scholarly journals Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs

10.2196/14956 ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. e14956 ◽  
Author(s):  
Erik Baltaxe ◽  
Thomas Czypionka ◽  
Markus Kraus ◽  
Miriam Reiss ◽  
Jan Erik Askildsen ◽  
...  
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Program Analysis ◽  
Digital Health ◽  
Scale Up ◽  
Implementation Process ◽  
Strong Relationship ◽  
Longitudinal Assessment ◽  
Wide Range ◽  
Assessment Strategies

Background Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. Objective The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. Methods A program analysis based on thick descriptions—including document examinations and semistructured interviews with relevant stakeholders—of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. Results Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. Conclusions Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.

scholarly journals Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs (Preprint)

2019 ◽  
Author(s):  
Erik Baltaxe ◽  
Thomas Czypionka ◽  
Markus Kraus ◽  
Miriam Reiss ◽  
Jan Erik Askildsen ◽  
...  
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Program Analysis ◽  
Digital Health ◽  
Scale Up ◽  
Implementation Process ◽  
Strong Relationship ◽  
Longitudinal Assessment ◽  
Wide Range ◽  
Assessment Strategies

BACKGROUND Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. OBJECTIVE The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. METHODS A program analysis based on thick descriptions—including document examinations and semistructured interviews with relevant stakeholders—of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. RESULTS Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. CONCLUSIONS Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.

Health Policy in Cambodia: To What Extent Is an Aid-Dependent Country Able to Determine Its Own Policy?

2014 ◽  
Vol 44 (1) ◽  
pp. 171-187 ◽  
Author(s):  
VIRGINIE DIAZ PEDREGAL ◽  
BLANDINE DESTREMAU ◽  
BART CRIEL
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Low Income ◽  
Access To Health Care ◽  
Implementation Process ◽  
Health Care Provision ◽  
Care Provision ◽  
Low Income Country ◽  
Access To Health ◽  
Wide Range

AbstractThis article analyses the design and implementation process of arrangements for health care provision and access to health care in Cambodia. It points to the complexity of shaping a coherent social policy in a low-income country heavily dependent on international aid.At a theoretical level, we confirm that ideas, interests and institutions are all important factors in the construction of Cambodian health care schemes. However, we demonstrate that trying to hierarchically organise these three elements to explain policy making is not fruitful.Regarding the methodology, interviews with forty-eight selected participants produced the qualitative material for this study. A documentary review was also an important source of data and information.The study produces two sets of results. First, Cambodian policy aimed at the development of health care arrangements results from a series of negotiations between a wide range of stakeholders with different objectives and interests. International stakeholders, such as donors and technical organisations, are major players in the policy arena where health policy is constructed. Cambodian civil society, however, is rarely involved in the negotiations.Second, the Cambodian government makes political decisions incrementally. The long-term vision of the Cambodian authorities for improving health care provision and access is quite clear, but, nevertheless, day-to-day decisions and actions are constantly negotiated between stakeholders. As a result, donors and non-government organisations (NGOs) working in the field find it difficult to anticipate policies.To conclude, despite real autonomy in the decision-making process, the Cambodian government still has to prove its capacity to master a number of risks, such as the (so far under-regulated) development of the private health care sector.

scholarly journals Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

2020 ◽  
Author(s):  
Samia El Joueidi ◽  
Kevin Bardosh ◽  
Richard Musoke ◽  
Binyam Tilahun ◽  
Maryam Abo Moslim ◽  
...  
Keyword(s):  
Implementation Research ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Implementation Process ◽  
Evidence Based ◽  
Structured Interviews ◽  
User Friendliness ◽  
Domain 3 ◽  
And Performance

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012

scholarly journals Implementation Science in Nutrition: Concepts and Frameworks for an Emerging Field of Science and Practice

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Alison Tumilowicz ◽  
Marie T Ruel ◽  
Gretel Pelto ◽  
David Pelletier ◽  
Eva C Monterrosa ◽  
...  
Keyword(s):  
Implementation Science ◽  
Program Implementation ◽  
Implementation Research ◽  
Scale Up ◽  
Implementation Process ◽  
Implementation Quality ◽  
Wide Range ◽  
Intervention Policy ◽  
Culture Of Inquiry ◽  
National Governments

AbstractMalnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition implementation at various scales and in varied contexts.

