Remote care nearby

A telemedicine application has a better chance of being accepted if the users can easily handle it and if the application fulfils the clinical needs of both patients and professionals. This requires a methodology for development in which three keymatters need to be dealt with: (1) clinical content; (2) design; and (3) outcome. Concerning the clinical content, telemedicine services for patients with chronic disorders that aim to increase their level of functioning need to monitor aspects of the patient's functioning and provide adequate feedback about this. Promising parameters of functioning are related to general physical activity and muscle activation patterns. Providing adequate feedback requires choices about the content of the information, the modality of the feedback and its timing. Unfortunately, research into effective fedback strategies is still in its infancy. Concerning the design it appears that the different stakeholders involved speak different languages, that there is a lack of knowledge about aspects related to acceptance and a lack of good methods to define user requirements. Scenariobased requirements analysis is a promising technique to overcome these barriers. Concerning the outcome, evaluation of telemedicine services in everyday clinical practice has been mainly directed at measurement of technical performance and user satisfaction. Large scale clinical evaluation studies with multiple end points are needed. This development methodology with its three aspects was used for a myofeedback-based teletreatment service. This showed that telemedicine applications can be developed that have the potential to make health care more effective, efficient and accessible.