JMIR Publications

ABSTRACT

Background:

Traditional primary care is characterised by patient consultations by phone and physical visits. However, the current trend in Swedish primary care is to blend digital solutions with traditional solutions. This article addresses this development by examining the normalisation of embedding and integrating a digital healthcare platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input.

Objective:

To explore the work health care professionals (HCPs) have to undertake in order to implement and sustain a digital health care platform as part of everyday work practice.

Methods:

HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. Observations took place during training sessions with the HCPs, as well as at a formal workplace meeting. Interviews were conducted with four nurses, three doctors, two managers, one psychologist, and one rehabilitation coordinator from the same health care centre. One of the main initiators and developers of the platform was also interviewed. Normalisation process theory (NPT) was used to frame the interviews in the data analysis.

Results:

The analysis identified several themes related to the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring). The use of these constructs enabled the analysis to not only identify barriers to and facilitators of implementation but also to identify ways to support implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, for NPT gives ontological priority to human actors and social structures.

Conclusions:

Digital health care platform implementations are complex processes. Our findings provide insights into how individual and collective actions can be supported in order to embed and integrate a digital platform into everyday care routines. Primary health care organisations need to involve HCPs throughout the implementation process by reorganising work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practice if they perceive the digital platform to be beneficial compared to current practice. However, they also need resources (time, training and continuous support) to put the platform into practice. An important element in the implementation is patient engagement and appraisal. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.