Valeria Pannunzio

Background: In cardiovascular care, illness and recovery affect both patients and their families, particularly within home-based remote patient management (RPM). A recent scientific statement from the American Heart Association highlighted the importance of family involvement, identifying digital technologies as a key enabling opportunity. Despite this, research into the needs of families and the implications of RPM remains limited. Objective: This study explored the lived experiences and unmet needs of patients with cardiovascular disease (CVD) and their relatives within RPM-supported cardiac care, using perioperative care and myocardial infarction as representative trajectories. Based on the identified gaps, we proposed a set of features for remote patient and family management (RPFM) interventions to address these needs. Methods: This qualitative study was conducted at a Dutch university hospital with over a decade of experience in RPM across CVD pathways. A human-centered design approach was employed, including focus groups with 24 participants (13 patients with CVD and 11 relatives). Data analysis followed a framework analysis approach, combining inductive theme identification with deductive mapping onto existing frameworks. Care experiences and unmet needs were identified inductively and segmented along the Family Systems Illness Model’s phases of illness. The needs were subsequently categorized deductively into the domains of the Supportive Care Framework. Based on these user-informed insights, RPFM features were generated through author ideation and internal team consensus. Finally, these experiences, needs, and features were synthesized into a visual journey map illustrating key care moments across 3 phases: preadmission, admission, and postadmission. Results: We identified 47 unmet needs across 6 domains: informational (n=13), psychoemotional (n=13), social (n=7), physical (n=7), practical (n=6), and spiritual (n=1). The most significant gaps, described as “black holes” in care and support, emerged during the preoperative waiting period and early home recovery, which were characterized by a lack of information and psychoemotional support. To address the identified unmet needs, we generated 33 RPFM intervention feature ideas. These RPFM features were mapped across care phases and grouped into 7 categories: dynamic pathway navigation (n=8), on-demand support and information (n=5), family well-being modules (n=5), medical translation and consultation support (n=4), safety and assurance monitoring (n=4), collaborative lifestyle management (n=4), and peer support platform (n=3). Conclusions: This study identified experience gaps in RPM-supported cardiac care. It showed that most unmet needs for care and support extend beyond hospital admission and discharge and that most health behaviors and recovery occur in the home context, within the patient’s relational ecosystem with loved ones. The proposed RPFM features provide preliminary directions for exploration toward a transition from individually focused monitoring to inclusive, family-centered care and management.

BACKGROUND In cardiovascular care, illness and recovery affect patients and their families, particularly within home-based Remote Patient Management (RPM). A recent American Heart Association scientific statement highlighted the importance of involving family systems, identifying digital technologies as a key opportunity. Despite this, research into families' needs and RPM implications remains limited. OBJECTIVE This study explored the lived experiences of patients and relatives across RPM-supported perioperative and myocardial infarction care trajectories. Based on these experiences, we co-designed actionable recommendations for Remote Patient and Family Management (RPFM) to address identified gaps. METHODS This qualitative study was conducted at a Dutch university hospital with over a decade of RPM experience. A multi-step co-design approach was employed, including focus groups with 24 participants (13 patients, 11 relatives). Subsequent thematic analysis and expert consensus discussions informed the identification of unmet needs and the development of actionable RPFM recommendations. RESULTS Experiences were summarised in a family-centred journey map. We identified 59 unmet needs across six domains: informational (n=17), psycho-emotional (n=17), social (n=11), physical (n=7), practical (n=6), and spiritual (n=1). The most significant gaps, described as ‘black holes’ in care and support, emerged during pre-admission and early post-discharge. Based on these needs, 74 RPFM recommendations were co-created. CONCLUSIONS This study highlights experience-based opportunities to enhance RPM-supported cardiac care, particularly in terms of informational and psycho-emotional support for families. Drawing on extensive RPM experience, we advocate a shift toward RPFM. For this, we propose a strategy that offers guidance for developing RPFM across cardiovascular and other care contexts.

Implementing changes to digital health systems in real-life contexts poses many challenges. Design as a field has the potential to tackle some of these. This article illustrates how design knowledge, through published literature, is currently referenced in relation to the implementation of digital health. To map design literature’s contribution to this field, we conducted a scoping review on digital health implementation publications and their use of references from nine prominent design journals. The search in Scopus and Web of Science yielded 382 digital health implementation publications, of which 70 were included for analysis. From those, we extracted data on publication characteristics and how they cited the design literature. The 70 publications cited 58 design articles, whose characteristics were also extracted. The results show that design is mainly cited to provide information about specific design methods and approaches, guidelines for using them and evidence of their benefits. Examples of referenced methods and approaches were co-design, prototyping, human-centered design, service design, understanding user needs and design thinking. The results thus show that design knowledge primarily contributed to digital health implementation with insights into methods and approaches. In addition, our method showcases a new way for understanding how design literature influences other fields.

Background: Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience–measuring methods and tools exists. Objective: This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain. Methods: Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By “RPM interventions,” we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique. Results: In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation. Conclusions: At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain.

