Suggestions for health information technology trials for respiratory disorders in low- and middle-income country settings: what can we learn from trials in high-income country settings?

Niels H Chavannes,Robert S Du Puy,Chunxue Bai

doi:10.1038/npjpcrm.2015.45

Abstract

Health Information Technology (HIT) is sometimes seen as a silver bullet for human resource, medical and economic challenges facing health systems. The evidence supporting widespread use of HIT is, however, still patchy and inconsistent. In this Perspective piece, we seek to interpret and draw key lessons from a selection of illustrative trials in developed countries with robust health-care settings in respiratory medicine that failed to demonstrate effectiveness, and offer suggestions to maximise the chances of success in subsequent HIT deployments. Particularly low- and middle-income countries, with relatively weak health infrastructures and limited health care, propose considerable room for improvement. Early experiences of studying HIT thus far in high-income country settings suggest that this process should preferably begin with trials of low-cost, well-established technologies in patient groups with a moderate burden of disease while carefully evaluating patient safety.

Highlights

Futurists, politicians, researchers and health-care insurers are excited about the grand promises of health information technology (HIT; sometimes known as medical informatics or eHealth), with projected annual savings ranging up to $81 billion in the United States from a single HIT intervention alone.[1]
HIT is promoted as a silver bullet for the human resource, medical and economic crises in health care, which are driven by the worldwide steep increase in patients with long-term conditions and associated costs.[2]
As a first step for introducing HIT interventions, in low- and middle-income countries (LMICs), we propose low-cost, low-tech HIT applications in patient groups with a moderate burden of disease, as sufficient symptoms will be present while safety is not commonly an issue yet

Summary

Introduction

Politicians, researchers and health-care insurers are excited about the grand promises of health information technology (HIT; sometimes known as medical informatics or eHealth), with projected annual savings ranging up to $81 billion in the United States from a single HIT intervention alone.[1]. In this Perspective piece, we seek to interpret and draw key lessons from a selection of earlier high-quality illustrative large randomised clinical trials in developed countries with robust health-care settings that failed to demonstrate effectiveness, with a view to offering suggestions to maximise the chances of success in subsequent HIT deployments.

Results

Conclusion