Table 3.

Recommendations for improvement in policy and practice, based on barriers experienced in rapid virtual care tools development (after Houlding et al [1]).

Barriers	Normal practice	Rapid cycle	Suggestions for future
Poor internet connectivity	Solution delivery platform designed for optimal functionality for the target population; multichannel delivery with “low tech” where possible	Solution delivery can take into consideration the availability, access, speed, and other requirements of applications depending on the project context. The latter can encompass pilot applications across any of 3G, 4G, 5G, and WiFi	Create a registry of available technology platforms for areas where optimal solutions are unavailable; these could be related to geography, topology, rurality, service outages, or cost of access
Low health literacy	Design with language optimized for target populations	Considerations often overlooked or unavailable in the project context due to emphasis on rapid prototyping without participation of a spectrum of service users	Create design templates for developers to utilize in specific low literacy populations
Low digital literacy	Design with “low tech” optimized for target populations	Considerations often overlooked or unavailable in the project context due to emphasis on rapid prototyping without participation of a spectrum of service users	Consider development of support models for users (eg, training, adoption support)
Need for quality, best-practice guidelines for use of remote monitoring technologies in clinical care	Project design and funding aimed to support optimal solutions	Utilize technology already available and approved; design interface around available devices	Development and maintenance of tool sets and guidelines for remote and home monitoring use
Lack of resources to develop and support new technologies	Project design and funding aimed to support optimal solutions, which may include new technologies where feasible	Rapid design of applications leveraging existing technologies, devices, and/or platforms. Innovation is often in the reuse of technologies to extend and/or enhance functionality	Structured simulation and validation frameworks for rapid-cycle development, testing, clinical trial, and deployment. Consider total cost of ownership (eg, unmeasured development costs, hosting costs). Manage human resources cost (eg, informal time of subject matter expert clinicians, technical developers’ time)
Equity-related unaffordability of technology for users	Scoping outcomes and target clientele; mitigations for identified consumers; alternate funding models or subsidies; design for least-cost technology; stratified interventions	Equity considerations frequently not addressed; 80/20 rules due to rapid prototyping process for majority service users; mitigations for descoped users may be considered in a subsequent evaluation phase	Identify and resolve long-standing equity and access issues so that standing solutions are available to be incorporated at short notice; build in multilanguage capability; develop policies and mitigations for equity access as part of business as usual; apps delivered if possible over multiple channels, including low-cost SMS and phone