A Risk Management Framework for Triadic Telemedicine (RMFTT): A Conceptual Development Study

Background: The triadic model of assisted telemedicine, in which a trained nurse or caregiver facilitates the clinical encounter between a patient and a remote physician, holds considerable potential for improving access, diagnostic accuracy, and continuity of care. However, the distinctive risk architecture of this three-party model remains poorly characterized. Existing telemedicine risk literature addresses predominantly dyadic consultations, leaving the triadic context without a dedicated, integrative framework. Objective: This study aims to address the absence of a dedicated risk management framework for the triadic telemedicine context by proposing the Risk Management Framework for Triadic Telemedicine (RMFTT)—a structured, domain-specific tool for identifying, assessing, mitigating, and monitoring the principal risks inherent to nurse-facilitated assisted telemedicine. Methods: This conceptual framework development study employs a narrative literature review of PubMed, Scopus, Web of Science, and Google Scholar publications from January 2015 to June 2026, organized across five risk domains: clinical and diagnostic risk, communication risk, legal and liability risk, data privacy and cybersecurity risk, and workforce competency risk. Extracted evidence is synthesized using a structured risk architecture matrix, distinguishing risk type, source, likelihood, and consequence severity within the triadic telemedicine context. Results: The synthesis yields the Risk Management Framework for Triadic Telemedicine (RMFTT), a two-axis conceptual model mapping five risk domains against four risk management stages: identification, assessment, mitigation, and monitoring. Each domain is populated with literature-derived risk indicators and corresponding mitigation strategies tailored to the triadic care setting. Conclusions: To our knowledge, no dedicated risk management framework has previously been proposed for the triadic telemedicine context. The RMFTT provides the first structured, domain-specific tool for identifying, assessing, mitigating, and monitoring risk across the five principal dimensions of assisted triadic telemedicine. It offers actionable guidance for clinicians, nurse-facilitators, health system managers, and policymakers, and establishes a foundation for subsequent empirical validation across diverse healthcare settings.