Systemic Analysis of Barriers of High Quality of Care in Telemonitoring: Integrating the Seips Framework and Fault Tree Analysis

Amid the COVID-19 outbreak, healthcare systems have undergone a transformation with telehealth playing a key role. There has been a dramatic shift in the use of telehealth due to its benefits including the convenience it has offered. With the use of telehealth to monitor patients’ health on the rise, it has become more critical to improve the quality of care by identifying and resolving barriers to virtual care delivery systems. In this study, we apply the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework to systematically investigate telemonitoring implementation, as a main category of telehealth services, and identify barriers to high quality of care while monitoring care virtually. We analyze those barriers by capturing them across different work systems of the SEIPS framework, which are: people (patients, healthcare providers, nurses, telemonitoring staff), organization, tools and technology, tasks, internal environment, and external environment. We then, through some research, determine some of those barriers that are more influential and conduct Fault Tree Analysis to identify their root causes. Furthermore, some recommendations are provided to address the identified barriers and their root causes.