Table 1 Common barriers to the adoption of digital technology developed at a different institution and how they are addressed

Psychological barrier

Difficulty understanding how the technology fits into the local care model

Developed with informal feedback for the site-specific care model. Training relied on oral demonstrations.

Designed to support universal components of care. Formal training documentation and videos available.

Perception of less human interaction

Uncertain efficacy at a new site with a new population

Care is centered around ATTD diabetes consensus metrics with documented site-specific efficacy and efficiency.

Continued use of widely accepted ATTD diabetes consensus metrics. Functionality for rigorous evaluation with pseudo-randomization.

Infrastructure/ technical issue

Healthcare capacity of technology integration

Institutional IT required for instrumentation and maintenance.

No institutional IT professionals nor servers required for instrumentation nor maintenance.

Absence of standardized/harmonized systems at different facilities

Deployed at Stanford only; replication of TIDE at other institutions required adjustments and redeployment.

Institution-agnostic central deployment through Tidepool that is more widely accessible.

Concerns about workload

Concerns about increased workload and altered workflow

Clinical workflows were more efficient with TIDE but administrative workflows required additional tools such as Excel sheets to manage patient care.

Clinical workflows are as efficient while administrative workflows are also supported on the same platform.

Set up time

Set up required technical deploy and building out pipelines for data and onboarding.

Set up is out-of-the-box with streamlined onboarding and data management without a need for technical deployment.