Table 3.

An overview of the barriers, facilitators, and recommendations of the health care professionals.

Theme, subtheme		Barriers	Facilitators	Recommendations
Technical innovations
	General	Technical difficulties for children/parents learning to operate new diagnostic devices	Objective assessment Visualization of trend data	Create help desk Expand instruction with run-through on own devices
	Smart inhaler	Nuisance of device updates Limited compatibility to iPhone operating system Limited number of inhalers compatible	Ability to track therapy compliance real-time Gain insight into medication use behavior Assessing inhalation technique to select appropriate inhaler type for child	Expand range of compatible (pediatric) inhalers Automatic synchronization
	Puffer app	No integration with electronic health record Absence of real-time reminding system	Video assessment of symptoms Assessment of symptom perception by combining subjective and objective measures	Include pop-up reminders Connect data trend log to electronic health record
eHealth asthma care
	General	Risk of missing symptoms in case of noncompliance to eHealth Lack of physical examination	Individualized care plan Safe “substantiated by data” medical decision making Ability to step-wise learn for children/parents to self-manage asthma Shared care responsibility between health care professionals and children/parents	Children with uncontrolled moderate-to-severe asthma are primarily suited for eHealth Discuss the overlapping disease management goals at start of eHealth period The extent of eHealth care should be adaptable and confined to the individual needs.
Implementation considerations
	Time investment	Difficult to schedule time for eHealth care due to its varying character Increased time expenditure per patient	Parents/children admire the additional time effort	Regional cooperation to enable scheduled shifts No fixed eHealth period; option to quickly de-escalate eHealth care and option to easily restart.
	Health care professionals	Requires reorganization of personnel	Efficient task reallocation Multidisciplinary approach	Weekly multidisciplinary consultation Include a technical oriented care professional to the eHealth team.
	Compliance	Less compliance to eHealth in times when symptoms are not perceived	Ability to automatically track compliance to care tasks	Create a weekly routine of measurements Transparent noncompliance flowchart to protocolize reminders and eventual exclusion