163 Assessment of the KLIK PROM portal implementation Table 2. Identified current barriers for the KLIK PROM portal implementation using the CFIR-ERIC matching tool CFIR domain CFIR barrier What is already done? Why still a barrier? Intervention characteristics 1. Relative advantage • Overall, clinicians working with the KLIK PROM portal think it is a valuable tool to monitor PROMs in their patients [12,29,35] • The advantages about the KLIK PROM portal and discussing PROMs in the consultation room are spread during conferences and in scientific papers Some stakeholders are reluctant to change and do not see the advantages of using PROMs, or suggest that alternative solutions (e.g., administering PROMs using EHRs or on paper) can be used Intervention characteristics 2. Adaptability • KLIK is a very flexible system where many individual wishes of the multidisciplinary teams can be met (e.g., different PROMs for different patient groups at different timeslots, for different ages, various forms of feedback different for specific clinicians) • To make KLIK as user-friendly as possible. For example, KLIK is available in different languages and proxy reported PROMs are offered for patients with disabilities [13] Clinicians prefer the intervention as tailored as possible. A standard set of PROMs is currently being offered to patients automatically based on age and patient group, not yet on an individual patient level (selecting specific PROMs per individual patient per visit) Intervention characteristics 3. Complexity • The KLIK PROM portal is easy to use as a result of its origin in pediatrics. A recent evaluation study shows that the majority of clinicians (72%) think KLIK is easy to use [35] • Together with the use of the KLIK PROM portal, hospitals receive support and advise from the KLIK expert team during all steps of the implementation (see Fig 3) For some clinicians KLIK remains complex to use, for example if they are not familiar with ICT. In addition, it requires additional actions, because clinicians need to actively motivate patients and sometimes send out the PROMs to their patients Intervention characteristics 4. Cost • KLIK is being offered at low costs, as we are a non-profit organization, and alternative portals are often more expensive Within healthcare there are often insufficient financial resources. Therefore, some teams still decide to refrain from using PROMs because of the additional costs Inner setting 5. Structural characteristics • In general, KLIK is being implemented bottom-up, where small multidisciplinary teams show their interest in using KLIK Hospitals are large organizations, and obtaining permission to change existing workflows can be a long process The board of the hospital might not be aware of bottom-up processes and can, therefore, be perceived as a barrier in larger scale implementation Inner setting 6. Tension for change • Champions (clinicians who are enthusiastic about using KLIK) can explain the added value of using PROMs in clinical practice and persuade colleagues in trying out KLIK as well. Some clinicians do not see the current situation (not using PROMs in clinical practice) in a need of change. 6
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