Dynamic Evaluation Approaches to Telehealth Technologies and Artiﬁcial Intelligence (AI) Telemedicine Applications in Healthcare and Biotechnology Organizations

: The COVID-19 pandemic has ushered in an unprecedented adoption and integration of telehealth and artiﬁcial intelligence (AI) driven by telemedicine technologies into healthcare systems worldwide. These innovations promise to revolutionize healthcare delivery by offering greater accessibility, efﬁciency, and responsiveness to patient needs. However, the rapid deployment of these technologies in response to the crisis has illuminated the imperative need for systematic evaluation processes that comprehensively assess their operations and outcomes. This article underscores the critical importance of developing rigorous evaluation frameworks tailored to the evolving landscape of telehealth and AI-driven telemedicine technologies. The absence of standardized evaluation processes presents multifaceted challenges including uncertainties regarding long-term efﬁcacy, patient safety, data security, and ethical considerations. Ensuring the responsible and effective integration of telehealth and AI into healthcare systems requires adaptable, multidimensional evaluation mechanisms that align with clinical objectives and regulatory standards. Through an examination of documents, procedures, policies, and best practices by regional hospitals, this article advocates for developing evaluation processes that enable stakeholders to optimize the deployment of telehealth and AI technologies fostering patient-centered care while addressing emerging challenges. In an era marked by healthcare transformation, establishing robust evaluation frameworks emerges as a paramount endeavor essential for realizing the full potential of telehealth and AI-driven telemedicine in the post-COVID-19 healthcare ecosystem.


Introduction
The advent of the COVID-19 pandemic has propelled the healthcare landscape into an era of rapid transformation marked by an unprecedented integration of telehealth and artificial intelligence (AI)-driven telemedicine technologies.This paradigm shift, driven by the urgent need for innovative solutions, holds the promise of revolutionizing healthcare delivery, offering enhanced accessibility, efficiency, and responsiveness to patient needs.As these technologies become integral components of healthcare systems worldwide, the need for systematic evaluation processes becomes increasingly apparent.
In the midst of this transformative wave, there exists a notable gap in research that squarely addresses the needs and perspectives of those entrenched in the day-to-day operations of healthcare and the broader world of practice.While considerable attention is rightfully devoted to the potential benefits of telehealth and AI-driven telemedicine technologies, there is a pressing need to shift our focus to the systematic evaluation of their operations and outcomes, especially in real-world healthcare settings.
This paper endeavors to underscore the critical importance of developing a rigorous evaluation framework tailored to the unique challenges and dynamics of the evolving landscape of telehealth and AI-driven telemedicine technologies.The accelerated deployment of these technologies in response to the crisis has brought to light the necessity for standardized evaluation processes.The absence of such frameworks introduces multifaceted challenges including the uncertainties surrounding long-term efficacy, patient safety, data security, and ethical considerations.
In this context, our exploration aims to advocate for the establishment of adaptable, multidimensional evaluation mechanisms that align with clinical objectives and regulatory standards.Beyond the theoretical promises of these technologies, the responsible and effective integration of telehealth and AI into healthcare systems necessitates a nuanced understanding of their impact on patient outcomes and healthcare operations.
Through a comprehensive examination of the current landscape, this article seeks to contribute to the ongoing discourse by advocating for the development of evaluation processes that empower stakeholders to optimize the deployment of telehealth and AI technologies.The ultimate goal is to foster patient-centered care while proactively addressing emerging challenges.
In an era defined by healthcare transformation, the establishment of robust evaluation frameworks emerges as a paramount endeavor.Only through tools, checklists, and realworld approaches to the evaluation of operations and outcomes can we fully realize the potential of telehealth and AI-driven telemedicine in shaping the post-COVID-19 healthcare ecosystem based on real-world experiences and applications.

Problem Statement
The healthcare industry is undergoing a significant transformation propelled by the advent of digital technologies and the incorporation of artificial intelligence (AI).According to El-Yafouri [1], the global market for AI in healthcare exceeded $11 billion in 2021, and projections anticipate a substantial increase to approximately $188 billion by 2030.This exponential growth underscores the profound impact of AI on the healthcare landscape.
In the midst of this digital revolution that permeates every facet of our lives, healthcare is experiencing a paradigm shift.New innovations are emerging to reshape the delivery of healthcare services, elevating patient outcomes, and optimizing operational efficiency [1].The continuous evolution of the healthcare sector is closely intertwined with the ongoing transformation brought about by digital technologies.
In this dynamic landscape, digital advancements are not only altering the delivery of care but also redefining the dynamics between patients and healthcare providers.As patients increasingly turn to digital avenues for seeking care and physicians leverage technology to deliver it, the traditional healthcare paradigm is being redefined [1].This metamorphosis is not merely a trend; it represents a fundamental restructuring of the healthcare experience driven by the integration of digital technologies and AI.
The arrival of the COVID-19 pandemic has accelerated the adoption of telehealth and AI-driven telemedicine technologies revolutionizing the landscape of healthcare delivery.While these innovations offer immense potential to enhance accessibility, efficiency, and quality of care, the rapid deployment of these technologies has underscored the pressing need for robust evaluation processes to assess their operations and outcomes comprehensively.This problem statement elucidates the critical importance of establishing systematic evaluation frameworks tailored to the challenges and opportunities of integrating telehealth and AI-driven solutions in the post-COVID-19 era.
The unprecedented expansion of telehealth services and AI applications in healthcare has brought about an urgent imperative to ensure that these transformative technologies align with clinical objectives, protect patient privacy, and yield positive patient outcomes.Although the crisis necessitated rapid deployment, it has also introduced uncertainties and knowledge gaps regarding these interventions' long-term efficacy, safety, and ethical implications.The absence of standardized evaluation processes tailored to the evolving landscape of telehealth and AI-driven telemedicine technologies not only hinders the realization of their full potential but also poses risks to patient care, data security, and the sustainability of healthcare systems.As such, there is a compelling need for rigorous, adaptable, and multidimensional evaluation frameworks that can guide stakeholders in optimizing the integration of telehealth and AI in healthcare while ensuring that patientcentered goals and regulatory standards are met.This article explores and advocates for developing such evaluation processes imperative for advancing the responsible, effective, and equitable implementation of telehealth and AI-driven telemedicine technologies in the post-COVID-19 healthcare landscape.

