National implementation of telehealth in Denmark: A case study

Abstract Background With a growing number of chronic patients and a shortage of healthcare professionals, modern health systems face mounting economic pressures. Telehealth has emerged as a promising solution to address these challenges and is considered a critical component of future healthcare provision. However, implementing telehealth on a large scale is complex and challenging. To fully grasp these challenges, it is essential to look beyond the technology and delve into the processes and actors involved in its implementation. Actors on a political-administrative level are pivotal in large-scale implementation, yet this level remains understudied. Thus, this study investigates the dynamics of large-scale implementation at a political-administrative level through a case study of the national implementation of TeleCOPD in Denmark - a home-monitoring intervention targeting patients with Chronic Obstructive Pulmonary Disease (COPD). Methods An in-depth qualitative study of the implementation process at the political-administrative level was undertaken. Data consisted of comprehensive documentary material, including policy documents and meeting minutes and 12 semi-structured interviews with 16 key stakeholders across all levels of the implementation process. Data was analysed in accordance with thematic analysis using an abductive strategy. Results The analysis shows that large-scale implementation of telehealth is a profoundly complex process, necessitating the collaboration of various stakeholders across organisational hierarchies. Substantial translational work is required at the political-administrative level to implement telehealth across diverse organisational contexts. Moreover, understanding the role of context in this translation process is essential. Conclusions This study generates valuable knowledge about large-scale implementation of telemedicine in addition to insights into the role of the political-administrative level in the implementation process. Key messages • Implementing telehealth nationally involves intricate translation processes at multiple levels. • Balancing local adjustments with degrees of fidelity is crucial in large-scale implementation.