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

Remote Patient Monitoring in the Management of Chronic Obstructive Pulmonary Disease

“…The interpersonal relationship between patient and clinician is a driving force in patient participation in the RPM program 88. The amount of engagement between patients and clinicians—and type of clinician—in RPM is both variable and often not well-described.…”

Home health monitoring during the COVID pandemic: Results from a feasibility study in Alberta primary care

“…Historically, telehealth models have focused on patients with one chronic condition, assessed in a secondary care/hospital setting. [2][3][4] Unique to this HHM initiative is its integration within the PCN and its potential to serve the needs of patients with one or more chronic condition(s). Our program allowed the monitoring of patients from their home, educating and empowering them to confidently manage their conditions at an early stage, which has the potential to reduce their long-term impact on the health system.…”

“…Reports of virtual healthcare initiatives in Canada come primarily from secondary care settings (eg, studies in which patients are followed up remotely after acute hospital care). [2][3][4] To explore the feasibility of delivering virtual healthcare within the primary care setting, a multiparty collaboration came together to deliver home health monitoring (HHM) to patients with chronic conditions in Alberta's Central Zone, a largely rural area with a population of over 450 000. 5 The expansive geography of Central Alberta presents many barriers to optimal care, such as limited resources and access issues (distance, cost, weather, and ability to drive).…”