BACKGROUND Large-scale implementation of Remote Patient Management (RPM) promises to improve the overall quality of healthcare. However, innovation often remains on a small and local scale due to complex, multi-faceted challenges during the scaling process of RPM. Overcoming these challenges requires a thorough understanding of the scaling process. The current literature is heterogeneous, and, to our knowledge, there is no comprehensive overview of the multilevel complexity of the scaling process. OBJECTIVE This scoping review examines how the current literature describes the scaling process of RPM, what theoretical frameworks are used and what factors hinder or enable this process. METHODS Following PRISMA-ScR guidelines, a literature search was conducted in the Pubmed and Embase databases. This resulted in the inclusion of 12 studies. Data extraction focused on the characteristics of included studies, terminology of the scaling process, frameworks applied, and factors influencing scaling RPM. RESULTS The included studies exhibited considerable heterogeneity in methodology, focus, and approach to scaling RPM. The terminology used to describe scaling processes varied, reflecting a continuum across the RPM innovation lifecycle. 7 theoretical frameworks were identified that provided mainly descriptive and evaluative insights into the levels of scaling RPM. A total of 568 factors (barriers and enablers) were identified and categorised into 12 thematic clusters. CONCLUSIONS Three sources of complexity in scaling RPM were identified: the process continuum in the terminology used to describe the scaling process; the management of scaling as a multi-levelled process; and the multitude of interconnected categories of factors related to the transition from pilot to scaling. Recommendations for researchers and practitioners are proposed to navigate through these complexities, including clear terminology distinction, development of multi-level process frameworks, holistic assessment of factors, and the creation of integrated overarching scaling strategies. Scaling RPM within healthcare systems presents diverse challenges stemming from the complex nature of the process. Addressing these challenges requires more than “just” implementing in multiple contexts, it requires a strategic approach informed by robust frameworks and actionable recommendations. Future research directions should focus on leveraging knowledge from innovation management to develop effective strategies for scaling RPM in healthcare.

Digital health technologies, powered by digital data, provide an opportunity to improve the efficacy and efficiency of health systems at large. However, little is known about different approaches to the use of data for digital health design, or about their possible relations to system-level dynamics. In this contribution, we identify four existing approaches to the use of data for digital health design, namely the silent, the overt, the data-enabled, and the convergent. After characterising the approaches, we provide real-life examples of each. Furthermore, we compare the approaches in terms of selected desirable characteristics of the design process, highlighting relative advantages and disadvantages. Finally, we reflect on the system-level relevance of the differentiation between the approaches and point towards future research directions. Overall, the contribution provides researchers and practitioners with a broad conceptual framework to examine data-related challenges and opportunities in digital health design.

BACKGROUND Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience–measuring methods and tools exists. OBJECTIVE This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain. METHODS Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By “RPM interventions,” we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique. RESULTS In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation. CONCLUSIONS At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain.

Background: Remote patient monitoring (RPM) interventions are being increasingly implemented in health care environments, given their benefits for different stakeholders. However, the effects of these interventions on the workflow of clinical staff are not always considered in RPM research and practice. Objective: This review explored how contemporary RPM interventions affect clinical staff and their workflows in perioperative settings. Methods: We conducted a scoping review of recent articles reporting the impact of RPM interventions implemented in perioperative settings on clinical staff and their workflow. The databases accessed were Embase and PubMed. A qualitative analysis was performed to identify the main problems and advantages that RPM brings to staff, in addition to the approaches taken to evaluate the impact of those interventions. Different themes were identified in terms of the challenges of RPM for clinical staff as well as in terms of benefits, risk-reduction strategies, and methods for measuring the impact of these interventions on the workflow of clinical staff. Results: A total of 1063 papers were found during the initial search, of which 21 (1.98%) met the inclusion criteria. Of the 21 included papers, 15 (71%) focused on evaluating new RPM systems, 4 (19%) focused on existing systems, and 2 (10%) were reviews. Conclusions: The reviewed literature shows that the impact on staff work experience is a crucial factor to consider when developing and implementing RPM interventions in perioperative settings. However, we noticed both underdevelopment and lack of standardization in the methods for assessing the impact of these interventions on clinical staff and their workflow. On the basis of the reviewed literature, we recommend the development of more robust methods for evaluating the impact of RPM interventions on staff experience in perioperative care; the adoption of a stronger focus on transition management when introducing these interventions in clinical practice; and the inclusion of longer periods of assessment, including the evaluation of long-term goals.

BACKGROUND Remote patient monitoring (RPM) interventions are being increasingly implemented in health care environments, given their benefits for different stakeholders. However, the effects of these interventions on the workflow of clinical staff are not always considered in RPM research and practice. OBJECTIVE This review explored how contemporary RPM interventions affect clinical staff and their workflows in perioperative settings. METHODS We conducted a scoping review of recent articles reporting the impact of RPM interventions implemented in perioperative settings on clinical staff and their workflow. The databases accessed were Embase and PubMed. A qualitative analysis was performed to identify the main problems and advantages that RPM brings to staff, in addition to the approaches taken to evaluate the impact of those interventions. Different themes were identified in terms of the challenges of RPM for clinical staff as well as in terms of benefits, risk-reduction strategies, and methods for measuring the impact of these interventions on the workflow of clinical staff. RESULTS A total of 1063 papers were found during the initial search, of which 21 (1.98%) met the inclusion criteria. Of the 21 included papers, 15 (71%) focused on evaluating new RPM systems, 4 (19%) focused on existing systems, and 2 (10%) were reviews. CONCLUSIONS The reviewed literature shows that the impact on staff work experience is a crucial factor to consider when developing and implementing RPM interventions in perioperative settings. However, we noticed both underdevelopment and lack of standardization in the methods for assessing the impact of these interventions on clinical staff and their workflow. On the basis of the reviewed literature, we recommend the development of more robust methods for evaluating the impact of RPM interventions on staff experience in perioperative care; the adoption of a stronger focus on transition management when introducing these interventions in clinical practice; and the inclusion of longer periods of assessment, including the evaluation of long-term goals. CLINICALTRIAL

This contribution explores the potential of lead user research for early-stage designing for intelligent ecosystems through a literature review and a single case study concerning a lead user research initiative on blood pressure monitoring. The results suggest advantages of executing lead user research in early-stage designing for intelligent ecosystems from the points of view envisioning broad initial ecosystem boundaries, developing first intelligence components, and overcoming research challenges related to technical issues.