JMIR Publications

ABSTRACT

Background:

Home care services are under increasing pressure due to population aging, rising chronic disease prevalence, and workforce shortages. Digital health technologies, particularly home telemonitoring systems, are seen as promising tools to detect early clinical deterioration, reduce hospital use, and support continuity of care. However, real-world evidence on the implementation of such technologies in public home care systems remains limited. In 2023–2024, the Quebec Ministry of Health and Social Services funded a pilot to implement a multidevice telemonitoring intervention for older adults with heart failure across three integrated health and social services centers (CISSS). The initiative aimed to assess feasibility, acceptability, and the organizational conditions shaping implementation.

Objective:

This study documents the real-world implementation of a multidevice telemonitoring program from the perspective of home care nurses, with complementary insights from managers. It identifies perceived barriers, enablers, and contextual strategies for adaptation and sustainability.

Methods:

We conducted a qualitative study guided by the iCHECK-DH framework and principles of implementation science. Data sources included 30 semi-structured interviews, 19 with home care nurses and 11 with clinical and administrative managers. The intervention combined four connected devices (Bluetooth scale, smartwatch, xPill adherence system, and voice-activated tablet), monitored by nurses through the VirtuoseTM dashboard. Data were analyzed thematically, focusing on implementation processes, user experience, and organizational integration.

Results:

The intervention involved approximately 50 patients and was implemented across three home care organizations. About 75% of nurses accessed the dashboard daily or near-daily, but challenges included alert fatigue, workflow disruption, and limited integration with clinical systems. Implementation was shaped by five factors: (1) strong governance and coordination; (2) hands-on, timely training, though sometimes perceived as fragmented; (3) clinical relevance of digital tools, tempered by high alert burden; (4) need for local adaptation of workflows and roles; and (5) reliance on external vendors, raising concerns about sustainability and interoperability. Nurses emphasized the continued importance of relational care, even in digitally mediated contexts.

Conclusions:

Telemonitoring programs can be successfully implemented in public home care settings when supported by strong leadership, responsive training, and adaptive workflows. This study highlights the relational, technical, and organizational dimensions of implementation and offers lessons to inform future scale-up efforts in similar public health systems.