Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review

Abstract

Background: Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact.

Aim: The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability.

Methods: A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases.

Results: Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof.

Conclusion: The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.

Keywords: Accessibility; Adoption and scalability; Design framework; Integration; Remote patient management; Versatility.

Fig. 1

Cause-effect diagram for RPMTSs’ low adoption and limited scope for scaling

Fig. 2

Article search and screening process

Fig. 3

SR-RPMTS deployment in the healthcare domain

Fig. 4

PA-RPMTS deployment in the healthcare domain

Fig. 5

SR spread of integration into CWF

Fig. 6

PA spread of integration into CWF

Fig. 7

Comparison of targeted diseases between SR and PA

Fig. 8

Levels of accessibility to the general public

Fig. 9

SR — healthcare organization’s main purpose

Fig. 10

PA — healthcare organization’s main purpose

Fig. 11

SR — design approach layout

Fig. 12

PA — design approach layout

Fig. 13

Summary concept map for analysis