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Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework
Open accessPublished version of a preprint
Abstract
Background: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use.
Checked 2026-10-06 · 2 references not checked yet
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This systematic review synthesized 13 papers on video consultation services that had spread beyond initial pilot or feasibility stages, using the NASSS framework to examine scale-up, spread, and sustainability. It found limited evidence and theorization for widespread adoption, with enablers such as telehealth champions and reimbursement but persistent challenges in technical support, workflows, funding, and training.
Key findings
- The review identified 13 papers describing 10 different video consultation services in 6 regions, covering video-to-home, hub-and-spoke, and large-scale top-down models across rehabilitation, geriatrics, cancer surgery, diabetes, mental health, general specialist care, and primary care.
- Across the 13 articles, 38 opportunities and 47 unique challenges were reported. The most common opportunities were clinical and/or nonclinical telehealth champions or coordinators (n=8), provider acceptance (n=4), adequate funding (n=4), strong interorganizational communications (n=4), and absence of billing or licensure restrictions (n=3). The most common challenges were lack of technical telehealth-specific support for clinical staff (n=6), need for redevelopment of workflows and organizational routines (n=6), financial pressures (n=5), and lack of training (n=5).
- Potential enablers of spread and scale-up included embedded leadership and a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation over time; challenges included absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and technical experience of staff.
- There was limited articulation and theorization of scale-up and spread: papers tended to view spread and scale-up as the sum of multiple technical implementations rather than distinct social, interorganizational, and policy-related processes. Of the articles, 10 (77%) reported both challenges and opportunities, 2 (15%) reported challenges exclusively, and 1 (8%) focused more on opportunities.
Methods
- Systematic searches were conducted in PubMed, CINAHL via EBSCOhost, and Web of Science in December 2018, with an update in March 2020. Included articles were peer-reviewed, published since 2010, and reported on synchronous, video-based consultations that had scaled or spread to more than one setting beyond an initial pilot or feasibility stage.
- Initial searches identified 4484 unique articles, with 193 articles for full-text screening and 12 initially included; the updated search returned 185 new articles, of which 5 were full-text screened and 1 new relevant article was identified, bringing the total to 13.
- Data were extracted into a Microsoft Excel spreadsheet, analyzed descriptively with content analysis and frequency distributions, then synthesized inductively and deductively using the 7 domains of the NASSS framework. Quality was appraised with CASP and MMAT checklists, but articles were not excluded on quality grounds.
Limitations
- The paper states that publication bias likely impacts the broadly positive results across included studies; that the lack of theorization in included studies makes it hard to know how broadly challenges and opportunities were considered, so the review cannot claim a conclusive list of challenges; and that bias inherent in the reviewing process is a limitation.
- Evident from the text: the included evidence base is small in number and scope, many studies remained highly descriptive or illustrative, patient and caregiver challenges were primarily clinician perceptions rather than direct reports, and there was limited detail on the material properties and design of video consulting platforms.
- The review focused on published literature and did not search grey literature, as stated in the methods.
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Claims the paper makes
0 of 158 cited sources checked · 0 supported · 0 flagged
None of the sources cited for this claim have been checked yet.
