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Research Article
Lovisa Jäderlund Hagstedt
Karolinska Institute
Corresponding Author
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BACKGROUND
Digitalization 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.
METHODS
A 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.
RESULTS
The 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.
CONCLUSIONS
The 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.
Keywords
mEHR, mobile, homecare, primary care, work environment, CFIR, mHealth, eHealth, implementation
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No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
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CURRENT STATUS: Under Review
Version 1
Posted 27 May, 2021
No community comments so far
Editorial decision: Major revision
On 15 Dec, 2021
Reviewers agreed
On 01 Nov, 2021
Reviews received
Received 15 Sep, 2021
Reviewers agreed
On 27 Aug, 2021
Reviews received
Received 20 Aug, 2021
Reviewers agreed
On 14 Aug, 2021
Reviewers invited
Invitations sent on 28 Jul, 2021
Editor assigned
On 20 Jul, 2021
Editor invited
On 25 May, 2021
Submission checks complete
On 25 May, 2021
First submitted
On 25 May, 2021
Metrics
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PDF Downloads: ...
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Subject Areas
Medical Informatics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This preprint is under consideration at BMC Medical Informatics and Decision Making. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Lovisa Jäderlund Hagstedt
Karolinska Institute
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 27 May, 2021
No community comments so far
Editorial decision: Major revision
On 15 Dec, 2021
Reviewers agreed
On 01 Nov, 2021
Reviews received
Received 15 Sep, 2021
Reviewers agreed
On 27 Aug, 2021
Reviews received
Received 20 Aug, 2021
Reviewers agreed
On 14 Aug, 2021
Reviewers invited
Invitations sent on 28 Jul, 2021
Editor assigned
On 20 Jul, 2021
Editor invited
On 25 May, 2021
Submission checks complete
On 25 May, 2021
First submitted
On 25 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Medical Informatics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
BACKGROUND
Digitalization 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.
METHODS
A 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.
RESULTS
The 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.
CONCLUSIONS
The 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.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
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