Implementation Of E-health Solutions Research Articles

Designing a Future eHealth Service for Posthospitalization Self-management Support in Long-term Illness: Qualitative Interview Study.

For patients with noncommunicable diseases (NCDs; eg, heart failure [HF] and colorectal cancer [CRC]), eHealth interventions could meet their posthospital discharge needs and strengthen their ability to self-manage. However, inconclusive evidence exists regarding how to design eHealth services to meet the complex needs of patients. To foster patient acceptability and ensure the successful development and implementation of eHealth solutions, it is beneficial to include different stakeholders (ie, patients and health care professionals) in the design and development phase of such services. The involvement of different stakeholders could contribute to ensuring feasible, acceptable, and usable solutions and that eHealth services are developed in response to users' supportive care needs when transitioning to home after hospitalization. This study is the first step of a larger complex intervention study aimed at meeting the postdischarge needs of 2 NCD populations. This study aimed to explore the perspectives of patients with HF and CRC and health care professionals on patient self-management needs following hospital discharge and investigate how a future nurse-assisted eHealth service could be best designed to foster patient acceptability, support self-management, and smooth the transition from hospital to home. A qualitative, explorative, and descriptive approach was used. We conducted 38 semistructured interviews with 10 patients with HF, 9 patients surgically treated for CRC with curative intent, 6 registered nurses recruited as nurse navigators of a planned eHealth service, and 13 general practitioners experienced in HF and CRC treatment and follow-up care. Patients were recruited conveniently from HF and CRC outpatient clinics, and the nurses were recruited from the cardiology and gastro-surgical departments at a university hospital in the southwest of Norway. The general practitioners were recruited from primary care in surrounding municipalities. Semistructured interview guides were used for data collection, and the data were analyzed using thematic analysis. In total, 3 main themes were derived from the data analysis: expecting information, reassurance, and guidance when using eHealth for HF and CRC self-management; expecting eHealth to be comprehensible, supportive, and knowledge promoting; and recognizing both the advantages and disadvantages of eHealth for HF and CRC self-management. The data generated from this interview study depicted the diverse needs for self-management support of patients with CRC and HF after hospital discharge. In addition, valuable suggestions were identified regarding the design and content of the eHealth service. However, participants described both possible advantages and disadvantages of a remote eHealth service. This study is the first step in the development of an eHealth service for posthospitalization self-management support for long-term illnesses. It concerns patients' supportive care needs and user requirements of an eHealth service. The findings of this study may add value to the planning and development of eHealth interventions for patients with NCDs.

Insight into the Digital Health System of Ukraine (eHealth): Trends, Definitions, Standards, and Legislative Revisions.

This article aims to provide an in-depth examination of the digital health system of Ukraine, focusing on the emerging trends, precise definitions, established standards, and recent legislative revisions that shape the practice and implementation of eHealth solutions within the country. The digital health landscape in Ukraine has witnessed significant transformations, especially in the wake of the COVID-19 pandemic and subsequent military conflicts. These events have catalyzed the expansion of telemedicine services, leading to innovative approaches in healthcare delivery. The national strategy underscores the necessity for human-centric and accessible telemedicine, reinforced by technological neutrality, and harmonization with global standards. A review of the current literature, national strategies, and legal documents was conducted, alongside an analysis of data usage and service provision patterns in various Ukrainian regions. Participation in the "Science for Safety and Sustainable Development of Ukraine" competition facilitated project initiatives like the development of a cloud-based platform for patient-centered telerehabilitation for oncology patients. The utilization of telemedicine has significantly increased in conflict-affected regions, demonstrating the need for, and the effective deployment of, digital health strategies under crisis conditions. Private health facilities and entrepreneurs have been pivotal in the provision of telemedicine services. Legislative efforts have been geared toward framing telemedicine as an integral component of the national eHealth system, ensuring interoperability, and aligning with international standards and the Internet of Medical Things (IoMT). The findings underscore the resilience and adaptability of the Ukrainian healthcare system in the face of adversity. There is a clear trend towards a more integrated, patient-focused, and technologically advanced healthcare model, aligning with international trends and prioritizing public health goals over private profits. This progress, however, is contingent upon continuous development, investment in technological infrastructure, and legislative support to sustain and advance digital health initiatives.

