{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:35:38Z","timestamp":1787020538731,"version":"build-2736575974"},"reference-count":59,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["No. 676201"],"award-info":[{"award-number":["No. 676201"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12911-020-01221-y","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T14:03:52Z","timestamp":1599746632000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Challenges and opportunities for telehealth in the management of chronic obstructive pulmonary disease: a qualitative case study in Greece"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-0906","authenticated-orcid":false,"given":"Violeta","family":"Gaveikaite","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casandra","family":"Grundstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Schonenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minna","family":"Isomursu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Chouvarda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicos","family":"Maglaveras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,10]]},"reference":[{"key":"1221_CR1","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1016\/j.rmed.2011.06.012","volume":"105","author":"ASM Afonso","year":"2011","unstructured":"Afonso ASM, Verhamme KMC, Sturkenboom MCJM, Brusselle GGO. COPD in the general population: prevalence, incidence and survival. Respir Med. 2011;105:1872\u201384.","journal-title":"Respir Med"},{"key":"1221_CR2","doi-asserted-by":"publisher","unstructured":"Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2018. doi:https:\/\/doi.org\/10.1097\/00008483-200207000-00004.","DOI":"10.1097\/00008483-200207000-00004"},{"key":"1221_CR3","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1183\/09031936.06.00063205","volume":"28","author":"A Casas","year":"2006","unstructured":"Casas A, Troosters T, Garcia-Aymerich J, Roca J, Hernndez C, Alonso A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28:123\u201330.","journal-title":"Eur Respir J"},{"key":"1221_CR4","doi-asserted-by":"crossref","unstructured":"John Gibson G, Loddenkemper R, Lundb\u00e4ck Bo, Sibille Y. Respiratory health and disease in Europe: the new European Lung White Book. Eur Respir J. 2013;42(3):559\u201363.","DOI":"10.1183\/09031936.00105513"},{"key":"1221_CR5","unstructured":"COPD management. World Health Organization http:\/\/www.who.int\/respiratory\/copd\/management\/en\/. Accessed 15 Aug 2018."},{"key":"1221_CR6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1370\/afm.47","volume":"1","author":"K Grumbach","year":"2003","unstructured":"Grumbach K. Chronic illness, comorbidities, and the need for medical generalism. Ann Fam Med. 2003;1:4\u20137.","journal-title":"Ann Fam Med"},{"key":"1221_CR7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12911-017-0414-8","volume":"17","author":"C Velardo","year":"2017","unstructured":"Velardo C, Shah SA, Gibson O, Clifford G, Heneghan C, Rutter H, et al. Digital health system for personalised COPD long-term management. BMC Med Inform Decis Mak. 2017;17:19.","journal-title":"BMC Med Inform Decis Mak"},{"key":"1221_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41533-018-0101-y","volume":"28","author":"B St\u00e4llberg","year":"2018","unstructured":"St\u00e4llberg B, Janson C, Larsson K, Johansson G, Kostikas K, Gruenberger JB, et al. Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients. npj Prim Care Respir Med. 2018;28:1\u20137.","journal-title":"npj Prim Care Respir Med"},{"key":"1221_CR9","unstructured":"Stroetmann KA, Kubitschke L, Robinson S, Stroetmann V, Cullen K, McDaid D. How can telehealth help in the provision of integrated care? World Health Organization. 2010;:39. http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0011\/120998\/E94265.pdf. Accessed 15 Aug 2018."},{"key":"1221_CR10","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1136\/bmj.d120","volume":"342","author":"S Mclean","year":"2011","unstructured":"Mclean S, Protti D, Sheikh A. Telehealthcare for long term conditions. BMJ. 2011;342:120.","journal-title":"BMJ."