Purpose
The paper intends to explore evaluation approaches to telehealth technologies and emerging applications of AI in telehealth.This research aims to influence the world of practice and healthcare leaders as they make strategic and contingent plans to implement AI.

Design/Methodology/Approach
This inquiry is intended to influence the practice which matters significantly to those in leadership decision-making roles looking for actionable guidance as new healthcare technologies emerge.Collecting data for this conceptual paper was aimed at developing critical evaluation approaches and guidelines by benchmarking procedures and evaluation telehealth technology documents and emerging AI telehealth documents of the two largest VA hospitals in the state of Virginia and the state of West Virginia (four total).The process involved a comprehensive review of the hospitals' official documents, policies, and guidelines.The scrutinized documents exclusively encompassed the process and program evaluation materials pertaining to hospital protocols, quality assurance assessments, patient feedback records, and regulatory compliance documentation.All are germane to the realm of telehealth technologies and the applications of artificial intelligence therein.This method of document analysis was instrumental in engendering an exhaustive comprehension of the extant procedural frameworks and guidelines with the overarching objective of amalgamating divergent methodologies into a unified, comprehensive approach for critical evaluation that espouses pertinent and evidence-based criteria as corroborated by esteemed scholars such as Karppinen and Moe [2], and Bowen [3].Document analysis can successfully and effectively function in a central role as the solitary research methodology in certain instances [4][5][6].In such cases, the use of pre-existing documents affords researchers unparalleled access to a wellspring of data serving as the preeminent resource for the successful fruition of research projects as validated by the scholarly contributions of Karppinen and Moe [2], and Bowen [3].
Applied research approaches play a pivotal role in addressing and solving complex real-world problems and offering a direct bridge between theory and practice [4][5][6].The importance of applied research approaches lies in their capacity to generate actionable insights and practical solutions that have a tangible impact on individuals, organizations, and societies at large [4][5][6].Unlike purely theoretical research, applied research is grounded in the practical context allowing for the testing of hypotheses and the development of evidence-based strategies [6].This form of research provides invaluable guidance for decision-makers across various domains ranging from healthcare and business to public policy and technology, enabling them to make informed choices, optimize resources, and navigate the multifaceted challenges of our rapidly changing world.Ultimately, the significance of applied research lies in its ability to transform knowledge into action to foster innovation, progress, and meaningful change in the pursuit of solutions to some of the most pressing and intricate problems of our time [4][5][6].
Practical and applied approaches to topics are pivotal in building the foundation for future empirical and quantitative studies [4][5][6].These approaches provide a tangible connection between theory and real-world scenarios, offering researchers invaluable insights into the practical implications of their hypotheses [4][5][6].By delving into practical applications, researchers gain a deeper understanding of the challenges, nuances, and complexities that may not be apparent in the theoretical frameworks alone [6].This experiential knowledge serves as a vital precursor to the design and execution of empirical and quantitative studies guiding researchers to formulate relevant research questions, develop robust methodologies, and interpret data contextually and meaningfully [6,7].
Furthermore, practical and applied approaches often serve as a litmus test for the feasibility and relevance of research inquiries, helping researchers refine their focus and prioritize areas of investigation with the most significant potential for impact [6,7].In essence, the synergy between practical exploration and empirical analysis forms a dynamic continuum in research wherein the former informs and enriches the latter, ultimately advancing the depth and applicability of scientific inquiry [4][5][6].
Document analysis is an empirical research approach that is often underutilized and underestimated, and it offers a systematic and structured method for extracting valuable insights from existing documents contributing to the empirical foundation of applied research [8].Document analysis involves the comprehensive review and systematic examination of documents such as reports, policy documents, archival records, and other textual data to extract meaningful information, patterns, and insights [8].It operates on the premise that documents, as repositories of human knowledge and actions, contain valuable empirical data that can be rigorously analyzed to inform research inquiries [8].Document analysis is rooted in empirical inquiry as it relies on the tangible artifacts of human activity to draw conclusions and generate knowledge [8].

Key Principles of Document Analysis
Document analysis follows a structured and systematic approach which includes defining research questions, selecting relevant documents, and developing coding schemes.To enhance empirical rigor, document analysis often employs triangulation by crossreferencing information from multiple documents or sources [8].An exploration of documents emphasizes understanding the context in which the documents were created allowing researchers to interpret findings within their historical, social, and organizational contexts [8].Document analysis strives for transparency and reproducibility, ensuring that the research process can be replicated and verified by other scholars [8].

