eHealth Innovations Research Articles

Limitations of NHIC claim code-based surveillance and the necessity of UDI implementation in Korea

The E-Health Big Data Evidence Innovation Network (FeederNet) in Korea, based on the observational medical outcomes partnership (OMOP) common data model (CDM), had 72.3% participation from tertiary hospitals handling severe diseases as of October 2022. While this contributes to the activation of multi-institutional research, concerns about the comprehensiveness of device data persist due to the adoption of national health insurance corporation (NHIC) claim codes as device identifiers in the medical device field. This study critically evaluated the effectiveness and compatibility of NHIC claim codes and unique device identifier (UDI) within FeederNet to identify the optimal identifier for efficient Post-market surveillance (PMS). Specifically, this study addressed three main questions: (1) the number of UDIs classified as NHIC-covered items, (2) the number of UDIs included in each NHIC claim code, and (3) the number of NHIC claim codes each UDI covers. Among the 1,979,655 UDIs registered domestically, only 36.02% (712,983) were classified as covered by National Health Insurance. NHIC-covered medical devices were limited to categories (A) medical devices, (B) medical supplies, and (C) dental materials, excluding most software and in vitro diagnostics (IVD). Multiple UDIs could be registered under a single NHIC claim code, and a single UDI could be registered under multiple NHIC claim codes. Only 32.62% (13,756/42,171) of NHIC claim codes had registered UDIs, with an average of 53 UDIs per claim code. Of the UDIs listed as NHIC covered, 92.39% (659,046/713,341) had one claim code, while 7.25% (51,652) had multiple claim codes. Additionally, 2643 UDIs were listed as NHIC covered but had no registered claim codes. Due to this complex relationship, NHIC claim code-based PMS may pool safe and unsafe models or disperse problematic models across multiple claim codes, leading to a lower problem rate or insignificant differences between claim codes, thus reducing signal detection sensitivity compared to UDI-based PMS. In conclusion, NHIC claim code-based PMS has limitations in granularity and signal detection sensitivity, necessitating the adoption of UDI-based PMS to address these issues. The UDI system can enhance the accuracy of medical device identification and tracking, playing a crucial role in generating real-world evidence (RWE) by integrating data from various sources. Future research should explore specific strategies for integrating and utilizing UDI with NHIC claim codes, contributing to the implementation of a more reliable and comprehensive PMS in Korea’s healthcare system.

Use of eHealth and remote patient monitoring: a tool to support home dialysis patients, with an emphasis on peritoneal dialysis

ABSTRACT Implementing eHealth requires technological advancement, universal broadband and internet access, and devices to conduct telemedicine and remote patient monitoring in end-stage kidney disease patients receiving home dialysis. Although eHealth was beginning to make inroads in this patient population, the COVID-19 pandemic spurred telemedicine usage when many regulations were waived during the Public Health Emergency to limit the spread of infection by endorsing social distancing. At the same time, two-way communication automatic peritoneal dialysis cyclers were introduced to advance remote patient monitoring. Despite the numerous advantages and potential benefits afforded by both procedures, challenges and untapped resources remain to be addressed. Continuing research to assess the use of eHealth and technological innovation can make eHealth a powerful tool in home dialysis. We review the past, present and future of eHealth and remote patient monitoring in supporting home dialysis.

A narrative review of e-health systems' evolution - evidence from a regional study.

The growing implementation of electronic health (e-health) systems has raised the importance of analyzing how these systems have been implemented in diverse regions. By employing a contextual sensitive approach and social mechanism theory, this study aims to better understand the reasons for the success and failure of e-health initiatives in the ex-Yugoslav region and derive useful insights for policymakers. We employ a narrative review process grounded in the social mechanism theory, extended with field experts' review, to acquire state-of-the-art information. Findings indicate that different e-health systems coexist and evolve in different contexts in different countries, with varying levels of success. The contextual differences shape the broader environment, affecting the level of preparedness and capability for e-health implementation. Top-down approaches dominate e-health implementation in most countries when it comes to design process features, and more developed countries do not rely on strong social mechanisms for implementing e-health due to the openness of their culture towards e-health innovations. Analyzing the milestones, challenges and functionalities of e-health systems in the region of interest can assist policymakers, academics and practitioners in making informed decisions and recommendations to enhance future e-health implementation. No known studies evaluated e-health initiatives in the former ex-Yugoslav countries holistically and evolutionarily in the form of a comprehensive regional study. Further, our research endeavor is contextually specific since the health systems of these countries in the past were tied together under the federative umbrella health system and then diverged in terms of e-health development.

