Currently submitted to: Journal of Medical Internet Research
Date Submitted: Aug 7, 2020
Open Peer Review Period: Aug 7, 2020 - Oct 2, 2020
(currently open for review)
Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study
Despite the vast potential, the digital transformation of intensive care is lagging behind. Comprehensive evidence, along with guidelines for a successful integration of digital health technologies into specific clinical settings such as the intensive care unit (ICU), are scarce—yet essential.
We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU.
We conducted this study from May 2018 to March 2020 during the implementation of a tablet-computer based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. Results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework.
Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects.
The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks. Our proposed framework may guide health providers with concrete, evidence-based, and step-by-step recommendations for implementation practice facilitating the introduction of digital health in intensive care. Clinical Trial: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173
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