Table 2.

Thematic Factors Associated with Acceptability and Feasibility of Incorporating Remote Monitoring Technology into Routine Primary Care for Adult Patients

THEME	DESCRIPTION	REFERENCE (YEAR)
Supports early intervention and follow-up (facilitated by alert system)	Implementation of RMT perceived as useful for eligible patients by improving monitoring, follow-up, and diagnosis. RMT can help identify emerging health issues, aid in detection of other health issues, and prompt clinical interventions. However, a few expressed concerns regarding overtreatment from increased recognition of exacerbations. Alerts (via e-mail, fax, EHR notifications) help clinicians/staff assess when outreach is needed. RMT use may be facilitated if (a) alerts are tailored to specific users (e.g., family versus clinicians) or (b) electronic alerting systems are developed (most alerts triggered following nurse inspection).	Fursse et al.14 (2008) Gagnon et al.15 (2006) Goodrich et al.16 (2011) Hardisty et al.17 (2011); Peirce et al.27 (2011) Kim et al.25 (2011) Kobb et al.19 (2003) Lamothe et al.24 (2006) Liddy et al.21 (2008) Thompson and Thielke11 (2009) Ure et al.26 (2012) Van den Berg et al.23 (2009)
Uncertain medicolegal liability	Informants expressed concern regarding the medicolegal liability associated with receiving RMT data. In particular, there was uncertainty regarding who was supposed to respond to critical values and how quickly.	Gagnon et al.15 (2006) Hardisty et al.17 (2011); Peirce et al.27 (2011) Kim et al.25 (2011) Liddy et al.21 (2008) Van den Berg et al.23 (2009)
Fosters direct patient education	RMT served as a direct patient education tool (even without involvement of medical clinicians and staff ). Providing RMT data directly to the patient can lead to improvements in healthcare.	Abraham and Rosenthal13 (2008) Langstrup20 (2008) Liddy et al.21 (2008)
Data actionable and of clinical relevance	RMT data must be of clinical importance, from a trusted source, and relevant to the goals of the medical providers. It is helpful if the data are tailored to individuals (e.g., uses their personal baseline). RMT data should be actionable (e.g., you can make a change based on data that have the potential to improve health).	Hardisty et al.17 (2011); Peirce et al.27 (2011) Kim et al.25 (2011) Langstrup20 (2008) Liddy et al.21 (2008) Thompson and Thielke11 (2009) Ure et al.26 (2012) Van den Berg et al.23 (2009)
Ease of access and functional interface facilitates use	RMT should be easy to use and convenient to access across multiple settings. Ideally, the RMT interfaces directly with existing clinic systems (e.g., EHR) and doesn't require logging-in to a separate system. The RMT interface should be informative. Data presented in summaries or graphs are helpful.	Abraham and Rosenthal13 (2008) Gagnon et al.15 (2006) Goodrich et al.16 (2011) Hicks et al.18 (2009) Kim et al.25 (2011) Lamothe et al.24 (2006) Ure et al.24 (2012)
Changing clinical roles and patterns of clinical care	Use of RMT contributed to changes in clinician and staff roles, as well as in patient relationships. Although clinicians wanted to review RMT data during patient visits, there was not always adequate time. Frequently, the RMT allowed clinicians to delegate tasks to ancillary staff, contributing to increased autonomy for nursing staff. Use of RMT may reduce the need for face-to-face visits; some expressed concern this could lead to increased social isolation for patients and decreased quality of care. Communication between all involved stakeholders is critical.	Gagnon et al.15 (2006) Goodrich et al.16 (2011) Hicks et al.18 (2009) Kim et al.25 (2011) Lamothe et al.24 (2006) Liddy et al.21 (2008) Terschuren et al.22 (2007) Thompson and Thielke11 (2009) Van den Berg et al.23 (2009)
Support by and training for ancillary staff	Ancillary staff played critical roles in processing and reviewing RMT data so as not to overburden or overwhelm clinicians. However, the time required for staff to process RMT data was often underestimated as staff must respond ad hoc to patient needs in addition to delivering pre-established interventions. Additional staff training may also be needed.	Abraham and Rosenthal13 (2008) Gagnon et al.15 (2006) Kim et al.25 (2011) Lamothe et al.24 (2006) Langstrup20 (2008) Van den Berg et al.23 (2009)
Engaging end-users critical to adoption	Clinicians and staff had variable adoption of RMT. Not all clinicians used the system—and of those who do, not all use it in the same ways. Target users need to be involved in product development and implementation.	Goodrich et al.16 (2011) Hicks et al.18 (2009) Kim et al.25 (2011) Langstrup20 (2008)

EHR, electronic health record; RMT, remote monitoring technology.