Value of a Nationwide University Network in scaling up telemonitoring: a qualitative study

Orientation

Successes

• Our eHealth solution was developed for and by healthcare providers. The solution was, therefore, also a real solution. Gaining support was also of decisive importance, which is exactly what these people could do best. So when you start with eHealth implementation, make sure that it is ‘for and by’ end users.

• Very important was the policy of the Citrien programme to adopt the concept of telemonitoring, instead of the solution, technology or manufacturer. As a result, the view remained wide and the most suitable solution was chosen for each UMC. Keep your eyes wide open and do nt be afraid to use different or newer technologies.

• A major success of the Citrien network was to create support for telemonitoring during the phase of orientation back in 2019.

• The fact that the target population was selected by the medical profession itself was an essential success element.

• UMCs released their ‘not invented here syndrome’ during this Citrien programme. That made this a unique collaboration.

• The completion of the project canvas with the internal project team has allowed us to rapidly identify and agree on the goals, methodology, risks, scope and dependencies in all projects. In addition, the project canvas was useful for informing stakeholders.

Lessons learnt or areas for improvement

• The differences in needs per department and/or medical conditions were greater than expected. The lesson learnt is to not underestimate this. Implementation is not one-size-fits-all. Recognise that differences exist.

• It was assumed that all UMCs had the same problem definition. The selection of upscaling initiatives in this Citrien programme was primarily based on successful pilots, which is more innovation-driven than problem-oriented.

• An area for improvement is to conduct an ICT maturity scan within each organisation prior to implementation. We could have estimated whether there was additional complexity related to ICT immaturity.

• Although it was positive that each UMC was given the option of selecting an application for which there was significant support (both among medical specialists and the IT department), there remained a risk of ineffectiveness. It is more complicated to learn and collaborate when various solutions are chosen.

Insight

Successes

• Some nurses expressed a lot of concern. It was beneficial to introduce technology in selected patient rooms as early as possible so that nurses could experience how it operated first-hand.

• Innovation and creation were prioritised in Citrien 1. It continued on a modest scale and in a testing environment. We have now genuinely moved towards a national scale.

Lessons learnt or areas for improvement

• There is potential for improvement within the baseline measurement process. The baseline assessment must occur right from the start of the programme.

• Early consensus on the outcome indicators to be measured is an area for improvement.

Acceptance

Successes

• A short evaluation cycle is a huge success. Begin pilots as soon as possible to collect a variety of issues including people, technical (malfunctions) and environmental (financing). You can avoid complications by learning how to adapt to new technology in a pleasant manner.

• The project canvas is demonstrated to be useful for problem analysis.

• Each UMC has developed its own system for identifying barriers and enablers. This could be considered as an advantage.

• Engage with innovators and early adopters, then distribute success tales.

• An enabling factor was the availability of financial resources from the Citrien eHealth programme to launch the projects. As a result, departments were not required to make funding available immediately.

• It is critical to share experiences through the Citrien network. It helps if you can mention something like, ‘in UMC× they use this method, and in UMCy they use that method.’ It encourages healthy competitiveness.

• We learnt from the experiences of others. We needed to make modifications so that it worked well with the processes in the adoptive UMC. Involving specialists in the design of the care path and procedure, as well as establishing training courses, is a key success factor.

• Integrating new technology into current workflows as much as feasible is an essential enabler.

• Discussing financial and regulatory challenges to scaling up telemonitoring with a mirror group of healthcare insurers and the Dutch Healthcare authority is a success element.

• We made a significant contribution to the Dutch Health Insurance Companies’ Telemonitoring Guidelines.

• The exchange of organisational interventions was a success. A central monitoring centre, for example.

Lessons learnt or areas for improvement

• The execution of the problem analysis is an area for improvement. We should hold ourselves more accountable for our analyses within the network.

• The elements of the target group are not considered in the creation. Consider the early adopters against the late majority.

• The application of the NoMAD questionnaire in the problem analysis is an unused opportunity.

• In these types of projects, it is particularly important to assess organisational readiness.

• Before starting a project, ensure that the supplier’s planning expectations are met.

• It has been challenging to collaborate in reaching financial arrangements with suppliers.

Change

Successes

• Seven departments began adopting monitoring, leading to the internal formation of a steering group for monitoring. This requires upscaling that is structured and effective. It is advised that you form a diverse steering group that meets frequently when scaling up.

• By sharing monthly updates on their progress, project leaders keep each other on their toes.

• Sharing experiences is one of the benefits of networks. We shared our experiences with the many sensors UMCs used in the TM vitals project throughout the project leaders’ and steering group’s meetings.

• Joining this network was a success because it linked up with existing structures to accelerate upscaling.

• The Citrine eHealth programme’s additional financial support was a facilitator.

Lessons learnt or areas for improvement

Maintenance

Successes

• Major change initiatives, such as the Citrien programme, take time. The executive board’s support is crucial, providing both time and financial support for scaling up.

• Structured funding is required to ensure the long-term viability of telemonitoring. We shared our experiences with structural finance implementation at project leaders and steering group meetings. It was also advantageous that the Citrien programme had a delegate in the Dutch Healthcare authority’s telemonitoring working group, so that we could be informed and provide input for the structural funding of telemonitoring for (chronic) care pathways.

• Involve the Care Contracting Department and the Executive Board early so that telemonitoring can be included in agreements with health insurance.

• A key success factor is that critical preconditions for telemonitoring are sought and established in all UMCs. (Legal, administrative, and organisational)

Lessons learnt or areas for improvement

Evaluation

Successes

• We were able to learn from each other’s experiences by exchanging the (scientific) findings of evaluations and research conducted for the Citrien programme eHealth.

• The organised manner of the Citrien network was useful for evaluating upscaling collectively.

Lessons learnt or areas for improvement

• A recommendation for future eHealth programmes is to undertake cost-effectiveness research based on actual adoption.

• Each UMC has defined their own outcome measures in their project canvas, as well as SMART goals for evaluation. This has not been coordinated. An essential lesson learnt is to agree on the outcome markers so that the outcomes may be compared.

• The ability to evaluate is an area for development. It is advised to include an evaluation paragraph in the project canvas.

  TM, telemonitoring; UMC, University Medical Centre; SMART, Specific-Measurable-Achievable-Relevant-TimeBound; NoMAD, NOrmalisation MeAsure Development questionnaire; ICT, Information and Communication Technology; IT, Information Technology.