Lessons learned from a living lab on the broad adoption of eHealth in primary health care

Background: Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective: This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods: Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results: The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. Conclusions: For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced

A patient perspective on eHealth in primary care: Critical reflections on the implementation and use of online care services

Smart devices like mobile phones with internet are becoming an indispensable part of our everyday lives. Digital solutions are expected to contribute to the healthcare sector (e-health) in the form of online patient portals and home measuring devices. Nevertheless, e-health is being utilised very little in daily practice. This dissertation focuses primarily on the patient's perspective, with the main aim of researching the need and the use of e-health by general practitioners. This dissertation also examines the implementation of e-health in the Netherlands in a broader context. It appears that e-health is not commonly used by patients due to a lack of: 1) understanding and information about the possibilities and advantages of e-health; 2) understanding about the possibilities and skills required to use e-health; and 3) the expected value of e-health in terms of disease-specific characteristics. The low usage rate of e-health may be particularly problematic for patients that could benefit from it, but do not have access to it or the ability or skills to use it. This dissertation found that e-health is not equally relevant for all patients and therefore does not have to be implemented for everyone. Its introduction in GP care depends on the efforts of the parties involved, including patients, healthcare providers, e-health developers, health insurers, the government and researchers. They will have to draw on their own perspectives and values and work together to point the large-scale deployment of e-health in the right direction