Identifying the Problems Facing the Development of Patient Telemonitoring Systems and Providing Solutions from Users' Perspectives: Application of Soft Systems Methodology

Abstract

Introduction: Telehealth systems, including patient telemonitoring systems, have consistently faced challenges in user adoption since their introduction. The diversity and conflicts in users' views, needs, and concerns about changes in health service delivery create a complex situation, which can be defined as a "soft problem." Designing these systems requires an approach to understand the issues and complexities and achieve feasible solutions considering the social and cultural conditions of the implementation environment. This research aims to use the modified soft systems methodology framework as a structured method to tackle these soft problems in the design and implementation of patient telemonitoring systems from the perspective of human factors.Methods: This research employs a hybrid approach, incorporating soft systems methodology to identify problems, define requirements, and determine actions, alongside the NASSS framework as a theoretical lens to guide participants' views. This approach was used to develop the patient telemonitoring system with a focus on system adoption. The study involved conducting interviews, drawing rich pictures, analyzing users' views, identifying problems during the finding phase, and performing root definition, CATWOE analysis, and presenting conceptual models in the modeling phase. During the discussion and definition phases, based on conceptual models from physicians' and patients' perspectives, desirable and feasible actions were defined.Results and discussion: Semi-structured interviews were conducted with 15 physicians and 13 patients, individually and in groups of two and three, as end-users of the patient telemonitoring system. The interview results were analyzed, and participants' views were categorized into four issues: telemonitoring process requirements, trust in the system, cost-effectiveness, and the implementation of the telemonitoring system within the current hospital structure and procedures. In the modeling phase, root definitions were created using the PQR formula and enriched with CATWOE analysis. Conceptual models of the problems were then presented based on patients' and physicians' perspectives. Finally, after the discussion and definition phases, desirable and feasible actions for developing the patient telemonitoring system were defined in four dimensions: expected system features, executive processes, required rules and instructions, and necessary policies.Conclusions: The results show that soft systems methodology, by understanding human factors' perspectives and identifying and conceptualizing the problems and complexities of various aspects of the patient telemonitoring system, can significantly aid system developers, implementers, and health system policymakers. It helps them understand the requirements and agreed processes of potential users before design and implementation, reducing resistance and increasing user adherence.

Keywords

• telehealth systems
• patient telemonitoring system
• soft systems methodology
• system design
• system adoption