JMIR Publications

ABSTRACT

Background:

Digitalization can optimize healthcare; however, many eHealth projects fail to meet their objectives. Analyzing the reasons behind unsuccessful eHealth implementations can provide valuable insights into achieving successful digitalization in primary and home care settings.

Objective:

This study aims to elucidate the implementation process of a tablet computer with a mHealth app, providing mobile access to the electronic health record (EHR) in home care, to understand the barriers to and potential facilitators of successful mHealth interventions.

Methods:

A tablet computer with mobile access to the EHR was introduced in four primary care centers and one municipal home care organization in Sweden. Focus groups and interviews were conducted to assess the impact of the implementation on the work of healthcare professionals. Qualitative content analysis informed by the Consolidated Framework for Implementation Research was used to analyze the implementation process and interpret the results.

Results:

The implementation of the eHealth application was unsuccessful, mainly because the application did not fully support the users’ needs, but also due to immature technology and unstable infrastructure. The outcome of the intervention was dependent on context and user engagement. Users involved in the development process displayed more positive attitudes, despite the absence of certain functionalities, while those not involved encountered difficulties in adopting the mobile tool. Lengthy development and implementation processes negatively impacted user engagement. Inadequate implementation procedures and poor readiness for implementation also hindered application usage. Users perceived a lack of leadership engagement and questioned the availability of resources allocated to the implementation, in terms of training and dedicated support.

Conclusions:

The functionality of mHealth applications must align with users' needs and be effectively integrated into existing eHealth ecosystems to ensure success. Premature implementations can lead to change fatigue and impede future implementation efforts. To unlock the potential of mHealth, sufficient resources must be allocated to design, development, evaluation, feasibility studies, and user support and engagement throughout the implementation process.