Originality/Value
While theoretical discussions are valuable, the true fulfillment of these technologies' potential necessitates a shift toward practical tools, checklists, and real-world approaches.For healthcare leaders navigating unfamiliar territory, these tangible resources will serve as guiding lights providing structured pathways for the evaluation of operations and outcomes.It is in these practical applications that the transformative power of telehealth and AI-driven telemedicine will manifest concretely.
For those with limited exposure to these technologies, the starting point lies in the systematic exploration of existing evaluation frameworks.This involves understanding the intricacies of assessing operations and outcomes, identifying key performance indicators, and establishing benchmarks for success.Furthermore, embracing a learn-as-you-go approach can demystify the complexities, allowing healthcare leaders to incrementally incorporate telehealth and AI into their operational landscape.
Equally crucial is the creation of user-friendly guides and toolkits tailored for healthcare leaders with varying levels of expertise.These resources should provide step-by-step instructions, best practices, and case studies offering practical insights that bridge the gap between theory and application.Collaborative platforms for knowledge sharing and peer-to-peer learning can further enhance the accessibility of these resources, fostering a supportive community for healthcare leaders navigating the integration of telehealth and AI technologies.
In essence, our journey toward unlocking the full potential of telehealth and AI-driven telemedicine involves not just theoretical discourse but also a commitment to practical, actionable steps.By providing accessible tools and frameworks, we empower healthcare leaders with limited exposure to navigate these transformative technologies confidently, ensuring that the promises of enhanced patient care and operational efficiency become a tangible reality.This research is valuable because it is intended for real-world healthcare managers who often face challenges with solving actual organizational problems through the abstract nature of theoretical and highly quantitative research studies.This paper represents a pioneering practice endeavor characterized by its profound originality and novelty by developing evaluation approaches and recommend steps.The originality of this study lies in its exploration of the swift and unprecedented adoption of telehealth technologies in response to the urgent demands imposed by the COVID-19 pandemic.With the rapid proliferation of telehealth, healthcare systems across the globe have been compelled to embrace these technologies as a primary means of delivering care, often bypassing the conventional thoroughness of evaluation methods and processes.This research endeavors to shed light on this remarkable juncture where necessity expedited innovation and healthcare practices underwent a paradigm shift characterized by adaptability and innovation amidst uncertainty.
Furthermore, this research aims to distill invaluable insights from this unique context, thereby informing future strategies for the integration of telehealth into routine healthcare delivery.By traversing this uncharted territory, it seeks to foster a deeper understanding of the intricate interplay among technology, healthcare, and crisis response, ultimately contributing to the reservoir of knowledge essential for building resilient healthcare systems and safeguarding the well-being of patients in a world that continues to grapple with unforeseen challenges.

Findings
The rapid and unprecedented expansion of telehealth services and the integration of AI applications in healthcare have underscored the urgent necessity to align these transformative technologies with clinical objectives, safeguard patient privacy, and ensure positive patient outcomes.While the crisis-driven acceleration of these innovations was a response to immediate needs, it has simultaneously introduced uncertainties and created knowledge gaps about their long-term effectiveness, safety, and ethical implications.The absence of standardized evaluation mechanisms tailored to the ever-evolving terrain of telehealth and AI-driven telemedicine technologies not only impedes the realization of their full potential but also poses risks to patient care, data security, and the sustainability of healthcare systems.Consequently, a compelling imperative exists for developing rigorous, adaptable, and multifaceted evaluation frameworks.Such frameworks are indispensable tools for guiding stakeholders in optimizing the seamless integration of telehealth and AI technologies into healthcare systems, all while ensuring that patient-centered objectives and regulatory standards remain at the forefront of this transformative process.This article explores and advocates for establishing these crucial evaluation processes and imperative prerequisites for the responsible, effective, and equitable implementation of telehealth and AI-driven telemedicine technologies in the post-COVID-19 healthcare landscape.

Research Limitations
The research project's primary method, document analysis, offers valuable insights into the selected research topic, specifically the evaluation of telehealth technologies and artificial intelligence applications within healthcare settings.However, it is imperative to acknowledge certain inherent limitations that may impact the scope and generalizability of the findings.
This inquiry exclusively relies on pre-existing documents for data collection from only four government hospitals in a limited geographical area in the United States, which may introduce limitations related to data completeness and relevance.The documents available for analysis may not encompass all pertinent aspects of the research topic and thus omit information that could provide a more comprehensive understanding of the subject matter.Additionally, the research relies on the accuracy and reliability of the documents themselves, and any errors or biases present in the original documents could be perpetuated in the analysis.

Overview
Telehealth uses telecommunications technology to provide remote healthcare services, consultations, and patient support.It encompasses various healthcare activities including consultations, monitoring, education, and care administration conducted remotely via video conferencing, phone calls, mobile apps, and other digital platforms [9].Telehealth has gained significant traction recently, driven by technological advancements and the need for accessible and convenient healthcare, especially in remote or underserved areas [9].AI technologies are increasingly integrated into telehealth systems, revolutionizing patient engagement, treatment, and diagnosis processes [10][11][12][13].
Here is an overview of how AI-powered telehealth can be used in each of these areas:

Engaging Patients
Personalized Health Education: AI can tailor health education materials and messages to individual patients based on their medical history, preferences, and health goals [10][11][12][13].This promotes patient engagement and adherence to treatment plans.Chatbots and Virtual Assistants: AI-driven chatbots and virtual assistants can engage patients by providing realtime responses to inquiries, appointment scheduling, medication reminders, and general health guidance [10][11][12][13].

Treating Patients
Remote Monitoring: AI-enabled wearable devices and sensors can continuously monitor patients' vital signs and transmit data to healthcare providers.AI algorithms can analyze these data to detect anomalies or trends, enabling early intervention [10][11][12][13].
Decision Support: AI-powered clinical decision support systems assist healthcare providers in making accurate diagnoses and treatment recommendations by analyzing patient data and the medical literature [10][11][12][13].

