Background: Real-time audiovisual communication between healthcare providers (HCP) at different hospitals (TeleNeonatology) can improve neonatal outcomes, address capacity challenges, and reduce emotional burden on parents. Despite its potential, TeleNeonatology has yet to be widely implemented in routine clinical care, partly due to non-optimal integration into care pathways and working routines. To provide insights for further adoption, this study presents the evaluation of a pilot in the Netherlands. Methods: A prospective hybrid type III effectiveness-implementation study was conducted in 2024. During the pilot, a TeleNeo program facilitated both acute and elective communication between Erasmus MC NICU-level IV and Amphia NICU-level II. The TeleNeo program was developed and continuously improved during the pilot using co-creation with HCP and parents to enable embedding in care pathways and working routines. A mixed-methods approach was used for evaluation. The primary outcome was a validated 21-item usability questionnaire with five-points Likert Scale questions for parents (n = 50) and HCP (n = 85). Implementation determinants were evaluated with semi-structured interviews and surveys. Effectiveness was measured via parent reported experiences, and clinical outcomes length-of-stay and transfer rate. Results: Twelve months of implementation led to 99 consultations for 50 patients and families, including 33 acute patients, possibly in need of an acute transfer. Evaluation showed high feasibility and adoption. Usability was high among parents (n = 26, median score 5 [interquartile rage: 4–5]) and HCP (n = 48, median score 5 [interquartile range 4–5]). Parents valued rapid expert availability, involvement in transfer decisions, and experienced shared care between the NICUs. HCP observed quick and approachable communication, quicker medical decisions, improved quality of care, and smoother transitions between NICUs. Nurses were able to be more pro-active. In 18% (6/33) of acute cases transfers were perceived to be prevented. HCP highlighted TeleNeo’s influence on the local teams’ autonomy, communication styles, and financial aspects as important barriers in interviews (n = 12) and questionnaires (n = 65). Conclusions: Pilot implementation showed high feasibility of our TeleNeo program, enabling shared care at the optimal location for our patients. Our findings will guide a robust strategy for implementation in the Southwest of the Netherlands, enhancing neonatal care, parental satisfaction and nursing experience.

Implementing changes to digital health systems in real-life contexts poses many challenges. Design as a field has the potential to tackle some of these. This article illustrates how design knowledge, through published literature, is currently referenced in relation to the implementation of digital health. To map design literature’s contribution to this field, we conducted a scoping review on digital health implementation publications and their use of references from nine prominent design journals. The search in Scopus and Web of Science yielded 382 digital health implementation publications, of which 70 were included for analysis. From those, we extracted data on publication characteristics and how they cited the design literature. The 70 publications cited 58 design articles, whose characteristics were also extracted. The results show that design is mainly cited to provide information about specific design methods and approaches, guidelines for using them and evidence of their benefits. Examples of referenced methods and approaches were co-design, prototyping, human-centered design, service design, understanding user needs and design thinking. The results thus show that design knowledge primarily contributed to digital health implementation with insights into methods and approaches. In addition, our method showcases a new way for understanding how design literature influences other fields.

Background:
Neonatal intensive care unit admissions of newborns are emotional and stressful for parents, influencing their mental and physical well-being and resulting in high rates of psychological morbidities. Significant research has been undertaken to understand and quantify the burden of a newborn’s medical journey on parents’ well-being. Simultaneously, an increase has been observed in the development and implementation of telemedicine interventions, defined as the remote delivery of health care. Telemedicine is used as an overarching term for different technological interventions grouped as real-time audio-visual communication, remote patient monitoring, and asynchronous communication. Various telemedicine interventions have been proposed and developed but scarcely with the primary goal of improving parental well-being during their newborn’s medical journey.

Objective:
This study aims to identify telemedicine interventions with the potential to improve parents’ well-being and to present the methods used to measure their experience.

Methods:
A scoping review was conducted, including empirical studies evaluating telemedicine in neonatal care that either measured parental well-being or included parents in the evaluation. Abstract and title screening, full-text screening, and data extraction were performed by three researchers. Two researchers were needed to reach decisions on both the inclusion and extraction of articles.

Results:
The review included 50 out of 737 screened articles. Telemedicine interventions focused mainly on daily visits at the neonatal intensive care unit and discharge preparedness for parents. Surveys were the primary tool used for outcome measurement (36/50, 72%). Aspects of parents’ well-being were evaluated in 62% (31/50) of studies. Telemedicine interventions developed to provide education and support showed a potential to improve self-efficacy and discharge preparedness and decrease anxiety and stress when they included a real-time telemedicine component.

Conclusions:
This scoping review identified specific telemedicine interventions, such as real-time audio-visual communication and eHealth apps, that have the potential to improve parental well-being by enhancing self-efficacy and discharge preparedness, and reducing anxiety and stress. However, more insights are needed to understand how these interventions affect well-being. Parents should be included in future research in both the development and evaluation stages. It is important to not only measure parents’ perceptions but also focus on the impact of a telemedicine intervention on their well-being.

Challenges in implementing digital health in clinical practice hinder its potential. The complexities posed by implementation could benefit from using design practices. To explore the current role of design practices in digital health implementation, designers in the Netherlands were interviewed. The preliminary results indicate that designers contribute to digital health implementation processes, especially in the early stages. Design practices are mainly used for engaging the users, testing concepts, aligning the ideas of stakeholders, and adapting interventions to fit within the contexts.