A guide to utilisation and sustainment of telemedicine: Answering the question, 'what is in it for me?'

Despite a general consensus that many healthcare needs can be addressed through telemedicine, most telemedicine systems remain underutilised and provision of services are difficult to sustain. Five steps for establishing baseline utilisation and assuring long-term growth and sustainability are outlined along with field-tested techniques for achieving each. The five steps are identifying strategic partners, developing local champions, engaging the project team, securing executive buy-in, and garnering community support. Techniques for achieving each are based upon over eight years of experience in building telehealth programmes. Founded in exchange theory and reliant upon community development and mobilisation methods, these techniques aim to answer the question, 'What is in it for me?' at the individual, organisational, community, and societal levels. To achieve each step, techniques are described for assessing and responding to the relative value of money, power and prestige for each level and key player. Effectively implemented, this approach assures that once the 'deal is sealed' the leadership understands the risks and the opportunities, and the people on the ground floor have the resources and dedication to succeed. Scenarios based in real life experience are presented that demonstrate the ramifications of using and omitting some of these techniques. When fully implemented, these techniques result in projects that are built upon strong partnerships that distribute the risks, share resources and support multiple uses of the technology. In addition, the role of each partner - whether an individual, organisation or community - is aligned with its respective mission and strategic direction. The scenarios presented are based upon three projects for which these techniques were applied. A case study approach is used to describe the real world application of these steps in building strategic alliances between an academic health science centre and three universities. The first telemedicine alliance is being sustained, but is not growing. The second continues to grow and thrive. The third was never implemented.