Diagnosing Conditions
Medical Imaging Analysis: AI algorithms can analyze medical images (e.g., X-rays, CT scans, and MRIs) with high accuracy to assist radiologists in detecting and diagnosing conditions such as tumors, fractures, and abnormalities [10][11][12][13].
Natural Language Processing (NLP): NLP-powered AI can transcribe and analyze spoken or written patient information during telehealth consultations.It assists in extracting relevant medical history, symptoms, and insights for diagnosis [10][11][12][13].
Symptom Checker and Triage: AI-driven symptom checkers can evaluate patientreported symptoms, provide preliminary diagnoses, and recommend appropriate next steps such as scheduling a telehealth appointment or seeking in-person care [10][11][12][13].
AI-enhanced telehealth technologies are valuable in improving healthcare accessibility, streamlining diagnosis and enhancing patient engagement.They enable healthcare providers to reach a broader patient base, offer more personalized care, and make more accurate diagnoses, ultimately leading to better health outcomes and increased patient satisfaction.Additionally, AI continuously learns and improves, making it a valuable tool in the rapidly evolving field of telehealth [10][11][12][13].
Telehealth, mobile health, and remote patient monitoring technologies have been growing in popularity as they provide a convenient and cost-effective way of delivering patient care [14].Telehealth, which uses AI or Internet of Things (IoT) technologies, has the potential to revolutionize healthcare [12,15,16].However, ethical considerations must be taken into account to ensure that the unique needs of patients, particularly those whose first language is not English or those who are visually or hearing impaired, are met [12,15,16].
As these technologies become more widely adopted, it is important to remember that English is not the first language for many patients and other patients have visual and hearing disabilities related to telehealth, mobile health, and remote patient monitoring with the help of AI or the IoT.For telehealth to be used ethically, healthcare providers must consider the challenges associated with providing care to patients who do not speak English or have vision or hearing impairments [12,15,16].For instance, AI and IoT technologies may require new interfaces such as voice recognition that are not accessible to patients who are deaf or have limited vision.Furthermore, language barriers may impede communication between health providers and patients, leading to delays in diagnosis and treatment [12,15,16].
To address these challenges, healthcare providers must consider the unique needs of patients and design systems that are accessible to all regardless of language or disability.For example, healthcare providers can use AI and IoT technologies to develop user-friendly interfaces accessible to all patients including those with language barriers or who are visually or hearing impaired.Additionally, healthcare providers should consider using multilingual interfaces or voice-recognition software to ensure that language barriers do not hinder communication between the provider and patient.By taking these steps, healthcare providers can ensure that telehealth is used ethically and that patients receive the care they need regardless of their language or disability [12,15,16].
In addition to considering the unique needs of patients, healthcare providers must also consider the potential risks associated with using AI and IoT technologies in telehealth [11].For instance, data security is a significant concern as AI and IoT technologies may lead to collecting and storing large amounts of sensitive patient data.Using these technologies may also lead to privacy concerns as information about a patient's health may be shared with third parties without their consent.To address these issues, healthcare providers must ensure appropriate safeguards to protect patient data and privacy [9].
The use of key theories is a useful way to understand the adoption and successful use of telemedicine and AI telehealth technologies within healthcare organizations [9].This study employs this method by outlining critical elements of each theory and elucidates how these theoretical frameworks can shed light on the decision-making processes of patients and healthcare providers in adopting or resisting these innovative technologies.

Managing Diabetes and Heart Conditions
AI has made significant contributions to mobile health (mHealth), remote monitoring, and telemedicine, particularly in the context of managing diabetes and heart conditions [17][18][19].
Here are some notable uses.

Early Detection and Diagnosis
AI algorithms can analyze data from wearable devices, such as smartwatches and continuous glucose monitors, to detect early signs of heart conditions and fluctuations in blood glucose levels indicative of diabetes.This enables timely intervention and preventive measures.

Personalized Treatment Plans
AI can analyze vast amounts of patient data considering individual health records, lifestyle factors, and real-time monitoring data.This allows for the creation of personalized treatment plans for patients with diabetes and heart conditions optimizing medication regimens and lifestyle recommendations.

Remote Monitoring
Wearable devices equipped with AI capabilities enable continuous remote monitoring of vital signs, glucose levels, and other relevant health parameters.Healthcare providers can receive real-time data allowing for prompt adjustments to treatment plans and early identification of potential issues.

Predictive Analytics
AI algorithms can predict potential complications related to diabetes and heart conditions by analyzing historical patient data.This helps healthcare providers anticipate and address risks before they escalate, improving patient outcomes and reducing emergency situations.Medication Adherence AI-powered mobile applications can send reminders for medication adherence and provide educational resources to enhance the patient's understanding of treatment plans.These apps can also track medication usage patterns and notify healthcare providers if there are deviations from the prescribed regimen.
Teleconsultations AI-driven chatbots or virtual health assistants can facilitate teleconsultations to provide patients with instant access to healthcare information and guidance.This is particularly useful for routine check-ups, medication adjustments, and general inquiries, enhancing patient engagement and reducing the burden on healthcare systems.

Continuous Glucose Monitoring (CGM)
AI algorithms integrated with CGM devices can analyze glucose trends and patterns, providing valuable insights into a patient's diabetes management.This information can be shared with healthcare providers to enable informed decision-making and proactive adjustments to insulin therapy.

Rehabilitation Support
For patients recovering from heart conditions, AI-based applications can deliver personalized rehabilitation plans including exercise routines and dietary recommendations.These plans can be adapted based on the individual's progress and real-time health data.

Data Security and Privacy
AI plays a crucial role in ensuring the security and privacy of patient data in mobile health applications.Advanced encryption and authentication mechanisms backed by AI algorithms help safeguard sensitive health information.
The integration of AI into mobile health, remote monitoring, and telemedicine for diabetes and heart conditions enhances early detection, personalization of care, remote monitoring, and overall patient outcomes [17][18][19].It also contributes to more efficient and effective healthcare delivery.

Tele-ICU and Tele-Stroke Programs 10.1. Tele-ICU
Tele-ICU and Tele-Stroke programs exemplify the transformative impact of AI in enhancing healthcare delivery, particularly in critical care scenarios.The Tele-ICU initiative employs AI-powered technologies to connect specialty providers with intensive care unit (ICU) teams through video conferencing [20,21].Equipped with TV screens, cameras, and call-buttons, Tele-ICU rooms facilitate seamless communication between on-site healthcare providers and remote specialists.This technology enables virtual consultations where providers can engage with patients, review electronic health records, and document observations about health conditions.AI algorithms may assist in the real-time analysis of patient data offering valuable insights to the on-site care teams.The collaborative efforts between local providers and remote specialists supported by AI contribute to more informed decision-making during critical points of patient care.This integrated approach ensures that treatment plans align with the specific needs of each patient [20,21].

