A literature review of capability maturity models (MMs) to inform the conceptualization, development, implementation, evaluation, and mainstreaming of MMs in digital health (DH).
Electronic databases ...were searched using "digital health," "maturity models," and related terms based on the Digital Health Profile and Maturity Assessment Toolkit Maturity Model (DHPMAT-MM). Covidence was used to screen, identify, capture, and achieve consensus on data extracted by the authors. Descriptive statistics were generated. A thematic analysis and conceptual synthesis were conducted.
Diverse domain-specific MMs and model development, implementation, and evaluation methods were found. The spread and pattern of different MMs verified the essential DH foundations and five maturity stages of the DHPMAT-MM. An unanticipated finding was the existence of a new category of community-facing MMs. Common characteristics included:1. A dynamic lifecycle approach to digital capability maturity, which is:a. responsive to environmental changes and may improve or worsen over time;b. accumulative, incorporating the attributes of the preceding stage; andc. sequential, where no maturity stage must be skipped.2. Sociotechnical quality improvement of the DH ecosystem and MM, which includes:a. investing in the organization's human, hardware, and software resources andb. a need to engage and improve the DH competencies of citizens.
The diversity in MMs and variability in methods and content can create cognitive dissonance. A metamodel like the DHPMAT-MM can logically unify the many domain-specific MMs and guide the overall implementation and evaluation of DH ecosystems and MMs over the maturity lifecycle.
•The COVID-19 pandemic has demonstrated Australian primary care’s ability to adapt but also highlighted some areas to improve in virtual care.•Telehealth was the key component of the Australian ...digital health response in primary care.•There is limited evidence on the effectiveness, access, equity, utility, safety, and quality of digital health tools in the COVID-19 era.•Changing patient experiences during pandemics should not be overlooked and need to be at the centre of rapidly evolving new models of care.
The COVID-19 pandemic and its socio-economic impacts have disrupted our health systems and society. We sought to examine informatics and digital health strategies that supported the primary care response to COVID-19 in Australia. Specifically, the review aims to answer: how Australian primary health care responded and adapted to COVID-19, the facilitators and inhibitors of the Primary care informatics and digital health enabled COVID-19 response and virtual models of care observed in Australia.
We conducted a rapid scoping review complying with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews guidelines. Two reviewers independently performed the literature search, data extraction, and synthesis of the included studies. Any disagreement in the eligibility screening, data extraction or synthesis was resolved through consensus meeting and if required. was referred to a third reviewer. Evidence was synthesised, summarised, and mapped to several themes that answer the research question s of this review.
We identified 377 papers from PubMed, Scopus, Web of Science and Embase. Following title, abstract and full-text screening, 29 eligible papers were included. The majority were “perspectives” papers. The dearth of original research into digital health and COVID-19 in primary care meant limited evidence on effectiveness, access, equity, utility, safety, and quality. Data extraction and evidence synthesis identified 14 themes corresponding to 3 research questions. Telehealth was the key digital health response in primary care, together with mobile applications and national hotlines, to enable the delivery of virtual primary care and support public health. Enablers and barriers such as workforce training, digital resources, patient experience and ethical issues, and business model and management issues were identified as important in the evolution of virtual primary care.
COVID-19 has transformed Australian primary care with the rapid adaptation of digital technologies to complement “in-person” primary care with telehealth and virtual models of care. The pandemic has also highlighted several literacy, maturity/readiness, and micro, meso and macro-organisational challenges with adopting and adapting telehealth to support integrated person-centred health care. There is a need for more research into how telehealth and virtual models of care can improve the access, integration, safety, and quality of virtual primary care.
