Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation

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Abstract

In recent years, the number of digital health tools with the potential to significantly improve delivery of healthcare services has grown tremendously. However, the use of these tools in large, complex health systems remains comparatively limited. The adoption and implementation of digital health tools at an enterprise level is a challenge; few strategies exist to help tools cross the chasm from clinical validation to integration within the workflows of a large health system. Many previously proposed frameworks for digital health implementation are difficult to operationalize in these dynamic organizations. In this piece, we put forth nine dimensions along which clinically validated digital health tools should be examined by health systems prior to adoption, and propose strategies for selecting digital health tools and planning for implementation in this setting. By evaluating prospective tools along these dimensions, health systems can evaluate which existing digital health solutions are worthy of adoption, ensure they have sufficient resources for deployment and long-term use, and devise a strategic plan for implementation.

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Most cited references 25

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From triple to quadruple aim: care of the patient requires care of the provider.

Thomas Bodenheimer, Christine Sinsky (2014)

The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

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Rapid Response to COVID-19: Health Informatics Support for Outbreak Management in an Academic Health System

J Reeves, Hannah M. Hollandsworth, Francesca Torriani … (2020)

ABSTRACT Objective To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. Materials and Methods Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR) based tools to support clinical care. Results We outline the design and implementation of EHR based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. Discussion The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication and adoption, and coordinating the needs of multiple stakeholders while maintaining high-quality, pre-pandemic medical care. Conclusion The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.

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Randomized controlled trial of a 12-week digital care program in improving low back pain

Raad Shebib, Jeannie F Bailey, Peter Smittenaar … (2019)

Low back pain (LBP) is the leading cause of disability throughout the world and is economically burdensome. The recommended first line treatment for non-specific LBP is non-invasive care. A digital care program (DCP) delivering evidence-based non-invasive treatment for LBP can aid self-management by engaging patients and scales personalized therapy for patient-specific needs. We assessed the efficacy of a 12-week DCP for LBP in a two-armed, pre-registered, randomized, controlled trial (RCT). Participants were included based on self-reported duration of LBP, but those with surgery or injury to the lower back in the previous three months were excluded. The treatment group (DCP) received the 12-week DCP, consisting of sensor-guided exercise therapy, education, cognitive behavioral therapy, team and individual behavioral coaching, activity tracking, and symptom tracking – all administered remotely via an app. The control group received three digital education articles only. All participants maintained access to treatment-as-usual. At 12 weeks, an intention-to-treat analysis showed each primary outcome—Oswestry Disability Index (p < 0.001), Korff Pain (p < 0.001) and Korff Disability (p < 0.001)—as well as each secondary outcome improved more for participants in the DCP group compared to control group. For participants who completed the DCP (per protocol), average improvement in pain outcomes ranged 52-64% (Korff: 48.8–23.4, VAS: 43.6–16.5, VAS impact on daily life: 37.3–13.4; p < 0.01 for all) and average improvement in disability outcomes ranged 31–55% (Korff: 33.1–15, ODI: 19.7–13.5; p < 0.01 for both). Surgical interest significantly reduced in the DCP group. Participants that completed the DCP had an average engagement, each week, of 90%. Future studies will further explore the effectiveness of the DCP for long-term outcomes beyond 12 weeks and for a LBP patient population with possibly greater baseline pain and disability. In conclusion, the DCP resulted in improved LBP outcomes compared to treatment-as-usual and has potential to scale personalized evidence-based non-invasive treatment for LBP patients.

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Author and article information

Contributors

Jayson S. Marwaha:

ORCID: http://orcid.org/0000-0002-3833-7448

jmarwaha@bidmc.harvard.edu

Journal

Journal ID (nlm-ta): NPJ Digit Med

Journal ID (iso-abbrev): NPJ Digit Med

Title: NPJ Digital Medicine

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2398-6352

Publication date (Electronic): 27 January 2022

Publication date PMC-release: 27 January 2022

Publication date Collection: 2022

Volume: 5

Electronic Location Identifier: 13

Affiliations

[1 ]GRID grid.239395.7, ISNI 0000 0000 9011 8547, Department of Surgery, , Beth Israel Deaconess Medical Center, ; Boston, MA USA

[2 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Biomedical Informatics, , Harvard Medical School, ; Boston, MA USA

[3 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Department of Emergency Medicine, , Brigham and Women’s Hospital, ; Boston, MA USA

[4 ]GRID grid.427669.8, ISNI 0000 0004 0387 0597, Atrium Health, ; Charlotte, NC USA

[5 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Department of Medicine, , Brigham and Women’s Hospital, ; Boston, MA USA

Author information

Jayson S. Marwaha http://orcid.org/0000-0002-3833-7448

Adam B. Landman http://orcid.org/0000-0002-2166-0521

Article

Publisher ID: 557

DOI: 10.1038/s41746-022-00557-1

PMC ID: 8795422

PubMed ID: 35087160

SO-VID: 5d3d0f46-7eb8-4752-85d4-109145c7da3d

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 4 August 2021

Date accepted : 22 December 2021

Funding

Funded by: FundRef https://doi.org/10.13039/100007229, Harvard University;

Award ID: Biomedical Informatics and Data Science Research Training (BIRT) Program

Award Recipient : Jayson S. Marwaha

Funded by: FundRef https://doi.org/10.13039/100000092, U.S. Department of Health & Human Services | NIH | U.S. National Library of Medicine (NLM);

Award ID: T15LM007092

Award Recipient : Jayson S. Marwaha

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Keywords: health services,health policy

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Keywords: health services, health policy

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Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation

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Most cited references 25

From triple to quadruple aim: care of the patient requires care of the provider.

Rapid Response to COVID-19: Health Informatics Support for Outbreak Management in an Academic Health System

Randomized controlled trial of a 12-week digital care program in improving low back pain

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