E-health Implementation Research Articles

OP145 Review Of eHealth Interventions For Improving Primary Healthcare In Low-Middle Income Countries

IntroductionWeb-based and mobile health interventions, also called eHealth, have significant potential to deliver cost effective, quality health care. The present review maps common eHealth technology solutions for primary healthcare by evaluating their safety, efficacy, and effectiveness, and the challenges associated with their implementation in low-middle income countries (LMIC) in the last ten years.MethodsA search of various electronic database was conducted, including PubMed, Scopus, and PsycINFO, to identify articles published between 2009 and 2019 that focused on the implementation of eHealth in the primary healthcare setting across LMICs. A total of 450 articles were screened and thirty-nine relevant articles were selected for review.ResultsThe thirty-nine included studies were classified into the following four categories: (i) assessment of intervention effects (n = 26); (ii) cost-benefit analysis (n = 4); (iii) systematic review (n = 5); and (iv) conceptual exploration of eHealth interventions (n = 4). The eHealth studies covered three domains: (i) non-communicable diseases; (ii) reproductive, maternal, newborn, and child health; and (iii) other health issues. The included eHealth technologies comprised mobile health (n = 27), telemedicine (n = 10), and information and communication technology (n = 2).ConclusionsThe majority of studies assessed eHealth technologies based on the following eight dimensions: safety, clinical effectiveness, technical aspects, acceptability, cost, ethical aspects, adaptability to local needs, and scalability. However, evidence on safety, cost effectiveness, and scalability were limited. The main implementation challenges identified were technology development and maintenance costs, the need for trained human resources, and acceptability among users. The methodologies and assessment frameworks of the studies were heterogeneous in nature, highlighting the need for a robust, standardized, and comprehensive framework for assessing eHealth technologies.

E-Commerce and E-Health Strategies and Implementation Activities in the United Kingdom: Review Study

E-Commerce and E-Health Strategies and Implementation Activities in the United Kingdom: Review Study

Development of a framework for the implementation of electronic interventions in mental health: a protocol for a meta-synthesis of systematic reviews.

Background: During the COVID-19 pandemic, it has been necessary to incorporate technologies in the care of mental health problems. But there have been difficulties in the application of technology-based interventions in mental health. Some quantitative systematic reviews don't allow us to fully identify and properly describe this subject. In order to answer the question "how do electronic interventions apply in mental health and what makes the application of any of these interventions work", this study will carry out an overview of systematic reviews, which will make it possible to develop a theoretical framework on the implementation of electronic care in mental health problems. Methods: We will search MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020, with no language restriction. We will follow a qualitative method approach and include systematic reviews that assess primary studies relating to adults with common mental health problems using any type of mobile mental health intervention that includes a synchronic component and communication with a mental health professional. For the analysis, we will make a meta-synthesis of the systematic reviews, using an emergent grounded theory approach to synthesize the information, prioritizing the systematic reviews with the lowest risk of bias in the AMSTAR-2 tool. The meta-synthesis will be based on interpreting, integrating, and inferring the evaluation elements to understand better the e-health implementation process for patients with mental health problems. Finally, we will present the overall assessment in a Summary of Qualitative Findings table. Conclusion: Our results will allow a better understanding of the facilitator and limitations in implementing e-health interventions for mental health problems.

NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol

BackgroundSubstance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation.MethodsThis cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment–Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizationsDiscussionThis study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies.Trial registrationClinicalTrials.gov, NCT03954184. Posted 17 May 2019

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

Background The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability. Objectives We consider how evidence-based implementation strategies can be built to support eHealth implementation. Discussion What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context. Conclusion Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.

Digital and innovation skills in health care professionals in Europe

Abstract Background Rising life expectancy and ageing population are current phenomena that European society is facing and these are challenges for the European healthcare systems. To face them, several e-health solutions are already designed to optimize resources of the healthcare provider system. However, most of them are not being implemented or deployed. Some of the reasons are the lack of digital skills and innovation readiness in staff, and existing barriers to changing organizational practices. Objectives The DISH project (601008-EPP-1-2018-1-DK-EPPKA2-SSA) will develop 3 concepts to improve the digitalization of healthcare staff to help them in the use of e-health solutions already developed: 1)Learning Innovation Units, where healthcare staff, SMEs and educational institutions work together for improving the e-health solutions development and implementation; 2)On the job training, where healthcare staff will be trained in e-health and digital competences; 3)Assessment, where competences accomplished by healthcare staff will be recognized. All these concepts will be tested in 6 EU countries. Results The development of the 3 concepts is based on a needs analysis on present and future competences required to support the implementation of e-health solutions in Denmark, Norway, UK, Germany, Spain and Poland. Also, each country will test the 3 concepts and train 100 healthcare staff in the use of an e-solution/innovation already developed but not being fully implemented. An evaluation of the achieved skills/competences by the staff will be also conducted. Conclusions Healthcare workers and SMEs show willingness and motivation in contributing to the digitalization but there is a clear lack of digital skills (although this is different from country to country) to make easier the adoption in daily practice of such solutions. The project looks for promoting close collaboration between the interested parties to work together in overcoming the stated deficiency. Key messages The DISH concepts will facilitate a training framework for healthcare professionals in the use of digital solutions. The DISH project will promote the use of several innovations already available in the market.

