Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom

Abstract

Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being.Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings.Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant.Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care.

Present and Future Trends in Consumer Health Informatics and Patient-Generated Health Data

“…Barriers and opportunities exist that incorporate new technology for both providers and consumers. Since the locus of healthcare is shifting to the home and community setting, there is an increasing need to adopt a broader approach across the traditional boundaries of health and social care in order to operationalize a more integrated and personalized healthcare service provision [34].…”

Experience of Emergency Department Patients With Using the Talking Pole Device: Prospective Interventional Descriptive Study (Preprint)

“…Previous research suggested that multi-disciplinary cooperation is essential for effective implementation of digital health. [25] We designed, developed, and evaluated the "Talking Pole" through an inter-disciplinary approach, so that we could see that multi-disciplinary cooperation has an advantage in the implementation of digital health. Participants of this study were patients and caregivers.…”

A Flexible Toolkit for Evaluating Person-Centred Digital Health and Wellness at Scale

“…Furthermore, the proposed digital platforms earmarked for development as part of the program were intended to cross many organizational and cultural boundaries (health and social care for example) as well as being targeted at multiple geographies and populations [15][16][17][18]. From the outset our overall evaluation approach had three aspects as illustrated in Table 1 (descriptive, process and outcome) with a fixed underpinning theoretical framework, Normalization Process Theory (NPT) [19,20] to help us capture and organize the implementation data.…”

“…1 The dallas program funded four large multi-stakeholder consortia called 'Living It Up', 'Year Zero', 'More Independent', and 'i-Focus' [15][16][17][18]. These were jointly led by a variety of health and social care services, private industry, the voluntary sector, local government agencies and in some cases, supported by academic research partners.…”

“…Each dallas community developed and deployed a broad range of technologies and services from traditional telehealth and telecare systems, personal health records, mobile health apps, assisted-living devices and online digital health portals and activities to raise awareness of self-care and increase digital access and inclusion. These were targeted at a variety of people from patients and consumers, from children to older adults, and in both urban and rural regions of the UK [15][16][17][18].…”