WP: Going to Digital Health Overnight (GDHO)

Due to the COVID-19 pandemic there is an unprecedent effort to implement Digital Health Solutions (DHS) for remote management of patients. It has even been suggested to be a ‘black swan’ moment regarding the use of e-health for mental health (1). The focus on digital health has increased over time as technologies has matured and provided a more meaningful role, mainly enabled by wide spread use of ‘smart phones’.

DHS for remote management of patients compose a wide range of technologies which can exert their function in a wide spectrum of complexity. On one hand, we can find “simple” DHS that enable remote care, such as video-calls where the new approach has rather limited organizational impact, even though it requires careful consideration how to make it safe and robust as well as to provide the necessary training and equipment to the user.

On the other hand, many of the DHS that have been evolving have aquired a more “complex” and integrated function of the current disease management, which may alter the dynamics between patient and healthcare, and/or change the process of disease management, possibly leading to the need of organizational changes. In many health-related disciplines it has been difficult to demonstrate positive effects by the implementation of such solutions, however, the research is rather limited. In addition, whether this lack of positive results comes as a result of a non-effective DHS, or from an incorrect adaptation of the healthcare organization, still remains unclear. However, It must also be acknowledged that several studies have also shown positive results of DHS implementation, but if those results were driven by changes in adaptation of the healthcare organization rather than the DHS itself, is a question that remains also unanswered.   

In addition, some other issues must be discussed. There can be aspects of how the healthcare providers are reimbursed that can provide significant constraints in the ability to transform to the new way of working, (1) either through limitations in reimbursement for the DHS together with its associated activities, or (2) through the reduction of traditional activities associated to the funding to the hospital. In most countries there is limited if any relevant methodological guidance and management to ensure safe and effective implementation of such DHS solutions.

The urgency, caused by the COVID-19 pandemic, to manage patients remotely triggers the pressure to implement DHS which are both “simple” and do not require major organizational changes, and those which are “complex” and require changes at the healthcare organizational level, many times with limited discernment of when an implementation is complex and require a very different framework of operation.

We aim to help create an understanding of what is ‘simple’ vs ‘complex’ DHS to help decision makers initiate the appropriate actions to ensure safe and effective implementation of the DHS.

In the context of this work-package we want to develop knowledge and guidance for current initiatives to implement DHS as well as to shape a future research agenda to develop methodologies to ensure better utilization of DHS as an integrated part of the healthcare.

We aim to address the following topics:

  • Strategic:
    • Evidence based disease management integrating digital health
    • The evaluation methods for DHS
    • Funding mechanisms for DMP and DHS
  • Guidance and knowledge of non-disease specific issues:
    • Utilizing digital patient interaction / triaging to improve the patient experience and organizational efficiency
    • Broad use of remote management in a hospital.
    • Integration of new ways to interact with the patients, such as chat-bots
  • Guidance and knowledge of how to implement more complex DHS in specific disease areas.
    • Chronic disease
      • Asthma
      • COPD
      • Diabetes
      • Heart Failure
      • Hypertension
    • Vulnerable patient groups
      • Oncology
      • Cognitive impairment / Alzheimer
  • Basic technical and regulatory requirements
    • Basic understanding of regulatory requirements and the limitations that exist and how they should be managed.
    • Basic understanding of data privacy and security

The general format will be:

  • Basic analysis of the question at hand
  • Development of agenda and recruitment of relevant experts.
  • Webinar session to discuss / review the topic
  • When appropriate publish the conclusions from the sessions.
  1. Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: The “black swan” for mental health care and a turning point for e-health. Internet Interv. 2020 Apr;20:100317.