Allers Sanne, Carboni Chiara, Eijkenaar Frank, Wehrens Rik
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
J Med Internet Res. 2024 Dec 2;26:e58007. doi: 10.2196/58007.
Innovative eHealth technologies are becoming increasingly common worldwide, with researchers and policy makers advocating their scale-up within and across health care systems. However, examples of successful scale-up remain extremely rare. Although this issue is widely acknowledged, there is still only a limited understanding of why scaling up eHealth technologies is so challenging. This article aims to contribute to a better understanding of the complexities innovators encounter when attempting to scale up eHealth technologies and their strategies for addressing these complexities. We draw on different theoretical perspectives as well as the findings of an interview-based case study of a prominent remote patient monitoring (RPM) innovation in the Netherlands. Specifically, we create a cross-disciplinary theoretical framework bringing together 3 perspectives on scale-up: a structural perspective (focusing on structural barriers and facilitators), an ecological perspective (focusing on local complexities), and a critical perspective (focusing on mutual adaptation between innovation and setting). We then mobilize these perspectives to analyze how various stakeholders (n=14) experienced efforts to scale up RPM technology. We provide 2 key insights: (1) the complexities and strategies associated with local eHealth scale-up are disconnected from those that actors encounter at a broader level scale-up, and this translates into a simultaneous need for stability and malleability, which catches stakeholders in an impasse, and (2) pre-existing circumstances and associated path dependencies shape the complexities of the local context and facilitate or constrain opportunities for the scale-up of eHealth innovation. The 3 theoretical perspectives used in this article, with their diverging assumptions about innovation scale-up, should be viewed as complementary and highlight different aspects of the complexities perceived as playing an important role. Using these perspectives, we conclude that the level at which scale-up is envisaged and the pre-existing local circumstances (2 factors whose importance is often neglected) contribute to an impasse in the scale-up of eHealth innovation at the broader level of scale.
创新的电子健康技术在全球范围内正变得越来越普遍，研究人员和政策制定者主张在医疗保健系统内部及跨系统扩大其应用规模。然而，成功扩大规模的例子仍然极为罕见。尽管这个问题已得到广泛认可，但对于扩大电子健康技术规模为何如此具有挑战性，人们的理解仍然有限。本文旨在促进对创新者在尝试扩大电子健康技术规模时所遇到的复杂性及其应对这些复杂性的策略有更好的理解。我们借鉴了不同的理论观点以及对荷兰一项著名的远程患者监测（RPM）创新进行的基于访谈的案例研究结果。具体而言，我们创建了一个跨学科理论框架，该框架汇集了关于扩大规模的三种观点：结构观点（关注结构障碍和促进因素）、生态观点（关注当地复杂性）和批判性观点（关注创新与环境之间的相互适应）。然后，我们运用这些观点来分析各种利益相关者（n = 14）在扩大RPM技术规模方面的经历。我们提供了两个关键见解：（1）与当地电子健康扩大规模相关的复杂性和策略与行为者在更广泛层面扩大规模时遇到的情况脱节，这转化为对稳定性和可塑性的同时需求，使利益相关者陷入僵局；（2）先前存在的情况和相关的路径依赖塑造了当地背景的复杂性，并促进或限制了电子健康创新扩大规模的机会。本文使用的三种理论观点，因其对创新扩大规模的假设不同，应被视为互补的，并突出了被认为发挥重要作用的复杂性的不同方面。运用这些观点，我们得出结论，设想扩大规模的层面以及先前存在的当地情况（这两个因素的重要性常常被忽视）导致了在更广泛层面上电子健康创新扩大规模时的僵局。
