E-health Initiatives Research Articles

Discovering Gaps in Saudi Education for Digital Health Transformation

The growing complexity of healthcare systems worldwide and the medical profession’s increasing dependency on information technology for accurate practice and treatment call for specific standardized education in health informatics programming, and accreditation of health informatics programs based on core competencies is progressing at an international level. This study investigates the state of affairs in health informatics programs within the Kingdom of Saudi Arabia (KSA) to determine (1) how well international standards are being met and (2) what further development is needed in light of KSA’s recent eHealth initiatives. This descriptive study collected data from publicly available resources to investigate Health Informatics programs at 109 Saudi institutions. Information about coursework offered at each institution was compared with American Medical Informatics Association (AMIA) curriculum guidelines. Of 109 institutions surveyed, only a handful offered programs specifically in health informatics. Of these, most programs did not match the coursework recommended by AMIA, and the majority of programs mimicked existing curricula from other countries rather than addressing unique Saudi conditions. Education in health informatics in KSA appears to be scattered, non-standardized, and somewhat outdated. Based on these findings, there is a clear opportunity for greater focus on core competencies within health informatics programs. The Saudi digital transformation (eHealth) initiative, as part of Saudi Vision 2030, clearly calls for implementation of internationally accepted health informatics competencies in education programs and healthcare practice, which can only occur through greater collaboration between medical and technology educators and strategic partnerships with companies, medical centers, and governmental institutions.

Social Impacts of e-Health in Norway

Norway spends more on public healthcare per person than any other European country. The government and the Norwegian health authorities are committed to improving the country's healthcare service through the use of innovative information and communication technology, generally referred to as ehealth. Society in Norway benefits from an integrated ehealth care system where the patient is at its centre regardless of the person's level of income or geographical location. The long-term national ehealth strategy “one citizen – one record” is the basis for all ehealth national strategies and initiatives. With its challenging geographical environment and ageing population, telemedicine and other ehealth developments such as eprescription and electronic health records (EHR) are important tools in successfully implementing new ehealth reforms that continue to impact society in Norway.

Electronic Health Records Implementation Readiness: An Integrative Review

Purpose: The purpose of this review was to discuss the status of evidence related to the assessment of readiness of healthcare facilities for e-health initiatives implementation, specifically the common Electronic Health Record (EHR) systems. Methods: An integrative review approach was utilized. The databases of Google Scholar, Scopus, Science Direct, PubMed, Medline, CINAHL, Ovid, ProQuest, and EBSCO host were searched for related evidence published between 2000 and 2018. Results: Seventeen studies were included in the current review. In terms of methodological approach, the included studies were 7 correlational studies, 5 review papers, 4 qualitative papers, and one mixed methods study. At the current integrative review, the themes of complex healthcare change, and the main theme of e-health readiness assessment were identified. Conclusion: Assessing and reporting the levels of readiness for EHRs implementation are highly recommended as it has a high impact on the critically-needed adoption and usage of the implemented system. Selecting the right tool for the right audience to address readiness is essential in the assessment process which is recommended to be conducted early at the road map of the project implementation. Future research is recommended to address readiness for e-health initiatives at the different settings and different target populations including communities where the healthcare facilities functions and service receivers’ readiness.

The contribution of eHealth in closing gaps in primary health care in selected countries of Latin America and the Caribbean.

ABSTRACTObjectiveTo use a newly developed framework to assess the contribution that eHealth makes to closing gaps in primary health care (PHC) and to providing person-centered, integrated PHC services in Latin America and the Caribbean.MethodsThe new assessment model for eHealth-enabled primary health care (ePHC) is called the ePHC Assessment Framework. It is based on the National eHealth Strategy Toolkit developed by the World Health Organization and the International Telecommunications Union in 2012, and the Alberta Health Primary Health Care Evaluation Framework. To validate the ePHC Assessment Framework, a pilot study was conducted in 2017 in four locations: the city of Buenos Aires, Argentina, and the countries of Brazil, Costa Rica, and the Dominican Republic.ResultsThe ePHC Assessment Framework was successfully used to evaluate the building blocks of a primary health care–oriented approach to eHealth and the eHealth-enabled enhancements for management of chronic conditions needed to improve prevention and management at PHC centers in the studied locations. The study found that Brazil, Costa Rica, and Buenos Aires are clearly engaged in eHealth initiatives as part of the transformation of PHC to provide person-centered, high-quality services. As for the Dominican Republic, there was not enough evidence to verify the contribution of eHealth in improving PHC in the country.ConclusionsIt is clear that eHealth helps improve the quality and effectiveness of the prevention and management of chronic conditions at the PHC level. To improve the foundations of ePHC, policymakers should ensure that their national eHealth strategies explicitly identify and establish the opportunities for eHealth to enable an effective PHC system to provide person-centered, integrated, high-quality services.

