A Cross-Disciplinary Analysis of the Complexities of Scaling Up eHealth Innovation

Area of Science:

• Health Informatics
• Health Services Research
• Innovation Management

Background:

• Innovative eHealth technologies are increasingly promoted for healthcare systems globally.
• Despite widespread advocacy, successful large-scale implementation of eHealth remains rare.
• A limited understanding exists regarding the specific challenges hindering eHealth scale-up.

Purpose of the Study:

• To enhance understanding of the complexities faced by innovators when scaling up eHealth technologies.
• To explore strategies employed to address these scale-up complexities.
• To analyze the interplay between innovation and healthcare settings during scale-up.

Main Methods:

• A cross-disciplinary theoretical framework integrating structural, ecological, and critical perspectives on scale-up.
• An interview-based case study of a remote patient monitoring (RPM) innovation in the Netherlands.
• Analysis of stakeholder experiences (n=14) with scaling up RPM technology.

Main Results:

• A disconnect exists between local and broader-level eHealth scale-up complexities and strategies.
• Stakeholders face an impasse due to the simultaneous need for stability and malleability in scaling.
• Pre-existing local circumstances and path dependencies critically shape scale-up opportunities and challenges.

Conclusions:

• The level at which scale-up is envisioned and local pre-existing conditions are crucial, often neglected factors contributing to scale-up impasses.
• Complementary theoretical perspectives reveal diverse complexities in eHealth innovation scale-up.
• Addressing the identified disconnects and local context is vital for successful broader-level eHealth scale-up.