Application of activity theory to examine the implementation of e-health in Namibia

ABSTRACT Despite the investment and efforts to improve the health systems through the e-health solution, systems and activities remain fragmented, which hamper service delivery. These challenges persist because either the factors that influence the implementation of the e-health solutions are not known or they remain speculative. Empirically, this study reveals the factors that influence the development of e-health solutions in the country. It is an interpretivist study in which the semi-structured interview technique was employed to collect data and relevant documents authored by different health stakeholders, such as Ministry of Health and Social Services (MoHSS), Office of the Prime Minister (OPM) and from public and private health facilities in the country were gathered. The activity theory (AT) underpins the study, meaning it guided the analysis, from which eight factors: (1) disparity, which affects transparency; (2) isolation; means that e-health solutions are currently stand-alone; (3) governance; which includes standardization, policies, and principles; (4) requirements that cover functions and technology specifications; (5) know-how; entails skillset and human capacity; (6) interoperability; exchange and information use between IT solutions; (7) synchronization of data and processes; and (8) heterogeneity were found to be the main influence on the implementation of e-health solutions in the country.

Agent-Based Medical Health Monitoring System

One of the leading healthcare concerns worldwide is the aging population. Aged patients require more significant healthcare resources because they are more likely to have chronic diseases that result in higher healthcare expenses. The design and implementation of e-health solutions, which offer patients mobile services to assist and enhance their treatment based on monitoring specific physiological data, is one of the key achievements in medical information technology. In the last few decades, there have been tremendous advancements in healthcare technology regarding mobility, size, speed, and communication. However, the critical drawback of today’s e-Health monitoring systems is that patients are confined to smart rooms and beds with monitoring gadgets. Such tracking is not widespread due to chronic patients’ mobility, privacy, and flexibility issues. Further, health monitoring devices that are fastened to a patient’s body do not give any analysis or advice. To improve the health monitoring process, a multi-agent-based system for health monitoring is provided in this study, which entails a group of intelligent agents that gather patient data, reason together, and propose actions to patients and medical professionals in a mobile context. A multi-agent-based framework presented in this study is evaluated through a case study. The results show that the proposed system provides an efficient health monitoring system for chronic, aged, and remote patients. Further, the proposed approach outperforms the existing mHealth system, allowing for timely health facilities for remote patients using 5G technology.

Tele-critical health care: Lessons learned from the pandemic

The approach of remotely managing critically ill patients via an off-site command center was implemented since decades. However, SARS COV-2 pandemic lockdown triggered an urgent need for more innovations to ensure the continuity of intensive care units services when self-isolation was needed to prevent and reduce infection rates. Hence, implementing tele-intensive care units (tele-ICU) became a must and seems to be the future system cornerstone. The Society of Critical Care Medicine's Tele-ICU committee has recently described various models of tele-critical care (TCC) and its current adapted applications [1]. The ability to regionalize advanced critical care support such as nonconventional mechanical ventilation modes, extracorporeal membrane oxygenation, and other complex needs may be simplified with telemedicine [2]. Experienced intensivists can provide a real-time support to the local teams and participate to the decision making while performing virtual rounds using high-definition audio/visual (A/V) equipment. Moreover, TCC may enhance the intervention quality for emergency situations such as advanced cardiac life support. The immediate delivery of an intensivist to the room via A/V technology may save time and promptly initiate life-saving procedures. Instead of “all hands-on deck” approach, code leadership by a tele-ICU intensivist may allow to reduce the number of the on-site responding staff. The benefit was objective in several scenarios during the pandemic era and enabled a full compliance with the social distancing requirements [3]. The COVID Caregiver Cockpit is an approved connected health care solution which is compliant with the FDA classification for Mobile Medical Devices. It offers various enhanced features that allow remote patient monitoring, and secure inpatient ward staff communications. COVID Caregiver Cockpit might be an example of the great flexibility and adaptability of TCC solutions with unexpected emergencies [4]. The cost of Tele-ICU varies depending on the setting, hardware, software, training, and compatibility issues with other health systems. Cost was usually considered as limiting factor for the implementation of eHealth solutions. However, the return on investment (ROI) for an implemented Tele-ICU seems to be satisfactory especially in case of shortage in bedside board-certified intensivists [5]. Physician acceptance of TCC technologies was not optimal at the beginning of the experience. However, the urgent need during the pandemic has permitted to prove the TCC efficacy and increased its acceptability. Based on this objective benefit of TCC, several savant and scientific societies recommended the integration of telemedicine consultations into routine clinical care [6]. Recent reviews of the literature provided several examples of successfully implemented telehealth services. A framework of patient-centered telehealth models implementation should be introduced in all clinical practice settings [7,8].