Assessing Ghana\u2019s eHealth workforce: implications for planning and training

BackgroundeHealth—the proficient application of information and communication technology to support healthcare delivery—has been touted as one of the best solutions to address quality and accessibility challenges in healthcare. Although eHealth could be of more value to health systems in low- and middle-income countries (LMICs) where resources are limited, identification of a competent workforce which can develop and maintain eHealth systems is a key barrier to adoption. Very little is known about the actual or optimal states of the eHealth workforce needs of LMICs. The objective of this study was to develop a framework to characterize and assess the eHealth workforce of hospitals in LMICs.MethodsTo characterize and assess the sufficiency of the workforce, we designed this study in twofold. First, we developed a general framework to categorize the eHealth workforce at any LMIC setting. Second, we combined qualitative data, using semi-structured interviews and the Workload Indicator of Staffing Needs (WISN) to assess the sufficiency of the eHealth workforce in selected hospitals in a LMIC setting like Ghana.ResultsWe surveyed 76 (60%) of the eHealth staff from three hospitals in Ghana—La General Hospital, University of Ghana Hospital, and Greater Accra Regional Hospital. We identified two main eHealth cadres, technical support/information technology (IT) and health information management (HIM). While the HIM cadre presented diversity in expertise, the IT group was dominated by training in Science (42%) and Engineering (55%), and the majority (87%) had at least a bachelor’s degree. Health information clerk (32%), health information officer (25%), help desk specialist (20%), and network administrator (11%) were the most dominant roles. Based on the WISN assessment, the eHealth workforce at all the surveyed sites was insufficient. La General and University of Ghana were operating at 10% of required IT staff capacity, while Ridge was short by 42%.ConclusionsWe have developed a framework to characterize and assess the eHealth workforce in LMICs. Applying it to a case study in Ghana has given us a better understanding of potential eHealth staffing needs in LMICs, while providing the quantitative basis for building the requisite human capital to drive eHealth initiatives. Educators can also use our results to explore competency gaps and refine curricula for burgeoning training programs. The findings of this study can serve as a springboard for other LMICs to assess the effects of a well-trained eHealth workforce on the return on eHealth investments.

Scholarly Influence of the Conference and Labs of the Evaluation Forum eHealth Initiative: Review and Bibliometric Study of the 2012 to 2017 Outcomes.

BackgroundThe eHealth initiative of the Conference and Labs of the Evaluation Forum (CLEF) has aimed since 2012 to provide researchers working on health text analytics with annual workshops, shared development challenges and tasks, benchmark datasets, and software for processing and evaluation. In 2012, it ran as a scientific workshop with the aim of establishing an evaluation lab, and since 2013, this annual workshop has been supplemented with 3 or more preceding labs each year. An evaluation lab is an activity where the participating individuals or teams’ goal is to solve the same problem, typically using the same dataset in a given time frame. The overall purpose of this initiative is to support patients, their next of kin, clinical staff, health scientists, and health care policy makers in accessing, understanding, using, and authoring health information in a multilingual setting. In the CLEF eHealth 2013 to 2017 installations, the aim was to address patient-centric text processing. From 2015, the scope was also extended to aid both patients’ understanding and clinicians’ authoring of various types of medical content. CLEF eHealth 2017 introduced a new pilot task on technology-assisted reviews (TARs) in empirical medicine in order to support health scientists and health care policymakers’ information access.ObjectivesThis original research paper reports on the outcomes of the first 6 installations of CLEF eHealth from 2012 to 2017. The focus is on measuring and analyzing the scholarly influence by reviewing CLEF eHealth papers and their citations.MethodsA review and bibliometric study of the CLEF eHealth proceedings, working notes, and author-declared paper extensions were conducted. Citation content analysis was used for the publications and their citations collected from Google Scholar.ResultsAs many as 718 teams registered their interest in the tasks, leading to 130 teams submitting to the 15 tasks. A total of 184 papers using CLEF eHealth data generated 1299 citations, yielding a total scholarly citation influence of almost 963,000 citations for the 741 coauthors, and included authors from 33 countries across the world. Eight tasks produced statistically significant improvements (2, 3, and 3 times with P<.001, P=.009, and P=.04, respectively) in processing quality by at least 1 out of the top 3 methods.ConclusionsThese substantial participation numbers, large citation counts, and significant performance improvements encourage continuing to develop these technologies to address patient needs. Consequently, data and tools have been opened for future research and development, and the CLEF eHealth initiative continues to run new challenges.