Tele-Stroke Program
In a similar vein, the Tele-Stroke program uses AI-driven solutions to address the challenges faced by healthcare facilities, especially in rural areas lacking continuous acute stroke coverage [22,23].Delivering timely specialized stroke care is crucial for improving patient outcomes.Through video tools, Tele-Stroke neurologists remotely examine patients and leverage AI for a comprehensive analysis of neurological indicators.This virtual consultation allows timely collaboration with local healthcare providers, aiding in the swift diagnosis and recommendation of treatment plans [22,23].The use of AI in this context not only expedites the decision-making process but also enhances the accuracy of diagnostic evaluations, ultimately increasing the likelihood of successful patient recovery.
Both Tele-ICU and Tele-Stroke applications underscore the potential of AI to bridge geographical gaps and bring specialized medical expertise to areas where they may originally be limited.These programs showcase how AI technologies empower healthcare providers to deliver more efficient and effective care, particularly during critical junctures in patient treatment.The integration of AI into telemedicine initiatives exemplifies a paradigm shift in healthcare, leveraging advanced technologies to optimize decision-making, improve patient outcomes, and extend the reach of specialized care to diverse and underserved populations.

English as a Second Language
Telehealth, mobile health, and remote patient monitoring technologies can quickly increase access to health care for those who cannot access a medical facility [9].However, these technologies can be a double-edged sword for patients who cannot read or understand English.Technology can be a barrier to accessing care for these patients as the instructions and user interfaces are often written in English [12,15,16].
Language barriers can be especially problematic for patients who need urgent care and do not have access to an interpreter [9].To address this issue, providers should ensure that all patient-facing materials, such as instructions and user interfaces, are available in the patient's native language [12,15,16].The patient should also be provided with an interpreter if they cannot understand the instructions or the user interface.Additionally, providers should ensure that all patient data are stored securely and privately even when transmitted in a foreign language [12,15,16].AI telehealth technologies can be instrumental in addressing the unique healthcare needs of patients for whom English is a foreign language (EFL).These technologies can facilitate effective communication, provide language assistance, and enhance the overall healthcare experience [13,15].Here are some AI telehealth technologies that can be used to help EFL patients:

Multilingual Chatbots and Virtual Assistants
AI-powered chatbots and virtual assistants can be used to provide instant multilingual support to EFL patients.They can answer basic medical questions, schedule appointments, and offer guidance on common health concerns in various languages.

Real-Time Language Translation Services
AI-driven language translation tools integrated into telehealth platforms can be used to enable real-time translation of spoken or written communication between patients and healthcare providers.This ensures precise and accurate communication regardless of any language barriers.

Cultural Sensitivity Training Modules
AI can help create culturally tailored training modules for healthcare providers to enhance their understanding of diverse patient populations.This helps providers communicate more effectively and respectfully with EFL patients.

Automatic Medical Record Translation
AI can automatically translate medical records and documentation from English to the patient's preferred language.Translational tools ensure that patients can access their healthcare information in a language they understand.

Voice Recognition and Speech-to-Text
AI-driven speech recognition and transcription tools can be used to convert spoken words into text in real time.Speech recognition tools aid in capturing accurate patient information during telehealth consultations, which can then be translated or reviewed as needed.

Telehealth Platforms with Multilingual Interfaces
AI-powered telehealth platforms can offer multilingual user interfaces, making it easier for EFL patients to navigate and use the technology.AI-powered telehealth platforms include appointment scheduling, prescription refills, and access to educational resources.

AI-Powered Language Assessment and Learning Tools
AI can assess the language proficiency of EFL patients and provide tailored language learning resources.These tools can help patients improve their English language skills and better understand medical information.

Multilingual Medication Reminders and Health Alerts
AI-driven medication reminder apps and health alert systems can be used to deliver notifications and instructions in multiple languages, ensuring that EFL patients receive critical health information accurately.

Cultural Competency Algorithms
AI algorithms can analyze patient data and provide healthcare providers with insights into cultural factors that may impact a patient's health behavior and decision-making.Tools that consider cultural factors help by providing more culturally sensitive care.

AI-Enhanced Tele-Interpreting Services
Tele-interpreting services with AI enhancements can connect patients with trained interpreters in real time during telehealth consultations.AI can assist interpreters with medical terminology and context to ensure accurate communication.
These AI telehealth technologies bridge language barriers and promote cultural sensitivity, making healthcare more accessible and inclusive for EFL patients.By improving communication and understanding, these technologies enhance the quality of care and patient outcomes [13,15].

Visual and Hearing Disabilities
Patients with visual or hearing disabilities face challenges using telehealth, mobile health, and remote patient monitoring technologies [12,15,16].For example, if the patient is visually impaired, they may be unable to use the technology if it is not designed with accessibility in mind [9].Additionally, if the patient is hearing-impaired, they may need help understanding the instructions or user interface if it is provided in audio form.To address this issue, providers should ensure that all patient-facing materials, such as instructions and user interfaces, are designed with accessibility [9].Assisting technology tools include providing alternative forms of media such as text, video, and audio to accommodate patients with visual or hearing disabilities [9].
Additionally, providers should ensure that the patient is equipped with the necessary technology such as an audio amplifier or a Braille display to ensure that they can fully access the technology [9].Telehealth, mobile health, and remote patient monitoring technologies can increase access to care for vulnerable populations [9].However, these technologies can also be a barrier to accessing care if not designed with accessibility [9].Healthcare providers must be mindful of the potential for AI and IoT technologies to introduce bias into the healthcare system [12,15,16].For example, AI-driven decision-making may exclude specific patient populations such as those from lower socio-economic backgrounds or minority groups [9].To avoid this, healthcare providers must ensure that the data used to train AI and IoT systems are diverse and that algorithms are tested for bias before deployment [12,15,16].
Using AI and IoT technologies in telehealth can revolutionize healthcare and improve patient outcomes [12,15,16].However, ethical considerations must be considered to ensure that the unique needs of patients, particularly those whose first language is not English or those who are visually or hearing impaired, are met [9].By taking these steps, healthcare providers can ensure that telehealth is used ethically and that patients receive the care they need regardless of their language or disability.
AI telehealth technologies can be crucial in providing accessible healthcare services to patients with visual and hearing disabilities.AI telehealth technologies aim to enhance communication, support remote medical consultations, and ensure that healthcare information is accessible [13,15].AI telehealth technologies for patients with visual and hearing disabilities should include the following: Voice-Activated Assistants and Screen Readers AI-powered voice-activated assistants, like Amazon's Alexa or Google Assistant, can help patients with visual impairments by providing information and assistance through voice commands.Screen readers with AI capabilities can convert text on screens into synthesized speech, allowing visually impaired patients to access digital healthcare content [24].

