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Delivering Innovative eHealth Services at Scale: Implementers’ Views on Achieving ‘Buy-In’

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BCS Health Informatics Scotland (HIS) (HIS)

BCS Health Informatics Scotland (HIS)

2 - 3 September 2014

eHealth, Digital Health, Wellbeing, Engagement, Recruitment, Participation, Large-Scale, Implementation

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      Abstract

      The Living It Up project (LiU) is part of a £37 million UK-wide programme entitled Delivering Assisted Living Lifestyles at Scale (dallas). LiU aims to empower the people of Scotland to improve their health and well-being whilst enhancing their quality of life through innovative inter-connected technologies and services at scale. This study sets out to understand the experiences of ‘implementers’ and determine their views on the factors which can promote or inhibit successful implementation of a large-scale innovative eHealth deployment. N=6 semi-structured interviews have been conducted to date, and a further 12 are being conducted in order to capture how the views of implementers change over time. Normalisation Process Theory (NPT) is being used as the underpinning conceptual framework for the study. In this case-study, we focus on the NPT domain of ‘Cognitive Participation’. Initial findings highlight the difficulty of innovating at scale. For example, it became clear throughout our interviews that ‘co-designing’ innovative products and services takes time. This means that ‘polished’ end-products are not available immediately which in turns makes it more difficult to sustain enthusiasm and engagement from co-design activities participants. Also, personal communication has been a key driver of enrolment. However, this approach is difficult to sustain at scale. Further follow up of the implementation journey will allow us to gain valuable insights into the barriers and facilitators in the deployment of large-scale eHealth initiatives.

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      Most cited references 3

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      Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory

       D C May,  T Finch (2009)
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        Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

        Objective To assess the effect of home based telehealth interventions on the use of secondary healthcare and mortality. Design Pragmatic, multisite, cluster randomised trial comparing telehealth with usual care, using data from routine administrative datasets. General practice was the unit of randomisation. We allocated practices using a minimisation algorithm, and did analyses by intention to treat. Setting 179 general practices in three areas in England. Participants 3230 people with diabetes, chronic obstructive pulmonary disease, or heart failure recruited from practices between May 2008 and November 2009. Interventions Telehealth involved remote exchange of data between patients and healthcare professionals as part of patients’ diagnosis and management. Usual care reflected the range of services available in the trial sites, excluding telehealth. Main outcome measure Proportion of patients admitted to hospital during 12 month trial period. Results Patient characteristics were similar at baseline. Compared with controls, the intervention group had a lower admission proportion within 12 month follow-up (odds ratio 0.82, 95% confidence interval 0.70 to 0.97, P=0.017). Mortality at 12 months was also lower for intervention patients than for controls (4.6% v 8.3%; odds ratio 0.54, 0.39 to 0.75, P<0.001). These differences in admissions and mortality remained significant after adjustment. The mean number of emergency admissions per head also differed between groups (crude rates, intervention 0.54 v control 0.68); these changes were significant in unadjusted comparisons (incidence rate ratio 0.81, 0.65 to 1.00, P=0.046) and after adjusting for a predictive risk score, but not after adjusting for baseline characteristics. Length of hospital stay was shorter for intervention patients than for controls (mean bed days per head 4.87 v 5.68; geometric mean difference −0.64 days, −1.14 to −0.10, P=0.023, which remained significant after adjustment). Observed differences in other forms of hospital use, including notional costs, were not significant in general. Differences in emergency admissions were greatest at the beginning of the trial, during which we observed a particularly large increase for the control group. Conclusions Telehealth is associated with lower mortality and emergency admission rates. The reasons for the short term increases in admissions for the control group are not clear, but the trial recruitment processes could have had an effect. Trial registration number International Standard Randomised Controlled Trial Number Register ISRCTN43002091.
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          Methodologies for assessing telemedicine: a systematic review of reviews.

          Previous reviews have expressed concerns about the quality of telemedicine studies. There is debate about shortcomings and appropriate methodologies. The aim of this review of systematic reviews of telemedicine is to summarize methodologies used in telemedicine research, discuss knowledge gaps and recommendations and suggest methodological approaches for further research. We conducted a review of systematic reviews of telemedicine according to a protocol listing explicit methods, selection criteria, data collection and quality assessment procedures. We included reviews where authors explicitly addressed and made recommendations for assessment methodologies. We did a qualitative analysis of the reviews included, sensitized by two broad methodological positions; positivist and naturalistic approaches. The analysis focused on methodologies used in the primary studies included in the reviews as reported by the review authors, and methodological recommendations made by the review authors. We identified 1593 titles/abstracts. We included 50 reviews that explicitly addressed assessment methodologies. One group of reviews recommended larger and more rigorously designed controlled studies to assess the impacts of telemedicine; a second group proposed standardisation of populations, and/or interventions and outcome measures to reduce heterogeneity and facilitate meta-analysis; a third group recommended combining quantitative and qualitative research methods; and others applying different naturalistic approaches including methodologies addressing mutual adaptations of services and users; politically driven action research and formative research aimed at collaboration to ensure capacity for improvement of services in natural settings. Larger and more rigorous studies are crucial for the production of evidence of effectiveness of unambiguous telemedicine services for pre defined outcome measures. Summative methodologies acknowledging telemedicine as complex innovations and outcomes as partly contingent on values, meanings and contexts are also important. So are formative, naturalistic methodologies that acknowledge telemedicine as ongoing collaborative achievements and engage with stakeholders, including patients to produce and conceptualise new and effective telemedicine innovations. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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            Author and article information

            Affiliations
            Institute of Health & Well-Being

            University of Glasgow
            Dept. of Computer &

            Information Science,

            University of Strathclyde,

            Scotland
            Contributors
            Conference
            September 2014
            September 2014
            : 1-5
            10.14236/ewic/HIS2014.4
            © Ruth Agbakoba et al. Published by BCS Learning and Development Ltd. BCS Health Informatics Scotland (HIS), Glasgow, UK

            This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

            BCS Health Informatics Scotland (HIS)
            HIS
            Glasgow, UK
            2 - 3 September 2014
            Electronic Workshops in Computing (eWiC)
            BCS Health Informatics Scotland (HIS)
            Product
            Product Information: 1477-9358 BCS Learning & Development
            Self URI (journal page): https://ewic.bcs.org/
            Categories
            Electronic Workshops in Computing

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