Table 2

Technology problems encountered during the trial

Problem	Solution adopted	Impact on the use of the TiM	Recommendations for future TiM use
TiM Patient App software
Poor finger dexterity	Handheld stylus provided	85% used TiM independently.	Provide stylus to all patients.
Poor finger dexterity	Carer help to use device	Interview data suggested that help from carers was acceptable.	Encourage carer support.
Difficulties entering login password	Telephone support	Problem resolved with second TiM app release.	Provide face-to-face training. Provide telephone technical support.
Difficulties entering login password	Login page redesigned	No further problems reported.	Make local staff familiar with the software.
Lack of confidence using the app or other features on the TiM	Face-to-face training Partner/family helped	None: all participants could use the app.	Provide face-to-face training plus an additional contact after a few weeks to reinforce learning. Identify low confidence/experience users and provide extra training.
Patients not giving correct answers	Patient completing TiM with their family	Uncertain impact.	Capacity assessment at recruitment. Check TiM answers in training and in clinic.
Tablet
Tablet stored in place not accessible to patient	No solution available	Interviews suggested that adherence was reduced for two patients.	Use patients’ own equipment where possible.
Tablet battery drained, unable to switch on	Telephone advice	No impact.	Use patients’ own equipment. Familiarise local staff with hardware.
Unexpected screens/ software updates	Telephone advice	Reduced user confidence in tablet but no impact on use.	Use patients’ own equipment. Use a basic tablet that only displays the TiM app.
User fear of ‘breaking’ the tablet	Face-to-face training to improve user confidence	Patients/carers reluctant to use the additional features on the tablet.	Use patients’ own equipment. Face-to-face training.
Internet connection
Poor 3G phone signal	Used patients’ own broadband	None: solution found for all patients (3G or patients’ own broadband)	Use patients’ own broadband. Check internet availability prior to TiM enrolment.
Patients switched Wi-Fi off	Home visit required	Several TiM sessions failed to download.	Monitor adherence. Alert team if adherence is low.
Unreliable connection between scales and tablet/broadband	A separate 3G Wi-Fi route provided (‘Mifi’). No solution if using broadband	Additional home visits required and loss of weight data for several weeks.	Manual weight recording. Avoid using peripheral devices.
Clinician portal
Password/login problems	Support by external IT team	Delayed access during MDC visit.	Local systems access support.

MDC, multidisciplinary clinic; TiM, telehealth in motor neuron disease.