Four years upscaling telemonitoring to future-proof health care delivery in Dutch university hospitals: Before and after - where do we stand and what are the results?

Objectives: Upscaling digital solutions is crucial for future-proofing healthcare, yet effective and sustainable methods are underrepresented in literature. In the Netherlands, a University Medical Center (UMC) network collaborated within the Citrien eHealth program to future-proof care using telemonitoring (TM). From 2020–2022, three TM activities were initiated: TM for cardiac rhythm abnormalities/heart failure (TMCardio), TM of blood pressure in high-risk pregnant women (TMAnteNatal), and continuous wireless monitoring of vital functions (TMVitals). This study evaluated the scale-up of these TM programs in seven Dutch UMCs. Methods: An uncontrolled before-after study design was used.Primary outcome, ‘normalization of telemonitoring,’ was assessed using the 20-item NoMAD questionnaire. Results were structured according to the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework. Secondary outcomes included the number of UMCs offering TM programs and the number of patients using TM. Results: The NoMAD questionnaire had a 61 % response rate. Respondents were familiar with TM (N = 85, mean = 7.27, SD=2.13) and believed it would become more normal in their work (N = 98, mean = 8.42, SD=1.64). However, a significant difference between current practice and expected future use of TM was observed (p≤ 0.001). All UMCs ran TM programs, but not all implemented all three projects. TMCardio patients increased from 190 to 5185, TMAnteNatal from 41 to 1162, and TMVitals from 2666 to 13630. Conclusion: Telemonitoring uptake increased across Dutch UMCs, but not uniformly. The complexity of scale-up is highest in NASSS domains 4, 5, and 6, with a focus on management, resources, health care reimbursement, and regulations. Understanding the impact of the Citrien network collaboration on scale requires further qualitative analysis.