Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study

Probably not a substantial claim: may not pass S3 (load-bearing).

Several interviewees considered that the model of care should be developed first.

“Several interviewees considered that the model of care should be developed first”

Probably not a substantial claim: may not pass S3 (load-bearing).

Interviewees noted that introducing home telehealth altered the model of care to being more structured.

“Interviewees noted that introducing home telehealth altered the model of care to being more structured”

May combine two claims.

Despite the interviewees' seniority and experience in health services management, their views were underdeveloped, with little consistency in opinions about telehealth, even internally to each interview.

“From all of the above, it was clear that despite the interviewees’ seniority and experience in health services management, their views were underdeveloped, with little consistency in opinions about telehealth, even internally to each interview.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Palliative care services changed from an environment where individual clinicians operated according to their own preferences, to a system with set criteria for data gathering and responses to patient status.

“palliative care services changed from an environment where individual clinicians operated according to their own preferences, to a system with set criteria for data gathering and responses to patient status”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Others pointed out that disadvantaged populations, such as those on limited incomes or with chronic mental illness, may need the health service to supply devices.

“Others pointed out that disadvantaged populations, such as those on limited incomes or with chronic mental illness, may need the health service to supply devices.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Four interviewees suggested there should be a new organisation formed with strong community involvement.

“four that there should be a new organisation formed with strong community involvement”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

When state government was suggested as the manager, the funding mechanism would be block funding or activity-based funding, but interviewees said a compelling argument for either hospital avoidance or service efficiency would need to be made to obtain such funds.

“When state government was suggested as the manager the funding mechanism would be block funding or activity-based funding, but interviewees said that a compelling argument for either hospital avoidance or service efficiency would need to be made to obtain such funds.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In aged care a structured nursing assessment was introduced before the telehealth consultation.

“in aged care a structured nursing assessment was introduced before the telehealth consultation.”

May combine two claims.

Some interviewees were in favour of the patient paying at least part of the cost, but it was recognised that the elderly or chronically ill were currently not paying out-of-pocket for care so this was not likely to be a viable or acceptable model.

“some interviewees were in favour of the patient paying at least part of the cost, but it was recognised that the elderly or chronically ill were currently not paying out-of-pocket for care so this was not likely to be a viable or acceptable model.”

May combine two claims.

The ability to deliver services using off-the-shelf devices was regarded as a strength of the FTH trial, however the back-end technical management of these devices was not highly visible and not as simple as it may have appeared to the participants.

“The ability to deliver services using off-the-shelf devices was regarded as a strength of the FTH trial, however the back-end technical management of these devices was not highly visible and not as simple as it may have appeared to the participants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Perverse incentives were reported, with a clinician noting that an increase in efficiency could lead to a reduction in one's budget.

“Perverse incentives were reported, with a clinician noting that an increase in efficiency could lead to a reduction in one’s budget”

Probably not a substantial claim: may not pass S3 (load-bearing).

Five interviewees suggested government should take the lead in developing overarching governance of home telehealth.

“Five interviewees suggested government should take the lead in developing overarching governance of home telehealth”

Probably not a substantial claim: may not pass S3 (load-bearing).

Interviewees regarded using the patient's own device as the best option.

“Interviewees regarded using the patient’s own device as the best option”

Probably not a substantial claim: may not pass S3 (load-bearing).

A wide variety of opinions existed about managing the information required and produced by home telehealth services, from the patient themselves, to general practices, primary care organisations, or central government IT services.

“A wide variety of opinions existed about managing the information required and produced by home telehealth services, from the patient themselves, to general practices, primary care organisations, or central government IT services.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Grant funding was regarded as possible, particularly for primary care organisations, but this did not lead to long-term financial stability for services.

“Grant funding was also regarded as possible, particularly for primary care organisations, but this did not lead to long-term financial stability for services.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One interviewee wanted an existing government-owned body to operate the service.

“one wanted an existing government-owned body to operate the service”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two interviewees wanted primary health networks to run the system.

“two wanted primary health networks to run the system”

May combine two claims.

There was a diversity of views among interviewees on the form of operations, with no one approach standing out.

“however there was a diversity of views on the form of operations, with no one approach standing out.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two interviewees preferred commercial companies.

“two preferred commercial companies”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Three interviewees proposed many models, and two did not answer the governance question in a classifiable way.

“Three proposed many models, and two interviewees did not answer the question in a classifiable way.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Several interviewees said they could not give a definitive answer to the data management question.

