Check! - Region Midtjylland · Regardless of the scope of the solution, it may be a good idea to start out by identifying the main stakeholders, for example by undertaking a stakeholder

Check! Telehealthcare at Scale

Centre for Telemedicine and Telehealthcare

Telehealthcare is not just about technology.First of all, it is about people and organisations.

Preface

Telehealthcare is often presented as the solution to the future’s welfare and healthcare challenges. However, experience shows that it may be difficult to successfully move from pilot phases to telehealthcare at scale.

Telehealthcare is not just about technology, it’s also about learning how to cooperate in new ways. Therefore, it is often hard to break through the psychological, organisational and technological barriers to implementing telehealthcare. These barriers may prevent us from harvesting the clinical and economic benefits from our investments and from providing well-functioning and effective services for our patients.

To ensure that you achieve the full benefits of telehealth-care we have developed a tool to help you getting started. “Check! – Telehealthcare at Scale” provides a quick overview of what is needed for your telehealthcare initiative to have success - even at scale.

We hope you will enjoy using Check!

Bent HansenPresident of Central Denmark Region

An opening to the story

Check! is an extended version of the Sustainability – Model and Guide. Informed by the literature on implementation of telehealthcare, new factors have been added and tested. It provides an overview of themes and potential challenges which are essential to address in order to succeed in implementing telehealthcare solutions at scale.

Check! is a practical tool developed to assist project managers involved with telehealthcare projects in identifying and overcoming barriers for spread and sustainability in their specific context.

The Sustainability Model and Guide has helped health and social care staff in many different countries to successfully sustain improvements. I have every confidence that Check! will be equally helpful to healthcare professionals striving to succeed in implementing telehealthcare at scale.

Dr Lynne Maher Director for Innovation Ko Awatea

Honorary Associate Professor of Nursing– The University of Auckland New Zealand

I am delighted to introduce “Check! – Telehealthcare at Scale”. Check! has built on the “Sustainability - Model and Guide”, which was developed by NHS Institute for Innovation and Improvement to enable improvement teams’ ability to sustain their improvement efforts.

Check! can be used as a source of inspiration and as a way to analyse the implementation process.

Check! gives you:· an overview of factors that may impede a scaling process· an overview of important properties of the telehealthcare

solution related to scaling· an outline of focus areas that need to be strengthened to

achieve successful implementation· the opportunity to establish constructive and focused

dialogue across groups of professionals and organisations· a follow-up tool allowing you to assess the effects of

on-going adjustments to the implementation process.

Implementing telehealthcare at scale often leads to consider-able workflow changes and calls for cooperation across

organisations and professions. In other cases, scaling of a telehealthcare solution will only require minor changes within a single department or organisation.

Check! is all about bringing together the relevant people to perform a joint analysis of barriers hindering a large-scale implementation of a telehealthcare solution on the basis of the completed self-assessment. Check! is designed for staff partic ipating in steering groups, project- or implementation groups and anyone else involved in the process on a daily basis.

Regardless of the scope of the solution, it may be a good idea to start out by identifying the main stakeholders, for example by undertaking a stakeholder analysis. This will enable you to identify who could participate in the self-assessment process in Check!

Check! is designed to identify barriers to large-scale telehealthcare. Check! is a self-assessment tool targeting management and staff who work with telehealthcare solutions and need to implement these on a large scale.

Introduction

The process benefits from the participation of both manage-ment and staff of all relevant organisations as this helps to represent the perspectives of the stakeholders and provides the basis for a constructive dialogue.

Check! self-assessment should be completed individually. The subsequent analysis gains when many individuals contri-bute by sharing their knowledge and attitudes. Furthermore, individual contributions provide valuable insights into the other participants’ perspectives and fields of work.

It may be a good idea to bring in an external facilitator, a quality assurance expert for example, to facilitate and coordinate the dialogue. It is an advantage if the facilitator has some knowledge of the solution as well as the organisa-tional structure.

