Evaluating the readiness for delivering digital health at scale: lessons from a longitudinal qualitative evaluation of a national digital health innovation program in the United Kingdom

Marilyn R Lennon, Matt-Mouley Bouamrane, Alison M Devlin, Siobhan O'Connor, Catherine O'Donnell, Ula Chetty, Ruth Agbakoba, Annemieke Bikker, Eleanor Grieve, Tracy Finch, Nicholas Watson, Sally Wyke, Frances S Mair

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results: We identified 3 main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale.
LanguageEnglish
Article numbere42
Number of pages29
JournalJournal of Medical Internet Research
Volume19
Issue number2
DOIs
Publication statusPublished - 16 Feb 2017

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Health
Organizational Policy
Technology
United Kingdom
Social Responsibility
National Health Programs
Health Policy
Health Surveys
Focus Groups
Administrative Personnel
Causality
Uncertainty
Health Services
Ecosystem
Life Style
Motivation
Chronic Disease
Public Health
Research Personnel
Observation

Keywords

  • telemedicine
  • health plan implementation
  • community health services
  • health services research
  • electronic health records
  • instrumentation
  • qualitative research
  • diffusion of innovation
  • medical informatics

Cite this

Lennon, Marilyn R ; Bouamrane, Matt-Mouley ; Devlin, Alison M ; O'Connor, Siobhan ; O'Donnell, Catherine ; Chetty, Ula ; Agbakoba, Ruth ; Bikker, Annemieke ; Grieve, Eleanor ; Finch, Tracy ; Watson, Nicholas ; Wyke, Sally ; Mair, Frances S. / Evaluating the readiness for delivering digital health at scale : lessons from a longitudinal qualitative evaluation of a national digital health innovation program in the United Kingdom. In: Journal of Medical Internet Research. 2017 ; Vol. 19, No. 2.
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Evaluating the readiness for delivering digital health at scale : lessons from a longitudinal qualitative evaluation of a national digital health innovation program in the United Kingdom. / Lennon, Marilyn R; Bouamrane, Matt-Mouley; Devlin, Alison M; O'Connor, Siobhan; O'Donnell, Catherine; Chetty, Ula; Agbakoba, Ruth; Bikker, Annemieke; Grieve, Eleanor; Finch, Tracy; Watson, Nicholas; Wyke, Sally; Mair, Frances S.

In: Journal of Medical Internet Research, Vol. 19, No. 2, e42, 16.02.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluating the readiness for delivering digital health at scale

T2 - Journal of Medical Internet Research

AU - Lennon, Marilyn R

AU - Bouamrane, Matt-Mouley

AU - Devlin, Alison M

AU - O'Connor, Siobhan

AU - O'Donnell, Catherine

AU - Chetty, Ula

AU - Agbakoba, Ruth

AU - Bikker, Annemieke

AU - Grieve, Eleanor

AU - Finch, Tracy

AU - Watson, Nicholas

AU - Wyke, Sally

AU - Mair, Frances S

PY - 2017/2/16

Y1 - 2017/2/16

N2 - Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results: We identified 3 main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale.

AB - Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results: We identified 3 main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale.

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KW - health plan implementation

KW - community health services

KW - health services research

KW - electronic health records

KW - instrumentation

KW - qualitative research

KW - diffusion of innovation

KW - medical informatics

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