Integration of Remote Patient Monitoring Systems into Physicians Work in Underserved Communities: Survey of Healthcare Provider Perspectives

Remote patient monitoring (RPM) technologies have been identified as a viable alternative to improve access to care in underserved communities. Successful RPM platforms are designed and implemented for seamless integration into healthcare providers work to increase adoption and availability for offering remote care. A quantitative survey was designed and administered to elicit perspectives from a wide range of stakeholders, including healthcare providers and healthcare administrators, about barriers and facilitators in the adoption and integration of RPM into clinical workflows in underserved areas. Ease of adoption, workflow disruption, changes in the patient-physician relationship, and costs and financial benefits are identified as relevant factors that influence the widespread use of RPM by healthcare providers; significant communication and other implementation preferences also emerged. Further research is needed to identify methods to address such concerns and use information collected in this study to develop protocols for RPM integration into clinical workflow

Eliciting Requirements for a Diabetes Self-Management Application for Underserved Populations: A Multi-Stakeholder Analysis

Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey interviews were carried out on 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas, to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app’s usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual forms. Healthcare providers indicated that glucose monitoring, educational content, and the graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved can improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities

A Sociotechnical Framework for Telehealth Integration into Clinical Workflow

Telehealth, which involves the use of telecommunication technologies to provide virtual care, has received special attention in the recent years for improving access to healthcare and for supporting integrated care for chronic diseases. Constraints that the COVID-19 pandemic imposed over in-person care caused healthcare providers in clinical settings transition rapidly from in-person care to virtual care, causing changes in their clinical workflow. Considering that telehealth integration can alter healthcare providers’ practice patterns, impacting efficiency, quality of care, and patient safety, it is timely to identify and account for system-level components and considerations to improve the efficiency of telehealth integrations with healthcare providers’ daily activities. Despite isolated efforts to identify such considerations, a comprehensive framework for telehealth integration is largely absent. To address this gap, this research applied a mixed methods approach with the objective of developing a sociotechnical framework for telehealth integration into clinical workflow. This framework, based on findings from the literature (Chapter 2) and insights from three case studies at different levels of telehealth integration and different telehealth modalities (Chapters 3-5), provides a set of components that must be considered to achieve successful integration of a telehealth system in clinics, hospitals, and other healthcare settings. The resulting framework, titled the System Adoption and Integration of New Telehealth Systems (SAINTS) framework (Chapter 6), account for components specific to the context of telehealth and the main temporal stages in the integration of telehealth into clinical workflow: (1) System Preparation, (2) Patient Enrollment, and (3) System Implementation. In addition, the developed framework is influenced by socio-technical system models with application in complex healthcare systems and use Systems Modeling Language (SysML) as a reference to define the components of the telehealth system integration and model the structural relationships with other components. Despite the publication of models that includes aspects of the implementation of health information technologies into complex healthcare systems, this is one of the first efforts in establishing a framework in the context of the integration of telehealth systems into clinicians’ work