Pathways to optimize a pediatric telemedicine and medication delivery service: A multi-level qualitative study in Haiti.

Telemedicine has secured a permanent role in healthcare delivery worldwide; however, scaling novel telemedicine applications presents challenges. Among the many emerging initiatives is the telemedicine and medication delivery service (TMDS) that our team established in Haiti to enable early access to pediatric care. To gain deeper insights into the challenges associated with scaling a TMDS, we conducted focus group discussions and administered written questionaries to TMDS staff, including physicians, nurses, and medication delivery drivers. We employed framework matrix analysis to identify and summarize insights into the challenges and opportunities associated with the TMDS model. We found key areas for improvement relate to obtaining quality information from virtual exams, the reliability of technology and communication infrastructure, the conditions required for effective in-person exams, the limited scope of the workflow and clinical resources, and long-term sustainability. These findings led to the development of essential action items, categorized into three domains: conceptual, physical and mission oriented. These action items will guide our internal efforts to scale the TMDS and hopefully catalyze improvements among similar telemedicine initiatives.