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Roadmap for Planning Development of Telehealth Services

Oct 22, 2021 4 min read

As the use of telemedicine continues to make major inroads into the standard practice of modern health services, many hospitals and medical providers are still playing catch-up. 

A lot of them are either beginning the process of implementing a system of their own or trying to piece together fragments that already exist. This can appear to be a very daunting task. 

Therefore, in order to best help them achieve their goals, we need to understand every facet of the telehealth business model. To do this, we must first develop a telehealth business plan of our own that has concrete steps and follows a clear roadmap towards success that we can share with clients.  

This telehealth implementation plan must also keep in mind requirements of the state and limitations of their internal networks as well as the potential for monetization to other clients or systems. In this article, we’ll provide concrete steps as well as references for further information. 

Telemedicine Strategic Plan Template

In setting up a telehealth system, it’s often hard to know where to begin. 

Fortunately, there is a very good planning document that is a great starting point for developing a telehealth implementation plan. 

It was created and published by the Northeast Telehealth Resource Center (NETRC) and entitled Roadmap for Planning Development of Telehealth Services .

In the document they list a series of steps in what they believe to be the best overall structure for creating any telemedicine plan, which are:

• Evaluate needs . Take a look at your hospital or organization. What are you trying to accomplish? For example, are you trying to expand your existing telemedicine program or are you starting from scratch? Educate yourself on different approaches other hospitals have taken. 
• Develop care services plan . Go over the needs of your telemedicine plan. Think about how and where patients and doctors will be located and what security measures will be implemented to allow only credentialed users. Also consider things like how scheduling, documentation, and billing will be integrated within the system.
• Develop a business plan and risk analysis . This is a step that is critical to the process but often overlooked. In fact, lack of planning is one of the top 10 reasons most businesses fail. It’s important to determine the level of service volume that will be the “break even” point between expenses and income. Assess the costs of the service as well as how it will offset expenses in other ways.
• Train personnel . Now is the time to prepare staff for the upcoming changes to policies and procedures that come with the shift to telemedicine. Develop a program to teach the new software to doctors and medical personnel or find a specialist to help. This also includes training administrators and other staff to its uses and benefits.
• Pilot service. Once the build is ready, it is very important to have a limited rollout of the software to test for bugs as well as useability issues. Important questions to resolve are how long the trial will run, how many participants, and whether or not you will attempt reimbursement from the efforts.
• Evaluate outcomes. One of the most important things to consider is whether the telemedicine pilot program has met the same quality standards as face-to-face care. This can be done with a simple survey for both providers and patients at the end of the visit. A plan to measure long range outcomes of telehealth using data collected should also be created. 

It is recommended to begin the telehealth upgrade process slowly by creating a planning group that can assess each of these steps in an abbreviated form before diving into all the details; they can then present their findings to the board. 

This will give all the stakeholders a general idea of the feasibility of the implementation project as well as a general estimate of the costs. If necessary, adjustments to the scope and direction can be made at this time. 

The complete NETRC Roadmap has 6 pages of steps and 24 pages of resources that include links to pdfs, web pages, and videos that go into much greater detail in every area. They include sections on planning guides, room design, program evaluation, and more. 

Additional information can be found from: 

Office for the Advancement of Telehealth

Telehealth.HHS.gov

List of telehealth services payable under the Medicare Physician Fee

Other Telemedicine Business Plan Considerations

Another excellent overview is The Business Aspects of Telemedicine created by the Arizona Telemedicine Program. It has some Arizona-specific related content along with general ideas about revenue streams, expense considerations, and billing & reimbursement. 

Other things that should be considered and included in your telehealth development plan are:

• Regional requirements
• Computer and network systems
• Monetization of software products.

Regional requirements  

This is very important information to know about as each state has different demands regarding the management of private patient information as well as the creation of these types of software products. 

Therefore, the first thing the developer should ask is “where are you located?” and make the necessary preparations from there. An excellent resource is the Center for Connected Health Policy’s State Telehealth Laws & Reimbursement Policies which has information for all 50 states as well as the District of Columbia. 

Computer systems and networks

Another critical factor in the creation of a telehealth platform is the computer systems and networks it will be used on. The reality is many hospitals rely on very old computers that have slow processing speeds and very little memory. 

Therefore, when creating this software, we need to make sure that graphics-heavy pages are rendered and assembled on the server; this will put less strain on older machines and allow them to access similar information as newer ones. 

Monetization

Finally, let’s talk about making money from our hard work. We need to develop products for specific niches within the telemedicine system that are clearly defined as to who the end-user will be. 

For example, if we are developing an entire MIS (medical information system), this reaches a more general audience, like a network of hospitals or an insurance agency. 