Abstract
Actualizing the vision of Global Digital Health is a central issue on the Global Health Diplomacy agenda. The COVID-reinforced need for accelerated digital health progress will require ...political structures and processes to build a foundation for Global Digital Health. Simultaneously, Global Health Diplomacy uses digital technologies in its enactment. Both phenomena have driven interest in the term “Digital Health Diplomacy.” A review of the literature revealed 2 emerging but distinct definitions that have been published very recently, each with its associated discourse and practice. This multiplicity of ideas demonstrates the myriad ways in which global digital and political systems are becoming increasingly entangled. Untangling these, this paper proposes and discusses 3 dimensions of Digital Health Diplomacy: “Diplomacy for digital health,” “Digital health for diplomacy,” and “Digital health in diplomacy.” It calls upon digital health professionals, diplomats, political and social scientists, epidemiologists, and clinicians to discuss, critique, and advance this emerging domain.
Abstract
Introduction
Countries need to determine their level of digital health capability maturity to assess and mobilize their knowledge, skills, and resources to systematically develop, implement, ...evaluate, scale up and maintain large-scale implementations of standards-based interoperable digital health tools.
Objective
Develop a Digital Health Profile and Maturity Assessment Toolkit (DHPMAT) to assist Pacific Island Countries (PICs) to harness digital tools to support national health priorities.
Materials and Methods
A literature review guided the development of the conceptual framework to underpin the DHPMAT. Key informants collaborated to collect key digital health features and indicators to inform their country’s digital health maturity assessment. The DHPMAT was tested with country stakeholders at a Pacific Health Information Network workshop in 2019.
Results
A comprehensive list of indicators to describe country digital health profiles (DHP). A digital health maturity assessment tool that uses criteria codeveloped with country stakeholders to assess essential digital health foundations and quality improvement. DHPs created and maturity assessed and packaged into individualized DHPMATs for 13 PICs. PIC users perceived the DHPMAT as useful, especially the congruence with the 2017 WHO WPRO Regional Strategy but noted a “cognitive overload” from a plethora of complex digital health toolkits.
Conclusions
The cocreation approach optimized currency, accuracy, and appropriateness of information in the DHP, understanding, and use of the DHPMAT to facilitate informed iterative discussion by PICs on their digital health maturity to harness digital tools to strengthen country health systems. The DHPMAT can rationalize the choice and use of existing tools and reduce cognitive overload.
Abstract
Objective
Toolkits are an important knowledge translation strategy for implementing digital health. We studied how toolkits for the implementation and evaluation of digital health were ...developed, tested, and reported.
Materials and Methods
We conducted a systematic review of toolkits that had been used, field tested or evaluated in practice, and published in the English language from 2009 to July 2019. We searched several electronic literature sources to identify both peer-reviewed and gray literature, and records were screened as per systematic review conventions.
Results
Thirteen toolkits were eventually identified, all of which were developed in North America, Europe, or Australia. All reported their intended purpose, as well as their development process. Eight of the 13 toolkits involved a literature review, 3 did not, and 2 were unclear. Twelve reported an underlying conceptual framework, theory, or model: 3 cited the normalization process theory and 3 others cited the World Health Organization and International Telecommunication Union eHealth Strategy. Seven toolkits were reportedly evaluated, but details were unavailable. Forty-three toolkits were excluded for lack of field-testing.
Discussion
Despite a plethora of published toolkits, few were tested, and even fewer were evaluated. Methodological rigor was of concern, as several did not include an underlying conceptual framework, literature review, or evaluation and refinement in real-world settings. Reporting was often inconsistent and unclear, and toolkits rarely reported being evaluated.
Conclusion
Greater attention needs to be paid to rigor and reporting when developing, evaluating, and reporting toolkits for implementing and evaluating digital health so that they can effectively function as a knowledge translation strategy.
•What this study added to our knowledge•Research into mHealth for IPCHS is unequally distributed among high and low income countries in the Western Pacific, reflecting the global situation.•mHealth ...initiatives in integrated care focus on the community setting, and on specific service issues.•While half of studies were not disease-specific; those that were, focused on non-communicable diseases.•Text messages and mobile applications are the most commonly used mHealth modalities.•mHealth can be used to support IPCHS strategies; but more mHealth interventions should facilitate IPCHS strategy 2 (participatory governance and accountability).•Methods for evaluating mHealth initiatives are rarely theory-based and focus on cognitive/behavioral changes rather than patient outcomes.•Experimental designs are more popular than observational & qualitative approaches. More mixed-methods approaches are required.•Critical appraisal revealed issues with methodological rigour, raising doubts about validity. There is a need for better quality studies.•While reach and efficacy are commonly evaluated, more work needs to focus on the adoption, implementation and maintenance of mHealth interventions.
