A methodology for shifting the focus of e-health support design onto user needs: a case in the homecare field.

Background: Epidemiological shifts, financial pressures and changing policy priorities in healthcare initiate reflections on innovative ways to deliver care. Technologies offer opportunities to change health services delivery. One of the emerging fields is telehomecare-applications. Yet, these applications are not always adapted to the user needs and characteristics of the homecare setting, resulting in "system failure".

Objectives: We describe a generic methodological model to incorporate user perspectives in the design and development process of e-health systems. The model aims at grounding the choice of the technology in a clear understanding of the homecare field, and on interactive reflections with the technology developers.

Methods And Results: The methodological model develops over three phases. A first phase aims to identify and to select potential patient groups for which the technology will be developed: It holds (a) gathering of epidemiological data; (b) identifying relevant inclusion criteria to select patient groups; (c) qualitative weighting based on the inclusion criteria to include potential patient groups and (d) plenary discussion with the technology developers. In a second phase, the particular needs of the selected patient groups are assessed through literature review, document analysis and explorative interviews with key informants. In the third phase, "social" use cases are developed in which the use of potential technologies is written as virtual storylines. The writing of the use cases is prepared through a semi-structured questionnaire for all partners listing the "visions and expectations on the technology and user context". The use cases are the source documents for a plenary discussion with the technology developers in which priorities are set for functionalities of the e-homecare platform. The methodological approach is illustrated within the Coplintho-project. It is a Flemish initiative developing an e-homecare platform offering a package of services on a dedicated device to support the social integration and 'independent living' of people in their home environment.

Discussion: Our methodological approach provides a practical framework for understanding and considering user perspectives. The application of the method within the development of the Coplintho-e-homecare platform demonstrated its usefulness. The experience within the Coplintho-pilot project learned important lessons about the operational use of the method. The methodology is time-consuming and requires scientific input to assess and to document potential user needs, requiring specific means and human resources. The method also requires a very explicit project management of the preparatory phase.