A Systematic Review of the Adoption of eHealth Cloud-based Technology Applications during COVID-19

ABSTRACT


Introduction
The deadly pandemic caused by the Corona virus (COVID-19) has altered people's lives world-wide and citizens are battling for survival against this pandemic.From its first outbreak in Wuhan 2019, the coronavirus, a highly transmittable and fast spreading disease, has reached every corner of the globe.So far, the cases of this pandemic have been confirmed in 198 countries [1].
Because of an alarming rise in the number of cases outside China, the World Health Organization (WHO) officially declared the outbreak of this virus in March and implemented new social distancing methods to lower the curve of transmission [2].Consequently, cities were inaccessible and public gatherings were prohibited, changing people's usual lifestyle.Countries have experienced a variety of healthcare, financial, and social issues as a result of the Covid-19.Moreover, healthcare practitioners are having difficulties in providing systematic health services [3].To resolve healthcare difficulties brought by the COVID-19 pandemic, technical innovation is one of the possible solutions in present times.In specific terms, eHealth cloud-based services are technically viable and appropriate for assisting patients, family members, and healthcare providers during this pandemic [4].
According to WHO, eHealth is the use of information and communication technology in support of health and health-related disciplines such as healthcare, health surveillance, health education, knowledge, and research that is both cost-effective and secure [5].Electronic health technology applications and tools like mobile health, telemedicine, electronic health records and virtual healthcare are assumed to be effective in increasing healthcare services access and enhancing the healthcare service quality during coronavirus [6].Regardless of the benefits of eHealth resolutions to enhance health care quality, studies denote that their adoption rate is either low or underutilized [7].According to [7], there is a gap between planning for new technology adoption and its long-term execution to realize strategic or expected benefits.
Understanding the user's perspective on eHealth and associated initiatives is critical [8].Now the question is, what is the level of the adoption of eHealth cloud-based technology applications during COVID-19?Many reviews were done for the adoption of eHealth cloud-based technology applications.However, only a few reviews focused on the adoption of such technology applications during COVID-19.Thus, this study seeks to present what was done according to the literature to measure the level of the adoption of eHealth cloud-based technology applications during COVID-19 through a systematic review.

Materials and Method
The main objective of this research was to find out what was done according to the literature to measure the level of the adoption of eHealth cloud-based technology applications during COVID-19 through a systematic review.The methodology of this study followed the guidelines of the PRISMA group by Moher, et al. [9] to present methods and approaches used to collect and report data.

Search strategy
In this study, the literature on the adoption of eHealth cloud-based technology applications during COVID-19 was reviewed from the Scopus database.The keywords were searched from the Scopus database and it was found that there were 174 documents that were published from the initial search.

Selection criteria
The selection criteria for this research study was based on PRISMA framework.The PRISMA framework is a set of guidelines by Moher, et al. [9] which are used for systematic literature reviews, critical literature analyses and meta-analysis.The focus of the search was mapping the eHealth cloudbased technology application and COVID-19 to the computer science field, health sciences and social sciences.The search was then limited to the subject areas of computer science, healthcare professionals, engineering, social science and medicine.All articles before 2020 were excluded so that the focus can be on COVID-19.The search included documents from all countries.

Quality assessment
This systematic review was originally based on conference papers as well as journal articles.The exported data were checked for duplications so that the quality of this review can be maintained.To ensure the quality and relevance of the academic literature that was included in the review process, abstracts of articles were deeply analysed and purified.At a later stage, each research paper was carefully evaluated.Moreover, all selected published papers were limited to English language only.Only two studies were excluded from this review because they were not written in English language.
After the overall assessment, only 31 studies were selected aforementioned inclusion and exclusion criteria.Figure 1 shows the literature inclusion and exclusion at all stages.

Data extraction
Only 31 articles were selected in the data extraction phase with the following extraction characteristics:  An article must be an original basic, review or applied paper from a journal or conference publication.All published cases and reports were excluded. All articles must be limited to the subject area of computer science, healthcare professionals, engineering, social science and medicine.Furthermore, they must all be written in English language. Extracted articles were published from 2020 to 2021. The extracted papers are were not limited to any country.3.

