Purpose To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care. Design/methodology/approach The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care. Findings The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes. Originality/value The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.

One of the reasons why large scale deployment of telemedicine has not been successful is the difficulty healthcare workers have in managing the software. Good usability is essential to the success of a telemedicine solution. By ensuring that user needs are efficiently and effectively respected, usability encourages user acceptance and reduces the need for support. However, little is known about what healthcare workers require from telemedicine systems in terms of how patient acquired data is displayed and interrogated. This paper describes the results of a post-implementation investigation of the clinician web 'back-ends' of two telemedicine systems used for the monitoring of long-term conditions in Lothian, Scotland, focusing on the features healthcare workers would like to see in future systems. We conducted semi-structured interviews and questionnaires to ascertain the views of healthcare workers who had been using the systems. The results of the evaluation were used to design a new prototype generic telemonitoring website which we offered to participants to demonstrate possible improvements and to further seek their views. The prototype was very well received, participants considering that it was easier to use and more user friendly than the system that they had been using.

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