Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines: Qualitative Case Study

Abstract

Background Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input. Objective This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice. Methods HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis. Results The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures. Conclusions Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.

Digital consultation in primary healthcare: the effects on access, efficiency and patient safety based on provider experience; a qualitative study

“…The findings from our study highlight areas where the platform impact on quality of services, increasing the understanding of how it could be of best use. Recognising the importance of the implementation process, which has been addressed in several other studies of e-health innovations including similar platforms, and the time and effort it takes to put in place new routines in already existing everyday work practices [ 25 ], our study also brings to the forefront areas where quality gains could potentially be made and where further development of similar platforms should direct its focus.…”

“…Frennert et al. [ 25 ] describe the process to implement and sustain a similar platform and its practices into everyday work processes and found that new routines and practices were accepted if staff perceived them as beneficial. The findings suggest that similar platforms might do well to target specific patient groups where benefits are identified rather than the general population.…”

‘It increases my ability to influence my ways of working’: A qualitative study on digitally mediated patient management in primary healthcare

“…This study is part of a research project on the impacts on the working environment and primary healthcare professionals when transforming traditional primary healthcare practices into digitally mediated practices. As part of the project, we have explored the implementation process of a digital patient management platform [38] in regard to normalisation process theory [39]. In this article, we primarily aim to examine healthcare professionals' experiences of working with patient management through a digital patient management platform.…”

Materiality and the mediating roles of eHealth: A qualitative study and comparison of three cases

“… 29 – 31 Although eHealth solutions have been studied for years, there remains a gap in understanding of how the materiality of eHealth solutions affects care and care work. 18 , 32 – 34 Leornadi 35 defines materiality as ‘the arrangement of an artefact's physical and/or digital materials into particular forms that endure across differences in place and time and are important to users’. He argues that the material aspects of technology become materialised in a context and evolve in that context, that is, they are not fixed.…”

“…An eHealth solution can belong to one of these domains or contain elements from several domains. 3 Research on eHealth has focussed on changed roles for healthcare professionals, [4][5][6] the importance of alignment with care processes, [7][8][9] impact of staff turnover, 10 increased workload 11 and/or decreased workload, [12][13][14] changes in workflow [15][16][17][18] and changes in professional values. 5,7,19 Consequently, previous research shows that eHealth solutions influence the way healthcare professionals conduct their work and provide care.…”