AI-Enhanced Image Recognition
AI algorithms can describe images and visual content to patients with disabilities.For example, a smartphone app can use AI to describe medical images such as X-rays or MRIs to patients.

Braille Displays with AI Integration
Braille displays enhanced with AI can provide real-time translations of digital text into Braille so visually impaired patients can read healthcare information and communicate with healthcare providers.

Accessible Telehealth Platforms
Telehealth platforms with AI-driven accessibility features can ensure that patients with visual disabilities can navigate and use the platform easily.These platforms include voice-guided interfaces and screen reader compatibility.

Real-time Captioning and Transcription Services
AI-powered real-time captioning services can provide automated captions during telehealth video calls, making spoken information accessible to patients with hearing impairments.Speech-to-text transcription services can convert spoken words into written text for easy reading.

Sign Language Recognition and Translation
AI can recognize sign language gestures and translate them into text or spoken language for healthcare providers.These technologies can enable real-time communication with sign language users.Speech Enhancement and Noise Reduction AI algorithms can improve audio quality during telehealth consultations by reducing background noise and enhancing speech.These tools are particularly beneficial for patients with hearing aids or cochlear implants.

Text-Based Communication Tools
AI-driven chatbots and text-based communication tools can be used to facilitate written communication between patients and healthcare providers, ensuring that information is effectively conveyed.

Accessible Telehealth Interfaces
Telehealth platforms with AI-driven accessibility features can be used to offer visual cues and notifications to alert patients with hearing disabilities about upcoming appointments or essential information.

Remote Sign Language Interpreting Services
AI-powered tele-interpreting services can be used to connect patients with sign language interpreters during telehealth consultations, making communication seamless and accessible.By leveraging these AI telehealth technologies, healthcare providers can ensure that patients with visual and hearing disabilities have equal access to healthcare services, effective communication with healthcare professionals, and the ability to make informed decisions about their healthcare [13,15].These technologies are pivotal in promoting inclusivity and improving the overall quality of care for individuals with disabilities.
Evaluating the Implementation of New Telehealth Technologies Noel and Fabus [25] outline some areas of evaluation for the implementation of telehealth, including: The participation of patients: Patient participation may be impacted as telehealth continues to spread along the spectrum of healthcare.Patients may keep track of their medical issues, results, and general well-being using several technologies, and they can also stay in communication with their physicians to participate more actively in their medical care.These tools allow patients to engage more thoroughly with their medical state [25].
With the numerous advantages of using evidence-based best practices available via telehealth when using a particular kind of telehealth technology, it is the patient's responsibility to self-monitor and ensure that they maintain open communications with their physicians.This active collaboration has the potential to enhance the active management of symptoms, which may lead to fewer trips to the emergency department and hospitalizations in general.This would be a positive outcome.The implementation of telehealth demonstrates explicitly the potential to reduce costs, rates of hospitalization, and readmissions related to chronic illnesses [25].
The coordination of care: The coordination of care for patients who have complicated care requirements (e.g., patients who have numerous chronic diseases, patients who need rehabilitative services, or patients who need specialty care) is an essential component of treatment.Patients who have complex care needs include those making the transition of care from an outpatient setting to an inpatient setting and from an inpatient setting to a long-term care nursing facility or other clinical settings; telehealth may be able to facilitate communication, the sharing of information, and the making of joint decisions.An objective evaluation of telehealth's capacity to support such coordination would be a prerequisite for determining whether or not a telehealth program is successful and how it affects patients' health outcomes [25].
Traveling to the appointment impacts: Patients should not think of travel as just an accrued benefit for cost savings and convenience; instead, patients should use it to determine whether or not the use of telehealth has led to the correct diagnosis and appropriate follow-up care to reduce the need for further travel.Evaluations focus on using travel aspects more comprehensively to determine whether telehealth was responsible.The time the patient saves during the first appointment is considered, but it should also consider the outcomes.If the patient receives a negative diagnosis, there will be no need for a second visit in person [25].
The promptness of the care: There is a correlation between receiving care promptly and having better health results.A late diagnosis and treatment, missing abnormalities that showed on screening, and patients with correctly identified abnormalities who did not have a follow-up with a physician were some factors that led to worse survival rates with conditions such as cancer.In addition, a delayed diagnosis following an initial screening can lead to worse survival rates among individuals with certain forms of cancer (e.g., lung cancer) and difficulties due to chronic illness [25].
Information that can be acted upon: For care team members to use the information provided by telehealth technology during the initial visit, this information must be actionable.This information may contain data that enable a physician to diagnose and treat the patient and offer any necessary follow-up treatment.Additionally, this information may permit the provider to give any necessary follow-up care [25].

Evaluation Is Important
The integration of technology into healthcare has witnessed an exponential rise from electronic health records and telemedicine to artificial intelligence and wearable devices.While these innovations hold the promise of improved patient outcomes, increased efficiency, and enhanced healthcare delivery, they also bring forth a need for robust program evaluation methodologies to guide their implementation [26].This imperative stems from the recognition that the mere adoption of technology does not guarantee its effectiveness or alignment with healthcare objectives [27].Rather, it is the systematic assessment guided by inquiry into processes, policies, programs, procedures, and user experiences that elucidates the true impact of these technologies on healthcare systems and patient care [26].
The confluence of technology and program evaluation presents a remarkable opportunity to propel healthcare into a new era of excellence and efficiency [26].As healthcare organizations navigate the complexities of digitalization, program evaluation emerges as an indispensable compass guiding the effective use of technology to achieve healthcare goals [27].By systematically inquiring into processes, policies, programs, procedures, and user experiences, healthcare evaluators can illuminate the path toward a technologyenhanced healthcare ecosystem that optimally serves the needs of providers and patients alike [27].The significance of technology-driven program evaluation in healthcare is not merely a response to the digital age; it is a commitment to harnessing the full potential of technology to elevate the quality, accessibility, and equity of healthcare for all [26].
The use of questions focused on processes, policies, programs, procedures, and user experiences has, over the course of history, emerged as an enduring and widely embraced approach within the realm of program evaluation in healthcare [27].Evaluation frameworks deeply rooted in the discipline have historically served as the linchpin for assessing the efficacy, efficiency, and quality of healthcare interventions and systems [26].By inquiring into the intricacies of processes, the robustness of policies, the efficacy of programs, the adherence to procedures, and the experiences of users, healthcare evaluators have systematically navigated the complex terrain of healthcare delivery, striving to unravel the multifaceted dynamics that influence patient outcomes and system performance [27].
When evaluating the implementation of a new telehealth program for a medical practice, it is essential to consider various aspects to ensure its success and alignment with patient care.Here are some questions (see Table 1) to guide the evaluation process that were developed from a review of the VA hospital telehealth policy, process, and procedure documents for four hospitals, two Virginia and two in West Virginia in the United States.

