Background and Objective:
The COVID-19 pandemic accelerated the spread of telemedicine (TM). The WHO stresses the importance of developing digital solutions with the goals of making care more effective, safe, and of better quality. While market forces are eager to drive innovation, problems with usability and intraoperabilty remain. We analyzed two TM applications in different Italian facilities. The objective was to highlight key gap areas of criticality, and to develop a proactive implemetantion model to guide implementation of future effective telemedicine services.

Methods:
We analyzed the inherent risks of TM using robust mixed methods, including failure mode and effects analysis (FMEA), a prospective, team-based risk management methodology structured to identify high-risk process system vulnerabilities and failures before they occur. We report on a remote patient monitoring (RPM) program in which 200 COVID-19 patients were followed remotely to evaluate the effectiveness in treating and monitoring patients in home settings.

Results:
We demonstrated that a telemedicine device reduced the number of hospitalizations and costs significantly. Assessment based on FMEA offers important insights and considerations for evaluating the future implementation of RPM and the direction of TM. Telemedicine solutions are technically feasible, easy for staff to use, achieveing high adherence rates, but rigorous evaluation of devices and platforms is needed to clarify their value and guide optimal adoption strategies.

Conclusions:
Telemedicine saved lives and improved decision making during the pandemic, helped prevent the collapse of the health care system, and had a positive impact on continuity of care, quality of life, and self-care. Integration of electronic medical records and telemedicine devices represents a compelling innovative solution that could greatly improve quality of care and lower the error rates. Rigorous and ongoing evaluation of devices and platforms is essential to clarifying their value and guiding national decisions and adoption programs.