However, if we are just developing a third-party add-on to an MIS such as video, then there is no need to spend time and money duplicating functions that already exist; the target market may also be smaller. 

This must be taken into consideration and communicated to the marketing department, so they can help us reach out to the hospitals, doctors, and systems that will be receptive to and benefit most from our services.

If you are interested in learning more about telemedicine and how S-PRO can help you develop a system for your practice or hospital, please contact us.

Igor Izraylevych

• # healthcare
• # telemedicine

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Telehealth for chronic conditions

Developing a business plan and workflow for your telehealth program.

A successful telehealth program for patients with chronic conditions requires planning, research, and an understanding of your community’s needs. Our guideline for planning your telehealth workflow  can help with additional ideas and resources.

On this page:

Is telehealth a good fit for your community, determine what type of telehealth services you will offer, research telehealth technology, advertise your telehealth program for chronic conditions.

You know your community and your patients best. Using telehealth to treat chronic conditions can be beneficial across a wide range of diverse populations throughout rural, suburban, and urban areas.

Here are a few questions to consider:

• Does a large portion of your community struggle with treatable chronic conditions, such as Type 2 diabetes or obesity?
• Do you have high rates of asthma, COPD, or other respiratory disorders?
• What percentage of your community has access to reliable internet services?
• Do you have large communities of patients typically underserved by traditional health care programs?

There are several ways to approach telehealth when it comes to treating and managing chronic health conditions.

• Appointments for follow-up care
• Sick care appointments
• Phone call appointments for patients who do not have the technology or internet access for video chats
• Remote patient monitoring
• Mental health services
• Coordination with tertiary centers in local hospitals for certain diagnostic testing and imaging
• School-based telehealth  for students with chronic conditions

Staffing reminder

You may need to hire additional staffing or re-organize your current staff schedules to accommodate your new telehealth program. You will likely need someone to support the operation of the telehealth program or portal you will use with patients. Additional staff may also be needed to handle telehealth scheduling and patient support.

You will need to plan for and put into place technology to successfully launch and sustain your telehealth care program.

Technology considerations include:

• Stable and fast internet connection
• Back up internet services, such as a mobile hotspot
• A patient portal program that allows for asynchronous communication between providers and patients
• Programs that allow you to accept data transmissions from remote patient monitoring devices, including apnea and heart monitors, weight scales, and diabetes monitoring equipment
• Online training for providers and staff for topics such as HIPAA compliance, remote patient monitoring, and health equity

Advancing Health Equity at Every Point of Contact  — from the U.S. Department of Health and Human Services (HHS)

Multiple visits to your health care provider may be the norm for some patients with chronic illness. They may not know how chronic conditions can be managed through telehealth to cut down on in-person visits.

Advertising your telehealth program for chronic conditions is the best way to get information out to your community and build your practice.

Getting the word out could include:

• Printed signage near your office
• Brochures and handouts in multiple languages for your waiting room and local community groups
• An email or phone call to your current patients
• Social media posts
• An ad in your local newspaper or magazine
• Letters or postcards to the community
• A booth or stand at community events such as health fairs or town celebrations

Tip:  Improve your telehealth program by asking for suggestions and feedback from your patients and their families. This can help you tailor your services to retain and attract new patients.

Marketing Considerations for Telehealth Programs  — from the Rural Health Information Hub

Telehealth Campaign  — from the National Rural Health Resource Center

Evaluation Measures for Rural Telehealth Programs  — Rural Health Information Hub

Business Plan Template for Telemedicine

• Great for beginners
• Ready-to-use, fully customizable Subcategory
• Get started in seconds

Launching or expanding your telemedicine services can be a game-changer for your healthcare startup or medical practice. But to make it a success, you need a solid business plan that covers all the essential aspects. That's where ClickUp's Business Plan Template for Telemedicine comes in!

This comprehensive template is specifically designed to help you outline your strategies, target patient demographics, forecast finances, plan marketing campaigns, identify technology requirements, and ensure regulatory compliance. With this template, you can confidently present your telemedicine initiative to investors and secure the funding you need to bring it to life. Don't miss out on this opportunity to revolutionize healthcare—get started with ClickUp's Business Plan Template for Telemedicine today!

