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Table 1 Summary of empirical case studies and data sources (adapted from J Med Internet Res. 2017; 19: e367)

From: Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework

Study site(s) Technology/ies Participants Data sources
Case A. Video outpatient consultations
 A1: Acute hospital trust (3 specialties — diabetes, antenatal, cancer — on different sites)
 A2: Nurse-led heart failure service run from community hospital
Skype™ (acute hospital) and FaceTime™ (community hospital) together with commercially available blood pressure and heart rate monitors, weighing scales and oximeter A1: 24 staff (9 clinicians, 10 support staff, 5 managers); 27 patients
A2: 10 staff (8 nurses, one manager, one administrator); 8 patients
Plus 48 national stakeholders and wider informants on remote consulting
35 formal semi-structured interviews plus ~ 100 informal interviews; 150+ hours of ethnographic observation; 40 videotaped remote consultations (12 diabetes, 6 antenatal diabetes, 12 cancer, 10 heart failure); 500+ emails; 30 local documents, e.g. business plans, protocols; 50 national-level documents
Case B. GPS tracking for cognitive impairment
 Social care organisation in deprived borough in inner London GPS tracking devices supplied by 5 different technology companies, includes GPS tracking with virtual map and ‘geo-fence’ alert functions 7 index cases; 8 lay carers; 5 formal carers, 3 social care staff; 3 healthcare staff; 3 call centre staff 22 ethnographic visits and ‘go-along’ interviews with index cases (~ 50 h); 15 ethnographic visits with health and social care staff; 6 staff interviews; 5 team meetings; 3 local protocols
Case C. Pendant alarms
 C1: Healthcare commissioning organisation in deprived borough in outer London
 C2: Social care organisation in mixed borough in the Midlands
In both sites, pendant alarms and base units were supplied by multiple different technology companies and supported by local councils, each with a different set of arrangements with providers and an ‘arms-length management organisation’ alarm support service C1: 8 index cases; 7 lay carers; 12 professional staff
C2: 11 index cases; 9 health/social care staff from frontline service delivery to senior board level; 3 representatives from telecare industry
50 semi-structured and narrative interviews; 61 ethnographic visits (~ 80 h of observation) including needs assessments and reviews; 20 h of observation at team meetings
Case D. Remote biomarker monitoring in heart failure
 Acute hospital trusts in six different cities in UK Tablet computer and Bluetooth-enabled commercially available sensing devices (blood pressure and heart rate monitor, weighing scales) 7 research staff including principal investigator and research coordinator for SUPPORT-HF trial; 7 clinical staff involved in trial; 4 clinical staff not involved in trial; (to date) 18 patient participants and one spouse 1 patient focus group; 8 patient interviews; 24 additional semi-structured interviews; SUPPORT-HF study protocol and ethics paperwork; material properties and functionality of biomarker database
Case E. Care organising software
 E1: Healthcare commissioning organisation in northern England
 E2: National carer support charity in UK
Product A: Web-based portal developed by small tech company for use by families to help them organise and coordinate the care of (typically) an older relative
Product B: Smartphone app co-designed by carer support charity for same purpose
Product A: 2 technology developers and CEO of technology company; 4 social care commissioners; 30 health and social care staff considering using the device; 4 users of the device, one non-user
Product B (to date): 2 members of care charity (including CEO); 10 qualitative case studies of users undertaken by another academic team
22 semi-structured and narrative interviews; 16 h ethnographic observations of meetings; auto-ethnographic testing of functionality and usability of devices; secondary analysis of 3rd party evaluation of Product B
Case F. Data warehouse for integrated case management
 1 acute hospital trust, 1 community health trust, 3 local councils, 3 healthcare commissioning organisations Integrated data warehouse incorporating predictive risk modelling (in theory interoperable with record systems in participating organisations) 14 staff; 20 patient participants 14 semi-structured interviews; 50 ethnographic visits (~ 80 h); 12 h shadowing community staff; 4 h observation of interdisciplinary meetings; 12 local protocols/documents