An Ecosystem Approach to Developing and Implementing a Cocreated Bachelor’s Degree in Digital Health and Biomedical Innovation

Research ObjectiveDigital health innovation is the cornerstone of health care modernization internationally, yet innovations often fail to become part of routine practice. Translating evidence into practice remains a challenge despite the accumulating body of evidence regarding factors underlying success and failure. Innovations that establish proof of concept often lack a strategic plan for diffusion, which complicates adoption; however, high‐level policy barriers impede widespread adoption more broadly for even the most well‐positioned innovations. The aim of this study was to explore the challenges and opportunities in the implementation of digital health innovation to identify policy‐level actions to support uptake at scale.Study DesignA qualitative study was conducted using a constructivist paradigm. Semi‐structured interviews were conducted with senior leadership members from organizations engaged in digital health planning and/or implementation activities in Ontario, Canada. Interviews were transcribed and analyzed inductively to the point of thematic saturation (point at which no new themes emerged). Findings are presented in terms of the key aspects of policy that require attention to best promote the adoption of digital health innovations at a system level.Population StudiedThe research team generated a list of key organizations involved in digital health activities in Ontario, Canada, which was circulated to a broader advisory group for further recommendations. Participants were required to hold a senior position within their respective organizations to ensure they could speak to system‐level barriers.Principal FindingsTen participants participated across nine interviews. Participants were from the Ontario Ministry of Health, Ontario Telemedicine Network, Canada Health Infoway, Ontario MD, and the MaRS Excellence in Clinical Innovation program and represented key organizations engaged in the governance, implementation, and adoption of digital health activities. The importance of strong leadership at an organizational and system level was viewed as critical to the successful implementation of digital health innovation, with an emphasis on establishing a culture of innovation. Participants described six key priorities requiring action at the policy level to catalyze digital health innovation, including: 1) a system‐level definition of innovation; 2) a clear overarching mission for digital health innovation; and 3) clearly defined organizational roles. Operationally, there is a need to 4) provide guidance on standardized processes; 5) shift the emphasis to change management; and 6) align funding structures.ConclusionsGovernments and decision makers play a central role in charting the digital course by developing a vision and creating the foundation upon which (currently fragmented) innovation activities will be modeled. Health care systems around the world and their stakeholders can reflect on these findings and recommendations to consider their utility in advancing local health innovation agendas.Implications for Policy or PracticeThese findings emphasize the critical role of the government in developing a shared vision and creating a foundation upon which digital health innovation activities can be implemented and adopted in health care systems. Achieving change may rely more on the thoughtful and efficient reconfiguration of existing practices as opposed to the addition of new resources.Primary Funding SourceOntario Ministry of Health Canada.

Catalyzing healthcare transformation with digital health: Performance indicators and lessons learned from a Digital Health Innovation Group

Designing digital health applications for climate change mitigation and adaptation.

The Digital Revolution in Behavioral Health.

The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.

BackgroundDiscussions on the use of digital health to advance health have continued to gain traction over the past decades. This is important considering the rising penetration of mobile phones and other digital technologies and the opportunity to leverage those digital and electronic health methods and innovations to accelerate Universal Health Coverage (UHC) and the health Sustainable Development Goals (SDGs). In Nigeria, however, the full benefits of digital technologies to strengthen the health systems are yet to be fully harnessed due to critical challenges in the sector. These challenges include but not limited to weak health systems governance, weak infrastructural investments, inadequate resources, weak human resource capacity, high cost of scaling-up and coordination issues among others. Lack of systems thinking, and design have significant impact on coordination of efforts and has resulted in the fragmentation and non-interoperability among various applications. To discuss these challenges and propose the way forward for rapid sustainable, scalable and cost-effective deployment of digital health in Nigeria, a digital health capacity development workshop was held in Abuja and across the six geo-political zones of Nigeria from 20th – 30th November 2019. This paper documents key conclusions and achievements at the workshop.MethodsThe workshop was organized around eleven modules and seven thematic areas which explored the Nigerian digital health governance and coordinating mechanisms in view of its status, leadership, financing and deployment for effective service delivery. It was attended by over 100 participants from varied background including Ministries of Health, Ministries of Communications and Digital Economy, International Organizations, Operators, Civil Society, Academia and Private Sector Experts.ResultsThe workshop resolved that while digital health technologies offer profound opportunities to strengthen Nigerian health systems for UHC and the health SDGs, there should be a move from donor-driven pilot projects to robust, sustainable, cost-effective and nationally owned projects. This will involve a people-centered approach that should be demand-driven and not supply-driven to avoid wasting time on ineffective interventions, duplication of efforts and wastage of scarce health resources. Government ownership and leadership was identified as critical for sustainable financing and effective scale up of Digital Health projects in Nigeria.ConclusionsThe DH capacity development workshop was a good forum to deliberate important issues regarding sustainable and cost-effective DH solutions that could be scaled to strengthen health service delivery in Nigeria. Insightful ideas for scaling DH in Nigeria and other related settings emanated from the workshop, necessitating the need for a focused government commitment and leadership in institutionalizing digital health in Nigeria.

