Julian Houwen

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 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.