Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 6, 2020
Date Accepted: Jun 25, 2020
Evaluating the Implementation of a Remote Monitoring Program for Chronic Obstructive Pulmonary Disease using Qualitative Methods: a Service Design Perspective
ABSTRACT
Background:
Implementing 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.
Objective:
The goal of this study was to assess the implementation of a remote monitoring initiative for patients with COPD in Ontario, Canada using the [Tool+Team+Routine] framework, and to refine this approach to conceptualizing the adoption of technologies in health care.
Methods:
This study was a qualitative process evaluation that took place as part of a randomized controlled trial comparing a technology-enabled self-monitoring program (SM group) with a technology-enabled self- and remote-monitoring program (RM group) in COPD patients compared to standard care. The study included interviews with 5 RM patients, 3 SM patients, 2 caregivers, 5 health care providers and 3 hospital administrators. The interview questions were structured around the three main concepts of the [Tool+ Team + Routine] framework.
Results:
Findings emphasize that (a) 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 (b) technologies can produce new work that is not visible to management as a result of not being considered within the scope of the service.
Conclusions:
Literature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships with 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 those relationships and other sources of activity might lead to technological scope creep.
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