The Vision Of Delivering Innovative E-Health Services At Scale: Implementers Views On Achieving 'Buy-In'

INTRODUCTION Recent advances in the field of digital healthcare have seen the promise of e-health offering consumers a seamless and streamlined 'journey of care' with preventative benefits which include reduced health inequalities, reduced hospital admissions and cost savings [1]. In Scotland, the publication of government strategies and policy documents such as Building a Health Service fit for the Future (Kerr Report, 2005), NHS Scotland - eHealth Strategy 2008 -- 2011 (Scottish Government, 2008) and the Quality Strategy 2020 Vision (Scottish Government, 2010) has encouraged this drive. However despite this push there seems to be a translational gap in the normalization of e-health services into routine practice. Whilst there is a growing evidence base suggesting the effectiveness of e-health, the evidence regarding sustainability of such interventions remains scare. Living It Up (LiU) is a fresh and exciting project which is part of a 37 million UK-wide programme entitled Delivering Assisted Living Lifestyles at Scale (dallas). LiU aims to empower N=55,000 people (between 2012--2015) to improve their health and well-being via an established digital health portal which offers consumers a range of products and services (Shine, Discover, Connected and Flourish) to enable them to gain a sense of 'ownership' and to encourage positive lifestyles. The structure of the project consists of a collaborative consortium of over 30 organizations led by NHS 24, The Scottish Centre for Telehealth and Telecare (SCTT) and 5 NHS health boards across Scotland. This study seeks to understand the experiences of 'implementers' and determine their views on the factors which can promote or inhibit successful implementation of a large-scale innovative e-health deployment. In particular, the study aims to shed light on the varying factors affecting user 'buy-in' to e-health technologies, products and services which have a direct impact on the normalization (embedding, integration and sustainability) of an intervention. METHODS We are using a longitudinal qualitative research approach. To date, N=6 semi-structured interviews have been conducted and a further 12 are being conducted longitudinally in order to capture data on how the views of implementers change over time. Normalisation Process Theory (NPT) (May et al., 2009) is being used as the underpinning conceptual framework for the study [2]. In this paper we focus on the 'Cognitive Participation' NPT domain as a case study. RESULTS OF THE CASE STUDY Initial findings demonstrate that there is considerable value in seeking to report on the views of implementers as a programme of this scale is being deployed. Implementers were able to gain a rich understanding of the factors affecting service implementation and the initial challenges concerning user 'buy-in' at an early stage. For instance, the difficulty of innovating at scale (Cognitive Participation - Activation) was highlighted consistently as a challenge. The use of co-design takes time, so that polished end products are slow to become visible making it difficult to sustain user enthusiasm /engagement. Similarly personal communication has been a key driver of enrolment (Cognitive Participation--Initiation) but is difficult to sustain at scale. Preliminary analyses also highlighted facilitators such as the importance of identifying the 'hook' or selling point to consumers so that they are able to recognise the value of the intervention to them (Cognitive Participation--Enrolment). Further to this the use of a trusted platform such as an established health service aids buy-in (Cognitive Participation - Legitimation). DISCUSSION LiU is very much an ambitious yet complex intervention and a clear limitation of this study is the absence of 'user voices' which includes health professionals, carers, patients and the general public. We as a research team have sought to gain these views however due to the complex nature of this intervention, there have been several difficulties experienced in obtaining this data. These obstacles include: the time taken to define a \"user\" within the programme, the re-branding of services by the project host, outsourcing of recruitment by the project host, delays and re-scheduling of the official launching of the digital eHealth portal, hesitation from some implementers to enable us to approach 'end users' as it is felt this may lead to confusion regarding roles and responsibilities. A strength of this study lies in the multidisciplinary nature of the research team and careful checking of the coding framework which improves the robustness of the data analysis as well as the use of a clear underpinning theoretical framework. This preliminary data highlights facilitators of the deployment thus far but also highlights potential risks to successful large scale deployment, and further follow up of the implementation journey will allow us to gain valuable insights into the barriers and facilitators of e-health large-scale deployments.