JMIR Publications

ABSTRACT

Background:

Today telehealth is experiencing exponential growth in utilization. Paralleling this trend, is growth in the telehealth industry with sharp increases in the number of platforms, functionalities and levels of integrations within both the electronic health record (EHR) and other technical systems supporting healthcare. When a telehealth network is intended to be used across independent health care systems, an additional layer of complexity emerges. In the context of regionalized telehealth networks, that are not within the same healthcare system, not only are technical interoperability challenges a practical barrier, but administrative, clinical and competitive elements quickly emerge resulting in fragmented, siloed technologies.

Objective:

To describes a state-wide approach to deploying an interoperable Open Access Telehealth Network across multiple health systems.

Methods:

One promising solution to these concerns is an Open Access Telehealth Network (OAN). In the field of telehealth, an OAN can be defined as a network infrastructure that can be used by health care providers without a closed or proprietary platform, specific obligatory network, or service specific telehealth technologies. This framework for the development of an OAN is grounded in practical examples of clinical programs that function in each stage of network maturity based on the experience of the South Carolina Telehealth Alliance (SCTA). The SCTA’s experience details successes and challenges in an ongoing effort to achieve an OAN. The model describes an OAN in stages of collaborative maturity and provides insights into the technological, clinical and administrative implications of making the collaboration possible.

Results:

The four stages of OAN are defined according to operational maturity, ranging from feasibility to demonstration of implementation. Each stage is associated with infrastructure and resource requirements, technical and clinical activities. In Stage 1 technical standards are agreed upon, and the clinical programs are designed to utilize compliant technologies. In Stage 2, collaboration is demonstrated through technical teams working together to address barriers while clinical and administrative teams share best practices. In Stage 3, a functional interoperable network is demonstrated with differing institutions providing service through common telehealth endpoints at different patient care sites. In the fourth stage, clinical workflows are streamlined and standardized across institutions, and economies of scale are achieved through technical and administrative innovations.

Conclusions:

The approach to OAN development described provides a roadmap for achieving a functional telehealth network across independent health systems. The South Carolina experience reveals both successes and challenges in achieving this goal. Next steps toward development of open access networks include advocacy and ongoing engagement with the developers of telehealth technologies regarding their commitment to interoperability.