Abstract
BackgroundSignificant resources are being invested into eHealth technology to improve health care. Few resources have focused on evaluating the impact of use on patient outcomes A standardized set of metrics used across health systems and research will enable aggregation of data to inform improved implementation, clinical practice, and ultimately health outcomes associated with use of patient-facing eHealth technologies.ObjectiveThe objective of this project was to conduct a systematic review to (1) identify existing instruments for eHealth research and implementation evaluation from the patient’s point of view, (2) characterize measurement components, and (3) assess psychometrics.MethodsConcepts from existing models and published studies of technology use and adoption were identified and used to inform a search strategy. Search terms were broadly categorized as platforms (eg, email), measurement (eg, survey), function/information use (eg, self-management), health care occupations (eg, nurse), and eHealth/telemedicine (eg, mHealth). A computerized database search was conducted through June 2014. Included articles (1) described development of an instrument, or (2) used an instrument that could be traced back to its original publication, or (3) modified an instrument, and (4) with full text in English language, and (5) focused on the patient perspective on technology, including patient preferences and satisfaction, engagement with technology, usability, competency and fluency with technology, computer literacy, and trust in and acceptance of technology. The review was limited to instruments that reported at least one psychometric property. Excluded were investigator-developed measures, disease-specific assessments delivered via technology or telephone (eg, a cancer-coping measure delivered via computer survey), and measures focused primarily on clinician use (eg, the electronic health record).ResultsThe search strategy yielded 47,320 articles. Following elimination of duplicates and non-English language publications (n=14,550) and books (n=27), another 31,647 articles were excluded through review of titles. Following a review of the abstracts of the remaining 1096 articles, 68 were retained for full-text review. Of these, 16 described an instrument and six used an instrument; one instrument was drawn from the GEM database, resulting in 23 articles for inclusion. None included a complete psychometric evaluation. The most frequently assessed property was internal consistency (21/23, 91%). Testing for aspects of validity ranged from 48% (11/23) to 78% (18/23). Approximately half (13/23, 57%) reported how to score the instrument. Only six (26%) assessed the readability of the instrument for end users, although all the measures rely on self-report.ConclusionsAlthough most measures identified in this review were published after the year 2000, rapidly changing technology makes instrument development challenging. Platform-agnostic measures need to be developed that focus on concepts important for use of any type of eHealth innovation. At present, there are important gaps in the availability of psychometrically sound measures to evaluate eHealth technologies.
Highlights
Patient-facing eHealth is a multidisciplinary field focused on the delivery or enhancement of health information and health services through information and communication technologies [1]. eHealth helps consumers engage and collaborate more fully in their health care [2,3], independent of geographic location and enhances access to health care services by offering novel channels for communication and information flow that complement existing systems [4]
Platform-agnostic measures need to be developed that focus on concepts important for use of any type of eHealth innovation
Excluded were investigator-developed measures or sets of questions without psychometric evaluation, disease-specific assessments delivered via technology or telephone, and measures focused primarily on clinician use
Summary
Patient-facing eHealth is a multidisciplinary field focused on the delivery or enhancement of health information and health services through information and communication technologies [1]. eHealth helps consumers engage and collaborate more fully in their health care [2,3], independent of geographic location and enhances access to health care services by offering novel channels for communication and information flow that complement existing systems [4]. Patient-facing eHealth is a multidisciplinary field focused on the delivery or enhancement of health information and health services through information and communication technologies [1]. EHealth may improve the efficiency of and accessibility to clinical and health promotion services for patients. It is anticipated that eHealth may reduce the distance between services and the target user, improving accessibility, or reducing physician or patient workload for a specific task, enhancing efficiency [6,7,8,9]. Few resources have focused on evaluating the impact of use on patient outcomes A standardized set of metrics used across health systems and research will enable aggregation of data to inform improved implementation, clinical practice, and health outcomes associated with use of patient-facing eHealth technologies
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