EHealth in the European Union – Comparative Study

eHealth is one of the global modern trends in IT, medicine and politics. It is a broad term that refers to electronization of healthcare and health services and mainly describes the use of information and communication technologies in healthcare. In practice, the evaluation of eHealth is an important matter because it leads to selection of appropriate measures for further progress in the field of electronic healthcare. What is more, it proposes recommendations for the development of eHealth in the EU countries. The article is focused on the comparison of eHealth implementation in the European Union member states. The analysis is performed by means of ELECTRE III method. The results of the empirical research further evaluate the state of eHealth implementation in all European Union member states by selected criteria and enable the comparison of the eHealth implementation in the international context. The results are verified by application of MAPPAC method. It has been acknowledged that the best ranking countries in this area has been obtained by Denmark, Finland, Estonia and Sweden.

EHealth Technology in Forensic Mental Healthcare: Recommendations for Achieving Benefits and Overcoming Barriers

While eHealth technologies such as web-based interventions, mobile apps, and virtual reality have the potential to be of added value for forensic mental healthcare, there is a gap between this potential and the current situation in practice. The goal of this study was to identify recommendations to bridge this gap. In total, 21 semi-structured interviews and 89 questionnaires were conducted in a Dutch forensic mental healthcare sample consisting of professionals, patients, and eHealth experts. Based on the broad range of identified recommendations, it can be concluded that attention should be paid to the characteristics of professionals, patients, technology, and the organization throughout the development, implementation and evaluation of eHealth.

Correction: Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study

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Survey-based data describing readiness to adopt an electronic pregnancy registration-monitoring system amongst health workers.

Electronic Health (eHealth) systems show a growing trend in developing countries to enhance their respective healthcare services. However, there is a lack of empirical study regarding readiness during preparation for eHealth implementation in Primary Health Care (PHC) units, specifically for antenatal care health workers who serve not only for personal care but also community services. The survey-based data applied in this research describes the assessment of the pre-implementation of the Electronic Pregnancy Registration and Monitoring System amongst health workers who involved in ANC services in primary health care (PHC) units of South Tangerang district, an urban area of Banten Province, Indonesia. Primary data was collected from 210 ANC health workers who work in 6 PHCs of the district. The data consists of socio-demographic factors of respondents such as age, education, years of experience etc., and captures individual responses to measure their readiness for eHealth adoption. The availability of this data will provide valuable information for researchers, healthcare organisations and government as the policy makers to prepare strategies with regard to readiness for eHealth adoption amongst health workers in PHCs

Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study.

BackgroundDespite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase.ObjectiveThe objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase.MethodsThree consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an “eHealth evaluation cycle” and subsequently compose the online “eHealth methodology guide.”ResultsThe scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an “eHealth evaluation cycle” was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the “eHealth methodology guide” was composed by assigning the 75 evaluation approaches to the specific study phases of the “eHealth evaluation cycle.”ConclusionsSeventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online “eHealth methodology guide.” By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the “eHealth evaluation cycle,” the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions.

Security Value Issues on eHealth Implementation in Indonesia

eHealth is an information technology solution for improving healthcare to be more effective and efficient. eHealth innovations not only give expected benefits but also new problems, one of them is security value issues. This inquiry has purpose to identify problems of security-related value in eHealth implementation in Indonesia involving its stakeholders. We use constructivism as research paradigm with qualitative method. Data was collected through focus group discussion with five information security experts from State Cyber and Code Agency that work on security controls in healthcare sector. Data analysis using thematic coding with Atlas.ti as tool. This research explored some security value issues on eHealth implementation in Indonesia, including regulator value conflict, data integrity and reliability, and data privacy and confidentiality. Some of those problems are caused by specific regulation about information security for healthcare in Indonesia is not available yet that makes some value conflict among stakeholders involved in this sector. Some implications are also proposed, both practically and theoretically.

