JMIR Publications

ABSTRACT

Background:

Despite a growing body of knowledge about e-health innovations, there is still limited understanding of the implementation of such tools in everyday primary care.

Objective:

To describe the experience of healthcare staff of a digital communication system intended for patient/staff encounters via an e-route in primary care.

Methods:

Twenty-one individual interviews with staff at five primary-care centres in Sweden that employed a digital communication system for six months informed this qualitative study. The interviews were guided by narrative queries, transcribed verbatim and subject to content analysis.

Results:

Healthcare staff found the digital communication system easy to grasp but more complex to employ, affecting both staffing and routines for communicating with patients, and documenting contacts. The system’s templates strengthen equivalent procedures for patients but dictate a certain level of health and digital literacy for accuracy. Although patients often expected the “chat” to be synchronous, communication was extended over time. The system can provide the benefit of better assessments and enable more efficient use of resources, such as staff. On the other hand, telephone contact is faster and better for certain purposes, especially when the patient’s voice provides data in itself. However, many primary-care patients, particularly younger ones, expect digital routes for contact, and staff found it rewarding to match preferences for communicating to a place and time that suited patients. Staff are willing to accept some nuisance from a suboptimal service – at least for a while – if it procures patient satisfaction. A team effort, including engaged managers, scaffolds the implementation process, whereas being subject to a trial without likely success erects barriers.

Conclusions:

A digital communication system introduced in regular primary care involves complexity beyond merely learning how to manage the tool. Rather, it affects routines and requires that both the team and the context are addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggests including ethical perspectives on e-health tools, providing an important but novel aspect of implementation.