“Several interviewees said they could not give a definitive answer to this question.”

May combine two claims.

Interviewees particularly mentioned that differing perspectives between clinical services and IT services in the larger health system, plus the conservative nature of centralised IT departments, would be a problem for broader implementation.

“Interviewees particularly mentioned that differing perspectives between clinical services and IT services in the larger health system, plus the conservative nature of centralised IT departments, would be a problem for broader implementation.”

Classified as probably not a substantial claim. May combine two claims.

There was caution about establishing a new organisation or written agreements immediately, with a preference to transition over a 12-month period to a formal arrangement.

“There was caution about establishing a new organisation or written agreements immediately, with a preference to transition over a 12-month period to a formal arrangement.”

Classified as probably not a substantial claim. May combine two claims. The quote only partly states this claim.

The deliberative forum identified two key actions for enabling change: marketing telehealth and creating a community of practice.

“Two key actions for enabling change were elucidated at the deliberative forum, which as well as selecting a preferred model of implementation, was also set the task of describing the means of achieving this.”

May combine two claims.

Leadership support was regarded as a key factor because it was essential for allocating resources that are necessary for large-scale implementation, such as funding, workforce and equipment, plus giving operational permissions.

“Leadership support was regarded as a key factor because it was essential for allocating resources that are necessary for large-scale implementation, such as such as funding, workforce and equipment, plus giving operational permissions.”

Classified as probably not a substantial claim. May combine two claims.

Interviewees noted increasing pressure on acute hospital services from two sources: a change in demographics to an older population with an increased burden of chronic disease, and the inability of the health system to respond with new models of care.

“Interviewees noted increasing pressure on acute hospital services from two sources; a change in demographics to an older population with an increased burden of chronic disease, together with the inability of the health system to respond with new models of care.”

Classified as probably not a substantial claim.

Participants thought clinicians would quickly abandon telehealth if it proved unacceptable to patients.

“Patient acceptability was important, in that participants thought clinicians would quickly abandon telehealth if it proved unacceptable to patients.”

Classified as probably not a substantial claim.

Interviewees noted ongoing difficulties in achieving coordinated primary health care within the Australian federal-state health system.

“Interviewees noted ongoing difficulties in achieving coordinated primary health care within this environment.”

May combine two claims.

The main components of this model, suggested by qualitative data analysis, were new clinical and business models of care and evidence of benefits, which in turn supported clinician acceptance.

“The main components of this model, suggested by qualitative data analysis, were new clinical and business models of care and evidence of benefits, which in turn supported clinician acceptance.”

May combine two claims.

The specific operational permissions described were allowing health service IT networks to connect to patients' homes, counting telehealth as clinical activity, and approving budget allocations for new types of service.

“The specific operational permissions described were allowing health service IT networks to connect to patients’ homes, counting telehealth as clinical activity, and approving budget allocations for new types of service.”

Classified as probably not a substantial claim. May combine two claims.

Although it was acknowledged that the FTH trial staff had worked hard to bridge this divide, it was stated that senior executives would need to support this approach in order for it to continue.

“Although it was acknowledged that the FTH trial staff had worked hard to bridge this divide, it was stated that senior executives would need to support this approach in order for it to continue.”

May combine two claims.

It proved very difficult to engage GPs; reasons offered included GP concerns that consultant specialists were encroaching on their area, that it does not fit with the fee-for-service business model of private general practice, and that GPs are too busy and tired of change to participate.

“It also proved to be very difficult to engage GPs; reasons offered included GP concerns that consultant specialists were encroaching on their area, that it does not fit with the fee-for-service business model of private general practice, and that GPs are too busy and tired of change to participate.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some attendees at the forum were willing to be members of such a consortium.

“Some attendees at the forum were willing to be members of such a consortium.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Hospital-based interviewees noted that introducing home telehealth could provide an infrastructure that could better support coordinated chronic disease management.

“Introducing home telehealth was noted by hospital-based interviewees to provide an infrastructure that could better support coordinated chronic disease management.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Responses reflected the complexity of the area, covering models of corporate ownership, who would take responsibility for clinical standards, and quality improvement.

“Responses reflected the complexity of the area, covering models of corporate ownership, who would take responsibility for clinical standards, and quality improvement.”

Classified as probably not a substantial claim. May combine two claims.

The model proposes the use of change agents for marketing telehealth, demonstrating policy alignment and potential solutions for difficult problems, and the creation of aligned communities of practice supporting the case for change.