In the paper
“Across all papers reviewed, available technologies for video consultations posed challenges for establishing remote models of care as well as spread and scale-up.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies described 3 types of video consultation services: (1) video-to-home services [2,34,38,39,42] that connected providers directly to a patient who received a video consultation on their own device; (2) hub-and-spoke models [32,33,35,37,40,41] that connected a provider at a central hub to a patient at a rural spoke center who called in with the assistance of a provider at that organization;”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In total, 7 of the studies reported the conditions for which video consultations were used, including dermatology, diabetes, antenatal diabetes, postoperative cancer, spinal cord injuries, bipolar disorder, PTSD, and other mental health conditions.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies presented empirical findings relating to services that had (to varying degrees) undergone, were undergoing, or were about to undergo scale-up or/and spread.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Authors reported that support and high-quality training were necessary to achieve widespread growth [2,32-43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
- Not checked yetcites [33] source
- Not checked yetcites [34] source
- Not checked yetcites [35] source
- Not checked yetcites [36] source
- Not checked yetcites [37] source
- Not checked yetcites [38] source
- Not checked yetcites [39] source
- Not checked yetcites [40] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The above studies primarily report the use of frameworks as part of evaluating, rather than guiding, spread and scale-up efforts.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“For example, video consulting in an antenatal diabetes clinic was abandoned given the involvement of multidisciplinary teams across departments, the duration and severity of the condition (short-term, high-risk), and the use of patient-held medical records that were unavailable to the clinician conducting the video consultation [2,38].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [38] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Additionally, widespread implementation requires patients to have access to the appropriate “infrastructure” to participate in a video consultation (computer, webcam, data allowance) [40].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [40] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Opportunities for and challenges to the spread and scale-up of video consulting by type of clinical condition were reported in detail in only one study [2,38].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [38] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Elsewhere, unreliable or inconsistent national internet capability and service was reported as a challenge to implementation [32,41].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
- Not checked yetcites [41] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 38 opportunities to scale-up, spread, and sustainability and 47 unique challenges were reported across the 13 articles.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Reported Opportunities and Challenges
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Other studies pointed to the difficulties in conducting physical examinations as constraining spread and scale-up.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“For example, an investigation of video consulting scale-up for spinal cord injury suggested that a “common concern was the perceived limits to evaluate physical symptoms over [video]” and the difficulty to assess clients’ complaints without being able to physically examine them [35].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [35] source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Brooks et al [33] also reported on challenges setting up the infrastructure to be able to accommodate video consulting: “respondents noted many challenges in the clinic implementation process. Among these were … setting up the telehealth backbone.””
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [33] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Many of the articles included in the review emphasized a logic of change underpinned by implementation science (Multimedia Appendix 3).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Engaged leadership staff were also reported to be pivotal for promoting uptake and creating conditions for sustained and widespread provider uptake [42].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [42] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Contrastingly, Bhatta et al [32] reported how uncertain supplier relationships and funding threatened the sustainability and scale-up of their program in Nepal.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Staff concerns with video technologies were reported in all papers (n=13) and included the following: lack of provider buy-in and resistance to change [2,33,36,38,39,42]; lack of adequate training and telehealth staff to support sustainable operation of the video consulting programs [32,34,35,37,41], and the mobility of human resources within and between systems including “unplanned transfer of”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedn = 13Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“When patients were in front of a screen, it was reported by staff that patients felt uncomfortable participating in the consultation.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite the abundance of challenges to and opportunities for widespread implementation reported from the provider perspective, there was little in-depth consideration of the impact of patient and caregiver adoption on widespread implementation and how the work and acceptance of these groups may have influenced widespread and sustainable implementation.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was limited articulation of the challenges to scale-up and spread of video consultations.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Even when specialist information technology (IT) staff were available, a lack of service and procurement standards hindered spread across the system, as in the example of video consulting in the Veterans Health Administration: “telehealth projects were developed using bespoke interfaces at an individual medical center, ones that were not replicable across the system. Both Veterans Health”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [43] source
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“A weak or poorly articulated value proposition posed challenges for scale-up and spread (n=2).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Value proposition was primarily understood in terms of clinical stakeholder perception of patient demand and interest [39,42], perceived clinical need/utility [2,32,33,35,38,41,43], and supplier benefit [2,38].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedn = 10Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Interian et al [34] also described how a video consulting program aimed at improving access to mental health care did not spread successfully in an urban environment compared to other settings, because providers did not perceive a local need for the technology: “A second issue involving provider buy-in pertained to the perceived local need for implementation.””
