Presenting a Pattern of Telemedicine deployment in selected hospitals in the southeast of Iran using the Meta-analysis method

Abstract
In recent years, the use of information technology in the health industry has expanded, and in order to improve the quality and speed of providing services to patients, telemedicine has been proposed as a new solution. Therefore, for the successful implementation and optimal use of telemedicine, in addition to the necessary infrastructure and success factors of this technology, such as high-speed Internet, up-to-date hardware and software, remote video communication systems, and distance education equipment, Specialist human resources should also be used. Sistan and Baluchistan province is a vast province, and due to the uneven distribution of specialized healthcare facilities and specialists, as well as the lack of adequate health care centers in its cities and villages, people do not have adequate access to medical services. Therefore, the current research seeks to provide a model for establishing telemedicine in selected hospitals of Sistan and Baluchistan province.
Introduction
Telemedicine was introduced in the 1970s by Thomas Bird. Scott Cruz et al. (2018) defined telemedicine as use of medical and communication technologies to exchange any information, including data, voice or video communications between doctors and patients or doctors and healthcare professionals in separate geographical locations, in order to creating the possibility of exchange for medical, healthcare, research and educational purposes. The benefits of telemedicine can be seen as socio-economic benefits, reducing costs, reducing waiting lists, reducing travel, improving consultations, and reducing emotional stress (Jang et al., 2020). Telemedicine enables health and treatment experts to conduct quick consultations with relevant specialists in far-flung locations around the world, thus eliminate the costs and risks needed to transport a sick or injured person to distant places for further examinations (Brulé et al., 2020). In addition, the presence of telemedicine in developing countries, where specialized and subspecialty services are not readily available and are usually costly, is economical and effective (McDonald et al., 2014). Based on this, the goal of implementing telemedicine can be to improve the processes of providing health services and products, improve patient care and reduce the per capita costs of medical care, provide medical services without time and place restrictions (on a wide geographical and population level), improve access rural and disadvantaged areas and medical care in them, reducing the space of face-to-face care in hospitals and medical centers and introducing the use of artificial intelligence in diagnostic and treatment processes (babaMahmoodi et al., 2021).
Case study
The statistical population was the conducted and existing researches (between 2010 and 2022) in domestic and foreign scientific databases, which were searched and reviewed based on specified keywords, and among them, the most relevant documents with Purposive sampling method were selected.
Materials and Methods
The research was applied and exploratory research. In order to collect data, meta-analysis method was used. The analysis of the texts was done based on the content analysis, and finally, based on the extracted codes, the dimensions and components of telemedicine deployment were determined and the proposed research pattern was developed.  The extracted codes controlled by Kappa index and determining the weight of indices by Shannon entropy.
Discussion and Results
Based on the meta-analysis method and focusing on selected keywords, the articles in the field of telemedicine (in the years 2010 to 2022 and in domestic and foreign databases and publications) were reviewed and finally, 184 articles were found. Then, according to parameters such as title, abstract, content, access, quality and content of the research method, the articles were reviewed and evaluated, and finally, after removing 137 articles, 47 articles were analyzed. Based on the content analysis of the final articles, a total of 63 indicators, 6 sub-components and 5 components were discovered and labeled. To control the extracted codes, the Kappa index was used, and the value obtained for it (0.915) showed the level of agreement between the experts. Also, the amount of Shannon's entropy for all components showed that past researches support the findings of the current research.
Conclusion
The pattern of telemedicine deployment was formed in three layers of feasibility, implementation structure and deployment. In the feasibility layer of telemedicine, cultural, human and institutional empowerment, knowledge management, strategies and infrastructure (with components of technical infrastructure, security infrastructure, software and hardware, network, legal infrastructure and organizational infrastructure) dimensions were included. In the second layer, which deals with the implementation of telemedicine, taking into account the current situation of telemedicine, strategies are adopted to reduce or even eliminate the gap, and strategies for the establishing telemedicine are designed and operational plans are compiled. In the establishment phase, cultural foundation for more acceptance of telemedicine by the public, legal foundation and the formation of efficient executive committees, and trainings in the form of workshops are given to the public and experts in order to become more familiar with this concept and its benefits and effects in various fields. By implementing telemedicine processes and testing them, possible problems and obstacles during implementation, which is one of the best control methods, are identified and appropriate plans are made to solve them.