This review aimed to examine how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR).
Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract stages, followed by full-text appraisal, data extraction, and synthesis of eligible studies. Studies were extracted to capture details of the mhealth tools used, the service issues addressed, the study design, and the outcomes evaluated. We then mapped the included studies using the 20 sub-strategies of the WHO Framework on Integrated People-Centred Health Services (IPCHS); as well as with the RE-AIM (Reach, effectiveness, adoption, implementation and maintenance) framework, to understand how studies implemented and evaluated interventions.
We identified 39 studies, predominantly from Australia (n = 16), China (n = 7), Malaysia (n = 4) and New Zealand (n = 4), and little from low income countries. The mHealth modalities included text messaging, voice and video communication, mobile applications and devices (point-of-care, GPS, and Bluetooth). Health issues addressed included: medication adherence, smoking cessation, cardiovascular disease, heart failure, asthma, diabetes, and lifestyle activities respectively. Almost all were community-based and focused on service issues; only half were disease-specific.
mHealth facilitated integrated IPCHS by: enabling citizens and communities to bypass gatekeepers and directly access services; increasing affordability and accessibility of services; strengthening governance over the access, use, safety and quality of clinical care; enabling scheduling and navigation of services; transitioning patients and caregivers between care sectors; and enabling the evaluation of safety and quality outcomes for systemic improvement.
Evaluations of mHealth interventions did not always report the underlying theories. They predominantly reported cognitive/behavioural changes rather than patient outcomes. The utility of mHealth to support and improve IPCHS was evident. However, IPCHS strategy 2 (participatory governance and accountability) was addressed least frequently. Implementation was evaluated in regard to reach (n = 30), effectiveness (n = 24); adoption (n = 5), implementation (n = 9), and maintenance (n = 1).
mHealth can transition disease-centred services towards people-centred services. Critical appraisal of studies highlighted methodological issues, raising doubts about validity. The limited evidence for large-scale implementation and international variation in reporting of mHealth practice, modalities used, and health domains addressed requires capacity building. Information-enhanced implementation and evaluation of IPCHS, particularly for participatory governance and accountability, is also important.
•We conducted a hermeneutic review of frameworks, models and theories on social enterprise, digital health, citizen engagement and Integrated People-Centred Health Services (IPCHS).•We analysed ...interdisciplinary frameworks, models and theories, to synthesise a novel framework on how social enterprises could use digital technology, and citizen engagement for IPCHS.•This framework provides a theoretical grounding to guide future empirical inquiry.
To achieve Universal Health Coverage and the United Nations’ (UN) Sustainable Development Goals (SDGs) agenda for 2030, the World Health Organisation (WHO) recommended the use of social enterprise, digital technology, and citizen engagement in the delivery of Integrated People-Centred Health Services (IPCHS) as part of its strategic vision for 21st century primary care.
We conducted a hermeneutic review of frameworks, models and theories on social enterprise, digital health, citizen engagement and IPCHS. This involved multiple iterative cycles of (i) searching and acquisition, followed by (ii) critical analysis and interpretation of literature to assemble arguments and evidence for conceptual relationships until information saturation was reached. This process identified a set of constructs which we synthesised into a testable framework.
Several interdisciplinary frameworks, models and theories explain how social enterprises could use digital technology, and citizen engagement to enable the technical and social integration required to facilitate people-centred primary care. Innovative approaches can be used to maintain financial sustainability while delivering IPCHS at lower cost to vulnerable and marginalised populations in both developed and developing countries.
This framework provides a theoretical grounding to guide empirical inquiry into how social enterprises use digital technology to engage citizens in co-producing IPCHS.
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