Stakeholder Power Analysis of the Facilitators and Barriers for Telehealth Solution Implementation in China: A Qualitative Study of Individual Users in Beijing and Interviews with Institutional Stakeholders

Abstract

Background: Facing COVID 19, the use of telehealth solutions grows exponentially. However, despite the large investments made into telehealth solutions, the implementation process remains slow and sluggish. Moreover, during COVID-19, older people experienced difficulties and had the highest mortality rates, and those lucky enough to survive faced tremendous pressure to use QR code-based health monitoring systems. Objective: This paper aims to determine the barriers and incentives for the implementation of telehealth solutions via a case study about telehealth implementation in China. Methods: We conducted 8 semi-structured interviews following the design of the interactive learning framework (research question defining, participant recruitment, exploratory stage, consultation stage, integration stage, and follow-up interview). One interview with a government official from the National Health Commission and another interview with a government official from the China Center for Disease Control and Prevention was conducted in the exploratory stage. The consultation stage comprised one interview with a business manager from the Huawei Wearable Unit, one interview with a business manager from Alibaba Health Brain Unit, and one interview with a business manager from Xiaomi. Two interviews with doctors from Fudan University-affiliated Huashan Hospital and Fudan University-affiliated Zhongshan hospital were conducted in the integration stage. In addition, 8 focus group studies with 64 participants from rural and urban Beijing were conducted. Finally, another telephone interview with a business manager of the Xiaomi Wearable Unit was conducted in the follow-up stage. Results: Telehealth solutions are designed to assist health care providers in realizing the quadruple aim of better health outcomes, lowering health care costs, improved health care quality, and improved doctor and patient experiences. Governments have high incentives to improve health care efficiency via telehealth solutions. However, they have limited resources to make the necessary infrastructure transformation. Conclusions: To fully realize the potential of telehealth devices, heavy infrastructure investment in the telecommunication network is required beforehand to resolve the interoperability issue occurring during the data collection process for telehealth solutions. The industry also demands a mature business model incorporating collaboration between various stakeholders and industrial partners to invest in infrastructure. Governments have high interest and significant influence on building the necessary infrastructure for telehealth solution implementation in China. Industrial actors have a high interest and a medium level of power for telehealth solution implementation. Users have high interest but a lower level of power for the usage of telehealth solutions, and doctors have low interest and a medium level of power for telehealth solutions implementation.