Strategic Alignment
How does the introduction of telehealth align with the overall strategic goals and mission of the medical organization?
What specific objectives or outcomes are expected from the telehealth program?

Patient Access and Engagement
How will the telehealth program improve or expand patient access to healthcare services?What strategies are in place to promote patient engagement and participation in telehealth consultations?

Technology Infrastructure
Has the medical practice invested in the necessary technology infrastructure to support telehealth (e.g., secure video conferencing, EHR integration)?Are there contingency plans in case of technical issues during telehealth sessions?

Regulatory and Legal Compliance
Is the telehealth program compliant with all relevant regulations including state and federal laws (e.g., HIPAA)?
Have licensing requirements for telehealth practitioners been addressed?
Data Security and Privacy: Ensuring that AI implementations comply with stringent data protection regulations and that patient data remain secure are vital.Evaluations should address data encryption, access control, and compliance with HIPAA or other relevant privacy standards.
Cost-Efficiency: Analyzing the cost-effectiveness of AI-driven telehealth solutions compared to traditional methods is essential.This level of evaluation includes assessing reductions in healthcare costs, resource optimization, and the return on investment (ROI).
Interoperability: Evaluating the compatibility of AI tools with existing telehealth systems and electronic health records (EHRs) is critical for seamless integration and data exchange between healthcare providers.
Ethical Considerations: Examining the ethical implications of AI in telehealth such as bias in algorithms, patient consent, and decision-making transparency is crucial to ensure responsible and fair use.
Regulatory Compliance: Ensuring that AI implementations adhere to regulatory requirements and are subject to appropriate oversight are essential.Compliance with FDA regulations for medical devices and other relevant standards should be assessed.
Scalability and Adaptability: Evaluating the ability of AI-driven telehealth solutions to scale and adapt to changing healthcare needs, including pandemics or shifts in patient demographics, is vital for long-term sustainability.
Training and Education: Assessing the readiness of healthcare providers to use AI tools effectively and providing training and educational resources to bridge any knowledge gaps are essential for successful implementation.
Feedback Loop and Continuous Improvement: Establishing mechanisms for gathering feedback from healthcare professionals and patients, and using this feedback to iterate and improve AI tools and approaches are essential for ongoing success.
Legal and Liability Considerations: Evaluating liability issues and ensuring that appropriate legal frameworks are in place is important in addressing potential malpractice or other legal challenges related to AI use in telehealth.

AI Operations' Evaluation Approaches
Comprehensive evaluation across these areas will help ensure the successful implementation of AI tools in telehealth and contribute to improved healthcare delivery and patient outcomes.Indeed, evaluating AI implementation in telehealth requires a systematic approach involving asking pertinent questions across various dimensions.Here are some questions (see Table 2) to consider for a comprehensive evaluation based on the document analysis by benchmarking procedures and evaluation telehealth technologies documents and emerging AI telehealth documents of the two largest VA hospitals of Virginia and of West Virginia (four total).They include the following:

Clinical Effectiveness
How has AI impacted the accuracy of diagnoses and treatment recommendations in telehealth consultations?Can the practice provide examples of successful patient outcomes attributed to AI-driven telehealth interventions?What clinical trials or studies have been conducted to assess the efficacy of AI in telehealth, and what were the results?

User Experience and Acceptance
How do healthcare providers and patients perceive the usability and user-friendliness of AI-powered telehealth solutions?
Have there been any issues or challenges related to user acceptance, and if so, how are they being addressed?What feedback have users provided regarding their experiences with AI in telehealth, and how has this feedback been incorporated into improvements?

Data Security and Privacy
How are patient data protected and secured within the AI-driven telehealth system?What measures are in place to ensure compliance with data privacy regulations (e.g., HIPAA)?Are there mechanisms for patients to control access to their data and provide informed consent for their use in AI applications?

Ethical Considerations Long-Term Impact
How does the deployment of AI-driven telehealth account for geographic disparities, especially in rural or remote areas with limited access to traditional healthcare services?
Are there provisions for language access, considering linguistic diversity within the community, and how are language-related health disparities being addressed?
Are there plans to provide training or support for individuals who may face technological barriers in using telehealth services?
How will the deployment of AI-driven telehealth tools impact access to healthcare services in different communities, especially those facing economic challenges?
Are there disparities in the affordability of devices or internet connectivity required for telehealth, and how can these be addressed?