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [34] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Challenges to and opportunities for widespread implementation for patients and caregivers were reported in 6 articles [2,32-34,38,42].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
- Not checked yetcites [33] source
- Not checked yetcites [34] source
- Not checked yetcites [38] source
- Not checked yetcites [42] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Of the articles that did report patient or caregiver challenges [2,32-34,38,42], these were primarily clinician perceptions, rather than direct reports from patients or caregivers.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
- Not checked yetcites [33] source
- Not checked yetcites [34] source
- Not checked yetcites [38] source
- Not checked yetcites [42] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of papers (n=10) discussed the value proposition for video consulting and how this was articulated by different program stakeholders.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedn = 10Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Spread and scale-up were enabled by an adopter system with engaged and committed staff who were given protected time by the organization to conduct video consultations, as mentioned by Interian et al [34]: “having a team of providers who were detailed solely to provide mental health services by using telehealth technology and had protected time to do so… was rated as having a strong positive”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [34] source
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Brooks et al [33] highlighted the importance of information (eg, background information about services, clinical protocols) from other organizations using telehealth in promoting take-up and spread.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [33] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Other roles included health care coordinators or IT staff [33,35,40,43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Telehealth champions were typically clinical staff [2,34,36,41-43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [34] source
- Not checked yetcites [36] source
- Not checked yetcites [41] source
- Not checked yetcites [42] source
- Not checked yetcites [43] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all studies (n=13) [2,32-43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
- Not checked yetcites [33] source
- Not checked yetcites [34] source
- Not checked yetcites [35] source
- Not checked yetcites [36] source
- Not checked yetcites [37] source
- Not checked yetcites [38] source
- Not checked yetcites [39] source
- Not checked yetcites [40] source
Strength:plain· not yet calibratedn = 13Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Two other papers reinforced this [2,43], referring to, for instance, “telehealth communities,” “collaborations across clinics and staff,” and “collaborations with…government partners” not only as important catalysts for change, but also as critical to the ongoing evolution and spread of services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [43] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Political challenges included government instability, which affected related policy development, as a study in Nepal explained: “Due to the unstable political situation and frequent change of government, the policy related with the health care delivery system is fragile” [32].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the papers mentioned specific interorganizational initiatives (eg, quality improvement collaboratives).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“There was a gap in the papers reviewed, on the relevance of interorganizational networking for supporting and sustaining the spread and scale-up of video consulting [24].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [24] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: The absence of mention of specific interorganizational initiatives in the reviewed papers indicates that such initiatives were not present or studied in the included studies.
None of the sources cited for this claim have been checked yet.
In the paper
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [33] source
- Not checked yetcites [34] source
- Not checked yetcites [35] source
- Not checked yetcites [36] source
- Not checked yetcites [37] source
- Not checked yetcites [39] source
- Not checked yetcites [40] source
- Not checked yetcites [41] source
- Not checked yetcites [42] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Other challenges included how sites with existing video consulting programs and pre-existing routines may be hesitant or slower to implement new technologies and redesign workflows around a new technology [40]”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [40] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“lack of widespread video consulting implementation in Norway was at least partially attributed to the lack of organizational preparedness required to “integrate changes and initiate restructuring” [36].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [36] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Absence of or ambiguity in reimbursement was another common contextual barrier that influenced wider spread of video consultations [36].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [36] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“They reported how challenges such as the condition interact with the organization, determining the ability to scale up video consulting services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [38] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“how embedding video consultations in a clinic “involved significant reworking of … processes in ways that took account of the ‘virtual’ presence of the patient” [38]”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [38] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, limited attention has been paid to the spread and scale-up of video consulting.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A key finding is the paucity of evidence thoughtfully articulating challenges to the scale-up and spread of video consulting, which sits uncomfortably alongside the current global enthusiasm for expanding the use of video consulting services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The articles view spread and scale-up as the sum of multiple implementations, rather than theorizing the distinct processes required to achieve widespread adoption.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Notably, the absence of sustainable financial models was reported to threaten sustainability [32].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Interestingly, albeit much more localized, Hurricane Harvey was reported by Lindsay et al [42] to be an opportunity for provider buy-in for video-mediated mental health services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
- Not checked yetcites [42] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Previous systematic reviews have tended to isolate areas of specific interest, focusing on selected aspects of video consulting, such as patient satisfaction [3,72], feasibility [5], clinical effectiveness and cost-effectiveness [73], and specialized clinical areas (eg, cardiology [74], diabetes [75], mental health and addiction [10], teledermatology [76]).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Factors impacting resilience, “the intrinsic ability of a system to adjust its functioning prior to, during, or following changes and disturbances so that it can sustain required operations, even after a major mishap or in the presence of continuous stress” [62], and adaptation over time were reported in three articles [32,42,43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“However, in a comprehensive description of the 20-year evolution and adaptation of telehealth within the VHA in the United States, Darkins [43] illustrates a dynamic transition from a fragmented health care system with many short-term pilot telehealth implementations that slowly scaled up and increased the scope of video consulting services and the associated infrastructure [43].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [43] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“This addresses a fundamental gap in the literature, with prior studies typically focusing on individual technologies or services, rather than organizational implementation and spread across settings [5].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
What the sources say
- Not checked yetcites [5] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Many articles viewed spread and scale-up purely as the sum of multiple implementations, rather than explicating and theorizing the distinct (social, interorganizational, and policy-related) processes required to achieve widespread adoption.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This systematic review identified opportunities and challenges for the scale-up and spread of video consulting.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Little is currently known about how to successfully spread and scale up video consulting for sustained use across settings [23-25].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Introduction
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Findings suggest that, even where there is significant policy impetus and demand [4], those implementing video consultation services face significant challenges in redesigning existing services and implementing new pathways.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Introduction
What the sources say
- Not checked yetcites [4] source
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There remains a significant lack of evidence that can support the spread and scale-up of video consulting.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Abstract > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“These challenges are consistent with previous research concerning small-scale implementation and diffusion of video consulting services and the scale-up and spread of other eHealth interventions [67,68].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“The COVID-19 pandemic is producing what is essentially a “natural experiment” as alternatives to traditional face-to-face consultations become a necessity to prevent viral transmission [4].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
- Not checked yetcites [4] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesWhat the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the small sample sizes, select nature of samples, and high losses to follow-up call into question any unqualified conclusion that video consulting is “effective.””