Business Plan Template for Telemedicine Benefits

A business plan template for telemedicine can provide several benefits for healthcare startups or established medical practices looking to launch or expand their telemedicine services. Some of these benefits include:

• Streamlining the planning process by providing a structured framework to follow
• Ensuring a comprehensive analysis of the market, competitors, and potential challenges
• Helping to clearly define the target patient demographics and tailor strategies accordingly
• Facilitating financial forecasting and budgeting to attract investors and secure funding
• Guiding the development of marketing plans to effectively promote telemedicine services
• Assisting in identifying the technology requirements and infrastructure needed for successful implementation
• Ensuring compliance with regulatory standards and addressing legal considerations
• Providing a roadmap for the successful launch and ongoing management of telemedicine initiatives

Main Elements of Telemedicine Business Plan Template

Telemedicine is revolutionizing healthcare, and with ClickUp's Business Plan Template for Telemedicine, you can easily create a comprehensive plan to launch or expand your telemedicine services. Here are the main elements of this template:

• Custom Statuses: Track the progress of each section of your business plan with statuses like Complete, In Progress, Needs Revision, and To Do, ensuring that every aspect is accounted for and completed.
• Custom Fields: Utilize custom fields like Reference, Approved, and Section to add important information, such as relevant sources, approval status, and categorization, providing a clear structure to your plan.
• Custom Views: Visualize your business plan from different perspectives with five unique views, including Topics view to focus on specific areas, Status view to monitor progress, Timeline view to set milestones, Business Plan view for an overview of the entire plan, and Getting Started Guide to assist in navigating the template.

With ClickUp's powerful features and intuitive interface, creating a compelling business plan for your telemedicine initiative has never been easier.

How To Use Business Plan Template for Telemedicine

If you're looking to start a telemedicine business and need guidance, the Business Plan Template for Telemedicine in ClickUp can help you get started. Follow these five steps to create a comprehensive and effective business plan:

1. Define your telemedicine business

Start by clearly defining your telemedicine business. What services will you offer? Who is your target audience? What sets you apart from other telemedicine providers? Use a Doc in ClickUp to outline your business concept and value proposition.

2. Conduct market research

To ensure the success of your telemedicine business, you need to understand the market and your potential competitors. Conduct market research to identify the demand for telemedicine services in your target area, analyze your competitors' strengths and weaknesses, and identify any potential barriers to entry. Use tasks in ClickUp to organize your research and track your findings.

3. Develop a marketing strategy

In order to attract patients and healthcare providers to your telemedicine platform, you need a solid marketing strategy. Identify your target audience, determine the best channels to reach them, and create a plan to promote your services. Use Automations in ClickUp to schedule and automate your marketing activities, such as social media posts and email campaigns.

4. Outline your operations

To ensure smooth operations and provide high-quality telemedicine services, you need to outline your operational processes and procedures. This includes establishing protocols for patient onboarding, appointment scheduling, virtual consultations, and data security. Use custom fields in ClickUp to track and manage your operational tasks and milestones.

5. Create a financial plan

A robust financial plan is crucial for the success of any business. Determine your startup costs, projected revenue, and anticipated expenses. Calculate your break-even point and develop a pricing strategy that aligns with market demand. Use the Goals feature in ClickUp to set financial targets and track your progress over time.

By following these five steps and utilizing the Business Plan Template for Telemedicine in ClickUp, you'll be well on your way to launching a successful telemedicine business. Remember to regularly review and update your business plan as your business evolves and grows.

Get Started with ClickUp’s Business Plan Template for Telemedicine

Healthcare startups or established medical practices looking to launch or expand their telemedicine services can use the ClickUp Business Plan Template for Telemedicine to outline their strategies, target patient demographics, financial forecasts, marketing plans, technology requirements, and regulatory compliance considerations. This template will help you attract investors and secure funding for your telemedicine initiatives.

Here's how you can make the most of this template:

Hit “Add Template” to sign up for ClickUp and add the template to your Workspace. Make sure you designate which Space or location in your Workspace you’d like this template applied.

Invite relevant members or guests to your Workspace to start collaborating.

Use the Topics View to organize your business plan into different sections and topics for easy navigation.

The Status View will help you track the progress of each section of your business plan. Use the statuses: Complete, In Progress, Needs Revision, and To Do to keep track of each section's status.

The Timeline View will provide you with a visual representation of your business plan's timeline, allowing you to set deadlines and milestones.

Use the Business Plan View to have a comprehensive overview of your entire telemedicine business plan.

The Getting Started Guide View will provide you with a step-by-step guide on how to use the template effectively and get started with your telemedicine business plan.

Customize the template by adding custom fields such as Reference, Approved, and Section to provide additional context and information for each section of your business plan.

By using the ClickUp Business Plan Template for Telemedicine, you can streamline the process of creating a comprehensive and compelling business plan for your telemedicine initiatives, ensuring that you attract investors and secure funding for your healthcare startup or medical practice.

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Telehealth Business Models and Their Components: Systematic Review

Farnia velayati.

