Factors Influencing Procurement of Digital Health Care: A Case Study in Dutch District Nursing

2021 ◽  
Author(s):  
Sander Holterman ◽  
Marike Hettinga ◽  
Erik Buskens ◽  
Maarten Lahr
Keyword(s):  
Health Care ◽  
Health System ◽  
Task Force ◽  
Public Procurement ◽  
Digital Health ◽  
Third Party ◽  
Framework Analysis ◽  
Factors Influencing ◽  
Dutch Health

Background: Digital health is considered a promising solution in keeping health care accessible and affordable. However, implementation is often complex and sustainable funding schemes are lacking. Despite supporting policy, scaling up innovative forms of health care progresses much slower than intended in Dutch national framework agreements. The aim of this study is to identify factors that influence the procurement of digital health particular in district nursing. Methods: A case study approach was used, in which multiple stakeholder perspectives are compared using thematic framework analysis. The case studied was the procurement of digital health in Dutch district nursing. Literature on implementation of digital health, public procurement and payment models was used to build the analytic framework. We analysed fourteen interviews (secondary data), two focus groups organised by the national task force procurement and eight governmental and third-party reports. Results: Five themes emerged from the analysis: 1) rationale 2) provider-payer relationship, 3) resources, 4) evidence, and 5) the payment model. Per theme a number of factors were identified, mostly related to the design and functioning of the Dutch health system and to the implementation process at providers' side. Conclusions: This study identified factors influencing the procurement of digital health in Dutch district nursing. The findings, however, are not unique for digital health, district nursing or the Dutch health system. The results presented will support policy makers, and decision makers to improve procurement of digital health. Investing in better relationships between payer and care provider organisations and professionals is an important next step towards scaling digital health.

scholarly journals Accelerating Innovation in Health Care: Insights From a Qualitative Inquiry Into United Kingdom and United States Innovation Centers

10.2196/19644 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e19644
Author(s):  
Kathrin Cresswell ◽  
Robin Williams ◽  
Narath Carlile ◽  
Aziz Sheikh
Keyword(s):  
United States ◽  
Health Care ◽  
United Kingdom ◽  
Health System ◽  
Digital Health ◽  
Qualitative Inquiry ◽  
Health Science ◽  
Innovation Ecosystem ◽  
Center Staff ◽  
Innovation Activities

Background Digital health innovations are being prioritized on international policy agendas in the hope that they will help to address the existing health system challenges. Objective The aim of this study was to explore the setup, design, facilities, and strategic priorities of leading United Kingdom and United States health care innovation centers to identify transferable lessons for accelerating their creation and maximizing their impact. Methods We conducted qualitative case studies consisting of semistructured, audio-recorded interviews with decision makers and center staff in 6 innovation centers. We also conducted nonparticipant observations of meetings and center tours, where we took field notes. Qualitative data were analyzed initially within and then across cases facilitated by QSR International’s NVivo software. Results The centers had different institutional arrangements, including university-associated institutes or innovation laboratories, business accelerators or incubators, and academic health science partnership models. We conducted interviews with 34 individuals, 1 group interview with 3 participants, and observations of 4 meetings. Although the centers differed significantly in relation to their mission, structure, and governance, we observed key common characteristics. These included high-level leadership support and incentives to engage in innovation activities, a clear mission to address identified gaps within their respective organizational and health system settings, physical spaces that facilitated networking through open-door policies, flat managerial structures characterized by new organizational roles for which boundary spanning was key, and a wider innovation ecosystem that was strategically and proactively engaged with the center facilitating external partnerships. Conclusions Although innovation in health care settings is unpredictable, we offer insights that may help those establishing innovation centers. The key in this respect is the ability to support different kinds of innovations at different stages through adequate support structures, including the development of new career pathways.

scholarly journals Exploring health system readiness for adopting interventions to address intimate partner violence: a case study from the occupied Palestinian Territory

