Background:
Implementing digital health innovations in healthcare environments is challenging. Electronic Patient-Reported Measures (ePRMs) have proven to enhance patient-centred care and clinical decision-making. However, their integration into routine oncology care is often hindered by resistance and barriers. This case study showcases a statewide ePRMs implementation guided by ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) change management model to support adoption and sustainability.
Methods:
A case study methodology was used to document and evaluate the change management strategies employed during the implementation of the ePRMs system across 45 NSW cancer services. Each phase of the ADKAR framework was mapped to implementation activities, stakeholder engagement efforts, and system refinements. Identified barriers were coded using the Consolidated Framework for Implementation Research (CFIR), and corresponding mitigation strategies were aligned with the Expert Recommendations for Implementing Change (ERIC) taxonomy. Practical insights and lessons learned were synthesised into a transferable implementation checklist.
Impact on practice:
The structured application of the ADKAR model enabled the implementation team to anticipate and address a range of barriers. Strategies included tailored stakeholder engagement to build awareness and desire, role-specific training to develop knowledge, site-based troubleshooting and workflow adaptation to support ability, and performance monitoring to reinforce long-term use. Barriers such as perceived redundancy and time constraints, were effectively mitigated through context-specific strategies mapped to relevant CFIR and ERIC constructs. The resulting implementation checklist provides a practical guide for organisations undertaking similar digital health transformations.
Discussion:
Structured change management enabled a successful implementation of a digital health innovation at scale. By combining proactive planning, iterative design, and embedded support, digital health interventions can achieve sustained adoption. These findings offer actionable guidance for policymakers, healthcare leaders seeking to embed digital tools into routine clinical care.