Table 1

Description of the barriers for RPM implementation with additional recommendations

	Barrier	Recommendation
Service level	Regulatory	Most digital solutions have to be in accordance with the Medical Device Regulation and be CE marked. Involve experts for advice if unsure.
	Data governance	Keep care pathway simple. Be aware of regulations (eg, GDPR/HIPAA). Data warehousing (including cloud) must be within the EU jurisdiction for GDPR purposes.
	Data access	Ensure patient data is accessible and copies of data files available on request.
	Economical	Consider using existing digital products where appropriate rather than building bespoke solutions.
	Maintenance	Ensure any product provided includes ongoing regular service support and security patch updates to avoid development of ‘bugs/glitches’ over time.
	Reimbursement	Work with managers to understand how reimbursement may be affected by proposed care pathway changes. Successful use cases can offer suggestions (see text for online resources).
	Purchasing	In addition to cost, think about the long-term sustainability of the product including opportunities to improve/iterate the digital product within the clinical service.
	Clinical governance	Follow local clinical governance processes. Think about safety netting and ensure that any RPM data used to influence clinical decisions are documented in the notes. Check data and cybersecurity procedures are in place with the RPM solution provider.
Clinician	Awareness of available digital products and their quality	Use healthcare app directories where available to find suitable apps or review existing use cases to identify existing solutions and care pathways that could be adapted for local use.
	Enthusiasm	‘Start small to grow tall’—Win over unsure colleagues/organisations by starting with small cohorts of patients with simple tweaks to a clinical pathway to demonstrate potential.
	Data overload	Clear communication with patients about data monitoring in the pathway is essential. Include safety nets such as advice lines, monitored email addresses or on-call physicians.
Patient	Being seen	Communication and engagement with patient groups is essential. Consider codesigning the care pathway with patients to understand concerns and opportunities.
	Accessibility	Consider using a hybrid model of care that allows for both users and non-users of the technology. Try to ensure service benefits (eg, expedited reviews) benefit both those who are digitally engaged and not.
	Engagement and drop-off	Highlight the utility of the data when interacting with patients who have submitted information. Remind and encourage patients who stopped or not engaged with the digital solution

CE, Conformité Européene; EU, European Union; GDPR, General Data Protection Regulation; HIPAA, Health Insurance Portability and Accountability Act; RPM, remote patient monitoring.