.com.au/wp-content/uploads/2013/06/
Forducey, P. Telehealth for Persons with Severe Functional Potential-telehealth-benefits-of-high-speed-broadband.
Disabilities and their Caregivers: Facilitating Self-care pdf>
Management in the Home Setting, accessed August
National E-Health and Information Principal Committee
2014, <http://www.ncbi.nlm.nih.gov/pmc/articles/
2008, National E-Health Strategy, 2008, accessed June
PMC3375593/#R66>
2014 <http://www.health.gov.au/>
Foster, M. A. et al 2006, Telehealth Business Models: An
National Frontier and Rural Addiction Technology Transfer
assessment tool for telehealth business opportunities in
Centre Network 2013, Telehealth Capacity Assessment
remote rural communities, accessed July 2014, <http://
Tool (TCAT), accessed June 2014, <http://www.
www.iser.uaa.alaska.edu/Publications/TelehealthReport1b.
attcnetwork.org/regcenters/productDocs/20/NFAR_TCAT_
pdf>
web.pdf>
Gray l. & Smith A et al 2011 Telehealth Assessment Final
Sabesan, S. Practical aspects of telehealth: establishing
Report. accessed 27/12/13, <http://www.mbsonline.gov.
telehealth in an institution: Telehealth Series, Internal
au/internet/mbsonline/publishing.nsf/Content/EC471B
Medicine Journal (44) 2014
2E09EE7370CA2578A4001092BE/$File/UniQuest%20
Telehealth%20Assessment%20Report%20.pdf> Scott R, Mars M. Principles and strategies for ehealth
strategy development. J Med Internet Res 2013;15(7):e155
Hailey D, Crowe B. A profile of success and failures in
telehealth – evidence and opinion from the Success and Standards Australia Telehealth Subcommittee IT-014-012
Failure in Telehealth conference. J Telemed Telecare. http://www.ehealth.standards.org.au/IT014SubjectAreas/
2003;9 Suppl 2:S22-4 Telehealth.aspx

28
Thacker D. Moneypenny R, Olver I, & Sabesan S. Cost
savings from a telemedicine model of care in northern
Queensland, Australia. Med J Aust 2013; 199 (6): 414-
417.

Vanderwerf, M Ten Critical Steps for a Successful

Telemedicine Program, accessed August 2014, <www.
amdtelemedicine.com>

Wade V & Elliot J. The role of the champion in telehealth

service development: a qualitative analysis. Journal of
Telemedicine and Telecare 2012; 18: 490–492

Wade V et al. A qualitative study of sustainability and

vulnerability in Australian telehealth services. Stud Health
Technol Inform. 2010;161:190-201

Wade, V. How to Make Telehealth Work: Defining

Telehealth Processes & Procedures, accessed November
2014 <http://www.e-unicare.com.au/wp-content/
uploads/2014/10/unicare_ebook_edition_2.pdf >

Wade, V. Jaklin A. Eliott and Hiller, JE, Clinician

acceptance is the key factor for sustainable telehealth
services, Qual Health Res published online 31
March 2014, <http://qhr.sagepub.com/content/
early/2014/03/31/1049732314528809>

Wooton R & Herbert M. What constitutes success in

telehealth? 2001 J Telemedicine & Telecare 2001 7: 3

29