Abdulsalam Mohammed, November , 2024

Background : Telemedicine, leveraging ICT to deliver healthcare remotely, offers opportunities to expand access, reduce costs, and enhance patient satisfaction, particularly during the COVID-19 pandemic. While developed nations have established robust telemedicine systems, LMICs face challenges, including infrastructure deficits, resource constraints, and acceptance barriers. High failure rates in e-health projects often result from inadequate readiness assessments and limited user engagement. The objective of this study is to assess the institutional health system readiness of Korle Bu Teaching Hospital (KBTH) to adopt and integrate telemedicine services.

Methodology: The study employed a cross-sectional descriptive quantitative methodology, gathering data from 371 hospital clinical, non-clinical, and administrative staff members using structured self-administered questionnaires adapted from the standard E-health Readiness Framework. Data was analyzed using means, standard deviations, and Pearson correlation using Stata 17, with results presented in graphs, tables, and narratives.

Results: While the study indicated a high need for telemedicine (73%), the overall readiness score for KBTH was 57%, falling below the 70% threshold, indicating moderate readiness. This suggests that while a foundational level of preparedness exists, substantial efforts are needed in infrastructure investment, technological enhancement, and policy support to enable successful telemedicine integration. KBTH exhibited good readiness for telemedicine health service needs but poor readiness in core needs, governance, technology, workforce, and learning domains. Key challenges included infrastructure gaps, resistance to change, technological barriers, and quality-of-care concerns.

CGTW Conceptual Framework: The CGTW framework—Core (Need), Governance, Technology, and Workforce—was developed by Abdulsalam Mohammed as a tailored model for assessing institutional telemedicine readiness in Africa. This framework was designed based on the readiness assessment study conducted at KBTH between August and November 2024. It refines and builds upon existing models, such as the e-HARF (e-Health Assessment Readiness Framework) by Mauco et al. (2020) and the Human, Organization, and Technology-Fit (HOT-Fit) framework by Yusof et al. (2006), to better suit the specific conditions and needs of institutions in Africa.

The CGTW framework consists of four key components, all of which are highly relevant for institutional-level assessments.

Core Readiness ; evaluates an institution’s dissatisfaction with current healthcare services and its perception of e-health as a viable solution. It involves assessing operational challenges, technology gaps, and the general awareness and technology literacy of staff. Understanding these aspects allows institutions to tailor interventions that directly address existing needs, improving the likelihood of successful telemedicine implementation.

Governance Readiness; examines the institutional support and promotion of e-health and telemedicine innovations. It includes alignment with strategic plans, stakeholder engagement, and the presence of relevant policies such as financial, technology, regulatory, and resource mobilization plans. Effective governance ensures a clear implementation roadmap, resource mobilization, and comprehensive guidelines for project management. By developing financial plans, securing funding, and ensuring regulatory compliance, institutions can reduce risks and enhance the chances of successful telemedicine project execution.

Technological Readiness ; assesses the accessibility and cost-effectiveness of ICT resources required for e-health. Key factors include infrastructure and network availability, power supply reliability, and the availability of trained personnel and ICT support. By evaluating the current technological infrastructure and identifying necessary enhancements, institutions can bridge gaps and ensure they have the appropriate technological solutions in place. This prevents future technical challenges and ensures smooth telemedicine implementation.

Workforce readiness ; focuses on the preparedness of healthcare personnel to adopt and utilize new e-health technologies. This involves evaluating current skill levels, identifying training needs, and developing programs to build necessary competencies. Ensuring that staff are well-equipped with the required skills and knowledge is crucial for the success of e-health projects. A well-prepared workforce leads to higher acceptance and effective use of telemedicine technologies, significantly contributing to the project's overall sustainability and impact.

Findings : The study recommends enhancing digital infrastructure, initiating training programs, conducting pilot projects, and fostering stakeholder engagements and collaborations to address readiness gaps. The CGTW framework offers a structured approach for institutions in Africa to assess their readiness for telemedicine adoption. By evaluating Core, Governance, Technology, and Workforce readiness—components that are highly relevant for institutional-level assessments—healthcare organizations can develop comprehensive strategies to address gaps, optimize resources, and ensure the successful implementation of e-health initiatives. This framework serves as a critical tool for policymakers, healthcare administrators, and technology implementers aiming to advance digital health transformation in Africa.

Limitations and Recommendation: While the study successfully assessed the institutional readiness of Korle Bu Teaching Hospital (KBTH) for telemedicine adoption, a key limitation lies in its failure to incorporate an in-depth evaluation of patient readiness, particularly regarding their willingness to engage with telemedicine services. Factors such as patients' readiness to pay for telemedicine services and their familiarity with the technology were not fully explored directly from the patients perspective. These aspects are critical for the success of telemedicine implementation, as patient acceptance can significantly impact its adoption. The researcher recommends that subsequent studies should focus on assessing these factors, including the financial preparedness and technological literacy of patients, to provide a more comprehensive understanding of the readiness for telemedicine at both the institutional and patient levels. To augment these limitations, needs assessment was conducted across various departments to understand whether there is a demand for telemedicine and whether patients have expressed interest in utilizing telemedicine services.

References

Mauco, K.L., Scott, R.E. & Mars, M. Validation of an e-health readiness assessment framework for developing countries. BMC Health Serv Res 20, 575 (2020). https://doi.org/10.1186/s12913-020-05448-3

Yusuf, M., Ahmed, W., Jameel, A., & Khan, M. W. (2024). IT based telemedicine: Global and Indian prospects with future outlook. International Journal of Advanced Studies in Humanities and Social Sciences, 13, 128-150.

Author Details

Abdulsalam Mohammed, November , 2024

Article: Excerpted from Masters of Public Health Dissertation submitted to School of Public Health,

University of Ghana Legon

Topic: Assessing The Readiness Of Korle Bu Teaching Hospital To Adopt And Integrate Telemedicine Services