Schedule time beforehand for the process. It typically takes about 30 minutes to complete the self-assessment form. The time consuming part is not filling in the form itself but rather the time spent on discussing the results after completing it. The following dialogue typically takes a few hours. This is also where your organisation will really benefit!

Self-assessment comprises 27 factors described through a series of questions for reflection. Each factor is illustrated by a statement describing the ideal situation. During self-assessment, you assess to which extent your solution is in line with the statement.

For more information, please see www.telemedicin.rm.dk

IS THE STATEMENT ROOTED IN REALITY?

The statements in Check! have been prepared on the basis of our knowledge from implementation of large-scale tele-healthcare solutions and from research into implementation processes. The positive statements picture situations which the literature describes as characteristics of successful large-scale implementations.

Getting off to a good start with Check!1: Read the introduction

2: Complete the self-assessment individuallyThe self-assessment has three parts:

· Part 1: Planning and process · Part 2: People and relationships · Part 3: Organisation and culture

Each part consists of a series of questions for refl ection and a statement. Read the questions and the statement. You are now to assess how well the statement describes your telehealthcare project. The assessment should refl ect the current situation in your project.

If you fi nd it hard to answer the question, ask yourself why. Do you lack relevant information? Or is the statement irrele-vant? Keep a notepad at hand so that you may take note of your refl ections and remember them for later.

3: Transfer your results to the spider diagramCreate a quick overview of your answers by transferring them to the spider diagram. For each factor you should

add your answer to the diagram by putting a dot by the number representing your position. Next, connect the dots with a line. Write your stand on the ”Importance of the statement” under each factor in the diagram. Now you have a visual overview of your answers and assessments.

answers and assessments.

are now to assess how well the statement describes your telehealthcare project. The assessment should refl ect the

If you fi nd it hard to answer the question, ask yourself why. Do you lack relevant information? Or is the statement irrele-vant? Keep a notepad at hand so that you may take note of

Statement

Staff have participated

actively since the beginning.

They are encouraged to

present their ideas for

improvements, and these

Do you lack relevant information? Or is the statement irrele-improvements, and these

Do you lack relevant information? Or is the statement irrele-are put on the agenda.

Do you lack relevant information? Or is the statement irrele-are put on the agenda.

Do you lack relevant information? Or is the statement irrele-

Importance of the statement


(mark with an X)(mark with an X)

Extremely important

Extremely important

Very importantVery important

Rather important

Rather important

Not that important

Not that important

Of no importanceOf no importance

Your assessment of the statement


(mark with an X)(mark with an X)

Not relevant to us

Not relevant to us

0. Don’t know0. Don’t know

1. Disagree

2. Disagree more than I agree


3. Agree more than I disagree


4. Agree

How well does the statement describe your situation?


How important is the statement, in your opinion,


for successful implementation of the telehealthcare


solution at scale?

D

Adaptability

E

Future-proofing

1

0

2

3

4

A

Benefits

B Visibility

F

Monitoring of feedback

C Credibility

Importance:

Importance:

Importance:

Importance:

Importance:

Importance:

A








Future-proofing


Importance:

Importance:

X

DOES IT ALWAYS MAKE SENSE TO COMPARE THE RESULTS?

Differences in the results of the self-assessment may simply mean that your assessments of how you are currently doing are fundamentally different. Disagreements may also reflect that you do not share the same ”reality” or face the same challenges.

Experience shows that words such as ”staff” and ”key person” are often perceived differently from one sector or organisation to the next and may also vary according to your position and role in your organisation.

It may also be a good idea to discuss what you understand by ”involvement of citizens”. Check! will allow you to learn from each other’s perspectives and standpoints.

4. Discuss the results Compare your results and reflect on your differences. Discuss which measures should be implemented. What are the main advantages of the telehealthcare solution? Where is the potential for improvement greatest? How may you achieve the full benefit with the available resources in the short and long term?

5: Prepare an action plan Self-assessment will often identify many areas which could be improved. Therefore, it is important to prioritise by dec iding which areas should receive further attention. Which problems need to be solved first? How? What’s the deadline? Who is responsible? Plan the necessary measures.