Perceptions of Prescribers towards Electronic Prescription: A Pre-Implementation Evaluation

Objective: Electronic (e) prescribing is computerised prescribing. The Government of Kerala has started the e-health initiative. The objective of this study was to obtain the perceptions of prescribing doctors on e-prescription before its implementation. Method: This was a questionnaire based cross sectional study conducted for a period of six months in a Government tertiary care teaching hospital of Kerala. The prescribing doctors of the institution formed the sample population. The response to the structured questionnaire was measured on Likert scale. Data were analysed using SPSS 16. Domain scores of perceived usefulness, ease of use and fitness to the Institution were calculated by averaging the response. Chi square test was done to find the association of score of each domain with independent variables. Results: Two hundred and fifty seven prescribing doctors of age range 22-60 years participated of which 49% were females and 51% males. Response rate was 73% (257/350). Although 70.5% have heard of e-prescriptions only 14% participants had hands on exposure. The mean perceived usefulness, perceived ease of use and fitness were 3.5±0.47, 3.35± 0.49 and 2.95 ± 0.44. Conclusion: Dislike for paper prescriptions was the single most important factor associated with perceived usefulness, perceived ease of use and perceived fitness of e-prescription in the institution. Information technology training and infrastructure development should go hand in hand with implementation of e-prescribing. Key words: Electronic prescribing, Electronic prescription, Medication error, Health Information Technology

Development of a Web Portal for Physical Activity and Symptom Tracking in Oncology Patients: Protocol for a Prospective Cohort Study.

BackgroundSignificant benefits accrue from increasing physical activity levels in people with a history of cancer. Physical activity levels can be increased using behavioral change interventions in this population. Access to Web portals and provision of activity monitors to provide feedback may support behavior change by encouraging patient engagement in physical therapy. The Web portal evaluated in this study will provide a system to monitor physical activity and sleep, for use by both clinician and patient, along with symptom and health-related quality of life tracking capabilities.ObjectiveThe aim of this study was to outline a protocol for a feasibility study focused on a Web-based portal that provides activity monitoring and personalized messaging to increase physical activity in people with cancer.MethodsUsing a longitudinal cohort design, people with cancer will be serially allocated to 3 intervention cohorts of 20 participants each and followed for 10 weeks. Cohort 1 will be provided a wearable activity monitor and access to a Web-based portal. Cohort 2 will receive the same content as Cohort 1 and in addition will receive a weekly activity summary message. Cohort 3 will receive the same content as Cohorts 1 and 2 and in addition will receive a personalized weekly coaching message. Feasibility of the use of the portal is the primary outcome.ResultsResults are expected in early 2018. Outcome measures will include goal attainment and completion rate.ConclusionsThis study will provide information about the feasibility of investigating eHealth initiatives to promote physical activity in people with cancer.Registered Report IdentifierRR1-10.2196/9586

A systematic review of reviews to identify key research opportunities within the field of eHealth implementation

Introduction This paper is a systematic review of the relevant literature surrounding the implementation and utilisation of eHealth to identify key challenges and opportunities to future eHealth applications. Methods NHS Evidence, PubMed, IEEE Explorer, Cochrane Library and JMIR Publications were all searched for reviews published between 1 January 2010 and 30 June 2017. Results A total of 47 papers met the final inclusion criterion. The published literature focused on a wide array of challenges categorised into five areas, facing the implementation and utilisation of eHealth; from this, four areas of opportunity to advance eHealth were identified. Discussion The five challenge areas are (C1) stakeholders and system users, (C2) technology and interoperability, (C3) cost-effectiveness and start-up costs, (C4) legal clarity and legal framework and (C5) local context and regional differences. The four opportunity areas are (O1) participation and contribution, (O2) foundation and sustainability, (O3) improvement and productivity and (O4) identification and application. Conclusion The literature analysed in this systematic review identifies design and implementation priorities that can guide the development and utilisation of future eHealth initiatives.

