Table 1. Policies and initiatives on RM and/or telemedicine in the UK, Germany, Italy, and Spain.

UK[2, 11–13, 16, 21–23]	• Whole Systems Demonstrator Project (WSD): a large randomised controlled trial conducted to justify public funding for telehealth services in England
	• 3millionlives Campaign: aimed to expand telemedicine, mobile and telecare access to 3 million individuals in England with long-term conditions by 2017; superseded by the Technology Enabled Care Services (TECS) programme at NHS England
	• Remote Care Monitoring Preparation Scheme: £0.21 per patient payment to GP practices in 2013/14 for preparation for introduction of Remote Care Monitoring Directly Enhanced Service (DES) in 2014/15; DES ended March 2014
	• All-Wales Telemedicine Development Programme: three demonstrator projects in Wales to test a sustainable service model to manage and treat chronic diseases through telecare and telemedicine
	• NHS England A Call to Action: Commissioning for Prevention
Germany[21, 22, 24]	• Although no EBM codes exist for RM/telemedicine, a ‘criteria catalogue’ for telemedicine (established in 2013) provides guidance on what telemedicine studies should include to obtain an EBM code
	• Strong interest in telemedicine and e-Health in Germany has led to capital investment being made available to fund large scale clinical trials to better define the clinical benefits of RM and telemedicine and drive telemedicine projects
	• Some regions (e.g. Bayern, Baden-Württemberg and Wiesbaden) have negotiated integrated care contracts between the health insurer and the provider
	• Telemedicine strategies in Bayern, Nürnberg, and Sachsen-Anhalt may lead to future RM technologies; these strategies have helped to launch RM programmes such as Diabetiva in Sachsen-Anhalt
	• Germany’s developed IT health infrastructure (e.g. electronic health card) may be able to offer RM and other telemedicine technologies in the future but is currently only used for billing purposes
Italy[20, 25–29]	• National Observatory for the Evaluation and the monitoring of eCare Networks: an organisation initiated by the Ministry of Health in 2007, in agreement with the region of Emilia Romagna; created a web-platform where 700+ telemedicine initiatives are self-reported on the basis of the technology, organisation, cost, and clinical value; developed “Guidelines for the Development of Telemedicine Best Practices”
	• RM pilot projects are implemented at a regional level by the Azienda Sanitaria Locale (ASLs), the regional health authority
	• Horizon Scanning: initiated by AGENAS (National Agency for Regional Healthcare), this programme evaluates emerging technologies including telemonitoring
	• Board of Health Technical table (Tavolo Tecnico): established in February 2011 to determine a strategic framework for telemedicine and define taxonomies/classifications
Spain[30–34]	• In addition to a national HTA (Institute of Carlos III), regional HTAs are also involved in the evaluation of RM technologies; the Research Unit for Telemedicine and Information Society (UITeS), a division under the national HTA, is attempting to address the standards issue and encourage uptake of RM/telemedicine
	• Platform of Innovation in Telehealth Systems (PITES) is a government-supported initiative that provides services and tools to support research groups (public, private and organisations) in obtaining evidence for new RM and telemedicine models that provide health care for chronic illnesses and dependency
	• Multiple projects throughout Spain use PITES as its infrastructure (e.g. Hospital Universitario Virgen del Rocío, Hospital Universitario Ramón y Cajal)
	• Telemedicine programmes have long been implemented at certain regions (e.g. Valcronic teleHealth program, since 2011 in Valencia region, TELBIL program since 2013 in Basque Country) and local hospitals (e.g. Hospital Clinic in Barcelona since 1999), specifically in patients with chronic disease
	• Regions with high levels of telemedicine/RM include: Catalonia, Canary Islands (high level of telemedicine not RM), Basque Country, Valencia Region and Andalucia; national technological standards may be an issue since interoperability varies between and within regions (e.g. Catalonia providers use different information systems, Valencia, Andalucía and Basque Country each have its own system)