A Field Guide for Telemedicine: Read the Room!

Well laid plans can often fail, especially if you do not get everyone's buy in. That is to say, you have to convince all the individuals involved. You must read the room so to speak. You must listen and listen carefully, otherwise, you will likely miss an important point. ¹ In some cases failure, might become catastrophic. There are numerous examples of this in history. The Space Shuttle Challenger explosion is one example. ² The sinking of the Titanic is another. ³ While these are extreme outcomes of not listening, they do provide an understanding of the importance of the facts and the need to listen.

I have told my students for decades that everyone at the table must be heard. Whether it is a design, marketing of a product, safety, or a human factors issue, all must be heard. Otherwise, the project might fail or the product will not sell, or worse, someone might be hurt.

One way to ameliorate this is to have rules, standard operating procedures (SOPs), directions, an understanding of cause and effect, a concept of operations, or perhaps a field guide. In one of my father's boxes, I found a field guide given to all US Army personnel in the 1950s when station in Germany post–World War II. This guide contained all manner of information and instructions. What to do and what not to do—mainly so you would not get into trouble. This “how to guide” reminded me of the SOPs for working in the laboratory or instructions for operating equipment when not followed. Think of putting furniture together from a big box store! These are not developed out of thin air. They are crafted with facts, experience, knowledge, and perseverance.

In the space exploration arena, NASA has flight rules. What to do if this or that happens. Even though everything is thought through, written down, trained, and simulated, a bad day can still happen. These flight rules were developed because of cause and effect. In the early days, if something bad happened, there was no immediate answer on what to do. Thus, the “if this then that” became the rule.

Decision-making in management must be based on a number of attributes (1) knowledge, (2) need, (3) anticipated outcomes, (4) individuals, etc. We have all witnessed poor decisions. Rules and field guides can add value to what we are doing or attempting to do.

Consider the interest in applying telemedicine at the beginning of a pandemic when many had near-zero experience. A field guide would have been helpful. This journal has published thousands of manuscripts, highlighting what has worked and perhaps has not, for over 30 years now.

There are numerous published guidelines from the American Telemedicine Association and other professional societies. There is the scientific literature as well. While there is no oracle—unless you consider Google to be the prophetic vessel, in addition, there are how to books. Nevertheless, this field is growing so fast and as I have said before, often well-meaning individuals make decision without reading the room.

The basics of a field guide can be similar to an award-winning strategy our colleague's developed in support of some USAID work in the Balkans. This strategy is the Initiate, Build, Operate, and Transfer (IBOT). ⁴ The foundation of this has been (1) to establish the idea and garner support from all—a needs assessment (Initiate); (2) review technology that can be applied; (3) Build the system and train those to use it; (4) Operate it with systems thinking in mind and adding value to your patients and health care system; ⁵ and (5) in the Balkans' case, Transfer it to the Ministry of Health.

A field guide should also include evidence, which comes from the literature. It might contain case studies as well. Those who came before us gave us frameworks to build on! Do not just jump in, do your homework. Read the room!