The Doctor Is In: Why Does Telemedicine Look So Easy, But Is So Hard To Do?

Dr. Robert Cuyler

A walk through the exhibit hall at the recent American Telemedicine Association conference in Austin offered a spectacular tour of the latest health technologies and services. Almost all of the solutions feature high-definition displays of medical images that transport some aspect of medical care from distant locations to the doctor. From medical imaging to direct, real-time examinations of patients, these solutions promise unprecedented ease of access to care.

However, these compelling technologies may create fantasies of instantly-improved healthcare for the purchaser. The translation from exhibit hall to the field is more daunting than meets the eye. Telemedicine implementation holds some special challenges that many end users underestimate.

Here are a few reasons why:

An estimated 70 percent of technology implementations fail to meet management expectations when launched under the same roof of a single organization. Telemedicine projects, by contrast, characteristically involve:

  • Multiple organizations, often unrelated or distantly related, whose strategies, goals and organizational cultures may be more or less ‘in sync’ with one another
  • Independent management, medical and information technology personnel, whose sophistication, motivations and access to resources may be quite different (think well-resourced major medical center and a small rural hospital linked via telemedicine)
  • Different Electronic Medical Record Systems that don’t yet deliver interoperability
  • A highly complex and rapidly changing regulatory and reimbursement climate

For those who look at new telemedicine technologies and services and ask themselves, “how hard could this be?,” the answer is often, “much more complicated than it looks.”

Throughout this blog series, we’ve used the metaphor of the theatre to frame the essentials of telemedicine implementation. Think of a new play, simulcast between a big city and a small town, co-produced by a well-financed off-Broadway company and a dinner theatre team, and delivered in high-definition to multiple audiences.

If you think this play will need highly-coordinated planning, clear scripting and multiple dress rehearsals, you’re right.  If you think your telemedicine project will take less, please reconsider.

Robert N. Cuyler, PhD is President of Clinical Psychology Consultants Ltd, LLP, a consulting firm focused on telemedicine strategy and implementation.  He and Dutch Holland, PhD are co-authors of the book ‘Implementing Telemedicine: Completing Projects on Target On Time On Budget’.  He can be reached at

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