Beyond “implementation”: digital health innovation and service design

Shaw, James; Agarwal, Payal; Desveaux, Laura; Palma, Daniel Cornejo; Stamenova, Vess; Jamieson, Trevor; Yang, Rebecca; Bhatia, R Sacha; Bhattacharyya, Onil

doi:10.1038/s41746-018-0059-8

Cited by 136 publications

(114 citation statements)

References 29 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…We propose the strategies Use an implementation advisor and Establish an implementation unit to improve the implementation environment and the local conditions for a fast, e cient and sustainable implementation of technology that focuses on the needs of users and patients and adds value. These processes should always be re-evaluated to re-adapt interventions following the changing needs [51,53,54].…”

Section: Discussionmentioning

confidence: 99%

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

Mosch

Poncette

Spies

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundIntensive care is lagging with digital transformation. It is essential to provide evidence and guidelines for integrating digital health technologies into the intensive care unit (ICU).We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU.MethodsWe conducted this study from May 2018 to March 2020 during the implementation of a tablet-computer based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. Results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects.Conclusions The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks.Trial registrationClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

show abstract

Section: Discussionmentioning

confidence: 99%

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

Mosch

Poncette

Spies

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The framework used in this research study was the Tool+Team+Routine framework [ 17 ]. Unlike other implementation frameworks, this framework focuses explicitly on service design.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…This basic point formed the motivation for previous work by our research team to present an approach to the adoption of digital health technologies that emphasizes the links between technological innovations and service innovations, informed by a service design perspective [ 17 ]. Service design is an approach to the improvement or establishment of services that takes the entire service as the primary focus, emphasizing the importance of user experience and the realities of service delivery for health care providers and other staff [ 17 ]. In our past work, we formulated the objective of service design: to “carefully plan and promote the coordinated action required to execute a high quality health care service [ 17 ].” In this way, service design considers a technology for its contributions to a service more generally by focusing less on the adoption of the technology itself and more on its contributions to the work required to deliver an excellent service overall.…”

Section: Introductionmentioning

confidence: 99%

“…The recently developed Tool+Team+Routine framework [ 17 ] outlines a service design approach to innovation adoption that includes (1) identifying the value propositions of a given tool, (2) considering the implications of the tool for team relationships, and (3) explicitly addressing the new routines required in the technology-informed reconfiguration of the service. Although this approach is based on past empirical research examining this alternative approach to technology adoption, the Tool+Team+Routine framework is a simple heuristic that has not yet been subject to critical examination [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective

et al. 2020

Self Cite

View full text Add to dashboard Cite

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 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. Methods This 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. Results Findings 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. Conclusions Literature 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.

show abstract

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Walker,

Hefner,

MacEwan

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceDifferences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap.ObjectiveTo compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups.Design, Setting, and ParticipantsThis secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023.InterventionsA 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]).Main Outcomes and MeasuresPrimary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs.ResultsOf 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race.Conclusions and RelevanceIn this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity.Trial RegistrationClinicalTrials.gov Identifier: NCT02943109

show abstract

Beyond “implementation”: digital health innovation and service design

Cited by 136 publications

References 29 publications

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal

Contact Info

Product

Resources

About