},{"key":"1221_CR11","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1177\/1753465818754778","volume":"12","author":"M Vitacca","year":"2018","unstructured":"Vitacca M, Montini A, Comini L. How will telemedicine change clinical practice in chronic obstructive pulmonary disease? Ther Adv Respir Dis. 2018;12:153\u20136.","journal-title":"Ther Adv Respir Dis"},{"key":"1221_CR12","doi-asserted-by":"publisher","first-page":"1800851","DOI":"10.1183\/13993003.00851-2018","volume":"51","author":"J Bourbeau","year":"2018","unstructured":"Bourbeau J, Farias R. Making sense of telemedicine in the management of COPD. Eur Respir J. 2018;51:1800851.","journal-title":"Eur Respir J"},{"key":"1221_CR13","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1258\/jtt.2012.120219","volume":"18","author":"R Wootton","year":"2012","unstructured":"Wootton R. Twenty years of telemedicine in chronic disease management \u2013 an evidence synthesis. J Telemed Telecare. 2012;18:211\u201320.","journal-title":"J Telemed Telecare"},{"key":"1221_CR14","doi-asserted-by":"crossref","unstructured":"Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, et al. Effect of telehealth on use of secondary care and mortality: findings from the whole system demonstrator cluster randomised trial. BMJ. 2012;344.","DOI":"10.1136\/bmj.e3874"},{"key":"1221_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-015-0854-8","volume":"15","author":"C Davy","year":"2015","unstructured":"Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Serv Res. 2015;15:1\u201311.","journal-title":"BMC Health Serv Res"},{"key":"1221_CR16","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jcjd.2013.01.004","volume":"37","author":"P McGowan","year":"2013","unstructured":"McGowan P. The challenge of integrating self-management support into clinical settings. Can J Diabetes. 2013;37:45\u201350.","journal-title":"Can J Diabetes"},{"key":"1221_CR17","unstructured":"Valentijn DPP. The 3 differences between value based healthcare and triple aim that you need to know. 2018. https:\/\/www.essenburgh.com\/en\/blog\/the-3-differences-between-value-based-healthcare-and-triple-aim-that-you-need-to-know. Accessed 15 Aug 2018."},{"key":"1221_CR18","doi-asserted-by":"crossref","unstructured":"Amelung VE, Stein V, Goodwin N, Balicer R, Nolte E, Suter E. Evaluating complex interventions. In: Handbook Integrated Care: Springer Nature; 2017. p. 297\u2013313. https:\/\/www.researchgate.net\/publication\/318378091_Evaluating_complex_interventions.","DOI":"10.1007\/978-3-319-56103-5"},{"key":"1221_CR19","volume-title":"Redefining Health Care: Creating Value-based Competition on Results","author":"E Michael","year":"2006","unstructured":"Michael E, Porter EOT. Redefining health care: creating value-based competition on results. In: Redefining Health Care: Creating Value-based Competition on Results; 2006."},{"key":"1221_CR20","doi-asserted-by":"crossref","unstructured":"Lodewijckx C, Decramer M, Sermeus W, Panella M, Deneckere S, Vanhaecht K. Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation. Trials. 2012;13.","DOI":"10.1186\/1745-6215-13-229"},{"key":"1221_CR21","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.811","volume":"12","author":"CMA Utens","year":"2012","unstructured":"Utens CMA, Maarse JAM, van Schayck OCP, Maesen BLP, Rutten MPMH, Smeenk FWJM. Care delivery pathways for chronic obstructive pulmonary disease in England and the Netherlands: a comparative study. Int J Integr Care. 2012;12:e40 http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22977431%0A; http:\/\/www.pubmedcentral.nih.gov\/articlerender.fcgi?artid=PMC3440249.","journal-title":"Int J Integr Care"},{"key":"1221_CR22","doi-asserted-by":"publisher","first-page":"2831","DOI":"10.2147\/COPD.S104136","volume":"11","author":"R Kayyali","year":"2016","unstructured":"Kayyali R, Odeh B, Frerichs I, Davies N, Perantoni E, D\u2019Arcy S, et al. COPD care delivery pathways in five European union countries: mapping and health care professionals\u2019 perceptions. Int J COPD. 2016;11:2831\u20138.","journal-title":"Int J COPD"},{"key":"1221_CR23","volume-title":"The art of case study research","author":"R Stake","year":"1995","unstructured":"Stake R. The art of case study research; 1995."},{"key":"1221_CR24","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/1471-2288-11-100","volume":"11","author":"S Crowe","year":"2011","unstructured":"Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11:100.","journal-title":"BMC Med Res Methodol"},{"key":"1221_CR25","volume-title":"PervasiveHealth\u201919: 13th EAI International Conference on Pervasive Computing Technologies for Healthcare","author":"C Grundstrom","year":"2019","unstructured":"Grundstrom C, Gaveikaite V, LB, Maglaveras N, Winter S, Chouvarda I. User Profiles of Healthcare Professionals in a Chronic Obstructive Pulmonary Disease Care Pathway. In: PervasiveHealth\u201919: 13th EAI International Conference on Pervasive Computing Technologies for Healthcare; 2019."