1 Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Haleh Ayatollahi

2 Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran

Morteza Hemmat

3 Department of Health Information Technology, Saveh University of Medical Sciences, Saveh, Iran

Reza Dehghan

4 Department of Health Entrepreneurship Management, Virtual University of Medical Sciences, Tehran, Iran

Associated Data

Search strategies.

CASP (Critical Appraisal Skills Programme) checklist.

Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services.

The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry.

This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively.

Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components.

Conclusions

Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization.

Introduction

Currently, health care systems are experiencing significant increases in costs mainly due to the shortage of health care professionals, increasing life expectancy, growing elderly population, and identification of new diseases and treatment methods [ 1 , 2 ]. In addition, economic developments, improved quality of life, and better health conditions along with more efficient policy making have led to a demographic transition (ie, an increase in the elderly population and a reduction in the young population) [ 3 ]. To resolve the challenges associated with health care delivery to different groups of patients, information technology–based solutions such as telehealth technology have been proposed [ 4 - 6 ]. Telehealth is defined as the use of information and communication technology to provide a wide range of health care services [ 7 , 8 ]. Telehealth has also been considered a unique opportunity to bridge the gaps and inequalities in health care delivery and as a solution to reduce the pressure imposed on health care systems [ 9 , 10 ]. It should be noted that the term telehealth includes telemedicine, eHealth, and mobile health (mHealth), and these terms are sometimes used interchangeably [ 1 , 5 , 11 , 12 ].

Currently, commercialization in the telehealth industry has received significant attention and innovative technology–based start-ups are expanding. In fact, the real value of these innovations lies in their commercialization [ 13 - 17 ]. The results of various studies show that the use of innovative technologies in the fields of telehealth and telemedicine is very challenging, and many products in these fields either fail in the implementation phase or stop in the research and development phase [ 13 - 16 ]. Most of these innovations and new technologies have never been introduced at the market level, as they have mainly focused on technology-based solutions rather than real value [ 1 , 14 , 15 ]. There are also a number of nontechnical challenges such as the nature of the relationship between health care providers and patients, the responsibility of information technology professionals, and privacy and confidentiality issues that should not be underestimated [ 18 ]. To overcome these challenges, the use of business models seems inevitable for successful commercialization of innovative technologies, and it may lead to more effective and efficient provision of health care services [ 17 ].

Recently, different business models have been proposed for the telehealth industry [ 1 , 19 ]. However, the findings of the research conducted by Frederickson et al showed that a business model and its components should be chosen based on the purpose of the technology and the context of use [ 20 ]. The results of other studies have indicated that patients, health care providers, payers, vendors, and other stakeholders play a key role in providing telehealth and telemedicine services. If a business model provides social or economic value for all stakeholders, then the likelihood of the successful implementation of a technology will increase [ 13 , 21 ]. It should be noted that different business models may have different components, as reported in various studies [ 22 , 23 ]. As successful commercial investment in telehealth requires an appropriate business model and plan, understanding these models and their components will help technology developers and commercial investors to make more informed decisions in this field [ 22 , 23 ]. Therefore, the purpose of this study was to review different types of business models and their components used in the telehealth industry.

This study was a systematic review conducted in 2020. A systematic review is a type of review in which a systematic method is used to summarize evidence on questions with a detailed and comprehensive method [ 24 ]. Before conducting this review, ethical approval was obtained from the ethics committee of the Iran University of Medical Sciences (reference number: IR.IUMS.REC.1397.1328).

Eligibility Criteria

To select the most relevant studies, inclusion and exclusion criteria were set. According to the inclusion criteria, all research papers, reviews, conference papers, theses, and dissertations in which business models or business frameworks and their components were discussed in relation to telehealth, telemedicine, and mHealth were included in the study. No time frame was considered for searching the articles and the search was conducted until the end of January 2020. Papers published in English and full-text availability were the other inclusion criteria.

According to the exclusion criteria, books, book chapters, letters to the editor, and studies in which a business model or framework was used in fields other than telehealth, telemedicine, and mHealth were excluded. Publication languages other than English and unavailability of full texts were the other exclusion criteria.

Information Sources

The databases used for searching articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. The searches were conducted until the end of January 2020 and duplicate references were removed. Additionally, the OpenGrey database was searched to find grey literature. The search process was carried out by reference and citation tracking, and the scientific profiles of the authors of the articles were examined to find further related articles.

Search Strategy

To develop a search strategy, MeSH (Medical Subjects Headings) terms such as commerce, mHealth, and telemedicine and key terms such as business, business model, value chain, eHealth service, and commercial phenomena were used. The search strategies, number of records, and search dates are presented in Multimedia Appendix 1 . There was no time limit for searching the articles, but the language was limited to English and only full-text papers were included in the study.

