Presentation (CTI)

Problem Statement: Emergency medical services increasingly face diagnostic complexity and workforce shortages. Downstream emergency department crowding further amplifies pressure on prehospital triage decisions, contributing to conservative decision-making and potentially avoidable hospital transports. Telemedicine is frequently proposed to support prehospital decision-making, yet implementation at scale remains limited. A key barrier is the absence of structural reimbursement pathways for prehospital teleconsultation, resulting in a misalignment between where costs are incurred and where benefits accrue across the care continuum. This creates uncertainty for providers, insurers, and policymakers when deciding whether and how to invest in telemedicine interventions before effectiveness evidence is available.
Description: This HEOR impact case describes the early development of SMART Triage, a prehospital telemedicine intervention in the Dutch acute care region Hollands Midden, enabling real-time consultation between ambulance professionals and hospital-based specialists. HEOR considerations were embedded from the outset to inform development and financing decisions under non-integrated payment structures. Evidence generation combined exploratory analyses of potentially avoidable hospital utilisation, assessment of anticipated system-level efficiency gains, and evaluation of financial feasibility within existing reimbursement frameworks. Methods included stakeholder interviews, service blueprinting, simulation-based pilots, and development of business cases to support discussions with health insurers. Temporary transformation funding from the Dutch Integraal Zorgakkoord programme enabled initial development and piloting, while insurers were engaged to explore how early evidence and design choices could support future reimbursement decisions.
Lessons Learned: Embedding HEOR perspectives early in the development process influenced key design and implementation decisions, including prioritisation of patient groups with the highest expected system impact, selection of technology compatible with existing workflows, and clarification of professional accountability to reduce legal and organisational risk. While temporary funding facilitated innovation, it did not resolve long-term sustainability challenges. The case demonstrates that without integrated reimbursement pathways, telemedicine interventions risk stalling after pilot phases. Early alignment of evidence generation with payer decision needs is essential to support scale-up, future evaluation, and sustainable adoption.
Stakeholder Perspective: This impact case is presented from a combined provider and payer perspective, reflecting the experiences of ambulance services, hospital providers, and health insurers involved in development and financing discussions.