},{"key":"1221_CR26","unstructured":"Elfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. Emerg (Tehran). 2017;5(1):PMC5325924. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5325924\/."},{"key":"1221_CR27","first-page":"312","volume":"328","author":"PM Boynton","year":"2004","unstructured":"Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004;328:312\u20135.","journal-title":"BMJ."},{"key":"1221_CR28","first-page":"1","volume-title":"Triangulation in social research: qualitative and quantitative methods can really be mixed","author":"W Olsen","year":"2004","unstructured":"Olsen W. Triangulation in social research: qualitative and quantitative methods can really be mixed. In: Developments in Sociology. Causeway Press Ltd; 2004. p. 1\u201330."},{"key":"1221_CR29","doi-asserted-by":"crossref","unstructured":"Oliver DG, Serovich JM, Mason TL. Constraints and opportunities with interview transcription: towards reflection in qualitative research. Soc Forces. 2005.","DOI":"10.1353\/sof.2006.0023"},{"key":"1221_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2288-13-117","volume":"13","author":"NK Gale","year":"2013","unstructured":"Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:1\u20138.","journal-title":"BMC Med Res Methodol"},{"key":"1221_CR31","doi-asserted-by":"publisher","unstructured":"Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2017. doi:https:\/\/doi.org\/10.1164\/rccm.201701-0218PP.","DOI":"10.1164\/rccm.201701-0218PP"},{"key":"1221_CR32","doi-asserted-by":"crossref","unstructured":"Sen E, Guclu SZ, Kibar I, Ocal U, Yilmaz V, Celik O, et al. Adherence to GOLD guideline treatment recommendations among pulmonologists in Turkey. Int J Chron Obstruct Pulmon Dis. 2015;10:2657\u201363. https:\/\/pubmed.ncbi.nlm.nih.gov\/26715844\/.","DOI":"10.2147\/COPD.S85324"},{"key":"1221_CR33","doi-asserted-by":"publisher","first-page":"547","DOI":"10.2147\/COPD.S185362","volume":"14","author":"I Tsiligianni","year":"2019","unstructured":"Tsiligianni I, Kampouraki M, Ierodiakonou D, Poulonirakis I, Papadokostakis P, Lintovoi E, Karanassos D, Maltezis K, Chorti M, Petrovitsos E, Dimopoulou S, Hamind S, Gialamas I, Athanasiou P, Bempi VLI. COPD patients \u2019 characteristics , usual care , and adherence to guidelines : the Greek UNLOCK study. Int J COPD. 2019;14:547\u201356.","journal-title":"Int J COPD"},{"key":"1221_CR34","first-page":"853","volume":"10","author":"S Majothi","year":"2015","unstructured":"Majothi S, Jolly K, Heneghan NR, Price MJ, Riley RD, Turner AM, et al. Supported self-management for patients with copd who have recently been discharged from hospital: a systematic review and meta-analysis. Int J COPD. 2015;10:853\u201367.","journal-title":"Int J COPD"},{"key":"1221_CR35","first-page":"251","volume":"14","author":"F Yang","year":"2017","unstructured":"Yang F, Xiong Z-F, Yang C, Li L, Qiao G, Wang Y, et al. Continuity of care to prevent readmissions for patients with chronic obstructive pulmonary disease: a systematic review and Meta-analysis. COPD J Chronic Dis. 2017;14:251\u201361.","journal-title":"COPD J Chronic Dis"},{"key":"1221_CR36","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1016\/j.pec.2018.02.006","volume":"101","author":"R Janke","year":"2018","unstructured":"Janke R, Tetrault M, Ferrier M, Burton L, Rush KL, Hatt L. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: a systematic review. Patient Educ Couns. 2018;101:1310\u201321.","journal-title":"Patient Educ Couns"},{"key":"1221_CR37","doi-asserted-by":"publisher","first-page":"f6070","DOI":"10.1136\/bmj.f6070","volume":"347","author":"H Pinnock","year":"2013","unstructured":"Pinnock H, Hanley J, McCloughan L, Todd A, Krishan A, Lewis S, et al. Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial. BMJ. 2013;347:f6070.","journal-title":"BMJ."