Digital technologies for healthcareIs there and do we need evidence on eHealth interventions?
Introduction
The emerging of a connected and networked world as a result of the steady increase in the use of information and telecommunication technologies in all countries is impacting the health sector. Statistics from the International Telecommunication Union indicated that by end 2011 the total mobile-cellular subscriptions reached almost six billion, 590 million fixed (wired)-broadband subscriptions and 2.3 billion people were connected to the Internet [1].
The information society and knowledge economy have emerged as a result of the utilization of information and communication technology (ICT) in human activities for industrial, scientific, technical and socioeconomic development. The health sector is no exception despite the fact that it came late in making full use of ICT potential compared to other sectors.
The use of ICTs in health care or eHealth, therefore, is seen as essential for a modern, cost-effective health service which is capable of addressing challenges such as improving equity of access and quality of care in a world facing an increasing burden of chronic disease [2]. Throughout this paper, the term “eHealth” will be used as an umbrella term that covers the use of ICT in health in its broadest sense.
Section snippets
eHealth
The World Health Assembly (WHA) resolution 58:28 of 2005 described eHealth as the cost-effective and secure use of information and communication technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education. Other terms and definitions have also been used in the literature [3], [4], [5].
A wide range of eHealth applications in support of healthcare delivery aim at improving quality, improving equitable
eHealth evidence
The challenge that many policy- and decision-makers, investors, researchers, academicians and donors face is finding the compelling evidence that eHealth improves quality and equity and reduces cost.
eHealth decisions and implementations are influenced by the medical practice and profession. Healthcare delivery is very much influenced by evidence-based medicine approaches. Evidence has been defined as information that is collected in an orderly way about a disease or its treatment. This
Potential and promise of eHealth
As more evidence is being built in support of the assumptions or the potentials of eHealth, a significant body of literature is being developed anticipating that eHealth will transform the sector. The Summary Care Record (England) as an example anticipated a number of benefits, including safer care; more efficient care; better care; more equitable care; reduction in onward referral; and greater patient satisfaction [11].
Huge investments have been made based on the potential of eHealth. Examples
eHealth research
Research in eHealth has become more pressing as the need for more investments and policies are considered by countries and as eHealth is on the way to establish itself as an academic discipline. Among reasons have been identified in support of more research in eHealth:
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build the knowledge base for eHealth;
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establish evidence that aims and objectives of an intervention have been achieved, not achieved or partially achieved;
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introduce changes and/or improvements on the intervention based on the
Examples of eHealth evidence
A number of literature and systematics reviews have appeared in addition to case studies and evaluation reports of pilot projects. This section will cite some studies that have shown evidence that eHealth can improve quality, coverage and reduce cost.
eHealth IMPACT study “eHealth is Worth It”
This study [22] made a comparison between ten eHealth sites in Europe ranging from electronic health records, to electronic subscriptions and found that “The qualitative benefits were better informed patients and carers, better focused information allowing for more streamlined procedures, improved timeliness, improvements in safety, better effectiveness, improved access to information and greater efficiency. Timeliness, effectiveness and efficiency were prevalent at all ten sites”. It added
Mobile phones and human immunodeficiency virus (HIV)
The study aimed to assess whether mobile phone communication between health-care workers and patients starting antiretroviral therapy (ART) in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. It concluded that patients who received SMS support had significantly improved ART adherence and rates of viral suppression compared with the control individuals. Mobile phones might be effective tools to improve patient outcome in resource-limited settings [23].
UK: Telehealth can deliver
The Whole System Demonstrator Programme aimed to provide a clear evidence base to support important investment decisions and show how the technology supports people to live independently, take control and be responsible for their own health and care.
The early indications show that if used correctly telehealth can deliver a 15% reduction in Accident & Emergency (A&E) visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8%
Evidence of eHealth impact: the case for eIMCI in Republic of Tanzania
This study was set to identify evidence of the use of the electronic version of the Integrated Management of Childhood Illness (IMCI). IMCI is a systematic approach developed by World Health Organisation (WHO) to provide integrated care for child health. It is recognized that there are limitations to proper implementation of IMCI which can be addressed by electronic support tools. It was concluded that the results from a quantitative and qualitative study of eIMCI show the impact of electronic
Bulletin of the World Health organisation (WHB) Theme issue on eHealth: building the evidence base
The WHB is the peer-reviewed official monthly publication of the World Health Organization (WHO) which covers a range of areas of public and global health. A theme issue on eHealth was published in May 2012 which aimed to contribute to building the evidence base for eHealth. The call for papers was issued in November 2011 and resulted in 90 submissions being received, of which 14 were published;
Al-Shorbaji and Geissbuhler [26] in their editorial for the special issue highlighted the conclusions
Conclusion
The ICT infrastructure, the leapfrogging by many countries to utilize these technologies, the heavy reliance of the health sector on data and information and the pressure on the sector to be more aware of the cost, more efficient, more safe and more equitable have all resulted in both trying to build the evidence for eHealth and to use this evidence for policy development and investment.
More research is needed to measure and document eHealth impact. A comprehensive approach is required for
References (26)
Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomized trial
Lancet
(2010)- World Telecommunication/ICT Indicators Database, 16th ed. Geneva: International Telecommunication Union; 2012....
- Delivering 21st century IT support for the NHS. London: United Kingdom Department of Health;...
- Resolution WHA58.28. eHealth. In: Fifty-eighth World Health Assembly, Geneva, 16–25 May 2005. Resolutions and...
- et al.
What is eHealth (3): a systematic review of published definitions
J Med Internet Res
(2005) - Bashshur R, Shannon G, Krupinski E, Grigsby J. Policy: the taxonomy of telemedicine. Telemedicine and e-Health...
- Glossary. Atlanta, GA: Centre for Disease Control and Prevention....
- Evidence based medicine: what it is and what it isn’t (editorial). BMJ 1996;312:71....
- et al.
Evaluating eHealth interventions: the need for continuous systemic evaluation
PLoS Med
(2009) - Greenhalgh TJ, Stramer K, Bratan T, Byrne E, Russell J, Hinder S, et al. The devil's in the detail: final report of the...