BackgroundHealth care providers are at the forefront of the digital health transformation underway in low- and lower-middle-income countries (LLMICs). Digital health innovations (DHIs) promise more efficient and equitable health care delivery. However, their implementation often outpaces the generation of evidence supporting their effectiveness, resulting in fragmented projects that are poorly aligned with local system needs. Recognizing the diverse ways DHIs are used, the World Health Organization introduced a revised Classification of Digital Health Interventions in 2023 identifying 4 primary user groups, including health care providers.ObjectiveThis study aims to synthesize the current evidence on the use and impact of DHIs by health care providers in LLMICs.MethodsWe conducted an umbrella review of articles published between 2010 and 2024. Articles were sourced through PubMed, Embase, Scopus, and Web of Science. The search strategy combined keywords with Boolean operators. To be included, articles had to be original research published as systematic, thematic, or scoping reviews and had to use a systematic process for data identification and extraction. They needed to relate to a DHI implemented in at least 1 LLMIC and be available in English. World Bank country classifications were used to define LLMICs. Data extracted were deductively coded and thematically analyzed according to the 11 health system functions outlined in the 2023 World Health Organization classification of DHIs.ResultsOverall, 88 reviews were included. Telemedicine was the most commonly studied DHI (60/88, 68%), with evidence suggesting that it has improved information sharing among providers (eg, hospitals and private providers) and enhanced delivery efficiency, particularly in limited-access settings. Outside of telemedicine, the evidence remains thin and uneven across other categories of DHIs. While DHIs appear to help providers interact more effectively with clients, systems, and one another, many interventions remain short lived, limited in scale, or contextually misaligned. The use of personal mobile devices by health care providers emerged as a common and practical platform for delivering DHIs, highlighting the potential for cost savings and rapid uptake. Persistent challenges such as insufficient infrastructure, high setup costs, and limited workforce capacity remain key barriers to sustainable scale-up.ConclusionsSome evidence suggests DHIs are transforming health care delivery in LLMICs and contributing to broader health goals; however, robust and conclusive evidence on DHIs’ impact on health outcomes, cost-effectiveness, and long-term sustainability is lacking. Caution is warranted when introducing DHIs that may not align with underlying system constraints. Policy makers and development partners are encouraged to support implementation research to build a more coherent global evidence base. DHIs should be seen not as a stand-alone solution but as a complementary tool to strengthen health systems.Trial RegistrationPROSPERO CRD42024586285; www.crd.york.ac.uk/PROSPERO/view/CRD42024586285

Despite the common advantages of digital health, such as the increase of quality of care and the decrease in healthcare costs, the implementation of these innovations into public health are lacking. A positive impact in daily clinical practice is important for the successful implementation of digital health [1, 2]. Still it is difficult to assess the true impact of digital health in a real-life setting as proper evaluation studies are challenging [3-5]. Within a clinical setting the focus of these evaluations are mainly on clinical effectiveness or quality of care. But these kinds of evaluations are only feasible when the technology is mature and no further development is needed. This is also indicated by the most popular method for the evaluation of digital health, based on the Health Technology Assessment (HTA) model. This method, the Model for Assessment of Telemedicine (MAST) [6-8], is only applicable for fully mature technologies. Unfortunately, MAST does not specify when a technology is mature enough. Resulting in evaluations of immature technologies in clinical trials. In our opinion, the maturity of the technology can be assessed based on the Technology Readiness Levels (TRLs). With TRLs we can clearly communicate whether a technology, such as a digital health intervention, is ready for use in daily clinical practice. An understanding of both the performance and the intended use of the technology is required to establish TRL and should be the starting point for every evaluation. The objective of this workshop is to present our model for continuous eHealth evaluation [9] and to demonstrate it based on three evaluation studies of new developed digital health innovations for public health. All three innovations are still under development and have different TRLs. This will help other researchers to plan their evaluation studies with health technologies in an early phase of development. In our opinion the evaluation of digital health should be a continuous and iterative process, aligned to the progress in the development process itself. The presentations will each focus on the evaluation of a new digital innovation with real end-users and in a real-life setting. These evaluations are based on our model for continuous eHealth evaluation and will be presented as three separate cases. We will conduct a 60-minutes interactive workshop, which starts with an overview presentation (15 minutes) of our model for continuous eHealth evaluation. Next, three presentations (3x 10 minutes) on the evaluation of the three new digital health innovation will follow. The workshop ends with a plenary discussion (15 minutes) to discuss our view on the evaluation of digital health (model for continuous eHealth evaluation) and the development of the digital health innovations with the attendees. Key messages The evaluation of digital health is challenging but the maturity of the technology must be the starting point of every digital health evaluation. The evaluation of digital health should be a continuous and iterative process, aligned to the progress in the development process itself.