},{"key":"1221_CR38","doi-asserted-by":"crossref","unstructured":"Farmer A, Williams V, Velardo C, Shah SA, Yu LM, Rutter H, Jones L, Williams N, Heneghan C, Price J, Hardinge M, Tarassenko L. Self-Management Support Using a Digital Health System Compared With Usual Care for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial. J Med Internet Res. 2017;19(5):e144.","DOI":"10.2196\/jmir.7116"},{"key":"1221_CR39","doi-asserted-by":"crossref","unstructured":"Benjamin Waschki, Anne Kirsten, Olaf Holz, Kai-Christian M\u00fcller, Thorsten Meyer, Henrik Watz, Helgo Magnussen, Physical Activity Is the Strongest Predictor of All-Cause Mortality in Patients With COPD. Chest. 2011;140(2):331\u201342.","DOI":"10.1378\/chest.10-2521"},{"key":"1221_CR40","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.rmed.2014.10.008","volume":"109","author":"S Lundell","year":"2015","unstructured":"Lundell S, Holmner A, Rehn B, Nyberg A, Wadell K. Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea. Respir Med. 2015;109:11\u201326.","journal-title":"Respir Med"},{"key":"1221_CR41","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1136\/thoraxjnl-2016-209026","volume":"72","author":"H Demeyer","year":"2017","unstructured":"Demeyer H, Louvaris Z, Frei A, Rabinovich RA, de Jong C, Gimeno-Santos E, et al. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax. 2017;72:415\u201323. https:\/\/doi.org\/10.1136\/thoraxjnl-2016-209026..","journal-title":"Thorax"},{"key":"1221_CR42","volume-title":"ERS conference","author":"R Priori","year":"2017","unstructured":"Priori R, Van Genugten L, Barretto C, Schonenberg H, Stut W, Miller B, et al. Late breaking abstract - automated coaching for physical activity in COPD patients: results from a pilot study. In: ERS conference; 2017."},{"key":"1221_CR43","unstructured":"Harvard School of Public Health THM of H and SS, Education THM of, Affairs LL and R, and The Hellenic Anti-Cancer Society. The Greek Tobacco Epidemic. 2011. http:\/\/www.who.int\/fctc\/reporting\/party_reports\/greece_annex1_the_greek_tobacco_epidemic_2011.pdf. Accessed 19 Aug 2020."},{"key":"1221_CR44","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1001\/archinternmed.2009.109","volume":"169","author":"S-K Myung","year":"2009","unstructured":"Myung S-K, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of web- and computer-based smoking cessation programs. Arch Intern Med. 2009;169:929.","journal-title":"Arch Intern Med"},{"key":"1221_CR45","doi-asserted-by":"crossref","unstructured":"Jenny Ure, Hilary Pinnock, Janet Hanley, Gillian Kidd, Emily McCall Smith, Alex Tarling, Claudia Pagliari, Aziz Sheikh, William MacNee, Brian McKinstry, Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation. Prim Care Respir J. 2011;21(1):57\u201364.","DOI":"10.4104\/pcrj.2011.00065"},{"key":"1221_CR46","doi-asserted-by":"crossref","unstructured":"Brunton L, Bower P, Sanders C, Soyer HP. The contradictions of Telehealth user experience in chronic obstructive pulmonary disease (COPD): a qualitative Meta- synthesis. PLoS One. 2015;10. https:\/\/pubmed.ncbi.nlm.nih.gov\/26465333\/.","DOI":"10.1371\/journal.pone.0139561"},{"key":"1221_CR47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-9276-13-54","volume":"13","author":"II Kyriopoulos","year":"2014","unstructured":"Kyriopoulos II, Zavras D, Skroumpelos A, Mylona K, Athanasakis K, Kyriopoulos J. Barriers in access to healthcare services for chronic patients in times of austerity: an empirical approach in Greece. Int J Equity Health. 2014;13:1\u20137.","journal-title":"Int J Equity Health"},{"key":"1221_CR48","doi-asserted-by":"crossref","unstructured":"Huniche L, Dinesen B, Carl Nielsen C, Ove Grann, Egon Toft, Patients' Use of Self-Monitored Readings for Managing Everyday Life with COPD: A Qualitative Study. Telemedicine and e-Health. 2013;19(5):396\u2013402.","DOI":"10.1089\/tmj.2012.0135"},{"key":"1221_CR49","doi-asserted-by":"publisher","first-page":"230","DOI":"10.4258\/hir.2015.21.4.230","volume":"21","author":"H Chang","year":"2015","unstructured":"Chang H. Evaluation framework for telemedicine using the logical framework approach and a fishbone diagram. Healthc Inform Res. 2015;21:230\u20138.","journal-title":"Healthc Inform Res"},{"key":"1221_CR50","unstructured":"Schonenberg H, Chouvarda I, Filos D, Gaveikaite V, van der Heijden R, Lourida K, et al. Evaluation Engine Architecture Architecture to analyse and monitor scaling-up for integrated care programs. 2016. p. 12\u20135. https:\/\/www.act-at-scale.eu\/wp-content\/uploads\/2014\/08\/D4.1-Evaluation-Engine-Architecture.pdf. Accessed 20 Aug 2018."