Failed Implementation of Mobile Access to Electronic Health Records in Home Care: Qualitative Study in Sweden

Digitalization and mobile health (mHealth) technologies hold promise for improving home care delivery. However, many mHealth initiatives fail to achieve their goals. Understanding the reasons behind these failures is critical for informing the successful implementation of mHealth in primary and home care settings.

This study aimed to explore the implementation process of a tablet computer with an mHealth app providing mobile access to the electronic health record (EHR) in home care, identifying barriers and facilitators to its uptake.

A tablet with EHR access was introduced at 4 primary care centers and 1 municipal home care organization in Sweden. Participants were nurses and physicians working at the study sites. Focus group discussions and interviews were conducted to obtain a rich understanding of implementation-related issues experienced by the health care professionals. Qualitative content analysis was conducted using the Consolidated Framework for Implementation Research to guide interpretation.

Eighteen health care professionals (16 nurses and 2 physicians) participated in the study. The implementation of the mHealth app was largely unsuccessful. Key barriers included limited functionality of the app, technological immaturity, and unstable infrastructure. Organizational context influenced uptake, especially due to differing EHR systems and varying levels of user engagement. Users who were involved in the development process were more positive, despite the absence of certain functionalities, while those excluded struggled with adoption. Long development and implementation timelines and limited training reduced enthusiasm and negatively affected user engagement. Additional challenges included insufficient implementation planning, lack of leadership engagement, and inadequate resources for support and training.

For mHealth implementations to succeed, tools must meet users' needs and integrate seamlessly with existing eHealth ecosystems and infrastructures. Premature implementations can lead to change fatigue and diminish future engagement. Investments in user-centered design, thorough testing, organizational readiness, and sustained support are essential to realize the potential of mHealth in home care.