Check! helped us elaborate on and systematise our flows of thought.Team Leader, Department of Psychiatry, Central Denmark Region

References· Ahlgreen, Birgitte, Christiane Bundgaard Petersen,

Marianne Sigaard Balleby & Lica Nyerup Johansen. (2012). “Kortlægning af modeller for tværfagligt samarbejde:Afsluttende rapport.” [Mapping of Models for interdisci-p linary Cooperation. Final report.] Folkesundhed og Kvalitets udvikling & Socialstyrelsen.

· Bevan, Helen, Paul Plesk & Lynne Winstanle. (2011). “Leading Large Scale Change: A practical guide”. Institute for Innovation and Improvement. NHS.

· Det Etiske Råd. (2010). “Det Fælles Medicinkort: Fortrolighed og tilgængelighed i sundhedssektoren”. [Shared Medication Record - Confi dentiality and availability in health care.]

· Hajou, Ali, Steve Doeve, Martin Post, Judah Huigen & Danny van der Kuip. (2011). “Dutch Telecare Review. A Compilation of Success and Failure Factors for E-health, Telecare and Home Automation Found in Current Dutch Literature”.

· Hofmann, Bjørn. (2012). “Ethical Challenges with Welfare Technology: A Review of the Literature”. Centre for Medical Ethics, University of Oslo.

· Joseph, Victor, Robert M. West, Darren Shickle, Justin Keen & Susan Clamp. (2010). “Key Challenges in the Development and Implementation of Telehealth Projects”. Journal of Telemedicine and Telecare; 17:71-77.

· Kotter, John P. (1995). “Leading Change: Why Transfor ma-tion Efforts Fail”. Harvard Business Review. March/April, s. 59-67.

· Maher, Lynne, David Gustafson & Allision Evans. (2010) . “Sustainability - Model and Guide”. Institute for Innovation and Improvement. NHS. På dansk: Model til fastholdelse af ny praksis.

· Marckmann, Bella & Louise Paulsen Rønnov. (2010). “Implementeringsforskning om forebyggelse – en baggrunds-rapport”. [Research on implementation of preventive measures - a background report.] Sundhedsstyrelsen.

· May, Carl. et al. (2007). “Understanding the Implementation of Complex Interventions in Health Care: The Normalization Process Model”. BMC Health Service Research, 7:148.

· MedCom. (2010). “Udredning om telemedicin”. [Report on Telemedicine and Telehealthcare.]

· Ministry of Health Planning & Ministry of Health Services, British Colombia. (2001) .“Telehealth Projects: A practical Guide”.

· Murray, Elizabeth et al. (2011). “Why is it Difficult to Implement E-health Initiatives: A Qualitative Study”. Implementation Science. 6:6.

· NHS Institute for Innovation and Improvement. (2006-2013). “Spread & Adoptation Tool”.

· Normann, Tove, Elin Breivik, Eva Skipenes, Ellen K. Christiansen & Udine Knarvik. (2011). “Telemedisin i rutinedrift. Forutset-ninger og tiltak”. [Bringing telemedicine into routine service - prerequisites and actions] Nasjonalt senter for samhand-ling og telemedisin. Norge.

· Obstfelder, Aud, Kjersti H. Engeseth & Rolf Wynn. (2007) “Characteristics of Successfully Implemented Telemedical Application”. Implementation Science. 2:25.

· Office of Health & Information Highway Health, Canada. (2012). “Telehealth and Electronic Health Record: A Guide to Sustainability”.

· Sanders, Caroline et al. (2012). “Exploring Barriers to Partici pation and Adoption of Telehealth and Telecare within the Whole System Demonstrator Trail: A Qualitative Study”. BMC Health Service Research. 12.220.