“The model proposes the use of change agents for marketing telehealth, demonstrating policy alignment and potential solutions for difficult problems, and the creation of aligned communities of practice supporting the case for change.”

Classified as probably not a substantial claim.

The forum recommended that implementation should be small scale at first, covering the continuation of the FTH trial services plus other projects that consortium members could contribute.

“The forum recommended that implementation should be small scale at first, covering the continuation of the FTH trial services plus other projects that consortium members could contribute.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The opinions of interviewees as to the importance of policy alignment varied from minor to major.

“The opinions of the interviewees as to the importance of policy alignment varied from minor, “if the players are in the room saying how are we going to work together to achieve an outcome then it is actually better than a policy directive in my mind” to major, “I am not a policy person but I do recognise government policy is an important part of any business.””

Classified as probably not a substantial claim.

The deliberative forum chose the consortium model as the preferred option for development.

“The deliberative forum chose the consortium model as the preferred option for development.”

May combine two claims.

Participants directly involved with the FTH trial expressed many positive comments about how the trial opened clinicians' eyes to what is possible, and there was high satisfaction from clinicians expressed throughout the trial evaluation.

“From the interviews, those participants directly involved with the FTH trial expressed many positive comments about how the trial opened clinicians’ eyes to what is possible, and there was also high satisfaction from clinicians expressed throughout the trial evaluation.”

Classified as probably not a substantial claim.

The consultations undertaken during this study suggest that a small group, beginning with a community of practice, could make an impact.

“Nonetheless, the consultations undertaken during this study suggest that a small group, beginning with a community of practice, could make an impact.”

May combine two claims.

Interviewees regarded patient awareness as not sufficient to produce action, whereas active demand from patients could drive uptake.

“Whereas active demand from patients could drive uptake, interviewees regarded patient awareness as not sufficient to produce action.”

Classified as probably not a substantial claim.

Several interviewees mentioned that lack of evidence for benefits was a problem, particularly for supporting large-scale uptake.

“Several interviewees mentioned that lack of evidence for benefits was a problem, particularly for supporting large-scale uptake”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

From the interviews, the participants showed great interest in implementation issues; several commented that there were no easy answers and most engaged in extended thinking aloud about different options.

“From the interviews, the participants showed great interest in these issues; several commented that there were no easy answers and most engaged in extended ‘thinking aloud’ about different options.”

Classified as probably not a substantial claim.

By the conclusion of the deliberative forum, a consensus was reached that the preferred option for larger-scale implementation was to form a collaborative consortium.

“By the conclusion of the forum, a consensus was reached that the preferred option for larger-scale implementation was to form a collaborative consortium.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The state system has been pulling back from funding primary care services.

“This has been exacerbated by the state system pulling back from funding primary care services, as described by a senior manager, “State Health has been at pains to move their core business to acute services within hospitals and move away from hospital outreach or community based type services”.”

Classified as probably not a substantial claim.

Clinician acceptance is the key factor for making a successful transition to sustainable telehealth operations.

“and that clinician acceptance is the key factor for making a successful transition to sustainable operations [14]”

• cites [14] Wade VA, Eliott JA, Hiller JE. Clinician acceptance is the key factor for sustainable telehealth services. Qual Health Res. 2014;24(5):682–94. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A study of 36 Australian telehealth services using grounded theory concluded that champions are the main drivers of initial implementation.

“A study of 36 Australian telehealth services, using a grounded theory approach, concluded that champions are the main drivers of initial implementation [13]”

• cites [13] Wade V, Eliott J. The role of the champion in telehealth service development: a qualitative analysis. J Telemed Telecare. 2012;18(8):490–2. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

The remaining challenge is to understand how to scale up telehealth into routine use within the broader healthcare system.

“The remaining challenge, therefore, is to understand how to scale up telehealth into routine use within the broader healthcare system.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The difficulty of achieving both sustainable and large-scale telehealth services is a known problem reported in the research literature for over 20 years.

“The difficulty of achieving both sustainable and large-scale telehealth services are known problems that have been reported in the research literature for over 20 years [5, 6].”

• cites [5] Merrell RC, Doarn CR. Editorial: barriers or barricades. Telemed J E Health. 2012;18(2):79–80. sourceNot checked yet

  Not checked in the free run.

• cites [6] Miller EA. Solving the disjuncture between research and practice: telehealth trends in the 21st century. Health Policy. 2007;82(2):133–41. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Previous research into the uptake and sustainability of telehealth has identified the major enablers of usable technology, planned organisational change, provider acceptance, provider collaboration, the adoption of a business model, and policy support.