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“These elements are crucial in scale-up, spread, and sustainability because they address how the organization might respond to emerging challenges and how the innovation coevolves with organizational structures and processes [23].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [23] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“These factors shape the context in which the technology is implemented and influence the potential for growth and sustainability of video consulting services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [23] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- Probably not a substantial claim. 31
- It may state two separate claims as one. 54
None of the sources cited for this claim have been checked yet.
In the paper
“Complexity was mentioned in a few articles, although not as a key organizing framework.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most common opportunities included the availability of clinical and/or nonclinical telehealth champions or coordinators (n=8), provider acceptance (n=4), absence of billing or licensure restrictions (n=3), adequate funding (n=4), and strong interorganizational communications (n=4).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Reported Opportunities and Challenges
Strength:plain· not yet calibratedn = 8Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of these studies, 6 paid limited attention to how clinical characteristics played a role in the successful spread of video consulting services [32-35,37,42], although there was mention of provider concerns around using video consulting in specific conditions (eg, “for patients who are at high risk of suicide or who have psychotic symptoms”).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“One study noted that for patients with agoraphobia, the video medium removed the need to travel to the clinic and allowed patients to more easily receive mental health support [42].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [42] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A review of the included studies using the CASP and MMAT appraisal tools indicated that they generally fulfilled relevant quality standards, although in a few articles it was not clear how data collection or analysis methods were applied, sample sizes were small, or there was inadequate information on sampling frame; furthermore, they remained at a highly descriptive or even purely illustrative”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Not all articles explicitly reported opportunities and challenges: 10 (77%) reported both challenges and opportunities [2,33-35,37-41,43], 2 (15%) reported challenges exclusively [32,36] and 1 (8%) article focused more on opportunities and how these could be translated to other settings [42].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Reported Opportunities and Challenges
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Another two articles employed frameworks to support spread and scale-up efforts, although they did not draw on relevant approaches such as the Going to Full Scale framework, 3S infrastructure, or the Dynamic Sustainability framework [58-60].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In Norway, infrastructural differences between the different regions have challenged the spread of telemedicine and meant that the national eHealth strategy could not be implemented consistently [36].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [36] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 13 papers referred to various video consultation programs but focused on their implementation process rather than providing details of the video conferencing technologies used.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Services covered various clinical specializations including rehabilitation [35,39], geriatrics [39], cancer surgery [2,38], diabetes [2,38], and mental health [34,37,40,42], in addition to general specialist care and primary care [32,33,36,41,43].”