· Schepelern, Katrine Johansen, Jessica Larsen & Ann Nielsen. (2012). “Tværsektorielt samarbejde i psykiatrien. Videns- og erfaringsopsamling”. [Muliti-sectoral cooperation in psychiatry. Accumulation of knowledge and expertise.] KORA, Det Nationale Institut for Kommuners og Regioners Analyse og Forskning

· Sir Oldham, John. (2012). “System Enablers to Maximise the Effectiveness of Telehealth”. Udarbejdet som en del af IHI R&D 90-day, October 2012.

· Sundhedsstyrelsen (2005). “Vejledning om ansvarsforhold mv. ved lægers brug af telemedicin”. [Guidelines regarding responsibility etc. when doctors use telemedicine.]

· Vander Werf, Mark. (2004). “Ten Critical Steps for a Success-ful Telemedicine Program”. Studies in Health Technology and Informatics. 02/2004 vol. 104, s. 60-68.

Planning and process

Planning is of utmost importance when implementing a telehealth-care solution at scale. Thorough planning and an agile process are important in determining how well managers, staff and citizens adopt to the new routines and workflows that the telehealthcare solution will imply.

In the planning phase, effort typically goes into identifying the benefits and drawbacks associated with implementing a telehealthcare solution at scale. It is, however, also important that the effects are documented thoroughly to ensure that the right focus is maintained throughout the process. Clear objectives and visible effects make it easier to implement and maintain the telehealthcare solution over time and ensure that the expected results are achieved.

This section raises the following questions for reflection:

· How may you ensure that a large-scale telehealthcare solution will bring benefits to staff, citizens and organisations?

· How may you document that the solution brings benefits, and ensure that the benefits are visible?

· How may you systematically follow the process step by step and register the effects of the solution?

· How may you maintain the positive results, if staff members or managers are replaced and as the organisation’s structure changes?

1PART

· Does your telehealthcare solution bring additional benefits apart from aiding and improving the situation for citizens?

· Will your telehealthcare solution, for example, lead to less non-productive time or eliminate unnecessary duplication of work tasks?

· Will staff find that the telehealthcare solution makes a positive difference to their daily work?

· Will the telehealthcare solution bring more appropriate workflows and communication paths?

Benefits

Importance of the statement (mark with an X)

Extremely important

Very important

Rather important

Not that important

Of no importance

Statement

It can be demonstrated that our telehealth -care solution will bring a wide range of benefits in addition to helping citizens. Staff will experience more appropriate workflows and an increase in their job satisfaction.

Your assessment of the statement (mark with an X)

Not relevant to us

0. Don’t know

1. Disagree



4. Agree

AHow well does the statement describe your situation?

How important is the statement, in your opinion, for successful implementation of the telehealthcare solution at scale?

· Are the benefits associated with your telehealthcare solution visible to citizens, staff and to the organisation in general?

· Can staff members describe a wide range of advantages associated with your telehealthcare solution?

Visibility

Statement

The benefits of our telehealthcare solution are widely recognised and evident. Staff are able to describe a wide range of benefits associated with the telehealthcare solution.

B


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Have others had success introducing the same telehealthcare solution in a different location or field?

· Are the results well documented?

· Do staff believe in the benefits?

Credibility

Statement

The benefits of our telehealthcare solution are thoroughly documented and perceived as being credible by the target groups.

C


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Will a lack of willingness to adapt among the staff or other internal issues obstruct the transition to a large-scale solution?

· Does the transition to a large-scale solution and the retention of new workflows depend on specific persons, groups, providers or funding?

Adaptability

Statement

The introduction of a large-scale solution may be adapted so that it supplements or strengthens other organisational changes. The process will not be hampered if certain people or groups of people leave the organisation or are relocated to other tasks. D


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Does your telehealthcare solution meet future demands or needs?

· Have current or future national, regional or local standards been taken into account?

Future-proofing

Statement

Our telehealthcare solution is compatible with existing standards in the field, and any future standardisation requirements have been taken into account.

E


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Is it necessary to introduce specific monitoring systems to measure the changes triggered by the solution?

· Does a feedback system exist that may help identify benefits, challenges and any unforeseen issues?