“Previous research into the uptake and sustainability of telehealth has identified the major enablers of usable technology, planned organisational change, provider acceptance, provider collaboration, the adoption of a business model, and policy support [7–9].”

• cites [7] Broens TH, Veld RM H i't, Vollenbroek-Hutten MM, Hermens HJ, van Halteren AT, Nieuwenhuis LJ. Determinants of successful telemedicine implementations: a literature study. J Telemed Telecare. 2007;13(6):303–9. sourceNot checked yet

  Not checked in the free run.

• cites [8] Jarvis-Selinger S, Chan E, Payne R, Plohman K, Ho K. Clinical telehealth across the disciplines: lessons learned. Telemed J E Health. 2008;14(7):720–5. sourceNot checked yet

  Not checked in the free run.

• cites [9] Obstfelder A, Engeseth K, Wynn R. Characteristics of successfully implemented telemedical applications. Implement Sci. 2007;2(25):1–11.Not checked yet

  Not checked in the free run.

May combine two claims.

Evaluation of the FTH trial found that more allied health services could be delivered to rehabilitation patients in the home, with positive functional outcomes.

“that more allied health services could be delivered to rehabilitation patients in the home, with positive functional outcomes”

Classified as probably not a substantial claim.

Each of the three clinical services indicated that they wished to consider how these services could be expanded and continued as part of routine service delivery after the trial concluded.

“Subsequently, each of the three clinical services indicated that they wished to consider how these services could be expanded and continued as part of routine service delivery after the trial concluded.”

May combine two claims.

The Veterans Health Administration in the USA is a successful large-scale telehealth system that was built up by commencing with local innovation, then creating overarching clinical, technical and business systems that supported implementation at multiple sites.

“By contrast, the Veterans Health Administration in the USA is a successful large-scale telehealth system that was built up by commencing with local innovation, then creating overarching clinical, technical and business systems that supported implementation at multiple sites [17].”

• cites [17] Darkins A. The growth of telehealth services in the Veterans Health Administration between 1994 and 2014: a study in the diffusion of innovation. Telemed J E Health. 2014;20(9):761–8. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Nineteen interviews were conducted, which was the point at which data saturation occurred.

“resulting in 19 interviews, which was the point at which data saturation occurred.”

Classified as probably not a substantial claim.

Complex relationships between the technical, social and organisational dimensions need to be negotiated to achieve implementation.

“two other reports [11, 12] conclude that complex relationships between the technical, social and organisational dimensions need to be negotiated to achieve implementation”

• cites [11] Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretive review. Int J Med Inform. 2013;82:e73–86. sourceNot checked yet

  Not checked in the free run.

• cites [12] May C, Harrison R, Finch T, MacFarlane A, Mair F, Wallace P. Understanding the normalization of telemedicine services through qualitative evaluation. J Am Med Inform Assoc. 2003;10:596–604. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Communities of practice have been proposed as a means of bringing together providers with common interests to solve problems and innovate in healthcare.

“In healthcare, communities of practice have been proposed as a means of bringing together providers with common interests to solve problems and innovate [26].”

• cites [26] Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Serv Res. 2011;11:273. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

The interviewees were selected by having a connection to home telehealth, enough seniority to have influence over transitioning the FTH Trial into a sustainable service, and a diversity of roles.

“The interviewees were selected by having a connection to home telehealth (including but not necessarily the FTH Trial), enough seniority to have influence over transitioning the FTH Trial into a sustainable service, and to have a diversity of roles.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Communities of practice can grow from simple discussion and dissemination of expertise to a more coherent group that shares resources or infrastructure.

“Such communities can grow from simple discussion and dissemination of expertise to a more coherent group that shares resources or infrastructure.”

• cites [26] Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Serv Res. 2011;11:273. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Thirteen interviewees were health service managers, three were medical specialists and three were primarily concerned with service development.

“13 of the interviewees were health service managers, three were medical specialists and three were primarily concerned with service development.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Strengths were that this work was integrated into a longer term program of research into the uptake and implementation of telehealth, and that the participants were specifically chosen to be senior in status, experienced in health services development, and included those who would be directly responsible for large-scale implementation should this occur.

“Strengths were, however, that this work was integrated into a longer term program of research into the uptake and implementation of telehealth, and that the participants were specifically chosen to be senior in status, experienced in health services development, and included those who would be directly responsible for large-scale implementation should this occur.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Telehealth typically begins as small services started by champions who promote the method and build relationships between providers.