- Also stated in: § Results · plain
“Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Papers described 10 different video consultation services in 6 regions: Australia [39], Cabo Verde [41], England [2,38], Nepal [32], Norway [36], and the United States (Multimedia Appendix 3).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diverse research designs were employed in the included studies, including interpretive case studies [32], structured or semistructured qualitative interviews [33-35], mixed methods combining qualitative and quantitative data [2,36-38], action research and deliberative methods [39], prospective implementation studies including quantitative activity and performance indicators [40-42], and”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most common challenges were lack of technical telehealth-specific support for clinical staff (n=6), need for redevelopment of workflows and organizational routines (n=6), financial pressures (n=5), and lack of training (n=5).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Reported Opportunities and Challenges
Strength:plain· not yet calibratedn = 6Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Initial searches identified 4484 unique articles published between January 2010 and December 2018, with 193 articles identified for full-text screening and 12 initially included in the final review. An updated search in March 2020 returned 185 new articles for screening, of which 5 were identified for full-text screening. One new relevant article was identified, bringing the total records included”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Social science theory was also employed, although rarely in a highly theoretical mode.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Preoperative cancer surgery was deemed too complex for video consulting given the necessity of a physical exam combined with there likely being no pre-existing relationship between the patient and clinical team, but postoperative follow-up within the same clinic was deemed more appropriate [2,38].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [38] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“There was ambiguity in the use and variations of the term telehealth, with three studies giving no definition and others defining telehealth variably depending on study focus (Multimedia Appendix 3). The terms telehealth, telemedicine, and telemental health were common and often used interchangeably: 11 articles (85%) used the terms “video telehealth,” “telehealth,” “telemedicine,” or “telecare,””
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Description of Papers and Overview of Findings
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [38] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Reported patient and caregiver challenges to and opportunities for widespread implementation included patient trust and acceptance of video consulting [2,33,38], the patient’s ability to transport themselves to a “hub” site (for hub-and-spoke video consulting [33]), and patients requiring appropriate technology to participate in video consultations [34].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“For example, Martinez et al [35] reported that “some providers encountered initial hesitance from individuals with Spinal Cord Injuries or Disorder which they mostly attributed to patients’ uncertain feelings about the new technology.””
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [35] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Providers were slow or reluctant to buy in because they did not trust the technology or consider it clinically applicable [33,34,42]; did not have experience with the technology [34,40]; did not have adequate time to devote to the new technology [2,38]; did not have enough evidence to support video consulting use, resulting in resistance to changes in care models, as they found existing care”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Abstract > Results
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“For mental health care in the United States, patients reported liking the convenience and privacy of video consulting; however, these responses were collected from patients with repeated prior use of video consulting services, possibly excluding important challenges of patients with little or no experience with video consultations [42].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [42] source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The upstream supply of technology (ie, the relationship between the organization and the supplier or developer) was reported as a facilitator by Greenhalgh et al [38], who explained that scale-up in a Skype-based service was facilitated partially by “clear benefit for both the technology supplier and the patient.””
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [38] source
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In the paper
“In Nepal, challenges for patients were numerous and included cultural barriers (eg, patients’ feelings of inferiority to health care workers; women and older patients not speaking for themselves; lack of confidence) and literacy concerns, which were reported to make “it difficult and time consuming to use [video consults] for such patients” [32].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [32] Bhatta, R, 2015, J Nepal Health Res Counc
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Challenges reported in 5 articles included the labor-intensive process of scheduling video consultation appointments within and across organizations and the need to redesign organizational processes around the technology [2,36-38,40].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In contrast, centralized funding for video consulting in the Veterans Health Administration in the United States meant that the “availability of national support infrastructure and the absence of billing for services were distinct advantages” [37].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [37] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Even when the political environment was more stable, papers reported that national strategies did not always emphasize the potential for scale-up and spread against other priorities. Take the following report from an evaluation in Norway, which suggests that national approaches “were mainly focused on messaging services and electronic exchange, while less attention was paid towards telemedicine”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [36] source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, in a scale-up of 4 video consulting services, the challenges and opportunities for each service were connected across the domains; simply assessing a patient as having a theoretically appropriate condition for video consulting (micro) and having a supportive national policy (macro) did not guarantee success.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [2] Shaw, S, 2018, Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study
- Not checked yetcites [38] source
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In the paper
“In a UK study, the authors reported that, although lack of clarity on remuneration was often raised as a key barrier by implementing teams, published policy documents rarely explained how “reimbursement for virtual consultations would be implemented” [38].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [38] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The absence of consistent theorization was demonstrated in this review by the absence of consideration of how challenges and opportunities might interact with each other and influence the process.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
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None of the sources cited for this claim have been checked yet.
In the paper
“There are gaps in the existing evidence on the spread and scale-up of video consulting. This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The absence of mention of specific interorganizational initiatives in the reviewed papers indicates that such initiatives were not present or studied in the included studies.
None of the sources cited for this claim have been checked yet.