2019 ◽  
Vol 35 (3) ◽  
pp. 245-256 ◽  
Author(s):  
Manuela Colombini ◽  
Abdulsalam Alkaiyat ◽  
Amira Shaheen ◽  
Claudia Garcia Moreno ◽  
Gene Feder ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Partner Violence ◽  
Scale Up ◽  
Successful Implementation ◽  
Occupied Palestinian Territory ◽  
System Readiness ◽  
Palestinian Territory

Abstract Domestic violence (DV) against women is a widespread violation of human rights. Adoption of effective interventions to address DV by health systems may fail if there is no readiness among organizations, institutions, providers and communities. There is, however, a research gap in our understanding of health systems’ readiness to respond to DV. This article describes the use of a health system’s readiness assessment to identify system obstacles to enable successful implementation of a primary health-care (PHC) intervention to address DV in the occupied Palestinian Territory (oPT). This article describes a case study where qualitative methods were used, namely 23 interviews with PHC providers and key informants, one stakeholder meeting with 19 stakeholders, two health facility observations and a document review of legal and policy materials on DV in oPT. We present data on seven dimensions of health systems. Our findings highlight the partial readiness of health systems and services to adopt a new DV intervention. Gaps were identified in: governance (no DV legislation), financial resources (no public funding and limited staff and infrastructure) and information systems (no uniform system), co-ordination (disjointed referral network) and to some extent around the values system (tension between patriarchal views on DV and more gender equal norms). Additional service-level barriers included unclear leadership structure at district level, uncertain roles for front-line staff, limited staff protection and the lack of a private space for identification and counselling. Findings also pointed to concrete actions in each system dimension that were important for effective delivery. This is the first study to use an adapted framework to assess health system readiness (HSR) for implementing an intervention to address DV in low- and middle-income countries. More research is needed on HSR to inform effective implementation and scale up of health-care-based DV interventions.

scholarly journals Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Raja Ram Dhungana ◽  
Zeljko Pedisic ◽  
Achyut Raj Pandey ◽  
Nipun Shrestha ◽  
Maximilian de Courten
Keyword(s):  
Blood Pressure ◽  
Health System ◽  
Family Support ◽  
Digital Health ◽  
Illness Perception ◽  
Blood Pressure Target ◽  
Hypertension Treatment ◽  
Adherence To Medication ◽  
Factors Influencing ◽  
And Control

Background: Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. However, no systematic investigation of factors influencing hypertension treatment and control in Nepal is available. This study aimed to systematically review the published literature and synthesise the findings on barriers, enablers, and strategies for hypertension treatment and control in Nepal.Methods: Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat, and Nepali journals and government websites were searched for qualitative, quantitative, and mixed-methods studies on factors or strategies related to hypertension treatment and control in Nepal. Information from qualitative studies was analysed using template analysis, while results from quantitative studies were narratively synthesised. Summary findings were framed under “health system”, “provider”, and “patient” domains. The protocol was registered in PROSPERO (registration number: CRD42020145823).Results: We identified 15 studies; ten related to barriers and enablers and five to strategies. The identified barriers associated with the health system were: lack of affordable services and lack of resources. The barriers at the provider's level were: communication gaps, inadequate counselling, long waiting hours for appointments, lack of national guidelines for hypertension treatment, and provider's unsupportive behaviours. Non-adherence to medication, irregular follow-up visits, lack of awareness on blood pressure target, poor help-seeking behaviours, reluctance to change behaviours, perceived side-effects of anti-hypertensive medication, self-medication, lack of family support, financial hardship, lack of awareness on blood pressure complications, and comorbidity were barriers identified at patient level. The following enablers were identified: free essential health care services, family support, positive illness perception, and drug reminders. Strategies implemented at the health system, provider and patient levels were: establishing digital health records at health centres, health worker's capacity development, and health education.Conclusion: There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, health providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.