6.G. Workshop: Developing a consent model for health information – challenges in a rapidly changing digital world

Abstract Advances in eHealth and digital technologies have the potential to improve the quality of patient care and promote efficiency across a health service. The potential benefits have often not been realised, however, due to a sometimes greater focus on organisational needs rather than pursuing a person-centred approach. There are some concerns from the public in relation to the privacy and security of data, issues in relation to digital literacy and inadequate digital infrastructure, and the potential erosion of the patient-healthcare professional relationship. The introduction of new information systems requires clarity around consent to align with good information governance practices and support people's rights and involvement in relation to health information decisions. Internationally, the successful introduction of digital technologies in healthcare have been informed by effective public engagement and involvement from the outset. Public engagement helps to build trust and confidence in relation to health information use, and gives insight into important considerations for the development of a consent model. As part of this workshop, we will share the experiences of three different European countries who are at varying stages of development and implementation of eHealth solutions. Ireland is at the early stages of transition to a more digital healthcare service. In England, there are a number of eHealth systems in place although difficulties have been experienced at stages; understanding public expectations and involving the public in decision-making has been an important component of their progress. Estonia is recognised as a leader in eHealth and has much to offer in relation to the fundamental principles of successful implementation. The objectives of this workshop are to: 1) share experiences in relation to the process of public engagement across different contexts; 2) examine the eHealth landscape in relation to health information sharing; and 3) lead a discussion on the opportunities and challenges faced for the future of health information in a digital world. This workshop will be comprised of three presentations, from each of the above country perspectives, followed by a panel discussion with contributions invited from the audience. Key messages Building public trust, via public engagement, is essential for successful implementation of digital health technologies. Digital health can transform future health systems but success requires strong national leadership, information governance, robust standards, consent management, and access rights.

Engaging the public on health information – the importance of being inclusive, authentic and collaborative

Abstract Successful implementation of eHealth solutions will only be realised with the support, confidence and trust of the public. An important step in this process is engagement with the public to understand their expectations and attitudes in relation to the use of their health information. Involving people in important decisions about their health information and ensuring that their rights in relation to health information are upheld is crucial and will ensure that new technologies and initiatives are implemented in a way that is acceptable. Public engagement must be undertaken in a meaningful and authentic way to build trust and confidence. Three core principles must guide public engagement: ensuring each activity is inclusive and reflects a diverse range of views; there must be an openness about the boundaries of influence and intended outcomes; and a focus must be placed on partnership and collaboration, for engaging with the public and sharing learnings with relevant organisations. Public engagement undertaken as part of the ‘OneLondon' programme, one of the UK's most progressive large-scale public deliberation events on health information, highlighted that people expect greater clarity in the intended use of health information. This appeared to be of importance for both healthcare professionals and members of the public. Despite the complexity of particular technologies, people believe there should be transparency about why, by whom, and how health information is collected, used and shared. Transparency is the foundation of building a trusted system. Additional examples of public engagement activities include the establishment of a Citizen's Advisory Group, who explore, discuss and deliberate specific issues to inform future decision-making and policy development. Continued and alternative means of engagement will be necessary to meet future challenges and take advantage of potential opportunities.

Understanding needs and expectations of heart failure patients and their caregivers regarding digital health - the PASSION-HF project

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): INTERREG-NWE Background/Introduction Current heart failure (HF) healthcare provision is not sufficient. Due to demographic changes and subsequent increases in comorbidities, along with unequal distribution of medical care in rural areas, alternative approaches need be sought. The use of eHealth applications has potential to enable patients to become more self-sufficient. The "PASSION-HF" project aims to develop an interactive decision-making system – a virtual doctor – that provides solutions based on current guidelines and artificial intelligence. Patient independence is maximized through 24/7 access to personalized HF-management. Furthermore, the application defines decision points, where medical professionals need to be included. Purpose To understand needs and expectations of HF patients and their informal caregivers in regard to a virtual doctor. Methods We conducted an exploratory mixed-methods study within the Netherlands, UK, Ireland and Germany. Semi-structured qualitative interviews were supplemented by a standardized questionnaire. The interviews focused on i) acceptance and motivation to use a virtual doctor and ii) experience and perception of current health care provision. The interviews were analysed using the content analysis according to Mayring (2010) with the help of "ATLAS.TI" software. Additional information about the role of informal caregivers, technology acceptance and decision-making processes was collected via questionnaires. Results A total of 49 patients and 33 informal caregivers were interviewed. Most patients were male (76%), aged between 60 and 69 years (43%). Three key themes were identified in regard to an interactive decision-making system: 1) Reassurance, because patients felt uncertain about their condition and their symptoms, they had a strong desire for an application that could monitor their health 24/7, was able to spot deteriorations, before they occured and gave them instant feedback about their current health status; 2) Personalized advice, e.g. patients wanted the virtual doctor to adapt medication, sport activities and food recommendations to their current health status; and 3) Transparency, e.g. patients wanted to know, where the recommendations are coming from and justifications for management modifications. Interview findings also identified that the HF-nurses play a significant role in the care and management of the condition. Across all countries with HF-nurses, they were the primary point of contact, when patients had any HF related concerns. Conclusion The findings provide valuable information for the development and implementation of eHealth solutions. Patients want reassurance, independently of the availability of healthcare services, combined with personalized advice regarding day-to-day management of their HF. For the next step, we are planning a multicentre clinical trial to test the prototype of the application. Here all decisions are examined by a clinical committee and benefits are evaluated.

