Katz Che, Ruiz José María, Saigí-Rubió Francesc, Novillo-Ortiz David
Universitat Oberta de Catalunya, Faculty of Health Sciences, Barcelona, Spain.
World Health Organization Regional Office for Europe, Division of Country Health Policies and Systems, Copenhagen, Denmark.
J Med Internet Res. 2025 Jun 9;27:e70276. doi: 10.2196/70276.
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.
We aimed to evaluate the evidence base supporting telemedicine implementation knowledge tools; identify shared conceptual constructs and outliers; and formulate recommendations to guide the design, development, and optimization of telemedicine services.
We conducted implementation research using a rapid umbrella review, that is, an overview of systematic reviews, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). In total, we searched 3 databases (PubMed, Web of Science, and Scopus) for studies focusing on telemedicine implementation frameworks, models, and tools, collectively referred to as "knowledge tools." Reviews meeting the operational definition of a systematically undertaken, secondary evidence synthesis, such as systematic and scoping reviews, and those published from January 2018 to May 2024 were considered. A meta-aggregative qualitative analysis was undertaken, comprising inductive thematic synthesis.
In total, 18 reviews were selected, encompassing 973 primary studies. Global perspectives were reflected in 61% (n=11) of the reviews, while 33% (n=6) focused on low- and middle-income country contexts. The primary research included in the reviews represented 63 countries, spanning the Americas, Europe, Africa, the Middle East, and Asia and the Pacific. Findings indicated substantial heterogeneity across the identified telemedicine implementation theories, models, and frameworks. However, following evidence synthesis, considerable convergence was observed, highlighting a state-of-the-art understanding of the essential requirements for a national telemedicine implementation ecosystem. These were categorized into "process" and "thematic" dimensions. Process dimensions included readiness and needs assessment, road map and planning, managing change, implementing telemedicine services, and continuous improvement and measuring performance. Thematic dimensions covered human and sociocultural aspects; organization, operations, management, and leadership; communication and coordination; policy, legal, and financial considerations; clinical health condition and quality of care; and the wider context.
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 state of the art of key constructs in telemedicine implementation and recommends that future research focus on field-testing the evidence-based implementation tools to evaluate their usability and adaptability across diverse telemedicine contexts.
全球扩大远程医疗服务的努力面临着复杂、多层次、多方面的实施挑战，并且对于基于证据的实施基本要素缺乏共识。
我们旨在评估支持远程医疗实施知识工具的证据基础；识别共享的概念结构和异常值；并制定建议以指导远程医疗服务的设计、开发和优化。
我们按照PRISMA（系统评价和Meta分析的首选报告项目）进行了一项快速综合评价的实施研究，即对系统评价进行概述。我们总共在3个数据库（PubMed、科学网和Scopus）中搜索了关注远程医疗实施框架、模型和工具（统称为“知识工具”）的研究。符合系统开展的二次证据综合操作定义的评价，如系统评价和范围综述，以及2018年1月至2024年5月发表的评价被纳入考虑。进行了一项元聚合定性分析，包括归纳主题综合。
总共选择了18篇综述，涵盖973项原始研究。61%（n = 11）的综述反映了全球视角，而33%（n = 6）关注低收入和中等收入国家背景。综述中纳入的原始研究代表了63个国家，横跨美洲、欧洲、非洲、中东以及亚洲和太平洋地区。研究结果表明，在已识别的远程医疗实施理论、模型和框架中存在很大的异质性。然而，经过证据综合后，观察到了相当程度的趋同，突出了对国家远程医疗实施生态系统基本要求的最新理解。这些被分为“过程”和“主题”维度。过程维度包括准备情况和需求评估、路线图和规划、管理变革、实施远程医疗服务以及持续改进和绩效衡量。主题维度涵盖人类和社会文化方面；组织、运营、管理和领导；沟通与协调；政策、法律和财务考虑；临床健康状况和护理质量；以及更广泛的背景。
本研究的结果揭示了远程医疗实施中一个紧迫的转化研究知识空白，这阻碍了高质量、可持续和可扩展的远程医疗系统的实施。该研究有助于就远程医疗实施中关键结构的最新状况达成全球共识，并建议未来的研究集中于对基于证据的实施工具进行实地测试，以评估其在不同远程医疗背景下的可用性和适应性。