Selection Process

The screening process was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist [ 25 , 26 ]. After retrieving relevant articles, reference management was performed using EndNote software (Version X7, Clarivate) and duplicates were removed. The titles, abstracts, and full texts of the retrieved studies were screened. The initial search and screening processes were conducted by one of the authors (FV). In the next step, the other authors independently screened and appraised the remaining articles and resolved discrepancies by discussion and reached a consensus.

Data Collection Process

Data were extracted using a data extraction form comprising the name(s) of the author(s), year of publication, country, research objective, research method, business model, the model’s components, and a summary of the results. The first author (FV) initially collected the data, and the reports were reviewed independently by other researchers too. In case of disagreement, the researchers discussed the issue and resolved it by reaching a consensus.

In this study, the business models or frameworks and their components used for the commercialization of telehealth services were the main data items that were reviewed and compared in different studies.

Risk of Bias Assessment

The quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist [ 27 ]. As qualitative methods were used in the selected studies, the CASP checklist for qualitative research was used. It consists of 10 questions, with “yes,” “no,” or “can’t tell” as the answer options. The calculated scores showed if the quality of each study as high (7-10), medium (4-6), or low (1-3). The assessment was conducted by 2 researchers (FV and HA) independently (see Multimedia Appendix 2 ).

Synthesis Methods

In most of the selected studies, qualitative methods were used. Therefore, meta-analysis was not possible. The papers were divided into 2 groups. The first group included those studies in which a new business model or framework was presented, and the second group included papers analyzing existing business models used in the telehealth industry. To summarize data, tables were developed based on the data extraction form. The main components of the business models are also presented in figures for better understanding.

Study Selection

The preliminary search results in the selected databases included 4998 articles. After excluding duplicates, 2403 articles remained. Then, the titles of these articles were reviewed, and 2282 articles were excluded due to poor alignment of their aims with those of this study. In the next step, the abstracts of the 121 remaining articles were reviewed and 85 papers were excluded because their content was mostly irrelevant to the aims of this study. The full texts of the remaining articles (n=36) were reviewed, and 13 articles were excluded as they were mainly related to health care businesses (n=2), health organizations (n=4), Internet of Things (n=3), business strategy (n=1), sustainable business models in various industries (n=1), and organizational reports (n=2). Finally, 23 papers were selected to be included in this review. Figure 1 shows the article selection process.

Article selection process based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [25،26].

Study Characteristics

The papers selected for inclusion in this review were divided into 2 main groups. The first group included 13 studies that presented a new business model or framework [ 1 , 14 , 19 , 23 , 28 - 36 ], and the second group comprised 10 studies that evaluated existing business models or frameworks used in the telehealth industry [ 37 - 46 ]. These studies were published between 2005 and 2020. The first group comprised studies conducted in the United States (n=5), the Netherlands (n=1), Germany (n=2), Taiwan (n=3), Italy (n=1), and England (n=1); the second group included studies conducted in the Netherlands (n=6), China (n=1), Australia (n=2), and Sweden (n=1).

Results of Individual Studies

New business models or frameworks for telehealth industry.

Table 1 presents the 13 studies analyzing a new business model or framework for use in the telehealth industry [ 1 , 14 , 19 , 23 , 28 - 36 ].

Summary of the studies presenting a new business model or framework for use in the telehealth industry.

a VISOR: value proposition, interface, service platform, organizing model, and revenue.

The study by Barker et al [ 23 ] presents a 5-layer model for telemedicine. From the bottom to the top, these layers included the vendor services layer, infrastructure services layer, operational services layer, professional services layer, and client layer. In this model, each layer supported the top layer, and the model created a new and low-cost infrastructure for telecommunication by developing a membership program and connecting to other networks. It also led to the distribution of specialized clinical services in rural communities [ 23 ]. Mun et al presented 5 business models for teleradiology including stand-alone teleradiology practice, the “nighthawk” or on-call coverage, solo radiologist practice, expert or second-opinion teleradiology, and a global virtual radiology service based on workload sharing and reallocation. These models led to more effective, higher-quality, and less-expensive diagnoses [ 28 ].

In 2 studies, business models were presented for mHealth services [ 29 , 30 ]. Among these, the study conducted by Fife and Pereira used the 5-component VISOR (value proposition, interface, service platform, organizing model, and revenue) model as the analytical framework to identify and address barriers to the widespread use of telehealth [ 30 ]. Another study was conducted by Lee and Chang that provided designing a 4-component business model for mHealth services for chronic kidney disease. The 4 components of this model were data, data analysis/service, partner, and user, which finally provided a cost-effective and professional platform for disease support and management services [ 29 ].

