Telemedicine is a way to improve healthcare outcomes with greater efficiency for both patients and care providers. The great potential of digital technologies also lies in strengthening the patient-centered approach. The early successes and benefits of telemedicine in the Czech Republic, amplified by the COVID-19, have contributed to the fact that wider implementation of telemedicine is already generally supported at the expert and public levels. Our research focuses on the identification of key issues in the implementation of telemedicine and the challenges of telemedicine in the future, from the perspective of patients and other stakeholders. The study is based on a qualitative research approach, combining focus groups with key stakeholders, patient panels and expert panels (2021-2022). The lack of rules and uncoordinated development of various activities proved to be the main barriers to the integration of telemedicine in the health system. This regulatory uncertainty can generate a number of problems in the patient-doctor relationship in practice, including ethical ones, and can also lead to inequalities in access to healthcare and affect the overall quality of care provided. Furthermore, it has been shown that patients' interests in the implementation of telemedicine are: 1. a predictable and reliable framework that guarantees them certainty and security in the provision of telemedicine services, 2. telemedicine solutions that increase the availability and efficiency of the care provided while bringing comfort, and 3. user-friendly and simple solutions. At the same time, patients want to understand the new environment and be active participants in the process of digital innovation, including the practical implementation of telemedicine. The research team has developed recommendations for further developments in the implementation of telemedicine that reflect the patient's interest and can be implemented at three levels - the health system, institutional, and community level. In countries with a well-developed and institutionalized patient movement, the community level can be represented by patient organizations, thus becoming the link between telemedicine policy making and implementation at the individual level of healthcare provision. For the further development of telemedicine, the development of a national strategy involving all key stakeholders, including patients, in the implementation has proven essential.

Ernst and Young s r o Prague Czechia

Institute of Public Health and Medical Law 1st Faculty of Medicine Charles University Prague Czechia

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Cannavacciuolo L, Capaldo G, Ponsiglione C. Digital innovation and organizational changes in the healthcare sector: multiple case studies of telemedicine project implementation. Technovation. (2023) 120:102550. doi: 10.1016/j.technovation.2022.102550 DOI

Mitchell M, Kan L. Digital technology and the future of health systems. Health Syst Reform. (2019) 5:113–20. doi: 10.1080/23288604.2019.1583040 PubMed DOI

Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: evidence from the field. J Am Med Inform Assoc. (2020) 27:1132–5. doi: 10.1093/jamia/ocaa072 PubMed DOI PMC

Garattini L, Badinella Martini M, Zanetti M. More room for telemedicine after COVID-19: lessons for primary care? Eur J Health Econ. (2021) 22:183–6. doi: 10.1007/s10198-020-01248-y PubMed DOI PMC

Act No. 325/2021 Coll., on the Electronization of Healthcare. Available at: https://www.zakonyprolidi.cz/cs/2021-325 (Accessed February 17, 2023).

Bajowala SS, Milosch J, Bansal C. Telemedicine pays: billing and coding update. Curr Allergy Asthma Rep. (2020) 20:60. doi: 10.1007/s11882-020-00956-y PubMed DOI PMC

Schinasi DA, Foster CC, Bohling MK, Barrera L, Macy ML. Attitudes and perceptions of telemedicine in response to the COVID-19 pandemic: a survey of Naïve healthcare providers. Front Pediatr. (2021) 9:647937. doi: 10.3389/fped.2021.647937 PubMed DOI PMC

Dahlgren C, Spånberg E, Sveréus S, et al. . Short- and intermediate-term impact of DTC telemedicine consultations on subsequent healthcare consumption. Eur J Health Econ. (2023) 23:1572. doi: 10.1007/s10198-023-01572-z PubMed DOI PMC

Alexa J, Recka L, Votapkova J, van Ginneken E, Spranger A, Wittenbecher F. Czech Republic: health system review. Health Syst Transit. (2015) 17:1–165. PubMed

Dlouhý M. Measuring geographic inequalities: dealing with multiple health resources by data envelopment analysis. Front Public Health. (2018) 6:53. doi: 10.3389/fpubh.2018.00053 PubMed DOI PMC

Baumann LA, Brütt AL. Public and patient involvement (PPI) in health policy decisionmaking on the health system-level: protocol for a systematic scoping review. BMJ Open. (2021) 11:e043650. doi: 10.1136/bmjopen-2020-043650 PubMed DOI PMC

Dobiášová K, Kotherová Z, Numerato D. Institutional reforms to strengthen patient and public involvement in the Czech Republic since 2014. Health Policy. (2021) 125:582–6. doi: 10.1016/j.healthpol.2021.03.011 PubMed DOI

NAPO. O NAPO. [About NAPO]. (2023) Available at: https://silapacientu.cz/o-napo/ (Accessed February 17, 2023).

