Table 2.

Digital maturity scale for healthcare organizations in relation to remote services.

Organizational descriptor	How the organization currently uses traditional technology (e.g., phone, online access) and new technology (e.g., video, telehealth apps) to support remote consultations
Level 1: Traditional (reactive)	Limited leadership or vision for remote services (there may be a strategic decision and rationale to resist these). Phone is used for triage and call-backs e.g., for demand management and as a response to the pandemic. Patient online access is mostly disabled. Video and telehealth are rarely if ever used and may be actively discouraged. Key infrastructure may not be in place. Digital inequalities either not addressed or addressed by focusing on face-to-face services.
Level 2: Traditional with lone innovator (ad hoc, demonstration)	Within a traditional organization or department, one staff member is enthusiastic about remote care, s/he attempts to use novel technologies and engage others in doing so, but has not yet succeeded in getting others to share the vision, influencing practice strategy or changing practice routines or policies. Infrastructure may be inadequate. Digital inclusion not yet a priority issue.
Level 3: Digitally curious (experimenting)	The organization or department has a vision and plans for providing remote care. Traditional and new technologies are used creatively, and adjusted iteratively, to try to improve an aspect of care within the practice. These creative efforts may include measures to overcome digital inequalities. Focus is on technical details and feasibility (i.e., making something work). Infrastructure is adequate but may have limitations.
Level 4: Digitally embedded (learning and improving)	Both traditional and new technologies are used creatively and strategically, and benefits and disbenefits are evaluated, with the aim of improving remote care in all relevant areas across the organization, including efforts to meet the needs of digitally excluded groups. Digital capability is high (i.e., many services are successfully delivered remotely). Focus is on quality improvement and organizational learning. Work practices and routines are continuously adapted. Technical infrastructure is good as a result of strategic investment.
Level 5: System-oriented (extending and spreading)	Strategy and vision for remote services are strong and extend beyond the organization itself. Reducing digital inequalities is one aspect of a wider vision for an effective, efficient, equitable remote service. Digital capability is high. Staff are actively involved in developing and evaluating remote services beyond the practice—e.g., through inter-organizational benchmarking, quality improvement collaboratives, locality-wide planning, research, national guidelines.