Sustaining e-health innovations in a complex hospital environment: learning through evidence.

Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their "business case" and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers.

E-health education intervention to increase dietary adherence among diabetic ulcer patients

Background: Preventing complications of diabetes mellitus requires medical treatment and education. Diabetic ulcer is one of the complications of diabetes mellitus due to traumatized nephropathy. E-health education innovation makes it easy for patients to access education on how to prevent complications from diabetes mellitus. Purpose: Analyzing the effect of e-health education of diabetes mellitus based on the QR model website as a means of dietary compliance in grade 2 diabetic ulcer patients. Method: Employing true experimental pre-test post-test design with control group design. It involved 30 participants who were divided into 2 groups through simple random sampling. Saphiro-Wilk was used for data normality test and Man-Whitney was used for hypothesis testing with score difference test. This research was conducted at the Anak Lanang Wound Care Center Clinic, Semarang. Results: There was an increase in scores on dietary adherence between groups (64.13±2.82 vs 59.07±2.91). Both groups experienced an increase in scores, but the increase was greater in the intervention group given e-health education of diabetes mellitus compared to the control group given the Booklet. Conclusion: There is an effect of e-health education of diabetes mellitus on the level of dietary compliance in grade 2 diabetic ulcer patients. Suggestion: Future researchers are expected to develop database instrumentation and educational content for patients with diabetes mellitus.

Exploring Digital Health Horizons: A Narrative Review of E-Health Innovations in Poland, Spain, Romania and Estonia.

E-health offers new opportunities for self-management, health and social care and access to health information. Over the last decade, the use of e-health solutions by patients, healthcare providers, professionals and citizens has increased significantly. This article provides an overview of e-health innovations in Poland, Spain, Romania and Estonia, focussing on the digital development of healthcare services. It outlines the concept of e-health and the innovative solutions the countries listed have introduced in this area. They all face challenges such as the cost of implementing new technologies, data access and the security of patient data. As a result, there is a constant need for coordinated collaboration, legislation and clear guidelines for the use of technology in healthcare. The lessons learnt from these countries are helping to shape the digital future of healthcare in Europe. In Poland, the Ministry of Health oversees the eHealth Centre, which has made remarkable progress in the field of eHealth services such as the Internet patient account, electronic prescriptions and electronic referrals. The biggest challenges include financing innovation and improving digital skills. Poland has also recently introduced the no-fault system as an alternative compensation system for medical errors, modelled on similar systems in Denmark and Sweden. Technological progress is driving the transformation of the Spanish healthcare system, which is particularly evident in the area of telemedicine and innovative healthcare systems. The Spanish Digital Health Strategy lines up with broader national initiatives. Despite challenges such as underfunding, Romania has introduced digital healthcare with the Health Electronic Record since 2014. As an absolute pioneer in the digitalisation of healthcare in Europe, Estonia is proud of its achievements in the digitalisation of healthcare data and services. The Estonian eHealth Foundation and the nationwide health information system are an example of seamless integration and set a benchmark for comprehensive digital healthcare.

Managing Medications During “Sick Days” in Patients With Diabetes, Kidney, and Cardiovascular Conditions: A Theory-informed Approach to Intervention Design and Implementation

ObjectivesOur aim in this work was to 1) explore barriers and enablers to patient and health-care provider (HCP) behaviours related to sick-day medication guidance (SDMG), 2) identify theory-informed strategies to advise SDMG intervention design, and 3) obtain perspectives on an eHealth tool for this purpose. MethodsA qualitative descriptive study using qualitative conventional content analysis was undertaken. Interviews and focus groups were held with patients and HCPs from January 2021 to April 2022. Data were analyzed using the Behaviour Change Wheel and Theoretical Domains Framework to inform intervention design. ResultsForty-eight people (20 patients, 13 pharmacists, 12 family physicians, and 3 nurse practitioners) participated in this study. Three interventions were designed to address the identified barriers and enablers: 1) prescriptions provided by a community-based care provider, 2) pharmacists adding a label to at-risk medications, and 3) built-in prompts for prescribing and dispensing software. Most participants accepted the concept of an eHealth tool and identified pharmacists as the ideal point-of-care provider. Challenges for an eHealth tool were raised, including credibility, privacy of data, medical liability, clinician remuneration and workload impact, and equitable access to use of the tool. ConclusionsPatients and HCPs endorsed non-technology and eHealth innovations as strategies to aid in the delivery of SDMG. These findings can guide the design of future theory-informed SDMG interventions.

