JMIR Publications

ABSTRACT

Background:

As health care becomes more fragmented, it is even more important to focus on the provision of integrated, coordinated care between health and social care systems. With an aging population, this coordination is even more vital. Information and communication technology (ICT) can support integrated care if the form of the technology follows and supports functional integration. Health TAPESTRY is a program centred on the health of older adults, supported by volunteers, primary care teams, community engagement and connections, and an ICT known as the TAP-App, a web-based application that supports volunteers in completing client surveys, supports volunteer coordinators in managing the volunteer program, and supports primary care teams in receiving information and requesting more.

Objective:

To describe the development, evolution, and implementation of the TAP-App ICT in order to share the lessons we have learned.

Methods:

Qualitative case study, with the TAP-App as the case and perspectives of end-users and stakeholders as the units of analysis. The data consists of researchers’ perspectives on the TAP-App from both their own experiences as well as feedback from other stakeholders and end-user groups. Data were collected through a written retrospective reflection with the program manager, a specific interview with the technology lead, key emailed questions to the TAP-App developer, and viewpoints and feedback during paper drafting from other research team members. There were two iterations of Health TAPESTRY and the TAP-App, and we focus on learnings from the second implementation (2018-2020) which was a pragmatic implementation scale up trial using the RE-AIM framework in six primary care sites across Ontario, Canada.

Results:

TAP-App 1.0, iteratively developed, was introduced as a tool to schedule volunteer/client visits and collect survey data via tablet computer. TAP-App 2.0 was developed based on this initial experience and a desire for a program management tool that focused more on dual (or multiple) flow between users than one-way communication, and provided better support for management and research. The themes of our lessons learned were: 1. Iterative feedback is valuable; 2. If ICT will be used for research, develop it with research in mind; 3. Prepare for challenges with integration of ICT into existing workflow; 4. Ask: Should interoperability be the goal?; 5. Know that technology cannot do it alone… yet: the importance of human touch points.

Conclusions:

Health TAPESTRY, as many other health-promoting programs, is human-centred. The TAP-App does not replace those elements, but does help enable them. Despite this shift forward in supporting integrated care, there remained barriers to uptake of the TAP-App that would have allowed for a full flow of information between health and social settings in supporting patient care. This indicates the need for ongoing focus on the human use of ICT in similar programs.