Designing telemedicine apps that health commissioners will adopt

In countries with a national health service, new telemedicine and telehealth products and services are `commissioned' according to a fairly rigorous and regulated process, that usually involves pilot studies and the assembly of `evidence' to show that the innovation offers performance and/or cost advantages. This is problematic for several reasons and means that many innovations are piloted and performance evaluated, but relatively few pass into mainstream adoption. The current relationship between healthcare commissioners and technology developers is adversarial rather than collaborative. Evaluations and regulatory systems place the responsibility with the developer to prove that the solution works - in other words, to refute the assumption that the solution may not be appropriate. Furthermore, with telemedicine innovations the `user' and the `customer' is not a single individual or organisation - the healthcare professional, the patient (and perhaps carer, family or friends), as well as the organisation itself are all involved. A conventional evaluation ignores the organisationally disruptive aspect of the technology. A better question than `does it work?' would be `how can we use it?' This paper reviews barriers to adoption and considers the particular issues that developers of telemedicine apps need to address. We propose the Stakeholder Empowered Adoption (SEA) Model, as a process that builds stakeholder (staff and patients, managers, technologists) perspectives into the specification and early design stages and uses scenario modelling and simulations to avoid dependence on actual prototypes. The model recognises that the main economic stakeholders (the health organisation commissioning the innovation and the technology provider) need to drive the process, but end users (professionals and patients) are critical t