Failed implementation of mobile access to electronic health records in homecare: a qualitative study

Abstract

BACKGROUNDDigitalization could optimize healthcare; however, many eHealth projects are unsuccessful. By analyzing reasons for unsuccessful eHealth implementation, we could gain important knowledge on how to achieve successful digitalization in primary care and homecare.The aim of this study is to describe the implementation process of a tablet computer with an mHealth app that provides mobile access to the electronic health record (EHR) in homecare in order to understand reasons for unsuccessful implementations of mHealth interventions, as well as potential success factors.METHODSA tablet computer with mobile access to the EHR was implemented in 4 primary care centers and one municipality home care organization in Sweden. Focus groups, interviews and observations were used to evaluate how the implementation affects the work of the healthcare professionals. Qualitative content analysis informed by the Consolidated Framework for Implementation Research was used to analyze the implementation process and interpret the results.RESULTSThe implementation of the eHealth application was unsuccessful, mainly because the application did not fully support the users’ needs, but also due to immature technology and unstable infrastructure. Outcome of the intervention was dependent on context and user engagement. Users who had been involved in the development were more positive, despite missing functions, whereas those who had not been involved struggled to adopt the mobile tool. Development of the mHealth app and the subsequent implementation process was lengthy which affected user engagement negatively. The implementation process was insufficient and use of the application was affected by poor readiness for implementation. Users perceived lack of leadership engagement and questioned available resources dedicated to the implementation, in terms of resources and training.CONCLUSIONSThe functionality of mHealth must support users’ needs, be sufficiently integrated with existing eHealth ecosystems, and all aspects of the implementation process must be met to ensure success. Premature implementations may cause change fatigue and become a barrier for future implementation projects. In order to achieve the potential of mHealth, we have to ensure that sufficient resources are allocated to design and development, evaluation and feasibility studies and support and engagement during the implementation of mHealth in the future.

Nurses’ Roles in mHealth App Development: Scoping Review

“…Despite the ubiquity of mHealth apps for health care consumers and providers, health information technology implementation is frequently unsuccessful [ 9 ]. Previous research has found that apps may not align with end-user behavior and organizational needs, essentially showing a mismatch between how the app is designed to function and how the intended end user expects it to work [ 10 - 12 ].…”