Lessons learned from piloting a heart failure-based remote management care system in a general internal medicine program: A qualitative evaluation

Objective Medly is a remote patient management (RPM) tool that allows patients with heart failure (HF) to record daily measures to inform health status and receive personalized care instructions by a validated algorithm. Medly has been standard-of-care for patients with HF in the Cardiology Division at University Health Network since 2016. While patients with HF are often admitted to general internal medicine (GIM), there are few HF RPM programs used in the GIM setting. We piloted Medly for patients discharged from GIM in the summer of 2023. The purpose of this study was to understand staff factors that enabled or inhibited spread and scale of Medly into a GIM setting. Methods Semistructured interviews were conducted with 13 staff involved in the planning, delivery, and implementation of Medly in the GIM setting. Interviews were recorded and transcribed verbatim. Data were analyzed using deductive thematic analysis informed by the Consolidated Framework for Implementation Research. Results Implementation factors included: (1) communicative staff, (2) Medly adaptability and relative advantage, (3) need for long-term funding, (4) leadership engagement and learning-centered culture, and (5) sociodemographic characteristics of patients. Conclusion This study offers valuable insight into how an RPM can be adopted from the Cardiology to GIM context. Key enablers include providing appropriate staff time and compensation, engaging leadership early and often, modifying the application for the setting, and considering equity with respect to language barriers. A larger pilot with more than 10 patients actively embedded in the GIM pathway is required for further scale of the program.