Post-Implementation Evidence-Based Decision Making: The Telehealth Assessment Tool For Health (TeATH)
Few telehealth implementations survive the initial pilot phase, and any anticipated Return on Investment seldom materialises. Within South Africa a reason is the lack of post-implementation monitoring and assessment. To address this practice gap we developed a simple and practical tool to allow decision- and policy-makers to assess the post-implementation state of current telehealth applications. Recognised management approaches were reviewed, and elements adopted or adapted to develop the new decision support tool. A systems-based approach, applying a revised People, Process, and Technology methodology (incorporating Infrastructure), and Balanced Score Card and e-Readiness principles, was applied. This allowed development of the Telehealth Assessment Tool for Health (TeATH), whose utility was demonstrated by assessing the current performance of existing teleradiology implementations in three Provincial hospitals in Mpumalanga Province. Expected results were achieved, with TeATH revealing fair performance in the Technology dimension, but poor performance across People, Process, and Infrastructure for all three hospitals. TeATH is a simple and generic tool that provides decision support and guidance to health planners, differentiating weak or lagging implementations for which remedial action can be introduced. The tool has been adopted by the Provincial Department of Health, and has already influenced recent policy decisions. Broad application of TeATH would reduce wasteful expenditure, and facilitate implementation and uptake of telehealth in South Africa and elsewhere.
World Health Organisation. eHealth. (2014). Available at: http://www.who.int/topics/ehealth/en/ accessed 30 September 2016.
World Health Organization. World Health Report 2006: Working Together For Health. Geneva: WHO Press, 2006.
World Health Organization. World Health Statistics 2014 - Global Health Indicators. (2014). Available at: www.who.int/gho/publications/world_health_statistics/2014/en/ accessed September 30 September 2016.
Cooke R, Couper I, Versteeg M. Human resources for rural health. In: Padarath A, English R, editors. South African Health Review 2011. Durban: Health Systems Trust; 2011;107-118. Available at: http://www.hst.org.za/publications/south-african-health-review-2011 accessed September 30 September 2016.
Health Systems Trust. Health Indicators. (2014). Available at: http://www.hst.org.za/health-indicators-advanced-search accessed 30 September 2016.
Chanda L, Shaw JG. The development of telehealth as a strategy to improve health care services in Zambia. Health Inform Lib J 2010;27(2):133-139.
Mars M. Telemedicine and Advances in Urban and Rural Healthcare Delivery in Africa. Prog Cardiovasc Dis. 2013;56(3):326-335.
Khoja S, Durrani H, Scott RE, et al. 2013, Conceptual framework for development of comprehensive e-health evaluation tool. Telemed e-Health 2013;19(1):48-53.
Eighteen critical success factors for deploying telemedicine. (2014) Available at: http://telemedicine-momentum.eu/18-factors/ accessed 30 September 2016.
Dávalos ME, French MT, Burdick AE, et al. Economic evaluation of telemedicine: review of the literature and research guidelines for benefit–cost analysis. Telemed e-Health 2009;15(10):933-948.
Econex. Updated GP and Specialist Numbers for SA: 2011-2012. Annexure F. March 2013.
Gulube SM, Wynchank S. Telemedicine in South Africa: success or failure? J Telemed Telecare 2001;7(suppl2):47-49.
Gulube SM, Wynchank S. The national telemedicine system in South Africa-An overview and progress report. S Afr Med J 2002;92(7):513-515.
Mars M. Telemedicine in KwaZulu-Natal: from failure to cautious optimism. J Telemed Telecare 2007;13(suppl 3), 57-59.
Strachan K. Overview of SA telemedicine. S Afr Med J 2001;91:554-556.
Naidoo S. A review of telemedicine in the public sector of South Africa. MSc Thesis. University of KwaZulu Natal, South Africa, 2013.
National Department of Health. eHealth Strategy for South Africa 2012/2013-2016/2017. (2012). Available at: http://www.health-e.org.za/wp-content/uploads/2014/08/South-Africa-eHealth-Strategy-2012-2017.pdf accessed 30 September 2016.
Department of Health, Province of Mpumalanga. Annual Report 2012-2013. (2012). Available at: https://pmg.org.za/policy-document/608/ accessed 30 September 2016.
Ackoff RL, Addison HJ, Carey A. Systems thinking for curious managers: with 40 new management F-laws. Triarchy Press Limited, 2010.
Skyttner L. General systems theory: problems, perspectives, practice. Singapore: World Scientific Publishing Company, 2005.
Chen J, Popovich K. Understanding customer relationship management (CRM): people, process and technology. Business Process Manag J 2003;9(5):672-688.
Wang K. People, process, and technology management framework: a manager's practical guide to establishing a structure for growth. Charleston: Create Space Independent Publishing Platform, 2011.
Williams DE, Laesk J. People, process, technology strategy for enterprise 2.0. USA, Booz, Allen, Hamilton, 2011. Available at: http://www.boozallen.com/consulting/management-consulting/change-management/tlc accessed 30 September 2016.
Reyes B. People, process, and technology; bringing order to chaos on a large scale. Pariveda Solutions, 2011.
Kaplan RS, Norton DP. The balanced scorecard: translating strategy into action. Boston, MA. Harvard Business School Press, 1996.
Rigby D, Bilodeau B. Management tools and trends survey 2013. Bain & Company. (2013). Available at: http://www.bain.com/Images/BAIN_BRIEF_Management_Tools_%26_Trends_2013.pdf accessed 30 September 2016.
Zelman WN, Pink GH, Matthias C. Use of the balanced scorecard in health care. J Health Care Finance 2003;29:1-16.
Radnor Z, Lovell B. Defining, justifying and implementing the balanced scorecard in the National Health Service. J Med Marketing 2003;3(3):174-188.
Ittner CD, Larcker DF, Meyer MW. Subjectivity and the weighting of performance measures: Evidence from a balanced scorecard. Account Rev, 2003;78(3):725-758.
Khoja S, Scott RE, Casebeer AL, et al. e-Health readiness assessment tools for healthcare institutions in developing countries. Telemed e-Health 2007;13(4):425-432.
Légaré É, Vincent C, Lehoux P, et al. Telehealth readiness assessment tools. J Telemed Telecare 2010;16(3):107-109.
Parasuraman A. Technology Readiness Index (TRI) a multiple-item scale to measure readiness to embrace new technologies. J Serv Res 2000; 2(4):307-320.
O'Brien JA. Introduction to information systems: essentials for the e-business enterprise. Boston: McGraw-Hill, 2002.
Copyright (c) 2016 Renier L Beukes, Richard E Scott, Maurice Mars
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.