},{"key":"1221_CR51","unstructured":"Oderkirk J. Findings of the 2016 OECD HCQI Study of Electronic Health Record System Development and Data Use 2017. http:\/\/www.oecd.org\/els\/health-systems\/health-working-papers.htm. Accessed 20 Aug 2018."},{"key":"1221_CR52","unstructured":"Overview of the national laws on electronic health records in the EU Member States: Final report and recommendations. 2014. https:\/\/ec.europa.eu\/health\/ehealth\/projects\/nationallaws_electronichealthrecords_en. Accessed 10 May 2019."},{"key":"1221_CR53","doi-asserted-by":"publisher","first-page":"442","DOI":"10.7150\/ijms.7933","volume":"11","author":"G Rachiotis","year":"2014","unstructured":"Rachiotis G, Kourousis C, Kamilaraki M, Symvoulakis EK, Dounias G, Hadjichristodoulou C. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study. Int J Med Sci. 2014;11:442\u20137.","journal-title":"Int J Med Sci"},{"key":"1221_CR54","doi-asserted-by":"publisher","first-page":"973","DOI":"10.2105\/AJPH.2012.301126","volume":"103","author":"E Kondilis","year":"2013","unstructured":"Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. Economic crisis, restrictive policies, and the population\u2019s health and health care: the greek case. Am J Public Health. 2013;103:973\u201380.","journal-title":"Am J Public Health"},{"key":"1221_CR55","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1177\/1479972316636989","volume":"13","author":"D Spyratos","year":"2016","unstructured":"Spyratos D, Chloros D, Michalopoulou D, Sichletidis L. Estimating the extent and economic impact of under and overdiagnosis of chronic obstructive pulmonary disease in primary care. Chron Respir Dis. 2016;13:240\u20136.","journal-title":"Chron Respir Dis"},{"issue":"7","key":"1221_CR56","first-page":"1","volume":"2017","author":"FT Filippidis","year":"2016","unstructured":"Filippidis FT, Gerovasili V, Millett C, Tountas Y. Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece. Sci Rep. 2016;2017(7):1\u20137.","journal-title":"Sci Rep"},{"key":"1221_CR57","first-page":"3180","volume-title":"Annual International Conference of the IEEE Engineering in Medicine and Biology Society","author":"I Chouvarda","year":"2014","unstructured":"Chouvarda I, Philip NY, Natsiavas P, Kilintzis V, Sobnath D, Kayyali R, Henriques J, Paiva RP, Raptopoulos A, Ch\u00e9telat OMN. WELCOME \u2013 innovative integrated care platform using wearable sensing and smart cloud computing for COPD patients with comorbidities. In: Annual International Conference of the IEEE Engineering in Medicine and Biology Society; 2014. p. 3180\u20133."},{"key":"1221_CR58","volume-title":"European Respiratory Journal","author":"M Vasilopoulou","year":"2015","unstructured":"Vasilopoulou M, Papaioannou AI, Chynkiamis N, Vasilogiannakopoulou T, Spetsioti S, Louvaris Z, et al. Effectiveness of home telerehabilitation on functional capacity and daily physical activity in COPD patients. In: European Respiratory Journal; 2015."},{"key":"1221_CR59","volume-title":"Case study research: design and methods","author":"R Yin","year":"2009","unstructured":"Yin R. Case study research: design and methods. London: Sage; 2009."}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-01221-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-020-01221-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-01221-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T19:29:47Z","timestamp":1631215787000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-020-01221-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,10]]},"references-count":59,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1221"],"URL":"https:\/\/doi.org\/10.1186\/s12911-020-01221-y","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,10]]},"assertion":[{"value":"24 May 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All potential participants were informed in advance about the study in writing and provided with and signed an informed consent form. No ethical declaration was deemed necessary by the internal ethical processes of Philips as no personal data was disclosed. The informed consent forms are managed by the principal researcher (VG). Collection and storage of personal data are in accordance with the General Data Protection Regulation requirements.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Authors VG and HS are employees of Philips research, Eindhoven, the Netherlands. Author SW is employee of Philips Research, Aachen, Germany.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"216"}}