JMIR Publications

ABSTRACT

Background:

The global push to scale up telemedicine services is challenged by complex multilevel multifaceted implementation, and a lack of consensus on what the evidence-based essential building blocks of implementation are.

Objective:

We undertook a rapid umbrella review to identify the global state-of-the-art of theories, models and frameworks guiding telemedicine design, development and optimisation.

Methods:

An implementation research, rapid umbrella review, overview of systematic reviews, was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Three databases (PubMed, Web of Science and Scopus) were searched for studies focusing on telemedicine implementation frameworks, models and tools, collectively referred to as ‘knowledge tools’. Reviews meeting the operational definition of a ‘systematic review’ and published from January 2018 to May 2024 were considered. A meta-aggregative qualitative analysis was undertaken, comprising inductive thematic synthesis.

Results:

Eighteen systematic reviews were selected, encompassing 973 primary studies. Global perspectives were reflected in 61.1% of reviews, whilst 33.3% focused on low- and middle-income country contexts. The primary research included in reviews represented 63 countries, spanning the Americas, Europe, Africa, the Middle East, and Asia and the Pacific. Despite substantial heterogeneity across review knowledge tools, the evidence synthesis highlights considerable convergence of understanding on the essential requirements of telemedicine implementation. These were categorised into ‘process’ and ‘thematic’ dimensions. Process dimensions include readiness and assessing needs; roadmap and planning; managing change; implementing telemedicine services; and continuous improvement and measuring performance. Thematic dimensions covered human and sociocultural aspects; organisation, operations, management and leadership; communication and coordination; policy, legal and financial; clinical health condition and quality of care; and the wider context.

Conclusions:

The findings of this study inform a pressing translational research knowledge gap in telemedicine implementation hindering the implementation of high-quality, sustainable and scalable telemedicine systems. The study contributes to building global consensus on the essential constructs of telemedicine implementation and highlights the urgent need for field testing of knowledge tools for their usability and adaptability to different telemedicine contexts.