Act No. 372/2011 Coll., on Health Services and Conditions of Their Provision (Act on Health Services). Available at: https://www.zakonyprolidi.cz/cs/2011-372 (Accessed February 17, 2023)

Ministerstvo zdravotnictví. Pacientská rada. Portál pro pacienty a pacientské organizace [Ministry of Health. Patient’s council. Patients and patient’s organizations portal]; 2020. Available at: https://pacientskeorganizace.mzcr.cz/index.php?pg=pacientske-organizace–pacientska-rada (Accessed February 17, 2023). Czech.

Ministerstvo zdravotnictví. Statut a jednací řád pacientské rady ministra zdravotnictví. Příloha k příkazu ministra č. 15/2017 [Ministry of Health. Patient’s Council’s Statutes and Rules of Procedure. Attachment to ministerial direction no. 15/2017.]. Praha: MZ ČR; 2017. Available at: https://pacientskeorganizace.mzcr.cz/res/file/dokumenty/pacientska-rada-statut-jednaci-rad-20170727.pdf (Accessed February 17, 2023). Czech.

Act No. 371/2021 Coll. Amendment to Act No. 372/2011 Coll., effective from 1 January 2022. Available at https://www.zakonyprolidi.cz/cs/2021-371: (Accessed February 17, 2023)

Kitzinger J. (2006). Focus groups. Pope C., Mays N. (Eds.), Qualitative research in health care (21–31). Blackwell Publishing; BMJ Books.

Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. (2006) 29:489–97. doi: 10.1002/nur.20147 PubMed DOI

Wilkerson JM, Iantaffi A, Grey JA, Bockting WO, Rosser BR. Recommendations for internet-based qualitative health research with hard-to-reach populations. Qual Health Res. (2014) 24:561–74. doi: 10.1177/1049732314524635 PubMed DOI PMC

Clarke V., Braun V., Hayfield N. (2015) Thematic analysis. Smith J.A., (Ed.), Qualitative psychology: A practical guide to research methods, SAGE Publications, London, 222–248

Price A, Schroter S, Snow R, et al. . Frequency of reporting on patient and public involvement (PPI) in research studies published in a general medical journal: a descriptive study. BMJ Open. (2018) 8:e020452. doi: 10.1136/bmjopen-2017-020452 PubMed DOI PMC

Koskinas E, Gilfoyle M, Salsberg J. Exploring how patients, careers and members of the public are recruited to advisory boards, groups and panels as partners in public and patient involved health research: a scoping review protocol. BMJ Open. (2022) 12:e059048. doi: 10.1136/bmjopen-2021-059048 PubMed DOI PMC

Konference Digitální medicína (nejen) pro pacienty. [Conference Digital medicine (not only) for patients]. 1.LF UK. Akademie věd ČR, 30. 11. 2021, Praha. Available at: https://www.youtube.com/watch?v=T5Ig66OZdWo

WHO World Health Organization . (2021). Global strategy on digital health 2020–2025. Available at: https://apps.who.int/iris/handle/10665/344249 (Accessed January 7, 2023).

Mucha C, Býma S, Šonka P. A kol. Telemedicína. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. [Telemedicine. Recommended diagnostic and therapeutic procedures for general practitioners]. Společnost všeobecného lékařství, (2020). Available at: www.svl.cz/files/files/Doporucene-postupy/2020/DP-Telemedicina.pdf (Accessed January 7, 2023).