Systematic-interdisciplinary approach to eHealth equipment design

<p>EHealth has improved the performance of multiple health systems worldwide by integrating Information and Communication Technologies (ICTs) into national (structured and coordinated) strategies in the health sector. However, once the foundation is laid for the development and implementation of eHealth solutions, researchers, engineers, doctors and other stakeholders have no single way to develop eHealth solutions. Therefore, a systematic interdisciplinary method is proposed to design electronic health equipment to meet the requirements and needs of all people involved in the use of the equipment, and comply with the laws and regulations of different countries.</p><p>On the basis of systematic and interdisciplinary methods, a method is proposed, that is, the collaborative use of different systematic methods allows stakeholders to continue to cooperate and share the experience. Consequently, the method will allow the design of eHealth devices that, regardless of their use, meet the needs of the user, the requirements of the personnel who will use them, the standards and regulations of the country where they are developed, and provide total satisfaction with the device. Finally, the eHealth solution is designed through systematic thinking, through the analysis of needs and needs, and through exploring different perspectives, observation backgrounds, participant participation, discussion and stakeholder consistency, so as to provide a sustainable product that meets all participants.</p>

An international experience of electronic communication and implementation of eHealth solutions in a vascular surgery clinic.

Communication is key to any successful relationship with the patient-physician partnership being no different. Recent advances in technology have provided us with an array of new communication tools such as the mobile phone, computer, internet, and email. This new technology has revolutionized communications; however, limitations to their widespread use include access, literacy, and willingness for both the physician and patient to change. To gather international data, questionnaires were completed by patients attending vascular surgery outpatient clinics in hospitals in Ireland and Canada. Five hundred ninety-seven patients participated in the study. Of the participants, 83.2% were over 50years old. The mean age was 63.1years, with a range of 18-95years. Overall, home phone call was the most preferred method of communication with 41.0% of patients selecting this option. Of the patients, 82.4% had a mobile phone but just 48.5% use text message. In those over the age of 70, 72.1% use a mobile phone and just 25.3% use text message. Of the participants, 64.1% had access to a computer, and 67.2% had access to the internet with a decline in the usage of both with increasing age. Within this patient population, the use of technologies decreases with increasing age of the patients. This demonstrates a large population of service users who are contented with conventional methods of communication. Change within healthcare ICT is inevitable, and therefore, these patients need to be guided and educated to allow a smooth transition from the old to the new.

Antecedents of use of e-health services in Central Eastern Europe: a qualitative comparative analysis