Reporting findings
It is indicated by the results that there are only a few papers that have been published so far, on the adoption of eHealth technology applications during COVID-19 compared to 2020.In the year 2020, 18 documents were published on the Scopus database and this number was five times more than the number (13) in the year 2021.This denotes that up to date, the number of publications on the topic started to gradually decrease.Since this study focused on the adoption of eHealth cloud-based technology applications during COVID-19, the researchers believes that this pandemic is still new to the research field, hence the number of studies during this pandemic are limited.Table 1 displays the statistics on how papers for the adoption of eHealth cloud-based technology applications during COVID-19 were published each year.The largest number of articles on the adoption of eHealth cloud-based technology applications during COVID-19 were published from Italy and these were five articles.According to the findings, the second largest number of published articles was from China, France and Germany respectively with two articles each.Researchers from other remaining countries are making a very significant contribution to the topic with only one article published.Even if academics around the world tried to put their effort on the topic of the adoption of eHealth cloud-based technology applications during COVID-19, it is still clear that more research is required in this field.Table 3 indicates the number of studies that were published from each country from 2020 to 2021.[17] with 56 citations to date, followed by Novara, et al. [24] "Telehealth in Urology: A Systematic Review of the Literature.How Much Can Telemedicine Be Useful During and After" with 44 citations, Pappot, et al. [14] "Telemedicine and e-Health Solutions for COVID-19: Patients' Perspective" with 29 citations and Ndiaye, et al. [16] "IoT in the wake of Covid-19: A survey on contributions, challenges and evolution" with 19 citations.Table 4 shows the distribution of papers by their citations.

Conclusion, Limitations and Future Work
This study reviewed 31 research articles on the adoption of eHealth cloud-based technology applications during COVID-19, from 2020 to 2021 since coronavirus is still new in the research field.Different countries with different researchers tried to put effort in this topic.However, the results indicate that more research is still needed.It is indicated in the findings that many countries are still left far behind on this topic.Research on the adoption of eHealth cloud-based technology applications during COVID-19, was analysed according to the publication year, source title, country and author as well as distribution of papers by citations.One of the limitations of this study was that, the data was gathered from the Scopus database only.Researchers suggest that for future research, other additional sources need to be searched to find out more about the adoption of eHealth cloud-based technology applications during COVID-19.Secondly, the topic of this study was limited to cloudbased technology applications only.It is suggested that in future research, the topic could be extended to include modern technical innovations such as 5G and IoT.It is suggested that future research could focus on collecting data from other countries and parts of the world.

Figure 1
Figure1presents the summary of methodology utilized in this study in line with PRISMA framework.

Table 1
Distribution of Papers by YearThe distributions of papers by source title are shown in Table 2.The findings indicate that Telemedicine and e-Health sourced the majority of papers.This sourced a maximum of 4 articles on eHealth technology applications during COVID-19 from 2020 to 2021.Followed by European Urology, International Journal of Clinical Practice and International Journal of Environmental Research and Public Health respectively, with 2 articles sourced by each source to date.Other remaining sources are doing a very significant contribution by sourcing 1 paper each.

Table 2
Distribution of Papers by Source Title

Table 3
Distribution of Papers by Country [37]rding to the findings, research on the adoption of eHealth cloud-based technology applications during COVID-19 is being appreciated and acknowledged by other researchers in their studies.The most cited paper of eHealth technology application during COVID-19 was "The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health" authored by Wind, et al.[37].The paper citations have reached 190 citations up to date.The second most cited paper was "Telemedicine Online Visits in Urology During the COVID-19 Pandemic-Potential, Risk Factors, and Patients' Perspective" byBoehm, et al.

Table 4
Distribution of Papers by CitationsThis study was undertaken to find out what was done according to the literature, to measure the level of the adoption of eHealth cloud-based technology applications during COVID-19.A few articles that were reviewed in this study utilized the extended Technology Acceptance Model (TAM) to describe an individual's attitude and behavioural intention toward the adoption of eHealth cloudbased technology applications during COVI9-19.These studies revealed that eHealth technology applications are important tools that can be used to solve individual issues that are health related whilst maintaining a social distancing during COVID-19.It was further indicated that experience and IT knowledge, beliefs, attitudes as well as health professionals' desires have an impact on their willingness to utilize eHealth technology applications.A strong relationship amongst perceived usefulness, perceived ease of use and individuals' utilization of eHealth tools and applications was also discovered by previous studies.Moreover, it was found by previous studies that a lack of technical experience, lack of motivation as well as poor policies and support from the top management are some of the factors that contributes towards the adoption of eHealth cloud-based technology applications during COVID-19.Poor awareness of eHealth advantage, lack of technical infrastructure, lack of digital literacy and healthcare professionals' resistance were identified as barriers to eHealth adoption by related studies.