The National Coordinated Citrien eHealth Program to Scale Up Telemonitoring: Protocol for a Before-and-After...

Area of Science:

• Health Informatics
• Digital Health Implementation
• Healthcare Management

Background:

• Challenges in sustainable, nationwide telemonitoring implementation exist.
• The Dutch National eHealth program supports scaling telemonitoring in cardiology, obstetrics, and hospital wards across all University Medical Centers (UMCs).

Purpose of the Study:

• To evaluate the nationwide upscaling of telemonitoring in Dutch UMCs.
• To understand the processes, methods, and outcomes of scaling telemonitoring strategies.
• Hypothesis: Telemonitoring will be operational but not normalized in routine care post-Citrien program scale-up.

Main Methods:

• A before-and-after study design was employed.
• Theoretical frameworks include Nonadoption, Abandonment, Scale-up, Spread, and Sustainability; Normalization Process Theory; and Project Canvas.
• Primary outcome: degree of normalization (using NoMAD tool); Secondary outcome: telemonitoring uptake (using UMC business intelligence data).

Main Results:

• Data collection occurred from May 2020 to December 2022, with results retrieved in June 2023.
• A potential risk exists if UMCs cannot provide required management information.
• Evolving Dutch and European regulations (e.g., Electronic Data Exchange in Health Care Act, European Health Data Space Act) are expected to aid implementation.

Conclusions:

• The Citrien program facilitates national telemonitoring scale-up across diverse settings.
• The study yields original data on telemonitoring uptake and upscaling in Dutch UMCs.
• Findings offer guidance for future eHealth initiatives, identifying success factors and obstacles.