Innovation without scale: system-level lessons from Austria’s telemedicine landscape
Abstract
Background: Telemedicine is widely promoted to improve access, quality and efficiency in health care. While several European countries have moved towards scaled and integrated digital services, system-level implementation remains uneven. Austria is often characterised as innovation-friendly but slow in translating digital initiatives into routine care. This study examines Austria’s telemedicine landscape from a system perspective, focusing on maturity, scalability and the introduction of a novel communication-based classification.
Methods: We conducted a mixed-methods system analysis combining structured desk research, policy document review and expert validation. Telemedicine applications were identified and analysed using a communication-oriented framework distinguishing four types based on synchronous and asynchronous interactions between patients and healthcare providers and among providers. Applications in routine care, pilot phase and discontinued but policy-relevant initiatives were included.
Results: A total of 76 telemedicine applications were identified across Austria, of which only 48 are in routine operation, indicating that many remain pilot-based or have been discontinued. Implementation is highly fragmented: 75% are regional, while only 13% operate nationwide. Telemedicine is mainly applied in cardiology, followed by general practice and dermatology. Overall, the landscape shows high activity but low integration, with no coherent nationwide service model.
Conclusions: Austria’s telemedicine landscape illustrates a broader European challenge: innovation without scale. It remains a set of loosely connected projects rather than a coordinated system. Scaling requires addressing governance, financing and infrastructure as core public health issues, not merely technological adoption. A system-level perspective is essential to translate digital innovation into population-level impact.
Key messages: • High telemedicine activity does not translate into system-level scale, as many applications remain pilot based or are discontinued.
• Scaling telemedicine requires coordinated governance and integration, not only technological innovation.
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BibTeX
@article{wegleitnerkainz2026innovation,
title = {{Innovation without scale: system-level lessons from Austria’s telemedicine landscape}},
author = {C Wegleitner-Kainz and A Laschkolnig and EF Tanriverdi},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.449},
url = {https://doi.org/10.1093/eurpub/ckag169.449},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Innovation without scale: system-level lessons from Austria’s telemedicine landscape
AU - C Wegleitner-Kainz
AU - A Laschkolnig
AU - EF Tanriverdi
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.449
UR - https://doi.org/10.1093/eurpub/ckag169.449
AB - Background: Telemedicine is widely promoted to improve access, quality and efficiency in health care. While several European countries have moved towards scaled and integrated digital services, system-level implementation remains uneven. Austria is often characterised as innovation-friendly but slow in translating digital initiatives into routine care. This study examines Austria’s telemedicine landscape from a system perspective, focusing on maturity, scalability and the introduction of a novel communication-based classification. Methods: We conducted a mixed-methods system analysis combining structured desk research, policy document review and expert validation. Telemedicine applications were identified and analysed using a communication-oriented framework distinguishing four types based on synchronous and asynchronous interactions between patients and healthcare providers and among providers. Applications in routine care, pilot phase and discontinued but policy-relevant initiatives were included. Results: A total of 76 telemedicine applications were identified across Austria, of which only 48 are in routine operation, indicating that many remain pilot-based or have been discontinued. Implementation is highly fragmented: 75% are regional, while only 13% operate nationwide. Telemedicine is mainly applied in cardiology, followed by general practice and dermatology. Overall, the landscape shows high activity but low integration, with no coherent nationwide service model. Conclusions: Austria’s telemedicine landscape illustrates a broader European challenge: innovation without scale. It remains a set of loosely connected projects rather than a coordinated system. Scaling requires addressing governance, financing and infrastructure as core public health issues, not merely technological adoption. A system-level perspective is essential to translate digital innovation into population-level impact. Key messages: • High telemedicine activity does not translate into system-level scale, as many applications remain pilot based or are discontinued. • Scaling telemedicine requires coordinated governance and integration, not only technological innovation.
SN - 1101-1262
SN - 1464-360X
ER -