E-Health, m-Health, personalised medicine – challenges faced by healthcare systems in Central and Eastern Europe

Background and purpose: The purpose of this study aims to explore measures intended to remove barriers to the implementation of innovative interventions and identify best practices applicable in European countries that support the implementation of cutting-edge e-health, m-health and personalised medicine (PM) interventions at the micro-, meso- and macro-regional levels. Thanks to PM, people are closer to more accurate, predictable and powerful healthcare tailored to individual patients [1]. PM indicates treatment adapted to the patient's characteristics, needs and preferences. PM categorises patients according to the risk of developing a particular disease or degree of response to a given treatment using appropriate diagnostic markers. PM also aims to increase control over the optimisation of medical treatment outcomes and increase the precision of medical treatment, as well as improve disease prediction [2]. The study concept constitutes one of the indicators of the Regions4PerMed project entitled "Interregional coordination for a fast and deep uptake of personalised health" (Horizon 2020).
 Group of respondents: The group of respondents included stakeholders of the Regions4PerMed project - members of the Regions4PerMed Advisory Board, organisations associated with the Patients’ Organisations Council, small and medium enterprises involved in e-health innovation, presenters at conferences and workshops associated with research institutions, private funders, policymakers, policy advisors, project managers, researchers, patient representatives, physicians, academic staff and healthcare consultants.
 Techniques and tools: The qualitative research took the form of online questionnaires and focus group interviews (semi-structured) to identify key barriers and facilitators to the implementation of innovative e-health interventions at the micro-, meso- and macro-regional levels within health and social care systems conducted according to the following five thematic priorities of the Regions4PerMed project which are:
 1.Medical Big Data, Electronic Health Records and Health Governance
 2.Connected health: Better system integration and patient management
 3.Health industry: Driving healthcare innovations
 4.Facilitation of the flow of innovation in healthcare
 5.Socio-Economic Aspects – basic principles.
 
 Outcomes and contexts: The ongoing research will provide data for the development of recommendations that identify the limitations to and benefits of the implementation of innovative e-health interventions for health and social care, with regard to chronic diseases, at the micro-, meso-, and macro-regional levels. In Poland (as well as throughout Eastern Europe), there are still tangible barriers to the development of e-health and m-health in terms of chronic diseases.
 

Health Care Professionals' Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation.

The development and evaluation of eHealth interventions in clinical care should be accompanied by a thorough assessment of their implementation. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was designed to facilitate the implementation and scale-up of health technology programs, providing an option for analyzing the progression of these initiatives as they are implemented in real-time. Considering health care provider perspectives within the framework for implementation offers valuable insights into the early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. Nevertheless, there is a dearth of studies on eHealth interventions that encompass longer time frames and delve into the complexities of scaling up and sustaining such interventions within real-world health care environments. This study aims to investigate the perspectives and insights of health care professionals (HCPs) regarding the implementation of an eHealth intervention in pediatric health care while applying the NASSS framework to theorize and evaluate the conditions influencing the implementation of eHealth solutions. Semistructured interviews were performed with health care providers, including both staff and management personnel, within a university pediatric hospital (N=10). The data collection process occurred concurrently with a clinical trial focused on developing and assessing an eHealth app for self-management in pediatric care following hospital discharge. Using an abductive approach, the interviews were initially analyzed qualitatively and subsequently mapped onto the 7 domains of the NASSS framework to identify factors influencing implementation, encompassing facilitators, barriers, and varying levels of complexity. In the realm of pediatric care, the family was identified as the primary unit of care, and patient heterogeneity was a prominent feature. The implementation of eHealth tools, while deemed usable and flexible, was also seen as a delicate balance between safety and adaptability, highlighting challenges related to health care integration. Child participation and secrecy, especially for adolescents, contributed to the complexity of using eHealth. HCPs had high eHealth literacy, and thus challenges concerning adoption were related to work adaptations and the risk of "app overload." The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, HCPs raised concerns related to regulatory requirements for documentation, public procurement, and data safety. Implementation became more complex due to a lack of overview in a large organization. Important perspectives for implementation were considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular health care. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological, and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders. ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/ct2/show/NCT04150120.