In the paper
“Findings also raised a number of challenges including the following: technically challenged staff, resistance to change, cost, reimbursement, and patient characteristics [24], as well as project management, patient recruitment, leadership involvement, funding, absence of a long-term strategic plan, resistance to change, workflow changes, lack of resources, and liability [64-66].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Findings from the review pointed to potential enablers of the spread and scale-up of video consulting services, notably regarding the influence of the presence of a telehealth champion, especially during initial spread [63], as well as leadership at multiple levels, appropriate reimbursement mechanisms, user-friendly technology, pre-existing relationships between staff [64], and adaptation (of”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There is also limited data on the material properties and design of different video consulting platforms, and on the value proposition in relation to spread and scale-up when a technology is free (eg, part of a research study) in the place where it was initially developed or implemented, but potentially costly in other settings.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The review also reveals an absence of concrete operationalization and theorization of scale-up and spread, exemplified by the absence of analysis and concrete definitions and terminology, as well as a lack of appreciation of complexity (particularly, but not only, in relation to the clinical condition and organizational implementation).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
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In the paper
“Furthermore, the authors emphasized how measuring and assessing outcomes of implementation and sustainability then sharing those results with stakeholders “increases motivation and momentum for practice change and enables site to respond to challenges in real time” [42].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [42] source
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In this implementation project, resiliency and sustainability were enabled by introducing video consulting into general practice rather than training specific providers and using a flexible implementation approach that can be modified for different health system contexts.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [42] source
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The trials that have been undertaken on video consulting have provided few or no data on the organizational complexities of implementing a technology-based service, and do not address the question of how video consultation services become embedded in real-world settings.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The studies we reviewed are broadly positive about video consulting.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The application of the NASSS framework surfaced complexity in a number of domains, notably characterizing the importance of organizational support and the wider system in the scale-up and spread of video consulting services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Conclusions
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In the paper
“Other frameworks do exist that might support spread and scale-up (see [24] for an overview) but they have yet to be taken up in the context of expanding video consulting.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
What the sources say
- Not checked yetcites [24] source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Studies have drawn on specific implementation frameworks to support and theorize spread and scale-up of video consulting, with a mechanistic logic of change being dominant.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear? Based: unclearIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, there have been only a handful of rigorous and theoretically grounded qualitative or mixed methods studies that explore the emergence of video consultation services naturalistically. Such studies have yet to systematically study spread and scale-up beyond the initial implementation.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclearIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Prior reviews have also focused exclusively on the technical aspects of video consulting technology [7]; considered technologies at any stage of implementation, rather than technologies with widespread adoption [24]; or restricted the types of articles included in the review to randomized control trials [78].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Additionally, reviews have focused on telemedicine or eHealth in general without focusing on video consulting [24,77], with which our findings are consistent.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Comparison With Prior Work
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies tend to be small scale and focus on initial adoption in a research context [2,5,18]; adopt a technology-centric approach (in which the technology is the primary focus, rather than the service or organization by which the technology is being used); and use trial methodology to study whether video consultation technology works or not.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Introduction
What the sources say
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In the paper
“The COVID-19 pandemic, and the requisite need for self-isolation and social distancing, has prompted rapid and widespread adoption of video consultations [4].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Introduction
What the sources say
- Not checked yetcites [4] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“There is a rapidly growing literature on the feasibility, safety, acceptability, and effectiveness of video consultations across clinical areas [5] including diabetes [6,7], rehabilitation [8,9], mental health and addiction [10], cancer [11], palliative care [12,13], long-term care [14], geriatrics [15], postpartum support [16], and primary care [17].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Introduction
What the sources say
- Not checked yetcites [5] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“We worked inductively to surface the challenges to and opportunities for the spread and scale-up of video consulting across studies. Sensitized by the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) of health and care technologies framework [23], we then worked deductively to ensure we had not missed any of the 7 domains identified as relevant to the”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Data Extraction and Synthesis
What the sources say
- Not checked yetcites [23] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We piloted and refined this process on one paper and then extended the process across the rest of our data set.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Data Extraction and Synthesis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“We referenced our initial search strategy against two published systematic reviews on telegenetics [28] and implementation science [29] to identify supplementary terms.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Information Sources and Search Strategy
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In December 2018, we systematically searched 3 databases: PubMed, CINAHL via EBSCOhost, and Web of Science. The search was updated in March 2020.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Information Sources and Search Strategy
