A qualitative interview study to explore costing of implementation strategies to support digital health adoption “it’s the difference between success and failure”

Abstract

Abstract Background Economic evaluations determine the relative value for money of health innovations and are important for decision makers when allocating scarce resources. However, implementation strategies to support digital health adoption require additional resourcing which is typically not accounted for in published economic evaluations. This study sought to understand current practices for capturing the costs associated with implementing digital health initiatives in hospital settings, where the complexities of technology and systems present unique challenges for implementation efforts. Methods A qualitative study of semi-structured interviews with purposefully sampled experts in implementation science, health economics and/or digital health was conducted. The interview guide was informed by a literature review and was pilot tested. Interviews were digitally recorded and transcribed. A hybrid inductive/deductive framework analysis was conducted using thematic analysis to elicit key concepts related to the research question. Results Interviews were conducted with 16 participants of which eight had specialist expertise in implementation science, six in health economics, and eight in digital health. Five participants were experienced in more than one field. Five key themes were elicited from the data: terminology and boundaries of implementation; types of costs; why implementation is costed; how to cost implementation; and barriers and enablers to costing implementation. Broadly, while interviewees recognised implementation costs as important, only some costs were considered in practice likely due to the perceived ill-defined boundaries and inconsistencies in terminology of implementation. Labour was highlighted as being the main cost associated with implementation strategies to support digital health adoption. A variety of methods were used to collect and analyse implementation costs; the most frequent approach was staff time tracking. Implementation costs were typically recorded to support the delivery of high value care. Multidisciplinary collaboration facilitated this process, but the burden of collecting the necessary data was highlighted. Conclusions Current practices for costing implementation in the context of digital health initiatives discussed by participants highlighted inconsistent approaches that were likely to underestimate organisational implementation costs. Although participants had industry exposure, most were also academic researchers and findings may not be representative of non-academic industry settings. Development of appropriate methodology for costing implementation strategies to support digital health adoption remains a priority.