Statement

A system or a set of procedures has been introduced which may document that our telehealthcare solution will have the desired effects. Results will be communicated to the relevant target groups. The system or procedures will still work after the transition to large-scale operation. F


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



D Adaptability

EFuture-proofi ng

1

0

2

3

4

A Benefi ts

B Visibility

F Monitoring of feedback

C Credibility

Importance:

Importance:

Importance:

Importance:

Importance:

Importance:

People and relationships

2PART

New technology is only part of the solution. If you want to reap the benefits of telehealthcare at scale, it is essential to focus on the human dimension. People at all levels of the organisation greatly influence the result. Positive staff members who are willing to adapt, committed managers and support from key personnel can turn failure into success.


· How may you ensure that key persons at all levels feel acknowledged and have the opportunity to contribute to the process?

· How do you handle scepticism and ensure a sense of ownership?

· How may you establish effective and meaningful cooperation across organisations and professions?

· How may a mutually respectful and dynamic cooperation between staff and management be established?

· How may the professional opinion leaders and authorities become engaged in the implementation process?

· How may new procedures be established which ensure that citizens feel safe and well-informed?

· Are staff members encouraged to share their ideas for improvements, and are the ideas put on the agenda?

· Do staff members take active part in the planning and implementation of the telehealthcare solution at scale?

Staff involvement

Statement

Staff have participated actively since the beginning. They are encouraged to present their ideas for improvements, and these are put on the agenda. A


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do staff members have the right competencies and skills?

· Are training and competence development strategies in place to identify the need for in-service training, knowledge and skills?

· Is the necessary development of competencies accomplished?

Staff training

Statement

Our staff have received sufficient training for them to be able to support the transition to large-scale operation. They have access to advice and guidance in relation to their everyday work.

B


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do staff members see the telehealthcare solution as an improvement?

· Are staff members encouraged to express any uncertainty and doubts they may have concerning new workflows and using the new technology?

Staff’s attitudes

Statement

Staff members see the tele-healthcare solution as an improvement. Staff members are encouraged to express any uncertainty and doubts they may have concerning new workflows and using the new technology.

C


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do staff members from the various departments and sectors involved understand and share the objectives of implementing the telehealthcare solution?

· Is it evident which challenges, concerning cooperation, will be solved by using the telehealthcare solution?

Cross-disciplinary cooperation

Statement

Staff from the departments and sectors involved understand the joint objectives and challenges that are to be solved.

D


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Have you prepared co-operative agreements and procedures that clearly describe the division of responsibilities thereby making the cooperation between different groups of professionals more predictable?

· Do you have a well-functioning communication system to ensure that your stakeholders are timely informed?

· Do stakeholders have knowledge of and respect for the working conditions, competencies and norms of other professions?

The cross-disciplinary working environment

Statement

Our cooperation is based on clear agreements and procedures providing predictability. Communication works well. The members of the inter- professional teams are familiar with the other participants’ professions and norms and are well informed about their working terms and conditions.

E


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Is senior management involved in the process of implementing the solution at scale?

· Does senior management promote the importance of the solution and its results?

· Are they committed to help overcome any barriers and challenges encountered?

Senior management’s commitment

Statement

All relevant senior managers are visibly involved in the process.They help communicate the objective of the initiative and its expected results. They help overcome any challenges encountered. F


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do staff members trust senior management of the involved organisations?

· Are senior management influential, respected and credible?

· Are they respected by other managers and capable of inspiring others to become engaged in the process of implementing the solution at scale?

Senior management’s influence

Statement

Senior managers are respected by other managers and are capable of inspiring others to become engaged in the process. Staff members continually share information with management and actively seek their guidance.

G


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Have the right key persons been selected to participate in the process?

· Are they committed to implementing the solution at scale?

· Do they understand the objectives?

· Do key persons continuously communicate any achieved results?

· Are they committed to help clear out any barriers to the process?

