Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study (Preprint)

Abstract

Digital health technologies such as continuous remote monitoring and artificial intelligence (AI) driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for a successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce.

We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU.

We conducted this study from May 2018 to March 2020 during the implementation of a tablet-computer based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of seven semi-structured interviews with clinical ICU stakeholders and descriptive questionnaire data. Results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework.

This study revealed an insufficient implementation process due to lack of staff engagement and little perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to apply before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU.

Implementation of digital health in the ICU should involve thorough pre-implementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication and continuous feedback in an equal atmosphere is essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health providers with concrete, evidence-based, and step-by-step recommendations for implementation practice facilitating the introduction of digital health in intensive care.