Examining E-Government Enabling of E-Health Service Through the Lens of Structuration Theory

The concepts of e-government and e-health have usually been separately studied and sparsely implemented in many developing countries. In the few studies where both concepts are combined, the role of e-government is hardly examined in the implementation and practice of e-health. This article offers an exploratory analysis and provides insight on the factors that influence the complementarity of both concepts, with focus on the Africa continent. Existing literature in the areas of e-government and e-health were gathered and used as data, from a qualitative method viewpoint. Dimensions of change from the perspective of the structuration theory was employed as a lens to guide the data analysis, which was conducted by using the hermeneutic approach. From the analysis, the role of the e-government in the implementation and practice of e-health was found to manifest from six main factors, which are source, platforms, collaboration, transparency, heterogeneity, and privacy. Based on these factors, a model was developed, which is intended to guide professionals in their practices. Also, the study might be of interest to academics from theoretical standpoint.

Advantages and disadvantages of the use of eHealth technologies during the COVID-19 pandemic

Objective: to evaluate the experience and possibilities of the use of eHealth technologies during the pandemic.Material and methods. A systematic review of literature containing information about the use of telemedicine, crowdsourcing monitoring and other eHealth resources during the COVID-19 pandemic was performed. Results. The main advantages and disadvantages of the use of eHealth technologies have been highlighted, the main problems arising on the way of their implementation have been identified and options for their solution have been proposed.Conclusion. In developed countries the COVID-19 pandemic has already accelerated the implementation of eHealth as a tool to combat the pandemic. But despite this, new laws and regulations governing liability in the field of remote treatment are needed, as well as guidelines regarding the use of crowdsourcing disease monitoring systems in addition to traditional epidemiological surveillance systems.

Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study

BackgroundGiven the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for Partner in Balance, an electronic health (eHealth) intervention to support the caregivers of people with dementia.ObjectiveThe specific objectives of this study were to (1) formulate evidence-based implementation strategies, (2) develop a sustainable business model, and (3) integrate these elements into an implementation plan.MethodsThis case study concerns Partner in Balance, a blended care intervention to support the caregivers of people with dementia, which is effective in improving caregiver self-efficacy, quality of life, and experienced control. The large-scale implementation of Partner in Balance took place in local dementia case-management services, local care homes, dementia support groups, and municipalities. Experiences from real-life pilots (n=22) and qualitative interviews with national stakeholders (n=14) were used to establish an implementation plan consisting of implementation strategies and a business model.ResultsThe main finding was the need for a business model to facilitate decision-making from potential client organizations, who need reliable pricing information before they can commit to training coaches and implementing the intervention. Additionally, knowledge of the organizational context and a wider health care system are essential to ensure that the intervention meets the needs of its target users. Based on these findings, the research team formulated implementation strategies targeted at the engagement of organizations and staff, dissemination of the intervention, and facilitation of long-term project management in the future.ConclusionsThis study offers a theory-based example of implementing an evidence-based eHealth intervention in dementia health care. The findings help fill the knowledge gap on the eHealth implementation context for evidence-based eHealth interventions after the trial phase, and they can be used to inform individuals working to develop and sustainably implement eHealth.

Validation of an e-health readiness assessment framework for developing countries

BackgroundStudies document e-health as having potential to improve quality of healthcare services, resulting in both developed and developing countries demonstrating continued interest in e-health uptake and use. e-Health implementations are not always successful as high failure rates have been reported in both developed and developing countries. These failures are often a result of lack of e-health readiness. e-Health readiness has been defined as the preparedness of healthcare institutions or communities for the anticipated change brought by programs related to information and communication technologies. As such it is critical to conduct an e-health readiness assessment prior to implementation of e-health innovations so as to reduce chances of project failure. Noting the absence of an adequate e-health readiness assessment framework (eHRAF) suitable for use in developing countries, the authors conceptualised, designed, and created a developing country specific eHRAF to aid in e-health policy planning. The aim of this study was to validate the developed eHRAF and to determine if it required further refinement before empirical testing.MethodsPublished options for a framework validation process were adopted, and fifteen globally located e-health experts engaged. Botswana experts were engaged using saturation sampling, while international experts were purposively selected. Responses were collated in an Excel spreadsheet, and NVivo 11 software used to aid thematic analysis of the open ended questions.ResultsAnalysis of responses showed overall support for the content and format of the proposed eHRAF. Equivocal responses to some open ended questions were recorded, most of which suggested modifications to terms within the framework. One expert from the developed world had alternate views.ConclusionsThe proposed eHRAF provides guidance for e-health policy development and planning by identifying, in an evidence based manner, the major areas to be considered when preparing for an e-health readiness assessment in the context of developing countries.