Scope of E-Healthcare Services in Uttar Pradesh with Special Reference to Varanasi

&lt;p&gt;Innovation in the field of Healthcare will create new landmarks in this field. The Health related information in any country is confidential and is available in large amount. Effective Management of Health Data is important. E-Health exists in various forms. Mostly, the People living in Urban Areas having each sort of facility like Mobile Phone and good Internet Connectivity but then also they do not know about the free services provided by the Hospitals. There is less awareness about E-Health services in India. In this paper we had discussed about the E-Health Initiatives in Uttar Pradesh, the E-Health Models, its Architecture and its scope in urban areas of Varanasi, in detail and how it is essential for the atomisation of Health Management System (H.M.S.). There are different forms of E-Health discussed in this paper like Automated Physician Order Entry, E- Prescribing, Decision Support System, M-Health and Health Informatics.&lt;/p&gt;

OVERVIEW OF EHEALTH DEVELOPMENT MODELS AND EXISTING MEDICAL INFORMATION SYSTEMS. PROBLEMS OF CREATING A SINGLE MEDICAL INFORMATION SPACE

Міністерство охорони здоров'я України разом із громадськими та державними організаціями, активною медичною спільнотою та ІТ-бізнесом задекларували бажання започаткувати eHealth в Україні вже у 2017 р., як основну компоненту реформ Міністерства. Розглянуто моделі розвитку eHealth в Україні та надано інформацію про основні медичні інформаційні системи, які на сьогодні використовують в Україні. Визначено переваги та недоліки централізованої та децентралізованої систем розвитку eHealth в Україні. Розглянуто основні характеристики сучасних медичних інформаційних систем, які потрібно враховувати у загальному виборі системи. Проаналізовано переваги та недоліки різних підходів, з точки зору реалізації на практиці, та запропоновано рекомендації щодо забезпечення інтероперабельності для галузі охорони здоров'я України. З'ясовано основні характеристики медичної інформаційної системи, на основі яких проведено порівняльний аналіз розглянутих систем. Оцінено вплив різних підходів до забезпечення інтероперабельності в галузі, як результат – запропоновано узагальнену модель досягнення інтероперабельності, яка може бути рекомендована до застосування у вітчизняній системі охорони здоров'я.

EHealth in India: a model for healthcare accessibility at the 'bottom of the pyramid'

The objective of this research is to study the scope of eHealth as a means to reach the 'bottom of the pyramid (BOP)' in India and making healthcare services accessible to this segment. For this purpose, a detailed study of the eHealth initiatives in India is done in terms of their objectives, value proposition, penetration, customer segment, and operating model. This study also analyses the macro-economic, technological, social and other demographic factors in India in order to understand the scope of eHealth in terms of its drivers and inhibitors in the growth of eHealth in India. This is a qualitative and descriptive research study that is based on secondary research which involves a review of existing literature and data. The findings and analyses done on the basis of secondary research are further reinforced through discussions with healthcare providers, researchers and consumers.

Proposal to Expand UWALK’s Reach in Rural Alberta Communities ( poster )

Background Walking has many benefits and has been established as an ideal focus of public health promotion to increase physical activity. Rural communities, in particular, are an underserved population that have unique barriers and facilitators to engaging in walking and require tailored initiatives. Description of Program UWALK is a promising theory-informed community-wide eHealth initiative to promote physical activity, which is uniquely suited to support rural communities. The community specific features, free online access, and focus on walking that requires little training and equipment makes UWALK a suitable health promotion tool for the rural context. UWALK was originally developed in 2013 by the University of Alberta with funding from Alberta Health and is being transitioned to Alberta Health Services (AHS) for sustained administration. AHS highlighted rural engagement as a priority during this transition and is developing a strategy to expand the initiative’s reach to rural communities. Lessons Learned To date the program has not had a specific strategy targeting rural users, however, previous engagement of rural community libraries and in-person promotion has shown promise. To build upon this, various strategies, approaches and resources were identified in the literature and proposed: Develop collaborative relationships with community leaders and local health champions for UWALK promotion and implementation. Learn about where people gather in the community, identify relevant pre-existing groups (including AHS staff in the community), and support local initiatives; Develop communication strategies and materials that can be modified to match the needs of the communities. Specifically, work with community partners to identify which content to market and how to tailor communications to their local experience, and; Develop training for local champions. Support local knowledge and skill development including how to develop community specific walking challenges that are tailored to the local physical and social environment. Implications UWALK is a promising practice; however, to optimize its use in priority underserved populations, strategies are needed to address their unique features. The rural strategy proposes to engage community leaders and champions, target promotional materials, and support local champions to tailor UWALK to their own circumstances to ensure increased awareness and use of UWALK.

What is eHealth (6)? Development of a Conceptual Model for eHealth: Qualitative Study with Key Informants.