About The Author

Australian nursing programs aim to introduce students to digital health requirements for practice. However, innovation in digital health is more dynamic than education providers' ability to respond. It is uncertain whether what is taught and demonstrated in nursing programs meets the needs and expectations of clinicians with regard to the capability of the nurse graduates. This study aims to identify gaps in the National Nursing and Midwifery Digital Health Capability Framework , based on the perspectives of clinical nurses, and in nurse educators' confidence and knowledge to teach. The findings will direct a future co-design process. This study triangulated the findings from 2 studies of the Digital Awareness in Simulated Health project and the National Nursing and Midwifery Digital Capability Framework. The first was a qualitative study that considered the experiences of nurses with digital health technologies during the COVID-19 pandemic, and the second was a survey of nurse educators who identified their confidence and knowledge to teach and demonstrate digital health concepts. The results were categorized by and presented from the perspectives of nurse clinicians, nurse graduates, and nurse educators. Findings were listed against each of the framework capabilities, and omissions from the framework were identified. A series of statements and questions were formulated from the gap analysis to direct a future co-design process with nursing stakeholders to develop a digital health capability curriculum for nurse educators. Further work to evaluate nursing digital health opportunities for nurse educators is indicated by the gaps identified in this study.

IntroductionThe importance of meaningfully involving patients and the public in digital health innovation is widely acknowledged, but often poorly understood. This review, therefore, sought to explore how patients and the public are involved in digital health innovation and to identify factors that support and inhibit meaningful patient and public involvement (PPI) in digital health innovation, implementation and evaluation.MethodsSearches were undertaken from 2010 to July 2020 in the electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and ACM Digital Library. Grey literature searches were also undertaken using the Patient Experience Library database and Google Scholar.ResultsOf the 10,540 articles identified, 433 were included. The majority of included articles were published in the United States, United Kingdom, Canada and Australia, with representation from 42 countries highlighting the international relevance of PPI in digital health. 112 topic areas where PPI had reportedly taken place were identified. Areas most often described included cancer (n = 50), mental health (n = 43), diabetes (n = 26) and long‐term conditions (n = 19). Interestingly, over 133 terms were used to describe PPI; few were explicitly defined. Patients were often most involved in the final, passive stages of an innovation journey, for example, usability testing, where the ability to proactively influence change was severely limited. Common barriers to achieving meaningful PPI included data privacy and security concerns, not involving patients early enough and lack of trust. Suggested enablers were often designed to counteract such challenges.ConclusionsPPI is largely viewed as valuable and essential in digital health innovation, but rarely practised. Several barriers exist for both innovators and patients, which currently limits the quality, frequency and duration of PPI in digital health innovation, although improvements have been made in the past decade. Some reported barriers and enablers such as the importance of data privacy and security appear to be unique to PPI in digital innovation. Greater efforts should be made to support innovators and patients to become meaningfully involved in digital health innovations from the outset, given its reported benefits and impacts. Stakeholder consensus on the principles that underpin meaningful PPI in digital health innovation would be helpful in providing evidence‐based guidance on how to achieve this.Patient or Public ContributionThis review has received extensive patient and public contributions with a representative from the Patient Experience Library involved throughout the review's conception, from design (including suggested revisions to the search strategy) through to article production and dissemination. Other areas of patient and public contributor involvement include contributing to the inductive thematic analysis process, refining the thematic framework and finalizing theme wording, helping to ensure relevance, value and meaning from a patient perspective. Findings from this review have also been presented to a variety of stakeholders including patients, patient advocates and clinicians through a series of focus groups and webinars. Given their extensive involvement, the representative from the Patient Experience Library is rightly included as an author of this review.

