Abstract
BackgroundImplementing digital health technologies is complex but can be facilitated by considering the features of the tool that is being implemented, the team that will use it, and the routines that will be affected.ObjectiveThe goal of this study was to assess the implementation of a remote-monitoring initiative for patients with chronic obstructive pulmonary disease in Ontario, Canada using the Tool+Team+Routine framework and to refine this approach to conceptualize the adoption of technologies in health care.MethodsThis study was a qualitative research project that took place alongside a randomized controlled trial comparing a technology-enabled self-monitoring program with a technology-enabled self- and remote-monitoring program in patients with chronic obstructive pulmonary disease and with standard care. This study included interviews with 5 remote-monitoring patients, 3 self-monitoring patients, 2 caregivers, 5 health care providers, and 3 hospital administrators. The interview questions were structured around the 3 main concepts of the Tool+Team+Routine framework.ResultsFindings emphasized that (1) technologies can alter relationships between providers and patients, and that these relationships drove the development of a new service arising from the technology, in our case, and (2) technologies can create additional work that is not visible to management as a result of not being considered within the scope of the service.ConclusionsLiterature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships to conventional implementation strategies. By acknowledging the centrality of such relationships, implementation teams can better plan for the adaptations required in order to make new technologies work for patients and health care providers. Further work will need to address how specific individuals administering a remote-monitoring program work to build relationships, and how these relationships and other sources of activity might lead to technological scope creep—an unanticipated expanding scope of work activities in relation to the function of the tool.
Highlights
The digital health market continues to expand, with projected growth from US $79 billion in 2015 to an estimated value of US $206 billion in 2020 [1]
The implementation of digital health technologies remains an extremely complex area of health system improvement, and remote monitoring has served as an important example of the challenges associated with encouraging the meaningful use of technologies in routine care [5,6]
The first insight is the significance of interpersonal relationships for the functioning of this particular digital health technology in the context of delivering a comprehensive service of remote monitoring
Summary
The digital health market continues to expand, with projected growth from US $79 billion in 2015 to an estimated value of US $206 billion in 2020 [1] This growth is driven, in part, by the fact that many patient-facing digital health technologies, such as remote monitoring, have shown potential for positive effects on patient health and health care provider performance, such as enhanced chronic disease management and enhanced access to care [2,3]. Many technologies are advertised to be “plug and play,” suggesting there should be no barriers to their immediate use when, much local adaptation is required for them to be incorporated into users’ everyday lives [9] These observations illustrate the persistent and unresolved issues associated with determining both the mechanisms through which remote monitoring works for users and the optimal strategies to promote implementation.
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