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Included articles were peer-reviewed and reported on synchronous, video-supported consultations that had been scaled or spread to more than one setting beyond the initial pilot or feasibility stage (either within the same organization or to other organizations or geographic settings).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Eligibility Criteria
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In the paper
“Using content analysis, we compiled a descriptive overview of the opportunities and challenges identified in the papers, including frequency distributions. We then applied a more analytical lens to synthesize and interpret our findings using the NASSS framework [23].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Data Extraction and Synthesis
What the sources say
- Not checked yetcites [23] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our search strategies, developed with the help of a research librarian, used a mix of keywords, Medical Subject Headings (MeSH), and Major Headings (MH), as provided in Multimedia Appendix 2.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Information Sources and Search Strategy
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each record was first screened by title and abstract (initially by HJ, then verified by JW and SS). Remaining articles were screened by reading the full texts (HJ screening 100%, SS a 15% sample), with any disputes resolved through discussion and consensus with JW.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Screening
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used to draft the protocol for this review (unpublished) and PRISMA guidelines were consulted throughout the review as a guide.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Information Sources and Search Strategy
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Spread, scale-up, and sustainability are often used as interchangeable terms without a standard definition or adequate theorization (see Multimedia Appendix 1).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Introduction
What the sources say
- Not checked yetcites Multimedia Appendix 1
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Articles exclusively reporting use, feasibility, acceptance, or pilot implementation with no evaluation of the implementation process were excluded.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Methods > Eligibility Criteria
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None of the sources cited for this claim have been checked yet.
In the paper
“They also indicate that the same things that interfere with implementation at one site [eg, 48] are also seen as interfering with spread and scale-up [5,7,17,24], although this may be an artifact of how spread is commonly studied as the sum of multiple implementations.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
What the sources say
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The strengths of this review include the comprehensive searching methods used to identify a breadth of published research (albeit limited in numbers and scope).”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Limitations
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In the paper
“Publication bias is a long-standing and recognized phenomenon in health research [71] and likely impacts the broadly positive results across studies included in this review.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Limitations
What the sources say
- Not checked yetcites [71] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the lack of theorization in the included studies, it is hard to know how broadly the factors that may have acted as challenges or opportunities were considered in the evaluations.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Limitations
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The consequence of this is that we cannot claim that this evidence provides a conclusive list of the challenges to scale-up and spread generally, nor even specifically to the studies included in this review.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Limitations
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This review is limited by likely bias within the articles, bias inherent in the reviewing process, and the lack of theorization in the included studies.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Limitations
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This suggests that the wider context of the COVID-19 pandemic might similarly enable widespread adoption of video consulting services.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Principal Results
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The analysis and synthesis of the listed challenges has also been framed by a comprehensive theoretical framework.”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Discussion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The final domain, embedding and adaptation over time, focuses on the scope for adaptation and the resilience of the organization in the face of implementation and potential spread and scale-up [23].”
§ Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework > Results > Challenges to Scale-up, Spread, and Sustainability
What the sources say
- Not checked yetcites [23] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
The absence of mention of specific interorganizational initiatives in the reviewed papers indicates that such initiatives were not present or studied in the included studies.
“None of the papers mentioned specific interorganizational initiatives (eg, quality improvement collaboratives). This was a surprising silence given the recognized importance of interorganizational networking for the spread of innovation [44,55,61].”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Most such studies lacked descriptive detail; both the clinical condition and the technology were often described in bland and brief ways, omitting the nuances that might have explained variations in findings across studies (116)”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [116]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting counts for telehealth champions as an opportunity
MajorThe results count champions or coordinators as an opportunity in 8 articles, but later say that 11 articles reported telehealth champions helping manage organizational complexity.
“The most common opportunities included the availability of clinical and/or nonclinical telehealth champions or coordinators (n=8)”
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
Study [32] described as both challenges-only and covering opportunities
MinorThe results classify article [32] as reporting challenges exclusively, while the review elsewhere describes that article as an overview of both opportunities and challenges.
“2 (15%) reported challenges exclusively [32,36]”
“Bhatta et al [32] presented a descriptive overview of opportunities and challenges for telemedicine in Nepal”
Citations
Cites
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009) · Implementation Science · doi:10.1186/1748-5908-4-50 · Cited by 14,496
Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations
GREENHALGH, T., ROBERT, G., MACFARLANE, F., BATE, P., & KYRIAKIDOU, O. (2004) · The Milbank Quarterly · doi:10.1111/j.0887-378x.2004.00325.x · Cited by 7,448
Self-citationEvaluating the public health impact of health promotion interventions: the RE-AIM framework.
