Table 4.

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

Enablers	Normal practice	Rapid cycle	Suggestions for future
Governance: policies reflect required outcomes and describe allowable emergency and rapid-cycle processes and permissions framework	Review internal policies and ensure they reflect both business-as-usual and emergency situations to enable appropriate rapid responses	Existing policies describe acceptable process and outcomes in the absence of conformance with standing committee and approvals framework in defined circumstances	Identify “special needs and emergency” situations; review business-as-usual practice to reduce unnecessary delays
Master services contracts: reducing procurement delays with trusted providers	Individual projects defined, budgeted, and tendered; project management framework defined	Existing relationships leveraged to create short-term team with focused but flexible and evolving outcomes as external environment evolves	Establish panels of approved partners and consultants to enable rapid design and deployment, especially using existing enterprise solutions
Standing consumer working groups for rapid cycle codesign	Consumer groups engaged on project basis, often ad hoc	Consumer groups might be largely ignored in the rapid prototyping process and in participatory practices over the course of the rapid cycle	Establish panels of educated consumers who can contribute knowledgeably across all projects and be available at short notice; actively engage a spectrum of users and consumer organizations; cocreate a participation framework with a cross-section of consumers/service users throughout the life of the service, including options for training (eg, digital and health literacy)
Upskilling and enabling clinicians and subject matter experts to lead projects targeted at their specific issues (eg, predicting issues and rapid problem enunciation)	Clinician-led projects battle for priority and resourcing against “top-down” projects	Clinician-led and developed applications target local requirements using defined, secure, integrated platform applications; informal international clinical networks and peer review rapid publications flag concerns prior to official body pronouncements: lead the local curve	Training and enabling clinicians in supported platform applications (eg, Dynamics, Forms, REDCapa), reduces lead time and impact on core ITb/EMRc applications teams. Clinical networks promote data conformance and spread of successful applications
Collaboration (clinical and technical) networks facilitate shared understanding and requirements for development, together with resource sharing	Organizational, cross-organizational, and professional and clinical networks advise on priority applications and consulted ad hoc regarding application selection and deployment issues	Existing networks should be convened as priority to coordinate and share resources to expedite planning development and implementation. Parochial variation should be reduced or eliminated	Convene, support, and sustain these networks as business as usual so they deliver benefits and are functional when required in emergency scenarios

^aREDCap: Research Electronic Data Capture.

^bIT: information technology.

^cEMR: electronic medical record.