Challenges and solutions for implementing telemedicine in Iran from health policymakers' perspective

BACKGROUND

Despite significant progress in health technology and growing interest among countries in incorporating telemedicine into healthcare delivery, its usage remains limited in Iran. The aim of this study is to investigate the challenges related to telemedicine in Iran and pinpoint potential solutions from the viewpoint of health policymakers, marking the first such endeavor.

METHODS

This qualitative study was conducted in Iran in 2022. Data were gathered from 19 health policymakers who were selected using purposeful and snowball sampling techniques via in-depth and semi-structured interviews. The research findings were analyzed using the content analysis technique, with coding performed using MAXQDA software. The content analysis approach developed by Erlingsson was utilized to analyze the data.

RESULTS

The study revealed eight main challenges that inhibit the widespread use of telemedicine in Iran. These challenges include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Furthermore, four key solutions to these challenges were identified. These include a national commitment to the development of telemedicine, the establishment of a telemedicine roadmap, the enhancement of e-health requirements and infrastructure, and the preparation of the community to accept telemedicine as a viable option for healthcare delivery.

CONCLUSION

The implementation of telemedicine in Iran faces significant challenges, some of which are related to the national healthcare system, while others stem from various policy-related institutions and organizations. Addressing these challenges will require extensive inter-organizational cooperation and strong leadership at the governance level. However, it should be noted that fully resolving these issues is a time-consuming process.

Exploring the intersection of hermeneutics and implementation: a scoping review

BACKGROUND

An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices.

METHODS

We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components.

RESULTS

Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation.

CONCLUSIONS

Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation.

TRIAL REGISTRATION

The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.

The facilitators and barriers to implementing patient reported outcome measures in organisations delivering health related services: a systematic review of reviews

Background

There is increasing interest in using Patient Reported Outcome Measures (PROMs) within organisations delivering health related services. However, organisations have had mixed success in implementing PROMs and there is little understanding about why this may be. Thus, the purpose of this study was to identify the facilitators and barriers to implementing PROMs in organisations.

Method

A systematic review of reviews was undertaken. Searches were conducted of five electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews, during the week of the 20th February 2017. Additional search methods included website searching and reference checking. To be included, a publication had to be a review of the literature, describe its methods and include information related to implementing PROMs. The reviews were extracted using a standardised form and assessed for their risk of bias using the Risk of Bias in Systematic Reviews tool. The findings were synthesised using the Consolidated Framework for Implementation Research. The protocol was registered on the International Prospective Register of Systematic Reviews database (PROSPERO) (CRD42017057491).

Results

Initially 2047 records were identified. After assessing eligibility, six reviews were included. These reviews varied in their review type and focus. Different issues arose at distinct stages of the implementation process. Organisations needed to invest time and resources in two key stages early in the implementation process: ‘designing’ the processes for using PROMs within an organisation; and ‘preparing’ an organisation and its staff. The ‘designing’ stage involved organisations planning not just which PROMs to use and how to administer them, but also how the data would be used for clinical purposes. The ‘preparing’ stage involved getting an organisation and its staff ready to use PROMs, particularly persuading clinicians of the validity and value of PROMs, delivering training, and developing electronic systems. Having an implementation lead overseeing the process and developing the process based on feedback were also identified as facilitating implementation.

Conclusion

Organisations implementing PROMs need to invest time and resources in ‘designing’ the PROMs strategy and ‘preparing’ the organisation to use PROMs. Focusing on these earlier stages may prevent problems arising when PROMs are used in practice.

Electronic supplementary material

The online version of this article (10.1186/s41687-018-0072-3) contains supplementary material, which is available to authorized users.