BackgroundDespite rapid growth in eHealth research, there remains a lack of consistency in defining and using terms related to eHealth. More widely cited definitions provide broad understanding of eHealth but lack sufficient conceptual clarity to operationalize eHealth and enable its implementation in health care practice, research, education, and policy. Definitions that are more detailed are often context or discipline specific, limiting ease of translation of these definitions across the breadth of eHealth perspectives and situations. A conceptual model of eHealth that adequately captures its complexity and potential overlaps is required. This model must also be sufficiently detailed to enable eHealth operationalization and hypothesis testing.ObjectiveThis study aimed to develop a conceptual practice-based model of eHealth to support health professionals in applying eHealth to their particular professional or discipline contexts.MethodsWe conducted semistructured interviews with key informants (N=25) from organizations involved in health care delivery, research, education, practice, governance, and policy to explore their perspectives on and experiences with eHealth. We used purposeful sampling for maximum diversity. Interviews were coded and thematically analyzed for emergent domains.ResultsThematic analyses revealed 3 prominent but overlapping domains of eHealth: (1) health in our hands (using eHealth technologies to monitor, track, and inform health), (2) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients or patients), and (3) data enabling health (collecting, managing, and using health data). These domains formed a model of eHealth that addresses the need for clear definitions and a taxonomy of eHealth while acknowledging the fluidity of this area and the strengths of initiatives that span multiple eHealth domains.ConclusionsThis model extends current understanding of eHealth by providing clearly defined domains of eHealth while highlighting the benefits of using digital technologies in ways that cross several domains. It provides the depth of perspectives and examples of eHealth use that are lacking in previous research. On the basis of this model, we suggest that eHealth initiatives that are most impactful would include elements from all 3 domains.

The Digital Health Observatory of the Pierre Fabre Foundation: E-health, innovative projects, committed grant-winners.

Numerous E-health solutions are being created across the world, including in less advanced and emerging countries. These initiatives have a strong potential to improve access to information and care at all levels, especially in isolated regions that lack healthcare professionals, medical equipment, and infrastructure. Nonetheless, E-health deployment is still fragmented and rarely structured. It is important to support and disseminate research work to promote good practices, on the one hand, and, on the other, to harmonize its development by integrating it into public health-care systems. The aims of the E-health Observatory in Countries of the South are to identify, document, promote, and help to develop e-health initiatives in order to promote networking of the participants and the scaling up of initiatives with high potential for the disadvantaged populations of the South.

A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial

BackgroundEnhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients’ and clinicians’ behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes.MethodsThis article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake.DiscussionThis study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment.Trial registrationTrial registration: Dutch Trial Register NTR5677. Registered 17th January 2016.

Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya

BackgroundThe growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area.ResultsA total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials.ConclusionThis review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Self-assessment of independence in older people: First results from an open-access website for senior citizens and caregivers in France.

E-health initiatives on the Internet can be used to provide support to people with chronic diseases and to their caregivers. In 2014/2015, we created a free website called jesuisautonome.fr where older people, or their carers on their behalf, can assess their independence in daily living by filling out a simple questionnaire. To evaluate the interest of the public in websites of this kind, by analysing home care plans obtained via the self-assessment questionnaire. We also describe patterns of use and visitor behaviour. Over a period of 6 months, we analysed data from the website in terms of the basic characteristics of the user; the number of questionnaires completed; the main types of needs in terms of home support; and data from Google Analytics about the number of visitors, user behaviour and behaviour flow. During the 6-month study period, 439 visitors to the site either viewed, part-completed or fully completed the questionnaire. A total of 190 users completed the questionnaire. Seventy-one per cent of the completed questionnaires were from family caregivers, and 29% were from senior citizens. The mean age of those receiving care was 78 ± 10.46 years. Their main needs were for domiciliary care (29.3%). Data from Google Analytics showed about 420 visits per month. Approximately 7.5% completed a questionnaire, approximately 5.3% downloaded a home care plan and there was a bounce rate of about 62%. First results from this website tend to endorse its use as a means of making practical solutions available to caregivers and older people.

Assessing the Coverage of E-Health Services in Sub-Saharan Africa. A Systematic Review and Analysis.

E-Health has attracted growing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. To review publicly available literature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002-2014. Six types of e-Health interventions were reported, with 17 studies (65 %) based on telemedicine, followed by mHealth with 5 studies (19 %). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19 %), pathology (12 %) and radiology (8 %). Successes were 'widely reported' (representing 50 % overall acceptance or positive feedbacks in a study) in 10 studies (38 %). The prominent challenges reported were technical problems, poor internet and connectivity, participants' selection biases, contextual issues, and lack of funds. E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contextually feasible, acceptable, and sustainable.