scholarly journals Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study

10.2196/16473 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16473
Author(s):  
Tanvir Ahmed ◽  
Syed Jafar Raza Rizvi ◽  
Sabrina Rasheed ◽  
Mohammad Iqbal ◽  
Abbas Bhuiya ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Information ◽  
Mobile Phones ◽  
Access To Health Care ◽  
Digital Health ◽  
Electronic Devices ◽  
Technical Skill ◽  
Integrating Technology ◽  
Access To Health

Background Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. Objective This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. Methods A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). Results A total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (α=.05, α is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. Conclusions Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study’s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care.

scholarly journals Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study (Preprint)

2020 ◽  
Author(s):  
Leah Taylor Kelley ◽  
Jamie Fujioka ◽  
Kyle Liang ◽  
Madeline Cooper ◽  
Trevor Jamieson ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Business Models ◽  
Digital Health ◽  
Digital Technologies ◽  
Economic Incentives ◽  
Barriers To Entry ◽  
Health Innovation ◽  
Health Technologies

BACKGROUND Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging. OBJECTIVE This study aims to identify areas for health system improvement to promote the integration of innovative digital health technologies developed by SMEs. METHODS This paper qualitatively analyzes a series of case studies to identify health system barriers faced by SMEs developing digital health technologies in Canada and proposed solutions to encourage a more innovative ecosystem. The Women’s College Hospital Institute for Health System Solutions and Virtual Care established a consultation program for SMEs to help them increase their innovation capacity and take their ideas to market. The consultation involved the SME filling out an onboarding form and review of this information by an expert advisory committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzed their recommendation reports to identify common barriers to digital health innovation. RESULTS A total of 2 central themes were identified, each with 3 subthemes. First, a common barrier to system integration was the lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation. Second, the health system’s current structure does not create incentives for clinicians to use digital technologies, which threatens the sustainability of SMEs’ business models. SMEs faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals. CONCLUSIONS There is a significant disconnect between the economic incentives that drive clinical behaviors and the use of digital technologies that would benefit patients’ well-being. To encourage the use of digital health technologies, publicly funded health systems need to dedicate funding for the evaluation of digital solutions and streamlined pathways for clinical integration.

scholarly journals Role of the Internet in Solving the Last Mile Problem in Medicine

10.2196/16385 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e16385
Author(s):  
Bradford William Hesse
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Rural Areas ◽  
Task Force ◽  
Digital Health ◽  
The United States ◽  
Good News ◽  
The Internet ◽  
Last Mile ◽  
Last Mile Problem

Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the “last mile problem in health care.” In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission’s (FCC’s) Connect2Health Task Force, is the unanticipated emergence of “double burden counties,” ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at “point-of-need,” (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.

Health System Fragmentation and the Syrian Conflict

2021 ◽  
pp. 33-57
Author(s):  
Aula Abbara ◽  
Manar Marzouk ◽  
Hala Mkhallalati
Keyword(s):  
Health Care ◽  
Civil War ◽  
Health System ◽  
Health Systems ◽  
Delivery Of Health Care ◽  
Protracted Conflict ◽  
Factors Influencing ◽  
Syrian Conflict ◽  
The Way

This chapter takes the analysis of the politics of health care further by exploring the way in which Syrian health care fragmented during the civil war. It reviews how Syria’s health system has been devastated by a protracted conflict that has left it politicized and fragmented, with multiple subnational health systems functioning within the country’s borders. It also cites four health systems that have emerged as a result of various geopolitical, fiscal, and humanitarian drivers, making the case for increased collaboration among the various fragments of the Syrian health system. The chapter covers the evolution of the subnational health systems and factors influencing the delivery of health care across the country. It uses the COVID-19 pandemic as a lens to highlight crucial challenges for all Syrian health systems.

scholarly journals The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Digital Health ◽  
Health Sector ◽  
Building Blocks ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

scholarly journals Open Innovation via Crowdsourcing: A Digital Only Hackathon Case Study from Sweden