Key persons’ commitment

Statement

The primary key persons are committed and visible. They communicate the objectives and expected results continuously throughout the process. They make them- selves available to help counter challenges and clear out any barriers encountered. H


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do key persons of the involved organisations have the necessary support?

· Are they influential, respected and credible?

· Are they respected by colleagues and cooperative partners, and can they inspire others to participate in the process?

Key persons’ influence

Statement

The key persons are respected by managers and cooperative partners and are capable of inspiring others to contribute to the process. Others continually share information with the key persons and actively seek their advice.

I


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Are the ideas of the citizens heard, and do they influence the process?

· Do citizens see the telehealthcare solution as an improvement?

Citizens’ involvement

Statement

Citizens are actively involved and have been so from the beginning. Citizens see the telehealthcare solution as an improvement.

J


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do you have a strategy that ensures training and acquisition of skills needed for citizens in order to become familiar with the new procedures and technical equipment?

· Do citizens have access to guidance and advice?

· Are strategies in place to develop the staff’s competencies so that they may identify the individual citizen’s need for training and guidance?

Citizens’ training

Statement

The citizens have received adequate training and are familiar with the new procedures and technical equipment. Citizens have access to guidance and advice. Staff have been trained to identify the needs of each citizen with respect to training and guidance.

K


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



1

0

2

3

4

A Staff involvement

BStaff training

CStaff attitudes

DCross-disciplinary cooperation

F Senior management’s commitment

G Senior management’s

influence

Key persons’ commitment

Key persons’ influence

JCitizens’ involvement

K Citizens’ training

E Cross-disciplinary working environment

Importance:

Importance:

Importance:

Importance:Importance:

Importance:

Importance:Importance:

Importance:

Importance:

Importance:

H

I

People and relationships

Organisation and culture

Organisations are complex. Implementing telehealth-care solutions may affect the physical environment of institutions as well as the workflow and the professional identity of the staff. Such changes may meet opposition at all levels if culture and values of the organisation are not taken into account.


· How may you ensure that the telehealthcare solution is aligned with the organisation’s objectives and visions?

· How may you ensure that the telehealthcare solution is implemented in accordance with the culture of the organisation?

· How may the telehealthcare solution be effectively supported during and after the transition to large-scale operation?

· What is being done to foresee and handle any ethical and legal issues?

3PART

The organisation’s strategic objectives

· Are the objectives of the telehealthcare solution obvious and well-known?

· Are they clearly in line with the organisation’s overall strategic objectives?

· Have you prepared a strategy or action plan for implementing the telehealthcare solution at scale?

· Is the solution of strategic importance to the organisation and its management?

Statement

The objectives of our telehealth-care solution are obvious and well-known. They are aligned with the objectives of our organisation and are important to management at all levels. A strategy or action plan has been prepared to support the implementation of the tele-healthcare solution at scale.

A


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Has the organisation previously implemented similar change processes successfully?

· Is the organisation open to learning from the experiences of others and to using solutions that have been developed outside of the organisation?

The organisation’s culture

Statement

Our organisation has previously implemented similar change processes successfully. Our organisation is open to learning from the experiences made by others. B


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Does the organisation have the right physical premises, facilities and resources to implement the telehealthcare solution at scale?

· Have general guidelines and procedures been prepared which support and maintain the new workflows (e.g. clinical guidelines, job descriptions or access to support)?

· Has a well-functioning communication system for the involved staff, management and partners been established?

The organisation’s infrastructure and logistics

Statement

Our organisation has adequate physical premises, facilities and resources needed for implementing the telehealthcare solution at scale. The new tasks and workflows have been described thoroughly and are part of staff’s job descriptions and professional guidelines.

C


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Does the organisation have the necessary technical equipment, resources and know-how to support large-scale operation of the telehealth-care solution?

· Can the new solution be integrated into the organisation’s existing IT infrastructure?

· Have external and internal partnerships been established to ensure easy access to technical support and maintenance?

The organisation’s technical infrastructure

Statement

The large-scale implementation of our telehealthcare solution is supported by the right technical equipment and systems and can be integrated into the existing IT infrastructure. Internal and external cooperative agreements have been made to ensure access to support and maintenance of systems and equipment.

