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Kitanovikj B, Koteska B, Levkov N, Velinov G, Chagoroska Z. A narrative review of e-health systems' evolution - evidence from a regional study. J Health Organ Manag 2024; ahead-of-print. [PMID: 38802301 DOI: 10.1108/jhom-12-2023-0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
PURPOSE The growing implementation of electronic health (e-health) systems has raised the importance of analyzing how these systems have been implemented in diverse regions. By employing a contextual sensitive approach and social mechanism theory, this study aims to better understand the reasons for the success and failure of e-health initiatives in the ex-Yugoslav region and derive useful insights for policymakers. DESIGN/METHODOLOGY/APPROACH We employ a narrative review process grounded in the social mechanism theory, extended with field experts' review, to acquire state-of-the-art information. FINDINGS Findings indicate that different e-health systems coexist and evolve in different contexts in different countries, with varying levels of success. The contextual differences shape the broader environment, affecting the level of preparedness and capability for e-health implementation. Top-down approaches dominate e-health implementation in most countries when it comes to design process features, and more developed countries do not rely on strong social mechanisms for implementing e-health due to the openness of their culture towards e-health innovations. PRACTICAL IMPLICATIONS Analyzing the milestones, challenges and functionalities of e-health systems in the region of interest can assist policymakers, academics and practitioners in making informed decisions and recommendations to enhance future e-health implementation. ORIGINALITY/VALUE No known studies evaluated e-health initiatives in the former ex-Yugoslav countries holistically and evolutionarily in the form of a comprehensive regional study. Further, our research endeavor is contextually specific since the health systems of these countries in the past were tied together under the federative umbrella health system and then diverged in terms of e-health development.
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Affiliation(s)
- Bojan Kitanovikj
- Faculty of Economics - Skopje, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Bojana Koteska
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Nikola Levkov
- Faculty of Economics - Skopje, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Goran Velinov
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Zhaklina Chagoroska
- Ministry of Health of the Republic of North Macedonia, Skopje, North Macedonia
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Ndlovu K, Mauco KL, Makhura O, Hu R, Motlogelwa NP, Masizana A, Lo E, Mphoyakgosi T, Moyo S. Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study. JMIR Form Res 2024; 8:e50897. [PMID: 38625736 PMCID: PMC11061793 DOI: 10.2196/50897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). OBJECTIVE This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. METHODS A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants' requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. RESULTS Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap's capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. CONCLUSIONS Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries.
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Affiliation(s)
- Kagiso Ndlovu
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Kabelo Leonard Mauco
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Onalenna Makhura
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Robin Hu
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Audrey Masizana
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Emily Lo
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Ferreira VR, Metting E, Schauble J, Seddighi H, Beumeler L, Gallo V. eHealth tools to assess the neurological function for research, in absence of the neurologist - a systematic review, part I (software). J Neurol 2024; 271:211-230. [PMID: 37847293 PMCID: PMC10770248 DOI: 10.1007/s00415-023-12012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neurological disorders remain a worldwide concern due to their increasing prevalence and mortality, combined with the lack of available treatment, in most cases. Exploring protective and risk factors associated with the development of neurological disorders will allow for improving prevention strategies. However, ascertaining neurological outcomes in population-based studies can be both complex and costly. The application of eHealth tools in research may contribute to lowering the costs and increase accessibility. The aim of this systematic review is to map existing eHealth tools assessing neurological signs and/or symptoms for epidemiological research. METHODS Four search engines (PubMed, Web of Science, Scopus & EBSCOHost) were used to retrieve articles on the development, validation, or implementation of eHealth tools to assess neurological signs and/or symptoms. The clinical and technical properties of the software tools were summarised. Due to high numbers, only software tools are presented here. FINDINGS A total of 42 tools were retrieved. These captured signs and/or symptoms belonging to four neurological domains: cognitive function, motor function, cranial nerves, and gait and coordination. An additional fifth category of composite tools was added. Most of the tools were available in English and were developed for smartphone device, with the remaining tools being available as web-based platforms. Less than half of the captured tools were fully validated, and only approximately half were still active at the time of data collection. INTERPRETATION The identified tools often presented limitations either due to language barriers or lack of proper validation. Maintenance and durability of most tools were low. The present mapping exercise offers a detailed guide for epidemiologists to identify the most appropriate eHealth tool for their research. FUNDING The current study was funded by a PhD position at the University of Groningen. No additional funding was acquired.
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Affiliation(s)
- Vasco Ribeiro Ferreira
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands.
