Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care

Abstract

BackgroundElectronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated.ObjectiveThis viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives.MethodsReflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care.ResultsThe results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure.ConclusionsFor optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

“…The potential useful adoption of eHealth seems thus more facilitated in decentralized health systems, where local governance can allow integrated care initiatives which are more tailored on local/specific needs, with the help of new technologies. In particular, when patients, professionals, entrepreneurs, and government collaborate together, starting in local communities with few initial eHealth tools, the potential of eHealth can be "enforced" [100]. Furthermore, a greater adoption of eHealth seems to emerge where a NHS model are provided, that is with a tax-based financing system and with healthcare incentives which seem more favorable to eHealth implementation.…”

“…On the opposite, more general/national/international care programs, which are often related to temporary research projects and not based on local political/social policies, are more widespread in centralized countries and with weak PC, where the power for public health planning is not delegated to local/regional authorities but managed by the national/central government. Drawing on literature, we know that often adoption of eHealth applications ends when also related research projects are concluded, although successful [100], and that local health problems often require local solutions, with a crucial role of local research in providing adequate funds supporting local priorities [101]. In such a context, a strong PC represents the first…”

Optimising SME Potential in Modern Healthcare Systems: Challenges, Opportunities and Policy Recommendations

“…Meanwhile, many new products are being introduced which do not clearly fit the current regulatory framework, so a dialogue with the right regulatory agencies can accelerate the time to market. Companies need to consider not only current regulations but also future regulations going to be initiated in the next 5 years or so [78]. Public-private partnerships are seen as growing driving forces in the quest for the development of innovative healthcare both in the USA and the EU.…”

Exposure to and attitudes regarding electronic healthcare (e‐Health) among physician assistants in Canada: A national survey study

“…Despite its potential and a rapidly growing number of tools available, there continues to be barriers in the uptake and integration of e‐Health into practice (Moore et al, ; Swinkels et al, ). Even telehealth, which has enormous potential to bridge geographical access barriers, has been slow to achieve widespread adoption in some settings (Dorsey & Topol, ; Moore et al, ).…”

“…Despite its potential and a rapidly growing number of tools available, there continues to be barriers in the uptake and integration of e-Health into practice (Moore et al, 2017;Swinkels et al, 2018).…”