JMIR Publications

ABSTRACT

Background:

Innovative eHealth technologies are increasingly being introduced in healthcare systems worldwide, with researchers and policymakers advocating strategies to scale-up such technologies within and across healthcare systems. Despite this, examples of successful eHealth technology scale-up remain extremely limited. Although this lack of scale-up is widely acknowledged, there is still limited insight into why scaling up eHealth technologies is proving to be so challenging.

Objective:

This study aims to contribute to obtaining a better understanding of the complexities encountered when attempting to scale-up innovative eHealth technologies, and of the strategies applied to address these complexities.

Methods:

We performed a qualitative study, abductively moving between theoretical perspectives on the scale-up of healthcare innovations and the findings from an interview-based case study of a prominent Dutch eHealth technology involving remote patient monitoring (RPM). We created a cross-disciplinary theoretical framework by bringing together three perspectives on scale-up: a structural perspective (focusing on structural barriers and facilitators), an ecological perspective (focusing on local complexity), and a critical perspective (focusing on mutual adaptation of innovation and setting). We used these perspectives as an interpretive lens to analyse how representatives from various stakeholders (n=14) experienced the efforts in scaling-up the RPM technology.

Results:

Our study revealed two key insights: 1) the complexities associated with eHealth scale-up and the strategies applied to make scale-up happen differ depending on the level at which scale-up is considered, discerning between local and broader level scale-up; at the broader level a tension arises between the simultaneous need for stability and malleability resulting in an impasse; and 2) pre-existing circumstances and associated path dependencies shape the complexities of the local context and facilitate or constrain chances for eHealth innovation scale-up.

Conclusions:

This study brings together insights from different fields of literature to study eHealth innovation scale-up. The three perspectives, with diverging assumptions about innovation scale-up, should be viewed as being complementary, highlighting different aspects of the complexities perceived to play an important role. Using these perspectives, we conclude that the often-neglected importance of the level at which scale-up is envisioned and of pre-existing local circumstances contributes to an impasse in eHealth innovation scale-up at the broader level of scale.