Shaw JA, Donia J. The sociotechnical ethics of digital health: a critique and extension of approaches from bioethics. Front. Digit. Health. (2021) 3:725088. doi: 10.3389/fdgth.2021.725088 PubMed DOI PMC

Adjekum A, Blasimme A, Vayena E. Elements of trust in digital health systems: scoping review. J Med Internet Res. (2018) 20:e11254. doi: 10.2196/11254 PubMed DOI PMC

Landers C, Vayena E, Amann J, Blasimme A. Stuck in translation: stakeholder perspectives on impediments to responsible digital health. Front. Digit. Health. (2023) 5:1069410. doi: 10.3389/fdgth.2023.1069410 PubMed DOI PMC

Lazárová M, Hlavinka A, Šulc P, Dodulík J, Václavík J. Využití telemedicíny u pacientů se srdečním selháním (the use of telemedicine in patients with heart failure). Vnitr Lek. (2022) 68:154–8. doi: 10.36290/vnl.2022.031 PubMed DOI

Eze ND, Mateus C, Cravo O, Hashiguchi T. Telemedicine in the OECD: an umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One. (2020) 15:e0237585. doi: 10.1371/journal.pone.0237585 PubMed DOI PMC

OECD (2023), The COVID-19 pandemic and the future of telemedicine, OECD Health Policy Studies, OECD Publishing, Paris.

Chang JE, Lindenfeld Z, Albert SL, Massar R, Shelley D, Kwok L, et al. . Video visits during COVID-19: safety-net provider perspectives. J Am Board Fam Med. (2021) 34:1103–14. doi: 10.3122/jabfm.2021.06.210186 PubMed DOI

Berry CA, Kwok L, Massar R, Chang JE, Lindenfeld Z, Shelley DR, et al. . Patients’ perspectives on the shift to telemedicine in primary and behavioral health care during the COVID-19 pandemic. J Gen Intern Med. (2022) 37:4248–56. doi: 10.1007/s11606-022-07827-4 PubMed DOI PMC

Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of telemedicine during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak. (2022) 22:207. doi: 10.1186/s12911-022-01952-0 PubMed DOI PMC

Opatrný M, Šlegerová L, Táborský M, Bolcha P. Telemedicine services: barriers and the possible development in the Czech Republic. Working paper. (2022). Anglo-American University. Czech Republic. Available at: https://www.aauni.edu/. (Accessed January 7, 2023).

Agha Z, Roter DL, Schapira RM. An evaluation of patient-physician communication style during telemedicine consultations. J Med Internet Res. (2009) 11:e36. doi: 10.2196/jmir.1193 PubMed DOI PMC

Pogorzelska K, Marcinowicz L, Chlabicz S. A qualitative study of primary care physicians’ experiences with telemedicine during the COVID-19 pandemic in north-eastern Poland. Int J Environ Res Public Health. (1963) 2023:20. doi: 10.3390/ijerph20031963 PubMed DOI PMC

Černý D. Etika telemedicíny. The ethics of telemedicine Čas Lék čes. (2021) 160:282–6.

Solimini R, Busardò FP, Gibelli F, Sirignano A, Ricci G. Ethical and legal challenges of telemedicine in the era of the COVID-19 pandemic. Medicina. (2021) 57:1314. doi: 10.3390/medicina57121314 PubMed DOI PMC

Escobar O, Leone D, Malafronte P, Mele S. The effect of telemedicine on patients’ wellbeing: a systematic review. J. Innov. Econ. Manag. (2021) 35:9–31. doi: 10.3917/jie.pr1.0098 DOI

Meskó B, deBronkart D. Patient design: the importance of including patients in designing health care. J Med Internet Res. (2022) 24:39178. doi: 10.2196/39178 PubMed DOI PMC

Hartasanchez SA, Heen AF, Kunneman M, García-Bautista A, Hargraves IG, Prokop LJ, et al. . Remote shared decision making through telemedicine: a systematic review of the literature. Patient Educ Couns. (2022) 105:356–65. doi: 10.1016/j.pec.2021.06.012 PubMed DOI

Pappas Y, Vseteckova J, Mastellos N, Greenfield G, Randhawa G. Diagnosis and decision-making in telemedicine. J Patient Exp. (2019) 6:296–304. doi: 10.1177/2374373518803617 PubMed DOI PMC

Otto L, Schlieter H, Harst L, Whitehouse D, Maeder A. The telemedicine community readiness model – successful telemedicine implementation and scale-up. Front Digit Health. (2023) 5:1057347. doi: 10.3389/fdgth.2023.1057347 PubMed DOI PMC

Zhang Y, Chandra S, Peña MT, Lal L, Summers RL, Swint JM. Framework for evaluating and developing sustainable telehealth programs. Telemed J E Health. (2023) 29:1421–5. doi: 10.1089/tmj.2022.0407 PubMed DOI

Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic

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