Scaling-Up Digital Innovations in Healthcare: Expert Commentary on Success Factors and Barriers (Preprint)

2020 ◽  
Author(s):  
Hannes Schlieter ◽  
Lisa A. Marsch ◽  
Diane Whitehouse ◽  
Lena Otto ◽  
Ana Rita Londral ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Success Factors ◽  
Digital Health ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Rapid Change ◽  
Well Being ◽  
Scaling Up ◽  
Care Providers ◽  
Wide Range

UNSTRUCTURED Healthcare delivery is undergoing a rapid change from traditional processes towards the use of digital health interventions and personalized medicine. Hospitals and health care providers are introducing hospital information systems, electronic health records, and telemedicine solutions to create more efficient workflows in and beyond institutions. Patients are choosing among a wide range of digital health tools provided by wearables and mobile phone applications to support their self-management, health and well-being. The question of how sustainable digital health scale-up can be successfully achieved is not yet sufficiently resolved. This paper identifies and discusses success factors and barriers for scaling-up digital health innovations. The results discussed in this paper were gathered by 13 scientists and representatives of public bodies and patient organizations during the 1st International Workshop on Best Practices for Scaling-Up Digital Innovations in Healthcare – Scale-IT-up!, co-located with the BIOSTEC 2020 conference held in Valletta, Malta. The resulting success factors and barriers are explored in the context of prior research and implications for future work.

scholarly journals Tackling the scaling-up problem of digital health applications

2021 ◽  
Author(s):  
Peggy Richter ◽  
Lorenz Harst
Keyword(s):  
Digital Health ◽  
Scale Up ◽  
Implementation Process ◽  
Successful Implementation ◽  
Full Potential ◽  
Special Issue ◽  
Implementation Processes ◽  
Research Fields ◽  
Recent Developments ◽  
Health Applications

Abstract Aim The purpose of this editorial is to provide guidance for the readers concerning the broad realm of approaches towards successful implementation of digital health applications into the health care system. Recent developments due to the challenges posed by the COVID-19 pandemic are used as a current angle. Subject and Methods All contributions within the special issue were scanned for their most decisive contribution to the special issue and the field of implementation science, with a focus on digital health. Micro, meso, and macro layers of implementation processes, as well as the technological perspective itself, are used as broad categories for sorting the contributions and structuring the special issue. Results The ten contributions to this special issue cover micro (n = 1), technology (n = 1), meso (n = 4) and macro (n = 2) perspectives on the implementation process of digital health applications. Two further contributions also tackle the issue from a wider perspective when aiming to structure telemedicine application types and barriers encountered when implementing digital health. Conclusion Considering the wide array of research fields represented in this special issue, an emphasis is put on the importance of interdisciplinary work required for tackling the scale-up problem of digital health. As such, the special issue can assist in leveraging the full potential of digital health, not only when dealing with situations as out-of-the-ordinary as the current pandemic but also well beyond that, for example when dealing with the upcoming challenges of demographic change.

Digital Health, COVID-19 Pandemic, and Cybersecurity Issues

2021 ◽  
pp. 243-252
Author(s):  
Lev R. Klebanov ◽  
◽  
Svetlana V. Polubinskaya ◽  
Keyword(s):  
Health Care ◽  
Medical Information ◽  
Health Care Organizations ◽  
Digital Health ◽  
Digital Technologies ◽  
Expert Assessment ◽  
Legal Analysis ◽  
Healthcare Organizations ◽  
Wide Range ◽  
Public Health Challenges

The article focuses on a wide range of cybersecurity issues related to the use of digital technologies in healthcare. Many countries are increasingly adopting digital innovations into their national health systems and therefore raise their cybersecurity risks. The number of cyberattacks on health care organizations is steadily increasing; and the COVID-19 pandemic, which has required more frequent use of digital technologies to address public health challenges, has also influenced the proliferation of criminal cyberattacks. The aim of the study was to describe the main types of criminal, mostly digital, risks for digital health and identify the most important ways to counteract them. The article includes an analysis of international and national regulatory documents, foreign scientific literature, reports of organizations dealing with cybersecurity issues. In preparing it, the authors used general and specific scientific methods including analysis, synthesis, formal and legal analysis, historical method, interdisciplinary research, and expert assessment. The authors conclude that the increasing use of digital technologies in health care, especially in the context of the COVID-19 pandemic, expands the number of targets for cybercriminals. Three main types of digital health criminal risks are identified: attacks on health care organizations, attacks on devices used for medical purposes, including those associated with the Internet of Medical Things, and the theft and disclosure of digitally stored confidential medical information. The latter group of acts is committed by both outsiders and employees of healthcare organizations. The vast majority of registered cybercrimes are profit motivated ones, and the most common cybercrime is extortion with the use of malicious software (ransomware). To counter criminal risks for digital health, the authors propose a set of actions divided into three groups such as legal, technical, and educational. According to the authors, international and national criminal law should immediately respond to digital criminal threats to healthcare systems, in particular by making relevant international agreements and by including the manner in which such crimes are committed into criminal laws as an aggravating circumstance. In addition, the authors note the formation of a special direction in cybersecurity research and practice - healthcare cybersecurity - which requires the development of an appropriate industry, with respective hardware, software, informational and educational products that would be aimed at eliminating and reducing the risks for digital health.

