A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies

Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, Netherlands.
Journal of Medical Internet Research (Impact Factor: 3.43). 12/2011; 13(4):e111. DOI: 10.2196/jmir.1672
Source: PubMed


Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the reasons for this is that the current development of eHealth technology often disregards the interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity of health care and the rituals and habits of patients and other stakeholders.
The aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development and eventual integration in the health sector.
To identify the potential and limitations of current eHealth frameworks (1999-2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies; these principles underpin our holistic eHealth framework.
A total of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory development approach, persuasive design techniques, and business modeling.
To demonstrate the impact of eHealth technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate health care. It also requires new concepts and instruments to develop and implement technologies in practice. The proposed framework serves as an evidence-based roadmap.

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Available from: Hans C. Ossebaard, Feb 05, 2014
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    • "However, the results also showed that the PHR is mostly illness-driven instead of user-centered (with little attention for the needs of the end-users), indicating that involving the end-users (via a contextual inquiry and value specification [21]) is valuable in the development of new technologies [24]. By involving the end-users and having an eye for their needs, the added value of the new technology is already evident in the first stages of the developmental cycle [26], which may in turn lead to a better diffusion of the technology. "
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    ABSTRACT: A Personal Health Record is a promising technology for improving the quality of chronic disease management. Despite the efforts that have been made in a research project to develop a Personal Health Record for patients with type 2 diabetes mellitus in primary care (e-Vita), considerable differences have been reported between the number of registered users in the participating primary practices. Interviews among practice nurses indicated that a lack of infrastructure (integration in daily care processes), the ability to try the Personal Health Record with minimal investments and without commitment (trialability) and the relative advantage of using a Personal Health Record in comparison with other methods were important factors for the diffusion of the Personal Health Record in primary care.
    International Journal on Advances in Life Sciences 12/2014; 16(3&4):177-183. · 14.20 Impact Factor
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    • "The AI Application will be introduced on different wards and in other hospitals, following a re-design or adaptation of the application and its content to fit local work methods. This broad implementation will be accompanied by evaluations regarding stakeholder needs, use context and user satisfaction, following the CeHRes roadmap [8]. ACKNOWLEDGMENT This project was funded by the European Interreg IV " EurSafety Health-net " project. "
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    ABSTRACT: To ensure optimal treatment and patient safety, nurses need easily accessible information. An application was developed to support nurses in their antibiotic-related tasks. With log data analysis and user interviews we evaluated the application. We aimed to interpret log data by applying the Persuasive Systems Design model. The results show steady, continuing use that corresponds to nurse tasks regarding timing and content of use. Task support seems a top relevant motivation for using the system, given positive user comments and most popular content of instruction pages. The results show that a combination of log data and user interviews help to understand use and uptake of an application in practice.
    International Journal on Advances in Life Sciences 12/2014; 6(34):210-219. · 14.20 Impact Factor
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    • "In this study, we applied the CeHRes-Roadmap [9] to perform the formative research phases of contextual inquiry, value specification, and design evaluations (see Figure 1). Contextual inquiry entailed a twofold investigation: Which information problems do nurses encounter when fulfilling which ASP-associated tasks? "
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    ABSTRACT: Background Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses’ can be supported in ASPs by means of an eHealth intervention that targets their information needs. Methods We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital. Results To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application’s functionality, content, and structure to nurse work practice and tasks. Conclusions By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses’) and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspectives.
    BMC Medical Informatics and Decision Making 06/2014; 14(1):45. DOI:10.1186/1472-6947-14-45 · 1.83 Impact Factor
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