Tele-medicine, before tele- is medicine, with all that comes with it.

The systematic adoption of telemedicine cannot ignore a number of aspects that must be considered and planned. Telemedicine is not just a technology.

The risk of transforming telemedicine into a technological totem capable of making the health system more modern and effective is very high. Driven by enthusiasm, many doctors, technicians and even patient associations believe that the adoption, sic et simpliciter, of telemedicine is in itself an indisputable advantage that must be pursued without delay.

If we do not want to repeat, even with telemedicine, the same mistakes we have already made with other medical technologies and paradigms, it is necessary to place this practice in the overall context of the health system. In other words, telemedicine is not the end, that is to say, an innovation in itself, but it can be a tool with which to achieve a valuable innovation.

It is therefore necessary to start from the scenarios that design the health care of the future and to understand how telemedicine can play an enabling role or, in some cases, be decisive.

Depending on the scenarios, it is then necessary to define the models to implement them. Models concerning clinical, care and organisational aspects.

Only after defining the models it is possible to identify the tools that are necessary and that may concern infrastructures, devices, applications.

From the models then comes the set of rules that must be defined or met to ensure that the solutions chosen are compliant with the regulations and consistent with the professional roles and responsibilities that derive from them. The paradigm shift in the way of doing medicine raises a series of problems that are not present in traditional models, for example the concept of “continuous taking charge” that tele-health entails.

Telemedicine then touches the professionals called to use it, but also the patients who have to use it or who, in turn, are users. It should not be taken for granted that all of them will be able to cope with this change on their own. We need information, training and support if we want to avoid widening the gap that already exists between people.

In addition to all this, the sustainability of telemedicine must also be addressed. How and where to find the funds to finance it? What rates to apply? If we want to look at telemedicine in the broadest sense of the term and not limit ourselves to televisit, as many people are doing, then we need to set rates that include a whole range of new services or underperformances.

If additional resources are to be found, however, it is essential to think about the value that telemedicine-based models can determine, what benefits and savings they can bring. One cannot ignore the problem, as many do, thinking that telemedicine is in itself convenient for the health care system. Some models can certainly be, but only if they are well designed and produce synergies with the current health system. It is therefore necessary to identify indicators with which to measure before and evaluate the impact of these new models afterwards.

And then there’s the market. We need a process of demand qualification and the development of procurement models that go in the direction of generating value for the healthcare system. The offer must rethink its products and services avoiding the design of islands or separate silos, detached from the company or regional information systems. Interoperability should not be an addendum but an integral part of the architectures of these solutions and based on the most modern standards (HL7 FHIR). Quality must also be improved and brought to the level of industrial products.

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