Table 1.
Non-adaption, abandonment, scale-up, spread, and sustainability (NASSS) framework rubric rating.
| Rating | |||
|---|---|---|---|
| Domain and Questions | Simple | Complicated | Complex |
| The Condition or Illness | |||
| What is the nature of the condition? | Well-characterized, well-understood, predictable | Not fully characterized, understood, or predictable | Poorly characterized, poorly understood, unpredictable, or high risk |
| What are the relevant socio-cultural factors and comorbidities? | Unlikely to affect care significantly | Must be factored into care plan and service model | Pose significant challenges to care planning and service provision |
| The Technology | |||
| What are the key features of the technology? | Off-the-shelf or already installed, freestanding, dependable | Not yet developed or fully interoperable; not 100% dependable | Requires close embedding in complex technical systems; significant dependability issues |
| What kind of knowledge does the technology bring into play? | Directly and transparently measures [changes in] the condition. | Partially and indirectly measures [changes in] the condition | Link between data generated and [changes in] the condition is currently unpredictable or contested |
| What knowledge and/or support is required to use the technology? | None or a simple set of instructions | Detailed instruction and training needed, perhaps with ongoing helpdesk support | Effective use of technology requires advanced training and/or support to adjust to new identity or organizational role |
| What is the technology supply model? | Generic, “plug and play”, or COTS solutions requiring minimal customization, easily substitutable if supplier withdraws | COTS solutions requiring significant customization or bespoke solutions; substitution difficult if suppliers withdraw | Solutions requiring significant organizational reconfiguration or medium-to-large scale-bespoke solutions, highly vulnerable to supplier withdraw |
| The Value Proposition | |||
| What is the developer’s business case for the technology (supply-side value)? | Clear business case with strong chance of return on investment. | Business case underdeveloped; potential risk to investors | Business case implausible; significant risk to investors |
| What is its desirability, efficacy, safety, and cost-effectiveness (demand-side value)? | Technology is desirable for patients, effective, safe, and cost-effective. | Technology’s desirability, efficacy, safety, or cost-effectiveness is unknown or contested | |
| The Adopter System | |||
| What changes in staff roles, practices, and identities are implied? | None | Existing staff must learn new skills and/or new staff be appointed. | Threat to professional identity, values, or scope of practice, risk of job loss |
| What is expected of the patient (and/or immediate caregiver)—and is this achievable by, and acceptable to, them? | Nothing | Routine task, e.g., log on, enter data, converse | Complex tasks, e.g., initiate changes in therapy, make judgments, organize |
| What is assumed about the extended network of lay caregivers? | None | Assumes caregiver will be available when needed | Assumes a network of caregivers with the ability to coordinate their input |
| The Wider Context | |||
| What is the political, economic, regulatory, professional, and sociocultural context for program rollout | Financial and regulatory requirements already in place nationally; professional bodies and civil society supportive | Financial and regulatory requirements being negotiated nationally; professional and lay stakeholders not yet committed | Financial and regulatory requirements raise tricky legal or other challenges; professional bodies and lay stakeholders unsupportive or opposed |
| Embedding and Adaptation Over Time | |||
| How much scope is there for adapting and coevolving the technology and the service over time?” | Strong scope for adapting and embedding the technology as local need or context changes | Potential for adapting and coevolving the technology and service is limited or uncertain | Significant barriers to further adaptation and/or coevolution of the technology or service |
NASSS framework rubric rating for the integrated-caregiver portal system is indicated in bold with grey highlight for the domains and questions assessed (the full rubric is available in [30]. “The Organization” domain questions and question #2 of “Embedding and Adaptation Over Time” domain were not included in the table because they were not rated as this pre-assessment was not based on a specific institution but rather the concept of patient–caregiver portal in healthcare broadly.