In the field of telerehabilitation, 2 different business models were presented in 2 of the included studies [ 14 , 31 ]. In the study by Kijl et al, a business model was considered for treating patients with chronic pain in the shoulder and neck. The design of this business model included a demand component on one side and a supply component on the other side. Medical research and development organization, occupational health care organization, and disability insurance organization were the subsets of supply and demand. In the value network of this business model, the components were interrelated, and increased productivity compensated for the additional costs of information technology [ 14 ].

Fusco and Turchetti also presented 4 models of business governance for telerehabilitation after total knee replacement. These models included 1 conservative model, 2 partnership models between primary care units and supporting companies that supplied equipment for primary care units, and 1 model based on cooperation between stakeholders. The results showed that the innovation structure was enhanced from the first to the fourth business model. The main components of these models were key activities, customer and patient segments, and key resources. These models reduced costs and the number of people on the waiting list [ 31 ].

In telecardiology, the results of the study by Lin et al showed that using a sustainable business model with the 9 components including value proposition, target customer, distribution channel, (customer) relationship, value configuration, capability, partnership, cost structure, and revenue influenced the acceptance of technology by the general public and provided mutual benefits for service providers and patients [ 32 ].

In 2 studies, a business framework for telemedicine was presented [ 19 , 33 ]. In the study of Lin et al, the business framework included the components of value proposition, partnership, resources and capabilities, and geography [ 33 ]. In another study, Peters et al revealed that the CompBizMod framework in telemedicine created a new perspective for reviewing and evaluating current business models in terms of structure, logic, and value. This framework included 4 main components of value proposition, value co-creation, value communication and transfer, and value capture, and the framework could be used to generate different perspectives in telemedicine business models, evaluate competitors, and determine competitive advantages [ 19 ].

The results of the study conducted by Fachinger and Schöpke showed that a sustainable business model in sensor-based fall recognition systems consists of 9 interconnected components, building blocks, or partial models including customer, market, financing, proceeds, production, resources, procurement, network, and strategy; the combined application of these components led to the creation of a sustainable business model [ 34 ]. Oderanti and Li presented a conceptual framework for a sustainable business involving assisted living technologies that included value proposition, product innovation and commercialization, infrastructure management, customer relation management, financial viability and sustainability, stakeholder credibility, and revenue streams as the 7 components. The comparative advantage of this framework was the most important factor that encouraged older people to pay for eHealth services, even though health services were free [ 35 ].

In 2 other studies, the new business models were slightly modified [ 30 , 36 ]. In Pereira's study, the 5-component VISOR interactive business model was the same as that presented in Fife and Pereira’s study [ 30 ], but it was presented in more detail. This model had 5 components, namely value proposition, interface, service platform, organizing model, and revenue, and the results of the study showed that the weakness of one component could be compensated by strengthening another component [ 1 ].

Arkwright et al presented 8 common and successful telehealth business models in their study. These models included the direct-to-consumer (patient) business model, organization-to-organization business model, clinician-to-clinician business model, oversight and processes business model, online patient access/portals/technology, a business model based on mHealth/medical applications, a hardware/software model, and an international business model. The researchers believed that a successful telehealth business model should be safe, patient-centered, user-friendly, consistent, mission-oriented, strategy-oriented, and of proven value to the patient [ 36 ]. The key aspects of the aforementioned business models are presented in Figure 2 .

Key aspects of the new business models or frameworks for the telehealth industry.

Existing Business models or Frameworks Used in the Telehealth Industry

The findings of this study showed that 10 studies examined existing business models or frameworks used in the telehealth industry ( Table 2 ) [ 37 - 46 ]. Among them, 5 studies used the 9-component Osterwalder business model, which includes customer segments, value propositions, channels, customer relationships, key resources, key activities, key partnerships, cost structures, and revenue streams [ 37 - 40 , 43 ]. Hidefjäll and Titkova showed that the development of wearable sensor technologies should be considered as part of a more extensive commercialization process consisting of conceptual, financial, and organizational developments, and the requirements of the health system should be considered [ 37 ].

Summary of the studies that evaluated existing business models or frameworks used in the telehealth industry.

a STOF: service, technological, organizational, and financial.

b mHealth: mobile health.

c B2C: Business-to-Consumer.

d B2B: Business-to-Business.

e SHAAL: Smart Home and Ambient Assisted Living.

