Application of Telemedicine for Mission Support-Importance of a Cost-Benefit Analysis

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported — no quantitative effect sizes are presented; findings are qualitative and framework-based

• Primary Outcome: Identification of key performance indicators (KPIs) and a minimum data set for cost-benefit and cost-effectiveness analysis of telemedicine in mission environments

• Nnt Or Sensitivity: Not applicable — no NNT, sensitivity/specificity, or hazard ratios are calculable from this narrative review; the proposed KPIs include metrics such as evacuation rate reduction, teleconsultation resolution rates, and cost per consultation, but no empirical values are synthesised

• Confidence Interval: Not reported

Clinical Application

The proposed minimum data set and KPI framework is conceptually feasible for implementation in structured mission environments with existing telemedicine infrastructure. However, practical implementation requires prospective data collection systems, trained personnel, and organisational commitment to evaluation — resources that may be limited in austere operational settings. The low-bandwidth store-and-forward approach described is technically feasible in most contemporary mission environments. Australia has significant operational relevance to this topic through Australian Defence Force (ADF) deployments, Pacific regional humanitarian missions, and remote/rural healthcare delivery challenges. The ADF's Joint Health Command has existing telemedicine capabilities that could benefit from standardised evaluation frameworks as proposed. In the civilian sphere, the Australian Government's ongoing investment in telehealth (expanded under MBS telehealth items post-COVID-19) and the RACGP's telehealth guidelines provide a regulatory and clinical governance framework into which mission-adapted telemedicine principles could be integrated. The TGA does not currently have specific regulatory pathways for mission telemedicine devices distinct from general Software as a Medical Device (SaMD) frameworks. PBS considerations are largely inapplicable in military deployment contexts where formulary management differs from civilian practice. Remote Area Health Corps (RAHC) and Royal Flying Doctor Service (RFDS) operations represent analogous civilian mission environments where this framework could be piloted. Military personnel, humanitarian aid workers, peacekeeping forces, and other individuals operating in resource-limited or geographically isolated mission environments where conventional healthcare access is restricted. The framework may also have conceptual relevance for remote and rural healthcare delivery in civilian contexts.

Abstract

BACKGROUND: Digital health is more relevant now than ever before, and interventions have a clear potential to improve the quality of care while reducing health care costs. Telemedicine has emerged as a transformative approach to health care delivery, particularly accelerated by the COVID-19 pandemic. In mission environments, telemedicine increasingly supports the management of acute injuries, chronic conditions, predeployment screening, and follow-up assessments, often using low-bandwidth store-and-forward modalities. METHOD: By reviewing existing literature and considering several different (heterogeneous) programs for "telemedicine for mission support," the key performance indicators are explored to evaluate telemedicine in missions, following its implementation. Both acute and chronic care use cases, as well as operational, clinical, and technical determinants of feasibility, were considered. RESULTS: This article presents the clinical, operational, and economic benefits of "telemedicine in missions" and the metrics for a comprehensive cost-effectiveness analysis or cost-benefit analysis, considering its economic and clinical impacts. CONCLUSIONS: Telemedicine in missions shows considerable differences from other telemedicine applications depending on the actors and the resulting circumstances. Considering the heterogeneity of the metrics provided, even within the field of "telemedicine in missions," the analyses have to be conducted in accordance with the encountered conditions. Nevertheless, a set of metrics can be applied to nearly all use cases across the different applications and actors. A mission-adaptable minimum data set is proposed to support standardized evaluation across diverse operational contexts.

References

1. 1.Scheid, P. L., Padi, D., Schvach, H., & Scheid, S. E. (2026). Application of telemedicine for mission support-importance of a cost-benefit analysis. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association. Advance online publication. https://doi.org/10.1177/15305627261440753