JMIR Publications

ABSTRACT

Background:

The home care service in Norway still struggles to meet an increasing demand of health care under restricted budgets constraints, although about one fourth of municipal budgets are dedicated health services DigiHelse is a web based platform designed to reinforce the home care service in Norway, and is currently undergoing a development process to meet the predefined needs of the municipalities. The three main features of the platform are to enable digital messages between residents and the home care service, highlight information on planned and completed visits and provide an opportunity to cancel visits and final notifications of completed visits.

Objective:

The aim of the study was to test the usability and feasibility of adopting DigiHelse in four districts in Oslo applying registry and behavioural data collected throughout a one-year pilot. Early health technology assessment (HTA) was used to estimate the potential future value of DigiHelse, including the predictive value of behaviour data.

Methods:

Outcome measures identified in the project’s concept phase by stakeholder insights and scenario drafting, were used to assess quality gains and patient safety issues in a present value calculation on socioeconomic benefits. In this follow-up study, aggregated data was collected at baseline, 15 and 52 weeks after DigiHelse was introduced to assess changes in health consumption. To update the present value calculation, data from four intervention- and one control group was analysed using the quasi-experimental difference-in-difference design to estimate the casual effect. Descriptive behavioural data from the digital platform was applied to assess the usability of the platform.

Results:

A significant gap was found between the estimated value of DigiHelse in the concept phase of the project and after the one-year pilot. In the present pilot assessment costs are expected to exceed potential savings with 67 million Euro over ten years, as compared to the corresponding concept estimates with a potential gains of 172.6 million Euro. Interestingly, behavioural data from the digital platform revealed that only 3-4% of recipients used the platform actively after one year.

Conclusions:

Objective behavioural data provides an important source to assess usability. In this case study, the low adoption rate may, at least in part, explain the inability of the DigiHelse pilot to perform as expected: meet the citizens’ needs. This study points to early assessment of behavioural data as an opportunity to identify inefficiencies and direct digital development in the right direction. For DigiHelse, insight into why the recipients in Oslo have not made a greater use of the web based platform seems to be the next step in ensuring the right improvement measures for the home care service. Clinical Trial: The trial is reported in accordance with CONSORT-EHEALTH.