A sociotechnical framework for integration of telehealth into clinical workflow

Telehealth has received attention in recent years for improving access to healthcare and for supporting integrated care for chronic diseases. Considering that telehealth integration into clinical workflow can alter healthcare providers’ practice patterns, impacting efficiency, quality of care, and patient safety, it is timely to identify and account for system-level variables and considerations to improve the efficiency of telehealth integrations in healthcare settings. Despite the growth of telehealth, and isolated efforts to identify such considerations, a comprehensive conceptual framework for telehealth clinical integration is largely absent. To address this gap, this research effort applied a mixed methods approach to develop a sociotechnical framework to serve as a roadmap for clinics, hospitals, and other healthcare settings regarding the components that must be considered when developing and implementing a telehealth system. The developed framework, System Adoption and Integration of New Telehealth Systems (SAINTS), is grounded in literature and insights from three telehealth case studies in healthcare settings, is influenced by well-grounded sociotechnical models with application in complex healthcare systems, incorporates model-based systems engineering language for the development of structural models, and has been structured considering three temporal stages: system preparation, patient enrollment, and system implementation.