2021 ◽  
Vol 7 (1) ◽  
pp. 39 ◽  
Author(s):  
Serdar Temiz
Keyword(s):  
Health Care ◽  
Open Innovation ◽  
Digital Health ◽  
Future Health ◽  
Private Organizations ◽  
Health Community ◽  
Private And Public ◽  
Private Actors ◽  
User Friendly

This paper explores HacktheCrisis, the Swedish hackathon that was a response to the COVID-19 pandemic to address the challenges that it brought up. The main aims of the research were to explore the feasibility of the digital only COVID-19 hackathon as an open innovation method and to uncover the major issues that emerged during the HacktheCrisis hackathon in Sweden. The process and outcomes were assessed, leading to the lessons and development of recommendations for future health hackathons as an innovation in health care. We have found that conducting the virtual hackathon for COVID-19 resulted in significant growth in the digital health community in Sweden. Governments should be as fast as the private actors and citizens to address these challenges and to undertake organizational adaptations. Not only the hackathons, but the projects and processes after the hackathons should also be planned. Matchmaking between individuals and private and public actors should be facilitated throughout the year. Technology companies should provide platforms that facilitate flow of process with nice structures and user-friendly tools. Organizations were not ready to utilize the outcomes of these hackathons. Compared to public organizations, private organizations were faster to join hackathons.

scholarly journals Hackathons as Stepping Stones in Health Care Innovation: Case Study With Systematic Recommendations

10.2196/17004 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e17004 ◽  
Author(s):  
Akira-Sebastian Poncette ◽  
Pablo-David Rojas ◽  
Joscha Hofferbert ◽  
Alvaro Valera Sosa ◽  
Felix Balzer ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Digital Health ◽  
Participation Rate ◽  
Multidisciplinary Teams ◽  
Stepping Stones ◽  
Health Technologies ◽  
Health Community ◽  
Cost Efficient

Background Until recently, developing health technologies was time-consuming and expensive, and often involved patients, doctors, and other health care professionals only as passive recipients of the end product. So far, users have been minimally involved in the ideation and creation stages of digital health technologies. In order to best address users’ unmet needs, a transdisciplinary and user-led approach, involving cocreation and direct user feedback, is required. In this context, hackathon events have become increasingly popular in generating enthusiasm for user-centered innovation. Objective This case study describes preparatory steps and the performance of a health hackathon directly involving patients and health care professionals at all stages. Feasibility and outcomes were assessed, leading to the development of systematic recommendations for future hackathons as a vehicle for bottom-up innovation in health care. Methods A 2-day hackathon was conducted in February 2017 in Berlin, Germany. Data were collected through a field study. Collected field notes were subsequently discussed in 15 informal meetings among the research team. Experiences of conducting two further hackathons in December 2017 and November 2018 were included. Results In total, 30 participants took part, with 63% (19/30) of participants between 25 and 34 years of age, 30% (9/30) between 35 and 44 years of age, and 7% (2/30) younger than 25 years of age. A total of 43% (13/30) of the participants were female. The participation rate of medical experts, including patients and health care professionals, was 30% (9/30). Five multidisciplinary teams were formed and each tackled a specific health care problem. All presented projects were apps: a chatbot for skin cancer recognition, an augmented reality exposure-based therapy (eg, for arachnophobia), an app for medical neighborhood connectivity, a doctor appointment platform, and a self-care app for people suffering from depression. Patients and health care professionals initiated all of the projects. Conducting the hackathon resulted in significant growth of the digital health community of Berlin and was followed up by larger hackathons. Systematic recommendations for conducting cost-efficient hackathons (n≤30) were developed, including aspects of community building, stakeholder engagement, mentoring, themes, announcements, follow-up, and timing for each step. Conclusions This study shows that hackathons are effective in bringing innovation to health care and are more cost- and time-efficient and potentially more sustainable than traditional medical device and digital product development. Our systematic recommendations can be useful to other individuals and organizations that want to establish user-led innovation in academic hospitals by conducting transdisciplinary hackathons.

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