“Typically, telehealth begins as small services, started by champions who promote the method and also build relationships between providers [13].”

• cites [13] Wade V, Eliott J. The role of the champion in telehealth service development: a qualitative analysis. J Telemed Telecare. 2012;18(8):490–2. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Using patients' own devices would be difficult for some, such as individuals who are impoverished, have cognitive impairment, or are older with minimal digital literacy, and these are the very people who have more chronic conditions with a greater need for these types of health services.

“This would be difficult for some, such as individuals who are impoverished, have cognitive impairment, or are older with minimal digital literacy, and these are the very people who have more chronic conditions with a greater need for these types of health services.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

At a time when health budgets are tight, it appears that the healthcare system in Australia has reached an impasse, in which it both cannot change and yet must change.

“At a time when health budgets are tight, it appears that the healthcare system in Australia has reached an impasse, in which it both cannot change and yet must change.”

• AssumptionRests on an assumption: During the FTH trial, decisions taken at an Australian federal and state government level resulted in an environment of budgetary constraint.
• AssumptionRests on an assumption: During times of plenty, there are resources to experiment with new systems and funding for trials, yet resistance often prevents real change on a broader level.

Probably not a substantial claim: may not pass S3 (load-bearing).

Multiple organisational barriers to IT projects in health have been noted, covering structures, policies, incentives, training, changes to work processes, and work culture issues.

“On a cautionary note, multiple organisational barriers to IT projects in health have been noted [29], covering structures, policies, incentives, training, changes to work processes, and work culture issues.”

• cites [29] Lluch M. Healthcare professionals’ organisational barriers to health information technologies - a literature review. Int J Med Inform. 2011;80:849–62. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

By sector affiliations, ten participants worked for government health services, four were from primary care, three from research organisations and two from aged care providers.

“By sector affiliations, ten participants worked for government health services, four were from primary care, three from research organisations and two from aged care providers.”

May combine two claims.

The relationship between clinicians and IT services can be problematic, with the most frequent issues being that internal IT departments of health service raise barriers to telehealth installations, place telehealth at the bottom of their list of competing priorities, and are reluctant to authorise non-standard systems.

“The relationship between clinicians and IT services can also be problematic, with the most frequent issues being that the internal IT departments of health service raise barriers to telehealth installations, place telehealth at the bottom of their list of competing priorities, and are reluctant to authorise non-standard systems [30].”

• cites [30] Wade R, Cartwright C, Shaw K. Factors relating to home telehealth acceptance and usage compliance. Risk Mgmt Healthcare Policy. 2012;5:25–33. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

The model developed by this research offers focused advice for prioritising change management resource allocation.

“The model developed by this research offers focused advice for prioritising change management resource allocation.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The deliberative forum was an all-day event attended by 28 people, including two expert presenters in health system funding and e-health service development.

“The deliberative forum was an all-day event attended by 28 people, which included two expert presenters in health system funding and e-health service development.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Clinician acceptance was the key factor in the prior model for achieving sustainability of telehealth services.

“Clinician acceptance was the key factor in the prior model for achieving sustainability of telehealth services, and was regarded by participants as the third important influence on leadership support.”

• cites [14] Wade VA, Eliott JA, Hiller JE. Clinician acceptance is the key factor for sustainable telehealth services. Qual Health Res. 2014;24(5):682–94. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

A community of practice helps normalize telehealth, increasing confidence in the practice from clinicians and decision-makers, and can help overcome change fatigue and bridge the clinical-technical divide, providing both clinicians and IT staff are included.

“A community of practice helps “normalize” telehealth, increasing confidence in the practice from clinicians and decision-makers. This can help overcome change fatigue and bridge the clinical-technical divide, providing both clinicians and IT staff are included.”

Classified as probably not a substantial claim. May combine two claims.

A community of practice could only include a minority of clinicians, which is why moving to the normalisation stage supported by major stakeholders is so important.

“Such a community could only include a minority of clinicians, which is why moving to the normalisation stage supported by major stakeholders is so important.”

May combine two claims.

The new model adds the second key factor of leadership support to achieve large-scale uptake, whereas the prior model posited that clinician acceptance was the key factor to achieve sustainable telehealth services.

“Whereas the prior model posited that clinician acceptance was the key factor to achieve sustainable telehealth services, this new model adds the second key factor of leadership support to achieve large-scale uptake.”