D


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Has a document been prepared that outlines the ethical guidelines for the use of the telehealthcare solution?

· Does the document cover any consequences the solution may have for e.g. citizens’ identity, autonomy, privacy and dignity?

· Are formal procedures in place to ensure that the solution takes into account the needs of the citizens using the solution?

Ethical guidelines

Statement

An adequate description has been made of the ethical guidelines governing the introduction of our telehealthcare solution at scale. A procedure has been prepared to ensure that the individual needs of citizens are taken into account. E


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Have staff members been informed of the relevant legal requirements and any specific ethical issues of relevance?

· Are staff members encouraged to take part in an on-going dialogue with colleagues on ethical issues and dilemmas?

The staff’s ethical awareness

Statement

Staff members are aware of their duties and ethical responsibilities.Staff members actively participate in an on-going dialogue with colleagues on ethical issues and dilemmas? F


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Do you have an overview of the legal requirements relevant to operating the telehealthcare solution at scale?

· Have you sought legal counselling in the planning phase of the process?

· Do specific procedures exist to ensure that legislation is followed and that citizens are treated in accordance with existing laws?

Legal framework

Statement

Legal counselling was sought during our planning phase. Specific procedures were prepared to ensure that any legal requirements are met and that citizens receive the guidance and treatment they are entitled to. G


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Are staff members aware of their legal responsibilities and duties?

· Are staff members aware of their rights, e.g. in case of complaints?

Staff rights and duties

Statement

Procedures are in place to ensure that staff members are aware of any legal responsibilities and duties. Staff feel well-prepared and capable of handling their new tasks and know their rights. H


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Are citizens sufficiently aware of their rights?

· Are citizens informed that they are allowed to access their own data and can lodge a complaint?

Citizens’ rights

Statement

Procedures are in place to ensure that citizens receive the necessary guidance. Procedures ensure, that the citizens are informed of their legal position, including their right of to access own records, to lodge a complaint, requirements for them to provide consent, etc.

I


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



· Is there an easily accessible overview of the general rules governing public procurement?

· Has legal counselling been received while preparing any tenders and contracts involving private or public providers?

Contractual and legal issues related to procurement

Statement

Our organisation is familiar with current legislation in the field and complies with such legislation. Sufficient legal advice has been received during the preparation of tenders and before signing any agreements to ensure that the conditions established are clear. J


Extremely important

Very important

Rather important

Not that important

Of no importance


Not relevant to us

0. Don’t know

1. Disagree



4. Agree



1

0

2

3

4

A The organisation’s strategic objectives

BThe organisation’s culture

C The organisation’s infrastructure and logistics

D The organisation’s technical infrastructure

EEthical guidelines

FThe staff’s ethical awareness

ICitizens’ rights

J Contractual and legal issues

related to procurement

HStaff’s rights and duties

Importance:

Importance:

Importance:

Importance:

Importance:

Importance:

GLegal framework

Importance:

Importance:

Importance:

Importance:

Organisation and culture

Check! – Telehealthcare at Scale. Centre for Telemedicine and Telehealthcare, 2014.

Original title in Danish: Tjek! Telemedicin i stor skala. First published in 2013.

Central Denmark RegionCentre for Telemedicine and Telehealthcare

Olof Palmes Allé 15DK – 8200 Aarhus N

E-mail: [email protected]

You can order further copies of this publication on: www.telemedicin.rm.dk

Visit www.telemedicin.rm.dk for further information.

Copyright © Centre for Telemedicine and Telehealthcare, Central Denmark Region 2014.

All rights reserved.

Centre for Telemedicine and TelehealthcareOlof Palmes Allé 15DK – 8200 Aarhus N

E-mail: [email protected]

Documents

Check! - Region Midtjylland · Regardless of the scope of the solution, it may be a good idea to start out by identifying the main stakeholders, for example by undertaking a stakeholder