**2. Methodology**

The scientific approach in the development of the TMSMM (refer to Figure 1), resembles the procedure suggested in [17]. This procedure takes into account the iterative nature of the maturity model development process, as well as the need to combine theoretical and empirical research as recommended by other respected scholars of maturity models [6, 9, 18, 19].

researchers from the literature, was used to revise key design features, as well as the maturity

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Upon finalization of the conceptual model, a top-down approach was followed to develop the descriptive model [6]: An overarching maturity scale was defined, after which domain-specific maturity scales were developed in alignment with these. A first iteration of TMSMM descrip‐ tors was defined, using as inputs firstly, the insights gained in the development of the conceptual model and secondly, frameworks and theories for the management and evaluation

The conceptual TMSMM is shown in Figure 2, which also provides a framework for the

of telemedicine services. The descriptors were refined, based on stakeholder input.

**3. The Telemedicine Service Maturity Model (TMSMM)**

model itself [21-23].

remainder of this chapter.

**Figure 2.** Conceptual model of the TMSMM

**Figure 1.** Scientific approach to the development of the TMSMM

The conceptual telemedicine service maturity model (TMSMM) was developed by following an iterative process involving telemedicine practitioners from five different South African provincial departments of health (DoH). The involvement of these stakeholders in the process, ensured the contribution of their domain knowledge for solution creation and in turn, contributed to the validity of the model. As a consequence, greater user acceptance was achieved [20].

Between June 2011 and December 2011, a series of workshops was held throughout South Africa. Representatives included healthcare workers (e.g. specialists, radiologists, radiogra‐ phers and nurses), as well as persons responsible for the development, implementation and maintenance of hospital information and communication technology (ICT).

The first day of these workshops was aimed at educating representatives about current stateof-the-art telemedicine. The second day of each workshop was an interactive session in which groups of delegates engaged with the maturity model. At the end of each session, workshop delegates were asked to reflect upon and provide feedback on the effectiveness of the maturity model in terms of its characteristics. This feedback, together with the thoughts of other researchers from the literature, was used to revise key design features, as well as the maturity model itself [21-23].

Upon finalization of the conceptual model, a top-down approach was followed to develop the descriptive model [6]: An overarching maturity scale was defined, after which domain-specific maturity scales were developed in alignment with these. A first iteration of TMSMM descrip‐ tors was defined, using as inputs firstly, the insights gained in the development of the conceptual model and secondly, frameworks and theories for the management and evaluation of telemedicine services. The descriptors were refined, based on stakeholder input.