Toward digital inclusion of older adults in e-health: a case study on support for physical activity

AbstractOlder adults are a heterogeneous population for which many e-health innovations are inaccessible. Involving older adults in user-centered design (UCD) with a specific focus on inclusive design is important to make e-health more accessible to this user group. This case study aimed to explore the feasibility of a new UCD approach aiming to minimize bias in the design phase of a digital support for older adults’ physical activity (PA). The study used mixed methods and applied UCD principles in a four-iteration design phase followed by an evaluation phase where 11 and 15 older adults participated, respectively. The users’ gender, PA level and technology experience (TE) were considered in recruitment, data analysis and prioritization of improvement efforts. In the design phase, users with different gender, PA level and TE participated and contributed with feedback, which was prioritized in the development. The adaptation included improving readability, simplifying layout and features, clarifying structure, and making the digital content more inclusive and relevant. The evaluation showed that the users had a positive experience of the prototype and could use it with some help. The study demonstrated that adopting e-health to assure digital inclusion among older adults must address several aspects. The UCD approach was feasible for amending user bias and for confirming that users of both genders and with varied PA- and TE level shaped the design. However, evaluation of the method with larger samples is needed. Moreover, further research on methods to involve digitally excluded populations in UCD is needed.

Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach.

The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. The study used iterative cycles of planning, action, and reflection, whereby participants' experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users' needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users.

How to involve potential users in eHealth innovation: seven strategies from healthcare and design

To arrive at viable eHealth applications, it is important that future users are involved in research projects. In practice, however, it is difficult to involve potential users and keep them involved. In a multiple-case study, we investigate ten eHealth projects in which design researchers and healthcare researchers worked together. We focus on how they involved potential users and kept them involved. Both domains have a rich tradition of involving potential users and see their involvement of potential (future) users in the early stages of innovation as essential. Therefore it is interesting to investigate projects in which design researchers and healthcare researchers intensively work together. We discovered seven strategies to promote the involvement of potential users in eHealth research projects: (1) use research methods based on building personal relationships; (2) build trust before introducing research methods; (3) facilitate the preconditions around the moments of involvement; (4) facilitate by introducing a prototype as a boundary object; (5) choose the method that fits the research context; (6) integrate the values behind the eHealth tool into the research method; (7) involve proxies instead of the potential users. These strategies may guide future projects where design researchers and healthcare researchers work together with potential users.

The eHealth usage during COVID-19 pandemic 2020 year-Case of Poland.

According to the DESI 2022 digital economy and society ranking, Poland still ranks in one of the last position. Although, in digitising healthcare Poland has made significant progress over the last five years, some inequities in the usage of eHealth have been recognised. This has become an especially important topic after the COVID-19 pandemic. Suddenly, eHealth innovations were much needed to maintain the accessibility of healthcare. Thus, the aim of this study was to explore determinants of eHealth usage by Poles and identify existing potential barriers. Data was collected from the databases of Statistic Poland and statistical methods were employed in this research. The results showed that five variables such as Internet access, Internet use, Internet skills and average monthly disposable income per capita in PLN, along with the number of practicing physicians per capita were important determinants explaining eHealth usage by the analysed Poles between the age of 16-74. The findings showed to increase the usage of eHealth, health policy makers should ensure that Poles acquire and improve Internet skills. Based on results of the research an extended model of eHealth development in Poland, consisting of a central governmental institution and local facilities coordinating remote electronic services, collecting statistical data and providing educational campaigns, was proposed as well.

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.