Conclusions
The seismic shift triggered by the COVID-19 pandemic has thrust the healthcare sector into a new era defined by the integration of telehealth and AI-driven telemedicine technologies.The promises of enhanced accessibility, efficiency, and responsiveness to patient needs are captivating, but as these technologies become integral components of healthcare systems globally, the need for systematic evaluation processes becomes increasingly evident.
This exploration has journeyed through the transformative wave, highlighting a crucial gap in research that addresses the practical needs and perspectives of those deeply immersed in healthcare operations and the broader world of practice.While the benefits of telehealth and AI-driven telemedicine technologies rightly capture attention, our focus sharpens on the critical need for systematic evaluation, especially within the complexities of real-world healthcare settings.
This paper has endeavored to emphasize the paramount importance of developing rigorous evaluation frameworks tailored to the unique challenges of the evolving landscape.The accelerated deployment of these technologies, fueled by the urgency of the crisis, underscores the necessity for standardized evaluation processes.The absence of such frameworks poses multifaceted challenges, from uncertainties about long-term efficacy to concerns regarding patient safety, data security, and ethical considerations.
In response to these challenges, our exploration has advocated for the establishment of adaptable, multidimensional evaluation mechanisms aligned with clinical objectives and regulatory standards.Beyond the theoretical promises of these technologies, their responsible and effective integration into healthcare systems demands a nuanced understanding of their impact on both patient outcomes and healthcare operations.
As we navigate this discourse, our call to action resonates; the development of evaluation processes empower stakeholders to optimize the deployment of telehealth and AI technologies.However, the true realization of these technologies' potential lies not merely in theoretical discussions but also in practical tools, checklists, and real-world approaches to the evaluation of operations and outcomes.This is where the transformative power of telehealth and AI-driven telemedicine will find its tangible expression.
In the wake of the COVID-19 pandemic, the rapid and widespread integration of telehealth technologies and artificial intelligence (AI)-driven telemedicine technologies into healthcare systems have brought both unprecedented promise and unforeseen challenges to the forefront of our healthcare landscape.These innovations hold the potential to reshape healthcare delivery and to render it more accessible, efficient, and responsive to the ever-evolving needs of patients and providers.However, this transformative journey has accentuated the critical need for systematic and rigorous evaluation processes that can comprehensively scrutinize the operations and outcomes of these technologies.
The absence of standardized evaluation mechanisms has cast a shadow over the path ahead, raising multifaceted concerns ranging from uncertainties about long-term efficacy to questions of patient safety, data security, and ethical considerations.Yet, amid these challenges, a clear imperative emerges: the development of adaptable and multidimensional evaluation frameworks that are harmoniously attuned to the dynamic nature of telehealth and AI technologies.These frameworks must not only align with clinical objectives but also stand in compliance with the evolving regulatory landscape.
As healthcare organizations stand at the threshold of a new era in healthcare characterized by the transformative power of telehealth and AI-driven telemedicine, our commitment to establishing robust evaluation processes assumes paramount importance.These processes are not just a formality; they are the linchpin that enables us to optimize the deployment of telehealth and AI technologies, fostering a healthcare ecosystem firmly rooted in patient-centered care while vigilantly addressing emerging challenges.In this era of healthcare transformation, the establishment of comprehensive and adaptable evaluation frameworks emerges as a resounding call to action.It is an essential endeavor that holds the key to unlocking the full potential of telehealth and AI-driven telemedicine in the post-COVID-19 healthcare landscape.

Recommendations for Future Research
The evolving landscape of telehealth and AI-driven telemedicine technologies as catalyzed by the COVID-19 pandemic invites a rich array of opportunities for future research endeavors.To advance our understanding and harness the full potential of these transformative innovations, the following avenues for research are proposed: 1. Ethnographic studies: Employ ethnographic approaches to immerse researchers within healthcare settings where telehealth and AI-driven telemedicine are implemented.Observe daily practices, interactions, and challenges to gain a nuanced understanding of the technologies' impact.2. Stakeholder perspectives: Investigate the perspectives of key stakeholders, including healthcare administrators, policymakers, and technology developers.Qualitatively assess their motivations, concerns, and visions for the future of telehealth and AIdriven telemedicine.3. Case studies: Undertake in-depth case studies of healthcare organizations that have successfully integrated telehealth and AI-driven telemedicine.Examine the contextual factors, strategies, and challenges encountered in their implementation journeys.4. Cultural and societal impact: Investigate the cultural and societal impact of telehealth and AI in healthcare.Qualitatively explore how these technologies influence healthcare disparities, patient-provider relationships, and cultural norms surrounding healthcare practices.5. Ethical framework development: Given the ethical complexities inherent in AI-driven healthcare, research should focus on developing robust ethical frameworks that address issues such as informed consent, data privacy, and algorithmic bias.Additionally, investigations into the ethical implications of AI's role in clinical decision-making are paramount.6.Data security and privacy: Research should explore cutting-edge data security and privacy measures to safeguard patient information in telehealth and AI systems.Assessments of potential vulnerabilities, strategies for encryption, and compliance with evolving data protection regulations are essential.7. User experience and acceptance: In-depth studies on the user experience of patients, healthcare providers, and support staff when using telehealth and AI-driven technologies are imperative.Insights into the user's acceptance, usability, and factors influencing adoption will be instrumental in refining these systems.In conclusion, the ongoing transformation of healthcare through telehealth and AI-driven telemedicine necessitates a multifaceted research agenda.By addressing these critical research areas, we can maximize the benefits of these innovations, ensure their ethical and secure use, and advance patient-centered care in a rapidly evolving healthcare landscape.The collaborative efforts of researchers, policymakers, and healthcare practitioners are pivotal in shaping the future of healthcare delivery in the post-COVID-19 era.
8. Healthcare disparities and equity: Investigating the role of telehealth and AI in addressing or exacerbating healthcare disparities is vital.Research should identify barriers to evaluate interventions to reduce disparities and assess the impact of these technologies on marginalized populations.9. AI algorithm improvement: Continuous research into enhancing AI algorithms is essential.This research includes refining diagnostic accuracy, reducing bias, and optimizing predictive capabilities.Comparative studies on various AI models and their performance are warranted.10.Regulatory and policy frameworks: Research should explore the development of adaptable regulatory and policy frameworks that align with the dynamic nature of telehealth and AI in healthcare.Evaluations of the impact of regulatory changes on technology adoption and patient care are necessary.11.Interoperability and Integration: Investigations into improving the interoperability of telehealth and AI systems with existing healthcare infrastructure are needed.Research should identify best practices for seamless integration and data exchange across platforms.