The COVID-19 pandemic accelerated the uptake of digital health worldwide and highlighted many benefits of these innovations. However, it also stressed the magnitude of inequalities regarding accessing digital health. Using a scoping review, this article explores the potential benefits of digital technologies for the global population, with particular reference to people living with disabilities, using the autism community as a case study. We ultimately explore policies in Sweden, Australia, Canada, Estonia, the United Kingdom, and the United States to learn how policies can lay an inclusive foundation for digital health systems. We conclude that digital health ecosystems should be designed with health equity at the forefront to avoid deepening existing health inequalities. We call for a more sophisticated understanding of digital health literacy to better assess the readiness to adopt digital health innovations. Finally, people living with disabilities should be positioned at the center of digital health policy and innovations to ensure they are not left behind.

Digital health innovation is expected to transform healthcare, but it also generates ethical and societal concerns, such as privacy risks, and biases that can compound existing health inequalities. While such concerns are widely recognized, existing regulatory principles, oversight methods and ethical frameworks seem out of sync with digital health innovation. New governance and innovation best practices are thus needed to bring such principles to bear with the reality of business, innovation, and regulation.To grant practical insight into best practices for responsible digital health innovation, we conducted a qualitative study based on an interactive engagement methodology. We engaged key stakeholders (n = 46) operating at the translational frontier of digital health. This approach allowed us to identify three clusters of governance and innovation best practices in digital health innovation: i) inclusive co-creation, ii) responsive regulation, and iii) value-driven innovation. Our study shows that realizing responsible digital health requires diverse stakeholders’ commitment to adapt innovation and regulation practices, embracing co-creation as the default modus operandi for digital health development. We describe these collaborative practices and show how they can ensure that innovation is neither slowed by overregulation, nor leads to unethical outcomes.

The capacity to promote and disseminate the best evidence-based practices in terms of digital health innovations and technologies represents an important goal for countries and governments. To support the digital health maturity across countries the Global Digital Health Partnership (GDHP) was established in 2019. The mission of the GDHP is to facilitate global collaboration and knowledge-sharing in the design of digital health services, through the administration of surveys and white papers. The scope of this study is to critically analyze and discuss results from the Evidence and Evaluation GDHP Work Stream's survey, understand how governments and countries intend to address main obstacles to the digital health implementation, identify their strategies for a communication of effective digital health services, and promote the sharing of international based best practices on digital health. This survey followed a cross-sectional study approach. A multiple-choice questionnaire was designed to gather data. Choices were extracted from research publications retrieved through a rapid review. Out of 29 countries receiving the survey, 10 returned it. On a scale from 1 to 5, eHealth systems/platforms (mean = 3.56) were indicated as the most important tool for centralized infrastructure to collect information on digital health, while primary care (mean = 4.0) represented the most voted item for healthcare services to collect information on digital health. Seven Countries out of 10 identified lack of organization, skepticism of clinicians, and accessibility of the population as a barriers to adopt digital health implementation, resulting to be the most voted items. Finally, the most endorsed priorities in digital health for Countries were the adoption of data-driven approaches (6 Countries), and telehealth (5 Countries). This survey highlighted the main tools and obstacles for countries to promote the implementation of evidence-based digital health innovations. Identifying strategies that would communicate the value of health care information technology to healthcare professionals are particularly imperative. Effective communication programs for clinicians and the general population in addition to improved digital health literacy (both for clinicians and citizens) will be the key for the real implementation of future digital health technologies.

It is appreciated that digital health is increasing in interest as an important area for efficiently standardizing and developing health services in Ireland, and worldwide. However, digital health is still considered to be in its infancy and there is a need to understand important factors that will support the development and uniform uptake of these technologies, which embrace their utility and ensure data trustworthiness. This constituted the first study to identify themes believed to be relevant by respiratory care and digital health experts in the Republic of Ireland to help inform future decision-making among respiratory patients that may potentially facilitate engagement with and appropriate use of digital health innovation (DHI). The study explored and identified expert participant perceptions, beliefs, barriers, and cues to action that would inform content and future deployment of living labs in respiratory care for remote patient monitoring of people with respiratory diseases using DHI. The objective of this case study was to generate and evaluate appropriate data sets to inform the selection and future deployment of an ICT-enabling technology that will empower patients to manage their respiratory systems in real-time in a safe effective manner through remote consultation with health service providers. The co-creation of effective DHI for respiratory care will be informed by multi-actor stakeholder participation, such as through a Quintuple Helix Hub framework combining university-industry-government-healthcare-society engagements. Studies, such as this, will help bridge the interface between top-down digital health policies and bottom-up end-user engagements to ensure safe and effective use of health technology. In addition, it will address the need to reach a consensus on appropriate key performance indicators (KPIs) for effective uptake, implementation, standardization, and regulation of DHI.