Requirements of strong and sustainable Telehealth Programs

BACKGROUND. Post Hurricane Katrina, the Regional Coordinating Center for Hurricane Response initiated an effort to develop and/or support telehealth (TH) delivery models, with a focus on mental health services. To date, institutions involved show varying levels of success in the implementation of TH programs. OBJECTIVE. To identify elements critical to the sustainability of TH programs, based on the experiences of institutions and individuals involved in the establishment of TH programs post-disaster. METHODS. This qualitative study queried as Key Informants (KI) individuals engaged in the development of TH programs in the Gulf Coast, including health care regulators, advocates, program administrators, technology experts, mental health providers and support personnel. Transcripts of recorded interviews were independently coded by three researchers using qualitative analysis software. Subsequent analyst discussions led to consensus in the interpretation of each transcribed interview. Results were summarized and returned to KI for validation. RESULTS. The 37 KI participants identified six macro and eight micro level elements necessary for sustainability of TH delivery models. At the macro level: a) planning, communication and coordination among all governmental levels, b) defined legal and financial relationships, c) infrastructure creation and maintenance, d) standards for compatibility of systems and for measurement of quality of care, e) networking among programs, and f) effective advocacy and public education. At the micro level: a) need for a systematic business plan, including cost effectiveness, b) need for organizational policies, procedures and protocols particular to TH, d) buy-in at all organizational levels, e) training specific to TH, f) appropriate equipment and facilities, g) access to adequate resources including technical support, h) marketing, i) effective partnerships among providers DISCUSSION. Consideration of the macro and micro level elements required for sustainability of TH programs should be useful in the effort to incorporate TH to the fabric of health care delivery.