From pilots to integrated patient pathways: governing telemedicine scale-up in Austria

Issue/problem

Austria’s national eHealth strategy (2024–2028) envisions digitally supported patient pathways under the principle “digital before ambulatory before inpatient”, aiming to ensure access to appropriate care through integrated digital and in-person services. Telemedicine is a key enabler of access, coordination and continuity. In practice, provision remains fragmented and largely pilot-driven across regions, providers and indications. This gap highlights a core policy challenge: telemedicine does not fail due to lack of technology, but due to the difficulty of scaling it into coordinated routine care.

Description of the problem

Within Austria’s joint governance framework (Zielsteuerung-Gesundheit), telemedicine is addressed through a cross-cutting patient pathway initiative. In a multistakeholder working group, federal, regional and social insurance actors co-create a shared basis for policy decisions. Building on a common definition, the process focuses on integrating digital services across all phases of a modern patient journey. The initial focus is physician-led teleconsultation for acute, non-life-threatening cases, defining concepts, roles and cornerstones.

Results

The main effect is the creation of a shared governance frame positioning telemedicine within patient pathways. As a first operational step, stakeholders prioritised physician-led teleconsultation as a nationwide, standardised entry point, translating a broad digital vision into a concrete implementation pathway.

Lessons

Telemedicine scales when governed as patient pathway infrastructure rather than implemented as stand-alone services. Scaling depends on negotiated alignment of stakeholders, workflows, responsibilities, reimbursement, legal frameworks and interoperable infrastructures. Public health action should prioritise staged co-creation, transforming fragmented initiatives into coordinated, integrated and equitable digital care.

Key messages

• Scaling telemedicine nationwide requires recognising its role across patient pathways and aligning stakeholders, workflows and incentives beyond isolated pilots.

• Telemedicine scale-up is a governance process in which stakeholders co-create and stabilise shared solutions across the health system.