scholarly journals Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop (Preprint)

2018 ◽  
Author(s):  
Michelle Helena Van Velthoven ◽  
Carlos Cordon
Keyword(s):  
Health Care ◽  
Digital Health ◽  
Health Care Systems ◽  
Cost Effective ◽  
Health Care Spending ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Health Innovations ◽  
Wide Range ◽  
Stakeholder Workshop

BACKGROUND There are various complex reasons that influence sustainable adoption of innovations in health care systems. Low adoption can be caused by a lack of support from one or more stakeholders because their needs and expectations are not always considered or aligned. OBJECTIVE This study aimed to identify stakeholders’ perceptions of barriers and facilitators toward the sustainable adoption of digital health innovations. METHODS A stakeholder workshop was attended by 12 participants with a range of backgrounds on August 25, 2017, including people representing the views from patients, carers, local hospitals, pharmacy retailers, health insurers, health services researchers, engineers, and technology and pharmaceutical companies in Switzerland. On the basis of adoption of innovation frameworks, we asked participants to interview each other about 3 factors influencing the adoption of digitally delivered health interventions: (1) Facilitators and barriers in the external system, (2) Needs and expectations of stakeholders, and (3) Safety, quality, and usability of innovations. The worksheets and videos generated from the workshop were qualitatively analyzed and summarized. RESULTS Facilitators for adoption mentioned were high levels of income and education, and digital health is a high priority to stakeholders. Main common interests of different stakeholders were patient satisfaction and job protection. Health care spending was a misaligned interest: although some stakeholders were keen on spending more to obtain or provide the highest quality of care, others were focused on reducing health care spending to provide cost-effective services. Switzerland’s diversity and complexity, in terms of its organization with 26 cantons (administrative divisions), were barriers as these made it harder to ensure interoperability of interventions. A culture of innovation was considered a push factor, but adoption was inhibited by persistent paper-based systems, a fear of change, and unwillingness to share data. The sustainability of interventions can be promoted by making them patient-centered, meaning that patients should be involved throughout their development. CONCLUSIONS Promoting sustainable adoption of digital health remains challenging despite various push factors being in place. Barriers related to fragmentation, patient-centeredness, data security, privacy, trust, and job security need to be addressed. A strength is that people from a wide range of backgrounds attended the workshop. A limitation is that the findings are focused on the macro level. In-depth case studies of specific issues need to be conducted in different settings.

scholarly journals Emerging Innovations and Professional Skills Needed Within Pharmacy Curricula

2020 ◽  
Vol 7 ◽  
pp. 238212052094359 ◽  
Author(s):  
Amanda A Olsen ◽  
Lana M Minshew ◽  
Kathryn A Morbitzer ◽  
Tina P Brock ◽  
Jacqueline E McLaughlin
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Precision Medicine ◽  
Clinical Decision Making ◽  
Interprofessional Collaboration ◽  
Digital Health ◽  
Pharmacy Practice ◽  
Clinical Decision ◽  
Professional Skills ◽  
Wide Range

To ensure students are prepared for the rapidly evolving world of health care, curricula must be aligned with emerging innovations, as well as professional skills likely to influence students’ abilities to be successful. At the 2019 annual meeting of PharmAlliance institutions, we asked experts to identify innovations and professional skills necessary for the future of pharmacy practice. Experts identified a wide range of topics, including personalized and precision medicine, digital health, interprofessional collaboration, clinical decision making, and overcoming complexity and ambiguity. While these findings are useful for informing curriculum content, we must also commit to ensuring our pharmacy curricula are emerging, forward thinking, and effective at preparing students for the challenges in health care.

scholarly journals Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

2020 ◽  
Author(s):  
Samia El Joueidi ◽  
Kevin Bardosh ◽  
Richard Musoke ◽  
Binyam Tilahun ◽  
Maryam Abo Moslim ◽  
...  
Keyword(s):  
Implementation Research ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Implementation Process ◽  
Evidence Based ◽  
Structured Interviews ◽  
User Friendliness ◽  
Domain 3 ◽  
And Performance

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: · NCT02603536 – November 11, 2015· NCT01549457 – March 9, 2012

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