The results of Marjomaa's study [ 38 ] showed that the eHealth service market for chronic diseases was a multidisciplinary market with several different segments, and the use of a participatory strategy such as the Osterwalder business model had a significant impact on the success of this market. Leeuwerden has suggested that cost-benefit studies are essential for the success of assisted living technologies in dementia care, and they can be considered along with the components of the Osterwalder model [ 39 ]. Similarly, the results of a study conducted by Kho et al showed that although the Osterwalder model can be considered as a basis for different types of telehealth businesses, the 3 components of physician participation, medical risk management, and country-specific commitments must be considered to support the sustainability of teledermoscopy services [ 40 ]. Grustam et al have stated that although attention has been paid to the components of the Osterwalder model, synergy among manufacturers, health care providers, payers, and legislators is necessary to implement telescreening technology for patients with heart diseases [ 43 ].

Business-to-Business (B2B) and Business-to-Consumer (B2C) models were used in 2 studies. The aim of 1 study was to explore the systemic and economic differences in care coordination via B2B and B2C models for telemonitoring patients with chronic diseases [ 41 ], and in another study, the aim was to assess the B2C model for telemonitoring patients with chronic heart failure by analyzing its value for organizations or ventures that provided telemonitoring services [ 42 ]. In these studies, the B2C model was used with its 6 components of structure, financing, public policies, technology alignment, consumers (customers), and accountability. This model created value for customers, shareholders, service providers, and the community [ 41 , 42 ].

Furthermore, 3 studies used other existing business models [ 44 - 46 ]. Dijkstra et al used the freeband business blueprint method (FBBM) including service domain, technological domain, organizational domain, and financial domain as the components. The results indicated that costs can be divided between several telemonitoring services using a flexible infrastructure [ 44 ].

In a study conducted by Leunissen, the STOF (service, technological, organizational, and financial) model was used. The results showed that the added value in the telerehabilitation business model might be changed due to the impact of cash flows [ 45 ]. In another study, Simonse et al used the Johnson framework, which included customer value proposition, profit formula, key resources, and key processes. They noted that designing a business model is not separate from the organizational context [ 46 ]. The key aspects of the existing business models or frameworks used in the telehealth industry are illustrated in Figure 3 .

Key aspects of the existing business models or frameworks used in the telehealth industry.

The results showed that different types of business models and frameworks have been used in the telehealth industry and they have various components. However, value proposition, meeting the stakeholders’ and customers’ requirements, and financial issues were the most common components in these models and frameworks. These components might be described using different terms along with many other components, which were found important in relation to a specific type of technology and its context of use. Although new business models and frameworks focus on specific aspects of telehealth services, namely, service delivery, innovation, technology, and interface design along with other business components, the existing business models, such as Osterwalder’s business model canvas, have been used by some researchers to gain more comprehensive insight into the telehealth industry. It seems that using these business models and frameworks depends on the context of using the technology and many other components can be added to make them more appropriate for different purposes.

Principal Findings

The aim of this study was to review different types of business models and their components used in the telehealth industry. The search process yielded 4998 articles, from which 23 studies were included in the study. These studies were divided into 2 main categories. The first category included new business models or frameworks, and the second category included the existing business models and frameworks used in telehealth industry. These models and frameworks consisted of different components in various areas of telehealth.

As mentioned earlier, business models can help implement telehealth technology with the participation of all stakeholders and in a value-based manner [ 4 ]. Business models serve as an analytical framework for identifying and overcoming barriers to the implementation and extensive use of telehealth technologies and help apply beneficial emerging technologies. These models also help identify the value proposition of telehealth services and its challenges, as well as the appropriate revenue model, organizational structure, and stakeholder engagement model [ 1 ]. However, business models must be adapted to the social, geographical, and economic contexts of the technology. Understanding each component of a business model is essential to evaluate the success of telehealth services [ 13 , 47 ]. Moreover, providing a business plan based on the well-known business models or frameworks, especially in the early stages of product development, will reduce potential risks and significantly save the costs related to the establishment of services and technologies [ 14 , 29 , 31 ].

A business model should be able to create and transfer value to the customers in a profitable and sustainable manner [ 23 , 30 ]. Therefore, some studies have emphasized the differences among the business models used for various types of telehealth technologies in each country [ 13 , 48 ]. For example, the results of the study conducted by Fredriksson et al showed that it is more appropriate to use different business frameworks for specific purposes. These frameworks should be in line with the context and purpose of using the technology [ 20 ]. However, the application of business models in the field of telehealth does not guarantee the success of new technologies, and before taking any action, legal issues and challenges related to licensing, compensation methods, liability, data sharing, and data protection must be resolved [ 28 ].

According to research findings, the main components in most telehealth business models were financial issues and cost structures that could be influenced by service processes, resources, and partners [ 33 ]. Cost structure plays an important role in customer acceptance, and different financial strategies need to be considered for various circumstances, revenue makings, and geographical areas [ 33 ]. Thus, a successful business model must be able to provide the highest value and increase the customers’ willingness to pay [ 1 , 36 ].