Assessing the sustainability and scalability of a diabetes eHealth innovation: a mixed-methods study

BackgroundTo date, little is known about the sustainability and scalability of MyDiabetesPlan, an eHealth innovation designed to facilitate shared decision-making within diabetes care. To avoid the possibility of its short-lived implementation and promote wider adoption so as to promote patient-centred diabetes care, it is critical to understand MyDiabetesPlan’s sustainability and scalability in order to ensure its long-term impact at a greater scale. We sought to identify the sustainability and scalability potential of MyDiabetesPlan and its limiting factors.MethodsUsing a concurrent triangulation mixed-methods approach, data were collected from 20 individuals involved in the development and implementation of MyDiabetesPlan. The National Health Services Sustainability Model (NHSSM) and the Innovation Scalability Self-administered Questionnaire (ISSaQ) were administered using a ‘think-aloud’ approach and subsequently, short semi-structured interviews were conducted. Mean aggregate scores and stakeholder-specific scores were generated for the NHSSM and ISSaQ, to quantitatively determine facilitating and limiting factors to sustainability and scalability. Content analysis occurred iteratively with qualitative data, to examine commonalities and differences with the quantitative findings.ResultsThe top facilitating factor to sustaining MyDiabetesPlan was “Staff involvement and training to sustain the process.”, whereas the top limiting factors were: “Adaptability of Improved Process”, “Senior Leadership Engagement” and “Infrastructure for Sustainability”. The top three facilitating factors for scale-up were “Acceptability”, “Development with Theory” and “Consistency with Policy Directives.” Conversely, the top three limiting factors were “Financial and Human Resources”, “Achievable Adoption” and “Broad Reach”. Qualitative findings corroborated the limiting/facilitating factors identified.ConclusionsAddressing staff involvement throughout the dynamic care contexts, and resource constraints impacting scale-up can enhance the sustainability and scalability of MyDiabetesPlan. As such, future plans will focus on garnering organizational leadership buy-in and support, which may address the resource constraints associated with sustainability and scalability and improve the capacity for adequate staff involvement. eHealth researchers will be able to prioritize these limiting factors from the outset of their tool development to purposefully optimize its sustainability and scalability performance.

Evidence of internal structure of the transactional eHealth literacy among Vietnamese youth: An instrument validation study.

The progression into the Digital Age has brought an array of novel skill requirements. Unlike traditional literacy, there are currently few measures that can reliably measure eHealth literacy. The Transactional Model of eHealth Literacy and subsequent Transactional eHealth Literacy Instrument may provide a feasible option for measuring eHealth literacy. This instrument has yet to be validated, which is the aim of this study. In particular, this article was conducted to validate the TeHLI to see which components of the tool (how many and which components included) would be the best fit statistically and whether the tool applies to groups of different characteristics. We conducted an online cross-sectional study among 236 Vietnamese young people. A exploratory factor analysis was used to identify the best fit model of the Transactional eHealth Literacy Instrument. A confirmatory factor analysis tested measurement invariance at four levels: configural, metric, scalar, and strict invariance. Only metric invariance was partially invariant, while the rest tested fully invariant. Even with partial metric invariance, there is reason to assume that functional, communicative, critical, and translational eHealth literacy (the four levels according to the transactional model) are consistently measured when deploying the Transactional eHealth Literacy Instrument across groups. The study findings substantiate that the most optimal composition of the TeHLI consists of four factors: functional, communicative, critical, and translational eHealth literacy, with RMSEA = 0.116; CFI = 0.907, and the highest internal consistency (Cronbach's α = 0.91, 0.92, 0.88, and 0.92 for each factor respectively). After using measurement invariance, that gender, education, marital status, age, location, and household economy do not influence the way participants to respond to the TeHLI to the point that would introduce measurement bias. In other word, using TeHLI across population groups should not produce error margins that substantially differ from each other. This study suggests the instrument can be used for comparisons across groups and has the potential to generate high-quality data usable for informing change agents as to whether a particular population is proficient enough to adopt novel eHealth innovations.

Effectiveness of digital care platform CMyLife for patients with chronic myeloid leukemia: results of a patient-preference trial

BackgroundTwo most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring albeit still being suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients, aiming to improve their care, leading to an increased quality of life and the opportunity of hospital-free care.ObjectiveTo explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life.MethodsEffectiveness of CMyLife was explored using a patient-preference trial. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least 6 months, after which they completed the post-intervention questionnaire. Scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models.ResultsAt baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. Self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these.ConclusionsSince hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable.Trial registrationClinicalTrials.gov NCT04595955, 22/10/2020.

