Drivers and barriers for implementing remote monitoring of patients with cardiac implantable electronic devices in Sweden – a mixed methods study

Remote monitoring (RM) of patients with implantable cardioverter defibrillators enables quicker identification of device malfunction or acute heart conditions. Despite these advantages diffusion of RM into clinical practice has been slow. Two case studies, based on document studies, 18 semi-structured interviews with health professionals, participant observations, analyses of work flows at two different Swedish hospitals, were combined with a questionnaire distributed to 30 clinics in Sweden. Leading clinicians at the respective hospitals were either actively promoting RM, or passively regretting the lacking funding, questioning the clinical need, fearing organizational changes, and budget over-run. According to the survey, the most important advantage of RM was early problem detection and increased patient safety. Important drivers for the introduction of RM were reimbursement, entrepreneurial cooperation with manufacturers, and clear identification of a need for RM. Main barriers were lacking reimbursement, lacking interoperability. Initial funding, knowledge preparation, and legitimacy for testing RM were favorable starting conditions, but insufficient to make it long-term effective. Continued entrepreneurship to address emerging organizational and technical issues, ensure seamless electronic health record integration, and inclusion of RM in tenders were necessary to ensure financial sustainability. Apparent clinical and financial benefits of RM acted as an impetus for continued innovation.