Thesis (PhD)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: A telemedicine service is a healthcare service (-medicine) that is delivered over a distance (tele-). The interest in the potential of telemedicine to increase the quality, accessibility, utilization, e ciency and e ectiveness of healthcare services is fuelled by the rapid development of information and communication technology (ICT) and connectivity. Despite this potential, the success rate of telemedicine services disappoints. Many mistakes in the implementation of telemedicine services are repeated over and over again and best practices are not captured and replicated. This study responds to the need for reference models for the assessment and optimization of telemedicine services in a consistent, systematic and systemic way. Maturity models are reference models that describe typical patterns in the development of organizational capabilities and depict a sequence of stages towards the desired state. Many reference models exist that are applicable to telemedicine services, but none of these provide guidance for the optimization of services, like a maturity model does. Many maturity models exist within a health systems context, but none of these can be applied "as is" to telemedicine services. In this study an iterative top-down design approach is followed to develop a Telemedicine Service Maturity Model (TMSMM). This model facilitates the assessment of a telemedicine service on micro, meso, and macrolevel along all the domains that comprise the telemedicine health system. Sets of capability statements are de ned, which follow each other in a cumulative manner, hence providing a maturation path towards the desired maturity state. These sets of capability statements provide yardsticks according to which quantitative values are allocated to an intangible concept, such as maturity. Once an individual service is assessed, further actions towards the optimization of the service can be derived from these yardsticks. The multidimensional design of the TMSMM, as well as the fact that capability statements facilitate the consistent quanti cation of maturity, makes it possible to analyze the aggregated results of cohort of services. To accomplish this, principles of business intelligence and data warehouse design are applied together with online analytic processing (OLAP) procedures. The TMSMM addresses the previously unful lled need for a reference model to assess and optimize telemedicine services in a consistent, systematic and systemic way. This study spans several academic and professional domains and thereby contributes to the scienti c world of telemedicine and ehealth. / AFRIKAANSE OPSOMMING: 'n Telegeneeskunde diens is 'n gesondheidsdiens (-geneeskunde) wat oor 'n afstand gelewer word (tele-). Met die snelle ontwikkeling van inligtings-en kommunikasietegnologie hou telegeneeskunde die potensiaal in om die kwaliteit, toeganklikheid, benutting, doelmatigheid en doeltre endheid van gesondheidsdienste te verhoog. Ten spyte van hierdie potensiaal, stel die aantal onsuksesvolle telegeneeskunde dienste teleur. Heelwat foute in die implementering van telegeneeskundedienste word oor en oor gemaak, terwyl die beste praktyke nie vasgevang en herhaal word nie. Hierdie studie is onderneem in reaksie op die behoefte aan 'n verwysingsmodel vir die assessering en optimering van telegeneeskunde dienste op 'n konsekwente, sistematiese en sistemiese manier. Volwassenheidsmodelle is verwysingsmodelle wat tipiese patrone in die ontwikkeling van organisatoriese vermoeëns beskryf. Dit stip 'n aantal fases neer wat uiteindelik behoort te lei na die ideale organisatoriese toestand. Daar bestaan verskeie verwysingsmodelle wat van toepassing is op telegeneeskunde dienste, maar geeneen daarvan gee leiding met die oog op die optimering van die diens, soos in die geval van 'n volwassenheidsmodel nie. In hierdie studie word 'n iteratiewe van-bo-na-onder ontwerpsbenadering gevolg om 'n telegeneeskunde volwassenheidsmodel (TMSMM) te ontwikkel. Hierdie model fasiliteer die assessering van 'n telegeneeskunde diens op 'n mikro-, mesoen makrovlak en met betrekking to al die fasette waaruit 'n telegeneeskunde stelsel bestaan. 'n Aantal vermoeëstellings is gede nieer. Hierdie stellings volg op mekaar en akkumuleer om sodoende 'n volwassenheidspad na die verlangde toestand aan te dui. Hierdie vermoeëstellings verskaf maatstawwe waarvolgens kwantitiewe waardes toegeken kan word aan 'n ontasbare konsep, soos volwassenheid. Sodra 'n individuele diens geassesseer is, kan verdere aksies met die oog op die optimering van die diens afgelei word. Die multidimensionele ontwerp van die TMSMM, tesame met die feit dat die vermoeëstellings volwassenheid op 'n konsekwente manier kwanti seer, maak dit moontlik dat die data van 'n kohort dienste saamgevoeg kan word met die oog op analise. Beginsels van besigheidsintelligensie, datastoorontwerp asook aanlyn analitiese prosessering (OLAP) word hiervoor ingespan. Die TMSMM spreek tot die voorheen onvervulde behoefte aan 'n verwysingsmodel waarmee telegeneeskunde dienste geassesseer in geoptimeer word in 'n konsekwente, sistematiese en sistemiese manier. Hierdie studie strek oor verskeie akademiese en professionele domeine en lewer sodoende 'n bydrae tot die multidissiplinêre wetenskapswêreld van telegeeskunde en e-gesondheid.