JMIR Publications

ABSTRACT

Background:

News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people whilst maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefit but the rapid cycle development also created risks.

Objective:

To understand the socio-technical aspects of the rapid cycle development of seven different COVID-19 virtual care applications and identify enablers, barriers and risks at three health services in Victoria, Australia.

Methods:

This research used a qualitative, embedded, multiple case study design. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyse structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools.

Results:

The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and protecting staff. However, the governance, digital maturity and specific use cases at each institution framed the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes provided barriers. Existing relationships with technical services developers enabled strong solutions which in some cases were highly scalable. Traditional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and co-design, universal accessibility and post-implementation evaluation were almost universally ignored in this environment.

Conclusions:

Rapid cycle development of COVID apps at these health services reflected an international pattern of user requirements, methods and limitations. An exception was access issues such as non-English-language ability and device and network access for marginal communities, frequently described in the international literature but specifically addressed by only one health service in this study. Despite project-based limitations, apps generally delivered the required outcomes in a remarkably short time. Future health service governance and technical developments can be informed by the limitations identified. These barriers and limitations should be reduced not just in response to public health emergencies but for all routine virtual care developments, thus minimising issues to be addressed when new applications are implemented.