• AssumptionThe authors state this as an assumption: The explanation produced by the study is related to processes in the external world.

May combine two claims.

Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of practice.

“Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of practice.”

• AssumptionThe authors state this as an assumption: The explanation produced by the study is related to processes in the external world.

Classified as probably not a substantial claim. May combine two claims.

Communities of practice can serve as a means for engaging the wider clinical community (including general practitioners), supplying expertise in building telehealth service models, and becoming a consortium that could apply for further funding.

“Communities of practice can serve as a means for engaging the wider clinical community (including general practitioners), supplying expertise in building telehealth service models, and becoming a consortium that could apply for further funding.”

May combine two claims.

Data collection took place over the short period of three months, and the participants themselves had not directly experienced the trial being transformed into a large-scale telehealth service.

“Data collection took place over the short period of three months, and the participants themselves had not directly experienced the trial being transformed into a large-scale telehealth service.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

This should assist health leaders to move from trials to large-scale services.

“This should assist health leaders to move from trials to large-scale services.”

• AssumptionThe authors state this as an assumption: The explanation produced by the study is related to processes in the external world.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Change agents and a community of practice can contribute by marketing telehealth, demonstrating policy alignment and providing potential solutions for difficult health services problems.

“Change agents and a community of practice can contribute by marketing telehealth, demonstrating policy alignment and providing potential solutions for difficult health services problems.”

• AssumptionThe authors state this as an assumption: The explanation produced by the study is related to processes in the external world.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Most forum attendees had been previously interviewed, but because the interview sample contained a minority of clinicians and none from general practice, intentional recruitment for the forum included two general practitioners active in policy and service development.

“Most attendees were those who had been previously interviewed, but as the interview sample contained a minority of clinicians and none from general practice, intentional recruitment for the forum included two general practitioners who were active in policy and service development.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In relation to the FTH trial, six participants were highly engaged, six were aware of its activities, and seven had minimal or no awareness.

“In relation to the FTH trial, six participants were highly engaged, six were aware of its activities, and seven had minimal or no awareness.”

May combine two claims.

Systems theory suggests that the more complex the system which contains a greater number of competing demands, the harder it will be to find a new optimum solution that will enhance the functioning of the whole system, hence the more resistance to change will occur.

“Systems theory suggests that the more complex the system which contains a greater number of competing demands, the harder it will be to find a new optimum solution that will enhance the functioning of the whole system, hence the more resistance to change will occur.”

• cites [34] Coiera E. Why system inertia makes health reform so difficult. BMJ. 2011;342:d3693. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Telehealth is a complex intervention within an already complex environment, so resistance should be anticipated and managed.

“Telehealth in particular, is a complex intervention within an already complex environment, so resistance should be anticipated and managed.”

Probably not a substantial claim: may not pass S4 (based).

The implementation of home telehealth services is still in an early stage.

“The implementation of home telehealth services is still in an early stage.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All interviewees had senior positions within their own sectors, five being at the chief executive level, with the remainder leading either services or organisational units.

“All interviewees had senior positions within their own sectors, five being at the chief executive level, with the remainder leading either services or organisational units.”

May combine two claims.

This approach does have the advantages that devices can be adapted for lower capabilities and limited to a small number of functions, plus reliable connectivity can be supplied.

“This approach does have the advantages, however, that devices can be adapted for lower capabilities and limited to a small number of functions, plus reliable connectivity can be supplied.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The maximum number of interviewees was set in the mid-twenties to ensure a manageable number for a later consultative forum, but could be ceased earlier if data saturation was reached.

“The maximum number of interviewees was set in the mid-twenties, to ensure a manageable number for a later consultative forum, but could be ceased earlier if data saturation was reached.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The consortium approach may not translate to the environment in Australia, which is more fragmented and competitive, with major stakeholders being less willing to contribute resources to collaborations.

“This approach may not translate to the environment in Australia, which is more fragmented and competitive, with major stakeholders being less willing to contribute resources to collaborations.”

• AssumptionRests on an assumption: The Australian healthcare environment is more fragmented and competitive than other jurisdictions, with major stakeholders less willing to contribute resources to collaborations.

Probably not a substantial claim: may not pass S3 (load-bearing).

Ethics approval was granted by the Southern Adelaide Clinical Human Research Ethics Committee, application numbers HREC/13/SAC/88(168.3 and 203.13).

“Ethics approval was granted by the Southern Adelaide Clinical Human Research Ethics Committee, application numbers HREC/13/SAC/88(168.3 and 203.13).”