E-Health Research in Southeast Asia: A Bibliometric Review

eHealth or digital health innovations expanded tremendously during the COVID-19 pandemic. Innovation and digitalization offer creative solutions to build up a healthy society. The eHealth technologies are quickly taken up by Southeast Asia countries and continue to flourish to alleviate the burden of healthcare challenges. This study is the first review exploring and analyzing the whole literature of eHealth, specifically in the Southeast Asia region. The objective of this study is to document the size, growth trajectory, and geographical distribution of eHealth in Southeast Asia research, identify high-impact authors and documents, explore the intellectual knowledge structure, and analyze the topical trends of the field. The bibliometric analysis was used to analyze a data set of 1405 Scopus-indexed documents between 1976 and 2021. Descriptive analysis, citation, co-citation, and keyword co-occurrence analyses were conducted to gain insights into eHealth in the Southeast Asia knowledge base. The growth rate of literature has rocketed up since 2018, reflecting the significant increase in demand for eHealth in Southeast Asia. Among the eleven Southeast Asian countries, Indonesia, Malaysia, Singapore, and Thailand were the top four countries where the most eHealth-related research was conducted. The intellectual structure of eHealth in Southeast Asia literature comprises four schools of thought (i.e., four groups of similar theoretical perspectives and research interests): (1) analysis and adoption of hospital information system/eHealth records, (2) user intention and acceptance of information technology, (3) technology for healthcare and disease management, and (4) mobile health technology (m-Health). Mobile applications, social networks, the COVID-19 pandemic, patient referral, follow-up, self-care, quality of life, psychology, diabetes mellitus, and hypertension are the recent emerging research themes in the field of study. The eHealth development should consider long-term sustainable management along with the rapid evolution of the field. Additionally, eHealth systems should be holistic and pay attention to technology adoption, data security, and ethical issues involved in medical practices. This bibliometric review delivers reference points for scholars interested in Southeast Asia eHealth, reveals the emerging intellectual structure of this interdisciplinary field, and provides guidance to future research on this domain.

Embracing e-health systems in managing the COVID 19 pandemic in Sub-Saharan Africa

The COVID-19 pandemic and the policy responses adopted to curtail it have drastically altered how health services are delivered around the globe. To enable the public to continue accessing health care, e-health innovations have become the most viable tool to provide convenient, timely, effective and safe care, while reducing the spread of the virus. This paper utilized data from existing literature to explore the benefits and challenges of implementing e-health technologies in Sub Saharan Africa (SSA) amid this pandemic. Evidence suggests that these technologies have the potential to strengthen public health systems in SSA as they have in First World countries. However, there are a number of challenges that need to be addressed first in order to realize the full promises of e-health on the continent. The paper proposes that African governments should come together and implement similar e-health policies, share software, expertise and other critical ICT infrastructure as it can result in the successful implementation of e-health innovations, while reducing the financial burden associated with their set up.

A feasibility study of a best practice health literacy app for Australian adults with chronic kidney disease.

To investigate feasibility of the SUCCESS app; a cross-platform e-health innovation to improve health literacy, self-management and shared decision-making among culturally-diverse Australian haemodialysis patients. Multi-site, pre-post, mixed-methods study. Haemodialysis patients ≥18 years used the app for 12 weeks. Qualitative data from 18 interviews were thematically analysed to evaluate app acceptability. Quantitative analysis using paired sampled t-tests evaluated feasibility outcomes pertaining to recruitment, retention, data collection and app efficacy (including health literacy; decision self-efficacy; quality of life; behaviour; knowledge; confidence). We successfully recruited diverse participants (N = 116; 45% born overseas; 40% low/moderate health literacy) from four Local Health Districts in Sydney, Australia. However, only 61 participants completed follow-up questionnaires. Qualitative analyses provided insights into acceptability and user engagement. Quantitative analyses showed significant improvements on the health literacy domain 'Ability to actively engage with healthcare providers' (Mean Difference [MD] = 0.2 on a 5-point scale; CI95%: 0.0-0.4; p = 0.03) and decision self-efficacy (MD = 4.3 on a 10-point scale; CI95%: 0.6-7.9; p = 0.02) after 12 weeks app use. The SUCCESS app was feasible and acceptable to participants. The app will be adapted to facilitate ongoing use and engagement among diverse haemodialysis patients. This is the first health literacy-informed app to promote active participation in haemodialysis self-management and decision-making, tailored toward culturally-diverse and low health literacy groups.