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.9.1322 · Cited by 7,217
Publication bias in clinical research
Easterbrook, P. J., Gopalan, R., Berlin, J. A., & Matthews, D. R. (1991) · The Lancet · doi:10.1016/0140-6736(91)90201-y · Cited by 3,109 · cited 1×
“Publication bias is a long-standing and recognized phenomenon in health research [71] and likely impacts the broadly positive results across studies included in this review.”
BackgroundGreenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8775 · Cited by 2,887 · cited 10×
“We synthesized the data extracted from the 13 articles according to the 7 domains of the NASSS framework [23] (Figure 1).”
BackgroundMethodInfluentialSelf-citationEvaluating barriers to adopting telemedicine worldwide: A systematic review
Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x16674087 · Cited by 1,735
The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change
Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013) · Implementation Science · doi:10.1186/1748-5908-8-117 · Cited by 1,724
Telehealth and patient satisfaction: a systematic review and narrative analysis
Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016242 · Cited by 1,350
Grounded Theory: A Practical Guide
Bryan, R. R. (2011) · Adapted Physical Activity Quarterly · doi:10.1123/apaq.28.3.277 · Cited by 1,325
Harvey, G., & Kitson, A. (2015) · Implementation Science · doi:10.1186/s13012-016-0398-2 · Cited by 1,271
Flagged first, then by citations
Research works printed but not linked: 3
- Bhatta, R, 2015, J Nepal Health Res Counc, 13, 149
- Rodgers, EM, 1983, Diffusion of Innovations. 3rd edition
- Bradford, N, 2016, Rural Remote Health, 16, 4268
Cited by
Sorted by citations
Klaic, M., Kapp, S., Hudson, P., Chapman, W. W., Denehy, L., Story, D., & Francis, J. (2022) · Implementation Science · doi:10.1186/s13012-021-01171-7 · Cited by 443
Greenhalgh, T., Rosen, R., Shaw, S. E., Byng, R., Faulkner, S., Finlay, T., Grundy, E., Husain, L., Hughes, G., Leone, C., et al. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.726095 · Cited by 173
Self-citationAlami, H., Lehoux, P., Papoutsi, C., Shaw, S. E., Fleet, R. P., & Fortin, J. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-11112-x · Cited by 104
Self-citationDyb, K., Berntsen, G. R., & Kvam, L. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06262-1 · Cited by 67
Adoption of Machine Learning Systems for Medical Diagnostics in Clinics: Qualitative Interview Study
Pumplun, L., Fecho, M., Wahl, N., Peters, F., & Buxmann, P. (2021) · Journal of Medical Internet Research · doi:10.2196/29301 · Cited by 57
Metadata
- Authors
- James, H. M., Papoutsi, C., Wherton, J., Greenhalgh, T., & Shaw, S. E.
- Affiliations
- University of Waterloo (CA)
- University of Oxford (GB)
- Corresponding author
- Shaw, Sara E
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2021-01-26
- Volume
- 23
- Issue
- 1
- Pages
- e23775
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7837451
- OpenAlex
- W3119587736
- Semantic Scholar
- 69636694919b6dbba62313f2fadad76cf78164f6
- Cited by
- 164
- References
- 85
- Citations by year
- 2026: 18 · 2025: 21 · 2024: 34 · 2023: 47 · 2022: 29 · 2021: 15
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wellcome Trust (WT104830MA, 104830/Z/14/Z)
- National Institute for Health and Care Research (BRC-1215–20008, NIHR- BRC-1215-20008)
- Department of Health and Social Care
- University of Waterloo
- Economic and Social Research Council (ES/V010069/1)
- NIHR Sheffield Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Geriatrics and Gerontology › Technology Use by Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
- Keywords
- video consultation, telemedicine, scale-up, spreads, sustainability, NASSS framework, remote care, hub and spoke model, reimbursement, resistance to change, technology adoption, primary care, rehabilitation, mental health, geriatrics, cancer surgery, diabetes mellitus, organizational factors, health policy
- MeSH terms
- COVID-19, SARS-CoV-2, Delivery of Health Care, Humans, Primary Health Care, Telemedicine, Videoconferencing, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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