Creating an environment for virtual care in the Australian health system: a document analysis of infrastructure and capability frameworks

Abstract

Objective: Health systems worldwide are recalibrating in the post-COVID-19 era, refining virtual care strategies to ensure the sustainable, long-term integration of virtual modalities into routine healthcare. Realising the potential benefits of virtual care equitably across health systems requires that virtual modalities are consistently supported by the necessary system infrastructure and capabilities. This study sought to establish the infrastructure and capability requirements identified in Australian health system frameworks for effective virtual care integration across the system and the implications for long-term integration of virtual modalities in care provision. Methods: The READ (ready your materials, extract data, analyse data, distill findings) method of document analysis was employed to examine frameworks related to the infrastructure and capabilities required for virtual care. Frameworks were considered eligible if their scope encompassed federal, state, professional, or organisational levels that affect the delivery of healthcare services in Australia. A comprehensive search was conducted across the websites of 32 government and non-government organisations, private health companies, and professional organisations to identify publicly available or accessible documents. Inductive thematic analysis was subsequently applied to identify and synthesise key concepts into capability domains. Results: Fourteen frameworks pertaining to virtual care infrastructure and capabilities were identified, leading to the development of 10 primary capability domains. Frameworks primarily focused on ensuring the availability and success of operational aspects of virtual care implementation, such as appropriate technology, digital infrastructure, governance, and data management. Comparatively less attention was dedicated to the physical infrastructure, equity, inter-professional collaboration, workflow optimisation, and capability for change management. Conclusion: Frameworks that guide and govern the implementation of virtual care in Australian health settings commonly identify requirements related to operational aspects of implementing virtual care. Given that challenges of virtual care implementation are often attributed to gaps in change management, digital capability, and inequitable access, greater consideration of these capability areas in state and federal frameworks may support health system leaders in planning for virtual care integration.