Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study

Kelley, Leah; Fujioka, Jamie; Liang, Kyle; Cooper, Madeline; Jamieson, Trevor; Desveaux, Laura

doi:10.2196/20579

Cited by 26 publications

(14 citation statements)

References 22 publications

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“…A handful of other studies have shown similar results. 30 – 32 For instance, Kelley et al 30 reported that one of the barriers to implementing sustainable digital health business models in health systems is that the benefits/savings accrue at the system level (e.g. avoiding transfers and travel, improved patient health outcomes), without being reflected in organisational performance outcomes.…”

Section: Discussionmentioning

confidence: 99%

The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems

et al. 2023

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The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what is known as the ‘wrong pocket’ problem – where an organisation or sector makes expenditures and investments to address a given problem, but the benefits (return on investment) are captured by another organisation or sector (the wrong pocket). This problem is the origin of many difficulties in public policies and programmes (e.g. education, environment, justice and public health), especially in terms of sustainability and scaling-up of technology and innovation. In this essay/perspective, we address the wrong pocket problem in the context of a major telehealth project in Canada. We show how the problem of sharing investments and expenses, as well as the redistribution of economies among the different stakeholders involved, may have threatened the sustainability and scaling-up of this project, even though it has demonstrated the clinical utility and contributed to improving the health of populations. In conclusion, the wrong pocket problem may be decisive in the reduced take-up, and potential failure, of certain telehealth programmes and policies. It is not enough for a telehealth service to be clinically relevant and ‘efficient’, it must also be mutually beneficial to the various stakeholders involved, particularly in terms of the equitable sharing of costs and benefits (return on investment) associated with the implementation of this new service model. Finally, the wrong pocket concept offers a helpful lens for studying the success, sustainability, and scale-up of digital transformations in health organisations and systems. This needs to be considered in future research and evaluations in the field.

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Section: Discussionmentioning

confidence: 99%

The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems

et al. 2023

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“…Flexibility in interventions that allow for some degree of personalization, such as activating or deactivating features based on personal preferences and the ability to alter intervention design based on comorbidities (eg, visual impairments and hand osteoarthritis), may also foster adherence [ 106 ]. From the clinician’s perspective, reimbursement models that incentivize the use of digital health interventions are needed [ 115 ]. Although these findings provide some guidance, the best practice would be to include all stakeholders (clinicians and patients) while developing new digital health interventions [ 116 ].…”

Section: Discussionmentioning

confidence: 99%

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Shah¹,

Costello²,

Mehta³

et al. 2022

JMIR Rehabil Assist Technol

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Background With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR). Objective This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR. Methods In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included. Results Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively. Conclusions For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes.

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“…18 21 For example, incentives could be created to support the use of an innovation, such as a payment system that covers its costs. 48 Incentives are also facilitators for scaling de-implementation strategies. This framework adds the recommendation to also remove incentives for the use of LVC to support the scaling of de-implementation strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the literature on the scaling of innovations, for example, Rogers’ diffusion of innovations theory and the Consolidated Framework for Implementation Research, we have added several topics and nuanced the implications of the shared subdomains and determinants 18 21. For example, incentives could be created to support the use of an innovation, such as a payment system that covers its costs 48. Incentives are also facilitators for scaling de-implementation strategies.…”

Section: Discussionmentioning

confidence: 99%

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

et al. 2022

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ObjectiveWe aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework.Design and methodsThis study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies.ResultsThe literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients’ perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters.ConclusionsThe SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.

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Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study

Cited by 26 publications

References 22 publications

The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems

The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

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