title: Video teleconsultation service: who is needed to do what, to get it implemented in daily care?
abstract: BACKGROUND
  In telemedicine, technology is used to deliver services. Because of this, it is expected that various actors other than those involved in traditional care are involved in and need to cooperate, to deliver these services. The aim of this study was to establish a clear understanding of these actors and their roles and interrelationships in the delivery of telemedicine. A video teleconsultation service is used as a study case.
  
  
  METHODS
  A business modeling approach as described in the Freeband Business Blueprint Method was used. The method brings together the four domains that make up a business model, that is, service, technology, organization, and finance, and covers the integration of these domains. The method uses several multidisciplinary workshops, addressing each of the four domains.
  
  
  RESULTS
  Results of the four domains addressed showed that (1) the video teleconsultation service is a store and put-forward video teleconsult for healthcare providers. The service is accepted and has added value for the quality of care. However, the market is small; (2) the technology consists of a secured Internet Web-based application, standard personal computer, broadband Internet connection, and a digital camera; (3) a new role and probably entity, responsible for delivering the integrated service to the healthcare professionals, was identified; and finally (4) financial reimbursement for the service delivery is expected to be most successful when set up through healthcare insurance companies. Pricing needs to account for the fee of healthcare professionals as well as for technical aspects, education, and future innovation.
  
  
  CONCLUSIONS
  Implementation of the video teleconsult service requires multidisciplinary cooperation and integration. Challenging aspects are the small market size and the slow implementation speed, among others. This supports the argument that accumulation of several telemedicine applications is necessary to make it financially feasible for at least some of the actors.
authors.affiliation: Department of Technology Assisted Pain Rehabilitation, Roessingh Research and Development, Enschede, The Netherlands. j.visser@rrd.nl
authors.forename: Jacqueline J W
authors.initials: JJ
authors.lastname: Visser
authors.forename: J K C
authors.initials: JK
authors.lastname: Bloo
authors.forename: F A
authors.initials: FA
authors.lastname: Grobbe
authors.forename: M M R
authors.initials: MM
authors.lastname: Vollenbroek-Hutten
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D004493:Education; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D020407:Internet; D018803:Models, Economic; D009426:Netherlands; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D019114:Remote Consultation / Q000191:economics / Q000458:organization & administration*; D014741:Video Recording