beyond the research phase or they fail to become sustainable
following implementation [8–10]. This might be caused by
the complex, and often underestimated, process of telemedi-
cine implementation. The known factors which influence the
success of implementation are numerous such as the techno-
logical infrastructure, financial business models and legisla-
tion [10, 12, 13]. The literature offers various reasons for the
limited adoption and the lack of sustainable telemedicine ser-
vices. One of the main causes of failure in reaching a sustain-
able service model is the lack of sufficient planning prior to
the implementation of a telemedicine service [11, 14]. A sys-
tematic review that identified deployed telemedicine service
in hospital facilities (n = 137), found that while few papers
(18.2%) gave a brief description of their service, including
how it was established, no reference to need assessment as a
part of structured planning was made. Some of the reported
telemedicine service implementation was founded on the suc-
cess of a pilot study or research project, as a replacement for
an existing outreach clinic or an awareness of the need for an
additional service (for example, as the result of a long waiting
list.) [15].
To overcome this problem, the National R ural Health
Association have recommended seven s teps of telehealth
planning for program success [14]. These steps were
arranged in a sequential order in relation to their occur-
rence as the telemedicine program progresses. They are:
Evaluating needs, developing a care services plan, de-
veloping a business plan, planning technology, training
personnel, testing care and technology plans and evalu-
ating outcomes [14].
The first step for planning a successful implementation is
evaluating needs, adequate time should be dedicated to this
process as complex interventions usually require attention to
this phase [13]. Telemedicine should be driven by the needs of
patients and clinicians rather than technology [16]. Each com-
munity has its own unique requirements that should be ad-
dressed accordingly. This process in not new to the healthcare
sector, and it is a part of Health Service Planning which is
defined as the BHealth service planning that appraises the
overall health needs of a geographic area or population and
determined how these needs can be met in the most effective
manner through the allocation of existing and anticipated fu-
ture resources^ [17]. This process is usually investigated by
conducting a health needs assessment.
A framework that can provide a general sense of direction
and guidance to assess the health services needed prior to the
implementation of a telemedicine service delivery model does
not exist or, at least, is not published in the literature.
Therefore, the aim of this paper is to describe the development
of a framework to assess the health services needed in a com-
munity setting prior to the implementation of telemedicine
services. This paper provides 1) a brief overview for planning
a healthcare service using health needs assessment; 2) an
outline of the key process in needs assessment, definitions
and notable theories regarding needs and access; and 3) pre-
sentation of a planning framework for telemedicine health
services, as an approach to enhance telemedicine services
delivery.
Planning a healthcare service using health needs
assessment
Studying and analysing data regarding the utilisation of
healthcare services, the availability, accessibility, cost and af-
fordability of services can provide an understanding of the
current status of healthcare services. This information can then
be used to identify the requirements, investigate the available
options and identify whether telemedicine might play a role in
improving access to healthcare services.
The appropriateness of different data collection methods
should be considered carefully, so that the results reflect the
community’s health needs. The choice of the data collection
method and the data sources is heavily dependent on the avail-
ability of data in the community of interest. Quantitative or
qualitative data collection methods or a combination of both
(often the choice of demographers), can be used. Analysing
routinely collected data and combining it with other sources of
information such as surveys, questionnaires, suggestion box-
es, focus groups, participant observation and interviews are
useful method s for gaining insight into the community’s
health service needs [18].
Health needs assessment
Health needs assessment is an evidence-based method of plan-
ning for health services to ensure a health service uses its
resources to improve or maintain—in an efficient manner—
the public health, by gathering the required information and
the allocation of resources distributed to reduce inequalities. It
has evolved into a valid method of tailoring health services
[19, 20].
Health needs assessment is an integral component of health
service planning. The period that truly influenced needs as-
sessment and established it as a critical part of the healthcare
process, was the transition from the 1980s to the 1990s
[21]. Historically, service provision was service led at
the convenience of providers rather than focusing on
the needs of the patients. This changed when the
National Health Service ( NHS) made patients and their
needs the center of needs assessment [22]. However, in
the literature far too little attention has been paid to
applying he alth needs assessment as a main element
for planning telemedicine services.
74 Page 2 of 9 J Med Syst (2017) 41: 74