Telehealth can be viewed as an intervention in the established and stable clinician-patient system with outcomes that are not always predictable. The success of a new telehealth service depends far more on changing the clinicians and patient's expectations and patterns of behaviour than on technology. Success in telehealth projects is critically dependent on understanding how the new telehealth offering changes the distinct value proposition for each of the parties – clinicians, patients and administrators. As with any intervention, design is the key to ensuring more predictable outcomes. An approach to the design of telehealth services is described that takes a holistic view of telehealth by acknowledging the multiple and interdependent dimensions of telehealth services (clinical process change, clinical risk and governance, adoption and change management, clinician and patient experience, operational sustainability, support, and least of all, technology). The approach draws on current themes in design including ‘design thinking’ and service design.
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