Integrating People, Context, and Technology in the Implementation of a Web-Based Intervention in Forensic Mental Health Care: Mixed-Methods Study.

BackgroundWhile eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and processes should be studied holistically, paying attention to factors related to context, technology, and people.ObjectiveThe main objective of this mixed-method study was to holistically evaluate the implementation strategies and outcomes of an eMental health intervention in an organization for forensic mental health care.MethodsFirst, desk research was performed on 18 documents on the implementation process. Second, the intervention’s use by 721 patients and 172 therapists was analyzed via log data. Third, semistructured interviews were conducted with all 18 therapists of one outpatient clinic to identify broad factors that influence implementation outcomes. The interviews were analyzed via a combination of deductive analysis using the nonadoption, abandonment, scale-up, spread, and sustainability framework and inductive, open coding.ResultsThe timeline generated via desk research showed that implementation strategies focused on technical skills training of therapists. Log data analyses demonstrated that 1019 modules were started, and 18.65% (721/3865) of patients of the forensic hospital started at least one module. Of these patients, 18.0% (130/721) completed at least one module. Of the therapists using the module, 54.1% (93/172 sent at least one feedback message to a patient. The median number of feedback messages sent per therapist was 1, with a minimum of 0 and a maximum of 460. Interviews showed that therapists did not always introduce the intervention to patients and using the intervention was not part of their daily routine. Also, therapists indicated patients often did not have the required conscientiousness and literacy levels. Furthermore, they had mixed opinions about the design of the intervention. Important organization-related factors were the need for more support and better integration in organizational structures. Finally, therapists stated that despite its current low use, the intervention had the potential to improve the quality of treatment.ConclusionsSynthesis of different types of data showed that implementation outcomes were mostly disappointing. Implementation strategies focused on technical training of therapists, while little attention was paid to changes in the organization, design of the technology, and patient awareness. A more holistic approach toward implementation strategies—with more attention to the organization, patients, technology, and training therapists—might have resulted in better implementation outcomes. Overall, adaptivity appears to be an important concept in eHealth implementation: a technology should be easily adaptable to an individual patient, therapists should be trained to deal flexibly with an eMental health intervention in their treatment, and organizations should adapt their implementation strategies and structures to embed a new eHealth intervention.

Telemedicine and e-Health Solutions for COVID-19: Patients' Perspective.

Telemedicine and e-Health Solutions for COVID-19: Patients' Perspective.

EHealth in support for daily functioning of people with intellectual disability: Views of service users, relatives, and professionals on both its advantages and disadvantages and its facilitating and impeding factors

ABSTRACT Background: The use of eHealth in support for daily functioning of service users with intellectual disability (ID) is a rather unexplored domain. Therefore, the current study identified the a) level of familiarity, b) advantages/disadvantages, and c) facilitating/impeding factors for the use of eHealth in support for daily functioning of people with ID according to service users, relatives, and professionals. Method: Four focus groups and one semi-structured qualitative interview were conducted. Results: Participants were familiar with numerous eHealth applications. Benefits were related to service users (e.g., increased independency) and relatives/professionals (e.g., providing more efficient support). Adequate informing and involving all stakeholders and centrally positioning the needs and possibilities of service users were reported as important facilitators. Contrary, impeding factors were malfunctioning Internet, expenses of eHealth, and lack of proper IT-support. Conclusions: The results provide imperative information for future eHealth implementations and to direct its use more specifically to people with ID.

Developing a Conceptual Framework Suitable for E-Health in War-torn Zones: The Case of Libya Conflict Regions

The myriads of healthcare challenges are no doubt more complex among nations under the siege of war and conflicts, such as the case of Libya. The healthcare systems are mostly overburdened due to escalated cases of injury, poor hygiene and limited number of medical expertise. Libya prior to the civil uprising had depended on foreign medical expertise, and as a result of the uprising these experts were forced to relocate. Series of civil conflict and random attacks has further weakened the health care system in Libya, which is basically the traditional or conventional system. This conventional system of health record management, diagnosis and prescription can easily be damaged or loss in the phase of conflict. Application of ICT in the health sector known as e-health has proffered solutions to most of these challenges through electronic health record management, diagnosis, booking appointments and medical prescriptions. Hence health records can be accessed online and easily on request. While developed countries have since adopted and implemented the e-health system, it is still a relatively new phenomenon in most developing countries like Libya. It is pertinent to know that adoption and successful implementation of e-health requires a thorough assessment of readiness level in terms of the different components and factors affecting e-health system. The study aims to apply knowledge from e-health readiness assessment to the design of a suitable e-health framework for implementing e-health services for the case of conflict zones such as Libya.