From Pilot to Practice: A Sociotechnical Perspective for Sustainable Adoption of Patient Engagement Technologies

Abstract

Background: Despite widespread investment in patient engagement technologies-such as mobile apps, chatbots, and remote monitoring tools-few have achieved sustained adoption or integration into clinical workflows. The persistent gap between pilot success and real-world scalability reflects not only technical barriers but also sociotechnical challenges involving people, processes, and policy. Objectives: This study aimed to identify cross-cutting barriers and enablers of implementation across multiple real-world pilots of patient engagement technologies and extend the Sociotechnical Model (STM) of Health Information Technology (IT) to explicitly incorporate patient perspectives and lived experiences as determinants of adoption and sustainability. Methods: Drawing on our team's formal evaluations of implementing patient engagement technologies across four U.S. health systems-including applications for coronavirus disease 2019, hypertension, medication adherence, and chatbot-supported communication-we synthesized lessons learned across eight STM domains: hardware/software, clinical content, human-computer interface, people, workflow and communication, organizational policies, external pressures, and system monitoring. Results: Eight cross-cutting lessons emerged: (1) effective leadership and collaboration across clinicians, IT and informatics teams, patients, and electronic health record and app developers are essential; (2) uneven standards adoption and support continues to limit interoperability; (3) success depends on skilled technical resources with expertise in interoperability standards; (4) engage patients in codesign processes early and throughout; (5) sustained patient engagement requires structured onboarding and feedback loops; (6) account for diverse patient needs and preferences during the design; (7) clinician workflows must be redesigned to integrate and act on patient-contributed data without increasing burden; and (8) demonstrated return on investment is needed to justify long-term costs of maintenance. Conclusion: Sustaining patient engagement technologies requires expanding the sociotechnical lens to include patients' lifeflows alongside organizational and technical factors. Future implementation, research, and policy efforts should focus on collaborative leadership models, patient-centered engagement processes, enhanced interoperability, clear data monitoring workflows, and financial sustainability.

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