BackgroundThe objective of this paper is to identify the key conditions that positively affect the use of e-health services in Central Eastern Europe (CEE) countries. CEE countries after the political and economic transformation in 1989/90 implemented slightly different national health care models. The research question of the study is: how do the various institutional conditions at the national level affect the use of e-health services in CEE countries?MethodsThe e-health description was derived from papers indexed in Web of Science and Scopus. The data for computation were collected from the 2015 global survey by the WHO Global Observatory for eHealth. We used a narrative literature review in order to identify key terms associated to e-health and conditions for the implementation of e-health services. The search terms were “e-health” and “*” where * was particular thematic section of e-health according to WHO GOeH. The inclusion criterion was relevance of the paper to e-health and searched phase. Eligibility criteria for countries for being described as CEE countries: Estonia, Lithuania, Latvia, Poland, Hungary, Romania, Bulgaria, Czech Republic, Slovenia, and Croatia (we omitted Slovakia from the analysis because this country was not covered by the WHO Survey). We applied qualitative comparative analysis (QCA) to analyse the necessary order of conditions. The dependent variable of the study is the national rate of use of e-health services.ResultsQCA shows that legal medical jurisdiction, teleprogramme and electronic health records supplemented by adequate training constitute critical conditions to achieve success in e-health implementation.ConclusionsWe conclude that the more formalised a framework for e-health service delivery is, the more likely it will be used. Therefore formalisation fosters the diffusion, dissemination and implementation of e-health solutions in this area. Formalisation must be accompanied by tailored training for health care professionals and patients. Our analyses are related only to the paths of e-health implementation in CEE countries thus consequently the findings and conclusions cannot be directly applied to other countries. The limitations of this study are related the absence of a broader context of e-health development, including the development of ICT infrastructure and ICT literacy.

Analysis of eHealth solutions in Slovenia: A usage perspective

The project for the digitalization of Slovenian health care (eHealth) should integrate all fragmented information systems and provide relevant medical, economic and administrative data, which could improve the increasingly important evidence-based decision-making and management in the health care system. This paper explores the current state of the most important eHealth solutions in Slovenia, i.e. ePrescription, eAppointment and Central Registry of Patient Data, and furthermore specifically focuses on different aspects of their use by health care professionals and patients. The in-depth analysis included the review of eHealth-related sources and structured discussions with the experts responsible for the development and implementation of eHealth solutions. The research reveals that significant progress has been made in the last 3 years and that the short-term objectives of eHealth solutions have been met almost without exception. However, in order to further exploit the potentials of eHealth in the future, all efforts behind this project will have to be supported by systematic measures on all levels as well as the firm commitment of stakeholders.

Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana

BackgroundDespite the introduction of the Millennium Development Goal to reduce maternal deaths from 400 to 100 per 100,000 live births, the proportion of maternal deaths is still much higher in most developing countries like Ghana. Various interventions have been implemented in Ghana that focus on increasing skilled maternal care. These are especially needed in rural areas. EHealth has the potential to contribute to reducing the challenges in maternal healthcare (MHC) that poor areas suffer. This paper analyzes the potential of eHealth solutions to improve maternal health in rural Ghana as well as the challenges to their implementation. The work was carried out in cooperation with the local health directorate of Kpando Municipality, one of the administrative areas in the Volta Region.MethodsThe study is focused on remote peninsulas and islands in Kpando Municipality. Data was gathered through triangulated research methods. Maternal health challenges were identified using the Three Delays Model for MHC. The three delays are delay in seeking care, delay accessing health facilities, and delay receiving adequate care. Challenges to the implementation of eHealth solutions in remote communities were analyzed using the Drury’s 5C eHealth model for developing countries. The 5Cs correspond to context, community, capacity, connectivity, and content.ResultsThe results show that financial dependence of women, a decision-making process based on previous experiences and traditional beliefs, competitiveness between facilities, organizational loopholes, lack of equipment, and geographical situations directly influence MHC outcomes. EHealth solutions, thanks to the high number of health workers with basic IT skills, have high potential to reduce MHC delays. However, poverty, cultural beliefs, organizational issues, connectivity, and lack of human resources were identified as main challenges to the implementation of eHealth solutions.ConclusionIn Ghana’s rural areas the three delays proposed in the model affect the outcomes of MHC. These delays are influenced by socio-economic status, access to facilities, and quality of care. EHealth solutions show great potential to reduce the delays. Based on the 5C model, a mHealth solution aiming to improve guidance during pregnancy was outlined.

Korzyści dla wybranych interesariuszy związane z wdrażaniem rozwiązań e-zdrowia w podmiotach leczniczych

1. Ustawa z dnia 28 kwietnia 2011 r. o systemie informacji w ochronie zdrowia (Dz.U.2011.113.657, z późń. zm.). Google Scholar

De mogelijkheden van online hulpverlening in het maatschappelijk werk

The possibilities of eHealth in social work: Focus on self reliance and selfmanagement Many organizations raise the question of how eHealth can create value for clients, employees and organization. Kwadraad, an organization for social work, started two years ago with the implementation of eHealth solutions for their clients. The organisation sees eHealth as an important tool to facilitate and strengthen the self reliance and selfmanagment of its clients and thereby provide clients better assistance to their demands . This article provides insight into the uses of eHealth for organizations in the field of social work.