JMIR Publications

ABSTRACT

It is widely recognised that digital health solutions will be an integral element in the future of high-quality, and equitable person-centred care. Amongst the early examples of digitally enhanced care that are gaining traction globally are hospital-at-home or virtual wards (VWs) characterised by various configurations of digital and analogue monitoring systems and teams of multi-disciplinary care providers that combine to support patients in their place of residence. The potential of VWs to provide more precise, efficient contact with clinicians, improve patient outcomes, and cost-effectively manage geographically dispersed patients makes them an attractive proposition for high-, and low-and-middle-income countries alike. It appears that both share settings share not only the potential to recoup similar benefits from VWs but also face the same challenges in doing so relating to the intersection of infrastructure, technology, patients, providers and organisations. Considering these similarities and the need for rapidly generated evidence to support the growing number of VW initiatives it appears worth exploring how the various challenges are manifest in global healthcare and the extent to which reciprocal learning can support the widespread implementation of VWs. To systematically understand the existing evidence and the parallels that might be drawn across various systems we have used the seven domains of Non-adoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability of technologies for health and social care framework. It helped identify the need for mechanisms that enable the incorporation of the latest clinical guidance to support the care of complex patients (“Condition”); that the technological compatibility can be supported by conducting design and/or procurement of digital tools with those delivering (or receiving) the service (“Technology”); the need for culturally tailored and consistent messaging on the benefits to the quality and safety of care, resisting framing their introduction as the pursuit of service efficiency (“Value Proposition”); maintaining the positive response of patients by using analogue work arounds to support inclusivity and supporting staff by providing training in remote consultations and the appropriate digital skills (“Adopters”); how the delivery of VWs benefits from carefully nurturing the necessary collaborative networks across and within organisations (Organisation); that regional interpretation of large-scale VW programmes should be granted to accommodate local contexts (Wider system); and finally, acknowledging the above and enabling robust evaluation and transferable evidence by agreeing global standards for VW evaluation that shares agreed tools and metrics (Embedding over time). It is acknowledged that it is unlikely that specific solutions will be directly applicable to other systems in every instance due to the functional, cultural and systemic differences that impact models of service delivery across the globe. However, the similarities of the challenges faced appears well-evidenced and the opportunity for equitable and reciprocal learning one worthy of further exploration.