| | - Esther Metting
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- University Medical College Groningen, Groningen, The Netherlands
| | - Joshua Schauble
- Department of Knowledge Infrastructure, University of Groningen, Campus Fryslân, Leeuwarden, The Netherlands
| | - Hamed Seddighi
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lise Beumeler
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Valentina Gallo
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
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Stanimirovic D. Failures and fallacies of eHealth initiatives: Are we finally able to overcome the underlying theoretical and practical orthodoxies? Digit Health 2024; 10:20552076241254019. [PMID: 38766362 PMCID: PMC11100379 DOI: 10.1177/20552076241254019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/29/2024] [Indexed: 05/22/2024] Open
Abstract
The growing and ubiquitous digitalization trends embodied in eHealth initiatives have led to the widespread adoption of digital solutions in the healthcare sector. These initiatives have been heralded as a potent transformative force aiming to improve healthcare delivery, enhance patient outcomes and increase the efficiency of healthcare systems. However, despite the significant potential and possibilities offered by eHealth initiatives, the article highlights the importance of critically examining their implications and cautions against the misconception that technology alone can solve complex public health concerns and healthcare challenges. It emphasizes the need to critically consider the sociocultural context, education and training, organizational and institutional aspects, regulatory frameworks, user involvement and other important factors when implementing eHealth initiatives. Disregarding these crucial elements can render eHealth initiatives inefficient or even counterproductive. In view of that, the article identifies failures and fallacies that can hinder the success of eHealth initiatives and highlights areas where they often fall short of meeting rising and unjustified expectations. To address these challenges, the article recommends a more realistic and evidence-based approach to planning and implementing eHealth initiatives. It calls for consistent research agendas, appropriate evaluation methodologies and strategic orientations within eHealth initiatives. By adopting this approach, eHealth initiatives can contribute to the achievement of societal goals and the realization of the key health priorities and development imperatives of healthcare systems on a global scale.
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Zhao Q, Li C, Zhang Y, Tang HT, Wang J, Yu XH, Zhao Y, Xing Y, Yu J, Ye J, Shan EF, Li XW. Economic evaluations of electronic health interventions for people with age-related cognitive impairment and their caregivers: A systematic review. Int J Geriatr Psychiatry 2023; 38:e5990. [PMID: 37655517 DOI: 10.1002/gps.5990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
OBJECTS Dementia has physical, social and economic impacts, causing considerable distress for people with age-related cognitive impairment (PWACI) and their caregivers. Electronic health (e-health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e-health interventions will facilitate the decision making and implementation of integrating e-health into routine health services. The present review aimed to appraise economic evidence related to e-health interventions for PWACI and their caregivers. METHODS We systematically searched multiple cross-disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive-analytical narrative method was used to analyze the review findings. RESULTS Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi-experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost-effectiveness analysis, five cost-consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e-health multicomponent interventions can reduce the cost of health service utilization in short term (10-104 weeks). CONCLUSIONS Few studies calculated the incremental cost-effectiveness ratio to evaluate the cost-effectiveness of e-health interventions. Preliminary evidence indicates that e-health interventions can reduce the cost of health service utilization in the short term, but the cost-effectiveness of e-health interventions hasn't been identified. More robust evidence is needed to clarify the value of e-health interventions for PWACI and their caregivers.
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Affiliation(s)
- Qing Zhao
- School of Public Health, Southern Medical University, Guangzhou, China
- School of Health Management, Southern Medical University, Guangzhou, China
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yu Zhang
- School of Humanities, Changzhou Vocational Institute of Textile and Garment, Changzhou, China
| | - Hui-Ting Tang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jing Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiao-Hong Yu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jie Yu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Juan Ye
- Department of Internal Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, China
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Mamuye A, Nigatu AM, Chanyalew MA, Amor LB, Loukil S, Moyo C, Quarshie S, Antypas K, Tilahun B. Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study. JMIR Form Res 2023; 7:e41487. [PMID: 37171865 DOI: 10.2196/41487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/15/2022] [Accepted: 01/31/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. OBJECTIVE The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. METHODS A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. RESULTS A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5% (36/49) of them were male participants; and 71.4% (35/49) of them had a master's degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. CONCLUSIONS This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries.
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Affiliation(s)
- Adane Mamuye
- College of Informatics, University of Gondar, Gondar, Ethiopia
| | - Araya Mesfin Nigatu
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | | | | | - Chris Moyo
- Health Information Systems Programme Malawi, Lilongwe, Malawi
| | | | | | - Binyam Tilahun
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ferreira VR, Seddighi H, Beumeler L, Metting E, Gallo V. eHealth tools to assess neurological function: a systematic review protocol for a mapping exercise. BMJ Open 2022; 12:e062691. [PMID: 36167388 PMCID: PMC9516209 DOI: 10.1136/bmjopen-2022-062691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Population-based epidemiological studies investigating risk/protective factors are outlining prevention strategies for neurological conditions that often do not have effective treatment. However, ascertaining neurological outcomes can be a time consuming and expensive process, often requiring specialised personnel and/or equipment. Thus, collecting neurological data on a large scale has been an ongoing challenge for clinicians and researchers alike. The development of new technology and the emergence of several opportunities to adapt it to the health research and practice (eHealth) can be a promising solution to this problem. Several neurological eHealth tools have been developed, with many others being currently planned. METHODS AND ANALYSIS We propose a systematic review mapping the available eHealth tools for assessing the different aspects of neurological function. The search aims at identifying studies published in peer-reviewed journals, which focused on the development or implementation of eHealth for assessing neurological signs or symptoms. Four engine databases are being considered (PubMed, EBSCOhost, Web of Science and Scopus), and data extraction will follow a process aimed at classifying them by their characteristics and purposes. ETHICS AND DISSEMINATION This mapping exercise will be made available to researchers in order to aid them in successfully ascertaining neurological outcomes in large population-based epidemiological studies. Given the nature of this study, no ethical clearance was needed to conduct the review.
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Affiliation(s)
- Vasco Ribeiro Ferreira
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
| | - Hamed Seddighi
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
- Social Welfare Management Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Lise Beumeler
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
| | - Esther Metting
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Valentina Gallo
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
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A prospective interoperable distributed e-Health system with loose coupling in improving healthcare services for developing countries. ARRAY 2022. [DOI: 10.1016/j.array.2021.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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