Currently submitted to: Journal of Medical Internet Research
Date Submitted: Apr 8, 2026
Open Peer Review Period: Apr 9, 2026 - Jun 4, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Health system- and payer-level decision-making processes influencing the adoption and sustainability of patient-facing digital health tools
ABSTRACT
Background:
Patient-facing digital health tools such as mobile health (mHealth) apps, wearables, and digital therapeutics have expanded rapidly and show promise for improving chronic disease management. Despite increasing evidence of effectiveness, health systems and payers continue to face challenges integrating these tools into routine care.
Objective:
This study examined the decision-making processes of health system and payer leaders regarding the adoption and sustainability of patient-facing digital health tools within their organizations.
Methods:
We conducted semi structured interviews with nine senior leaders from a large Midwestern academic health system and affiliated payer organizations, including a provider owned health plan and a state Medicaid program. Interviews explored digital health adoption decisions, perceived value and fit, barriers, and sustainability considerations, focusing on adoption of an evidence-based mHealth intervention for alcohol use disorder as a use case. Transcripts were analyzed using thematic analysis with inductive and deductive coding.
Results:
Four decision making mechanisms shaped adoption and sustainability decisions: prioritization under organizational constraint, risk mitigation, operational fit, and value determination. These mechanisms describe how leaders navigate limited organizational capacity, reduce uncertainty and protect against clinical, financial, and operational risks, assess whether tools can integrate within existing clinical and technical systems, and determine whether anticipated and measurable benefits justify adoption and continued organizational support.
Conclusions:
Adoption and sustainability of patient-facing digital health tools are shaped by dynamic organizational decision-making processes that often remain invisible to patients, clinicians, researchers, and developers. Making these processes visible may help better align digital health tools with the realities of the healthcare system to support implementation.
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.