The results showed that it is possible to design different types of business models with various components to be used in telehealth industry. However, the components should be able to support the value of the technology in line with other components, such as the cost structure and revenue model. The components of a business model must be able to support each other, especially in unstable conditions of the health system. In addition, the components of a business model must be constantly monitored and updated [ 34 ].

A business model should ultimately lead to the acceptance of the technology by the general public. It should help in providing equitable distribution of services, effective diagnosis of diseases, and high quality of services, as well as in reducing pressure on health systems [ 35 ].

The results also revealed that some studies used existing business models or frameworks in telehealth services. Among these models, the Osterwalder business model was used more frequently than other models [ 37 - 46 ]. This model was helpful to meet the requirements of the health system and provided added value by increasing patient satisfaction and reducing the cost of care [ 37 , 43 ]. It also provided a better understanding of the business characteristics and covered various economic aspects of technology implementation [ 40 ].

A number of other studies used B2C and B2B models. The use of the B2C model allowed all stakeholders to enjoy the benefits of innovation, reduced the burden of service delivery, and improved efficiency [ 42 ]. However, when insurance companies supported the B2B model, it was more sustainable than the B2C model. Other studies used the FBBM, Johnson framework, and STOF model. The use of these models was influenced by cash flow to generate revenue and predict outcomes [ 44 - 46 ]. Similarly, Antoniotti et al showed that government and private payers are very influential in making telehealth payments and revenue policies should be considered in business models [ 49 ].

Although business sustainability is one of the major challenges lying ahead for the expanding telehealth industry, few studies have concentrated on this aspect [ 32 , 34 , 35 ]. The key aspects of the long-term sustainability of telehealth business include developing a skilled workforce, empowering consumers, reforming funding, improving digital ecosystems, and integrating telehealth into routine care. These requirements should be considered in implementation planning to ensure that effective integration of telehealth within complex health systems is in place and staff are willing to use telehealth technologies [ 50 , 51 ]. In another study, Cui et al highlighted that the sustainability of telemedicine must be improved by appropriate legislation, uniform standards, and powerful management [ 52 ].

The existing business models, especially the Osterwalder business model, are general tools and roadmaps that can provide a good understanding of business model components. However, one of its major drawbacks is the lack of sufficient emphasis on the importance of the digital economy and the functionalities of core enabling technologies. In fact, this business model cannot manage multiservice platforms and the use of other business models seems necessary to support it. Moreover, it is more product-oriented and the nature of key partner networks is less discussed in this business model [ 38 ]. In situations where the stakeholders, their roles, and the impact of their roles are different, the existing business models do not have the necessary flexibility for adaptation. Moreover, the customers (organization purchasing technology) and users (technology user) are different sometimes and considering the requirements of both groups may influence the design of the business model [ 53 ].

Practical Recommendations

Overall, applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, stakeholders’ interactions, market challenges, and possible future changes. In fact, understanding the innovation, market size, competitive strategy, and investment in the telehealth industry is not sufficient and the impact of such an investment on the whole society should be investigated [ 38 , 42 ]. Although several business models have been proposed for use in the telehealth industry, using a combination of models and their components can help commercialize the technology more successfully. Telehealth business models can also be used in combination with traditional patient care models to double their value proposition [ 40 , 43 ].

Strengths and Limitations

In this study, different types of business models and their components used in the telehealth industry were reviewed and the main components necessary for a successful telehealth business were identified. However, this study has some limitations. In most of the selected studies, qualitative approaches were used. Therefore, conducting meta-analysis was not possible. Moreover, although the main databases were searched, there might be other databases that were not searched and non-English papers that were excluded from the study. These limitations can be addressed in future studies by searching more databases and changing the exclusion criteria.

The results showed that new business models used in the telehealth industry focused on legal, organizational, insurance, and customer-related issues. Added value, financial variables, financial sustainability in the market, competition, service platform, annual membership and subscription, national incentives, cost structure, and revenue streams were the other important components of these models. The studies that used existing business models mostly focused on aspects such as design, structure, governance, organizational issues, country-specific obligations, public policy, financing, profit formula, physician participation, risk management, and key processes.

In general, the diversity of business models and their components in the telehealth industry indicates that different models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization.

Acknowledgments

This work was funded and supported by Iran University of Medical Sciences, Tehran, Iran (grant IUMS/SHMIS_98-1-37-14528).

Abbreviations

Multimedia appendix 1, multimedia appendix 2.

Conflicts of Interest: None declared.