Model for assessment of telemedicine
Model for assessment of telemedicine (MAST) is a framework for assessment of the value of telemedicine.
Telemedicine services may have many different types of outcomes and can be studied in many ways. In order for those who develop new telemedicine services to produce the information that healthcare managers need for making decisions on investment in telemedicine, a model for assessment of telemedicine (MAST) was developed. This work was done in 2010 through stakeholder workshops and on the basis of a systematic literature review.
If the objective of an assessment of telemedicine applications is to describe effectiveness and contribution to quality of care and to produce a basis for decision making, then MAST defines the relevant assessment framework fulfilling this objective as a multidisciplinary process which summarizes and evaluates information about the medical, social, economic and ethical issues related to the use of telemedicine in a systematic, unbiased, robust manner.
This statement is based on the definition of Health_technology_assessment (HTA) in the EUnetHTA project. Key concepts are "multidisciplinary" and "systematic, unbiased and robust". The first concept implies that the assessments should include all important outcomes of the applications for patients, clinicians, healthcare institutions and society in general. The others imply that assessments should be based on scientific studies and methods, scientific criteria for quality of evidence and scientific standards for reporting of results, e.g. as described in EQUATOR Network.
In practice the use of MAST includes three steps:
- Preceding assessment
- Multidisciplinary assessment
- Transferability assessment
Firstly, the assessment must start with preceding considerations in order to determine whether it is relevant for an institution at a given point in time to carry out the assessment. This step involves mainly assessment of the maturity of the technology and the organization planning to use it. If the technology is not matured and have not been tested in practice, then pilot studies must be carried out to mature the technology before a multidisciplinary study is initiated.
Secondly, after the preceding considerations, the multidisciplinary assessment is carried out in order to describe and assess the different outcomes of the telemedicine application. This involves assessment of ouctomes within the following seven domains:
- Domain 1: Health problem and characteristics of the application
- Domain 2: Safety
- Domain 3: Clinical effectiveness
- Domain 4: Patient perspectives
- Domain 5: Economic aspects
- Domain 6: Organizational aspects
- Domain 7: Socio-cultural, ethical and legal aspects
Thirdly, in relation to the description of the outcomes, an assessment should also be made of the transferability of the results to other settings or countries.
MAST is the most widely used framework for assessment of telemedicine in Europe. The model is used in large EU funded telemedicine project like Renewing Health, United4Health, Smartcare and inCASA. These projects include more than 20.000 patients and more than 18 randomised controlled trials. A large number of individual telemedicine projects also use MAST e.g. Patient@home, Durand-Zaleski (2013) and Campos et al. (2013) 
The number of publications of studies using MAST is still limited, but growing. The first clinical studies have been reported by Sorknæs et al. (2013), Karhula et al. (2015) and Rasmussen et al. (2015). Recently a study of the organizational outcomes of implementation of telemedicine was published by Rasmussen et al. (2015).
MAST has also been recommended as a usable structure for assessment of outcomes of telemedicine by the association of Danish Regions Telemedicine strategy, by the British Thoracic Society statement on telemedicine (2014) and within the field of wound care by Angel et al. (2015).
Difference between MAST and EUnetHTA Core model
MAST is based on HTA and the EUnetHTA Core model, but whereas the core model includes 9 domains, MAST only includes 7 domains. This is done by combining the content of several domains into one. MAST has also a separate domain describing the impact of telemedicine on patient perception and thereby underlining the importance of the patients' view of this type of health care technology. In addition the three steps in MAST underline that the assessment of outcomes should be seen in the light of the maturity of the technology and the transferability of the results to other countries.
- Kidholm K, Ekeland AG, Jensen LK, Rasmussen J, Pedersen CD, Bowes A, Flottorp SA, Bech M. A model for assessment of telemedicine applications: MAST. Int J Technol Assess Health Care. 2012 Jan;28(1):44–51. PMID 22617736
- Dyrvig AK, Kidholm K, Gerke O, Vondeling H. Checklists for external validity: a systematic review. J Eval Clin Pract. 2014 Dec;20(6):857-64
- Renewing Health
- Durand-Zaleski I, Zarca K, Charrier N, Treluyer L, Calinaud C. Deploying and assessing telemedicine in the Paris region: progress report. International Journal of Integrated Care (IJIC) . Nov2013, Vol. 13, p1-2. 2p.
- Campos C, Caudevilla E, Alesanco A, Lasierra N, Martinez O, Fernandez J, Garcia J. Setting up a telemedicine service for remote real-time video-EEG consultation in La Rioja (Spain). International Journal of Medical Informatics. Volume 81, Issue 6, June 2012, Pages 404–414.
- Sorknaes AD, Bech M, Madsen H, Titlestad IL, Hounsgaard L, Hansen-Nord M, Jest P, Olesen F, Lauridsen J, Østergaard B. The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation.J Telemed Telecare. 2013 Dec;19(8):466-74
- Torbjørnsen A, Jenum AK, Småstuen MC, Arsand E, Holmen H, Wahl AK, Ribu L. A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH. JMIR Mhealth Uhealth. 2014 Dec 11;2(4):e52. doi: 10.2196/mhealth.3535.
- Tuula Karhula et al.: Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial. Journal of Medical Internet Research; 2015 Volume 17, Issue 6 e153.
- Rasmussen BS, Froekjaer J, Bjerregaard MR, Lauritsen J, Hangaard J, Henriksen CW, Halekoh U, Yderstraede KB. A Randomized Controlled Trial Comparing Telemedical and Standard Outpatient Monitoring of Diabetic Foot Ulcers. Diabetes Care. 2015 Jun 26.
- Rasmussen BS, Jensen LK, Froekjaer J, Kidholm K, Kensing F, Yderstraede KB. A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients. Int J Med Inform. 2015 May 29
- Angel D, Bjerregaard J, O'Conner T, McGuinness W, Kröger K, Rasmussen BSR, Yderstraede KB. Chapter 3: The model for assessment of telemedicine (MAST) – evaluation of telemedical solutions. J Wound Care. 2015 May; 24 Suppl 5:S10-3.
- EUropean network for Health Technology Assessment (EUnetHTA): http://www.eunethta.eu/
- Renewing Health project: http://www.renewinghealth.eu/en/
- United4Health project: http://united4health.eu/
- Patient@home project: http://www.en.patientathome.dk/
- Smart Care project: http://www.pilotsmartcare.eu/home/
- InCASA: http://www.incasa-project.eu/news.php
- MAST manual
- Videos on MAST