This
dissertation addresses the urgent need for sustainable healthcare in the
Netherlands, focusing on the implementation and national scaling of
telemonitoring (TM). As the healthcare system faces rising costs, labour
shortages, and an aging population, digital technologies like TM offer
potential solutions to maintain quality, accessibility, and social
sustainability.
The
research is divided into two parts. Part I focuses on preparation,
identifying facilitating and hindering factors through literature reviews and a
baseline measurement across Dutch University Medical Centers (UMCs). Findings
highlight that while technical evaluations are common, there is a significant
lack of research on long-term implementation and daily integration. Key
barriers identified include financial reimbursement, interoperability with
electronic health records, and the need for organizational change management.
Part II evaluates the national
"Citrienfonds eHealth" program (2020–2022), which aimed to scale TM
in cardiology, obstetrics, and vital sign monitoring. Using frameworks such as
NASSS and Normalization Process Theory (NPT), the study tracks the growth of TM
users—from a few hundred to tens of thousands—across all seven UMCs. The
results demonstrate that while healthcare professionals recognize the value of
TM, full normalization into routine care remains a challenge. A crucial finding
is the added value of the national Citrien network; collaboration and knowledge
exchange between centers proved essential to overcome complex regulatory and
technical hurdles.
The
dissertation concludes that successful scaling requires a balanced approach of
national coordination and local flexibility, ultimately shifting care closer to
the patient and ensuring a more resilient healthcare system for the future.
