Digital health and mHealth is part of eHealth, which is defined as “the use of information and communications technology in support of health and health-related fields”. Mobile health (mHealth) is a subset of eHealth and is defined as “the use of mobile wireless technologies for health”.

The WHO guidelines 

The guideline  " first-ever evidence-based guidelines for digital health interventions"  provides nine recommendations on select digital health interventions that involve the use of a mobile phone or mHealth device. Also guidelines have information on implementation, evidence based quality and certainty of extant evidence, which can really help policy makers to develop good quality of mHealth intervention which can support health system.

There is obvious need of such guidelines now, as now population started developing trust and interest in wearable health devices to track and monitor health. Also, there are ample of devices available which does not provide exact reading of the bio parameters. Such guidelines will help in developing mark to certify such devices. 

Interesting article, and it has include various types of digital health intervention. One of the interventions can be online prescriptions and online lab reporting, the general issues with regards to readability of the prescriptions, prescribing generic medicines over branded. The reports generated online come with additional features of privacy, can be password protected. The online prescription and laboratory reporting are low hanging fruits which can be integrated easily 

The proposed digital health guidelines can be used for M-Health initiatives to promote public health and support population health outcomes. Especially in India, these guidelines could be helpful in promoting Mobile health, since the accessibility to mobile devices is more compared to computerized systems. As the guideline says, the mobile digital health interventions for birth, death notification, telemedicine would be really helpful in the Indian scenario.

Interesting read. It is rightly quoted in the document that "Technologies are no longer a luxury; they are a necessity". In India and most of the developing/LMIC's digital health is still in its initial stages. In current times, due to global social distancing norms, digital health has a promising future. But, for its proper implementation and expansion, there is a demand for multi-level collaborations among governmental and private organizations. The Indian government recently launched "The digital health mission" to address the public health crisis. The key components of the mission include a health ID, telemedicine, health records, health registry, along with Digi-doctor and e-pharmacy services. However, for turning the mission into reality it will have to address many obstacles such as shortage of medical personnel and insufficient infrastructure, data privacy and security, and low internet penetration and accessibility of digital records, particularly in rural areas. Combing proper infrastructure and digital health can prove to be essential in strengthing the healthcare system of India.

@Dr Ashish Joshi

Interesting topic and role of Digital health is very important in Health system strengthening. I want to highlight the importance of private sector, social enterprises which has potential to strengthen health systems and utilize digital health interventions and citizen engagement strategies to strengthen health services. (a) social enterprises as ‘a private-sector, socially-oriented solution to serve the unserved’(b) ‘digital technologies’ in health, including ‘electronic health (e-health), mobile health(m-health)’ and ‘electronic information systems & (c) engaging citizens and communities in implementing, Digital health is ‘the field of knowledge and practice associated with any aspect of adopting digital technologies to improve health system strengthening. It includes ‘eHealth’ as well as developing big data and artificial intelligence. Considering the global need and demand for health and care services, social enterprises that utilize digital technology in health system strengthening, citizen engagement promise for accelerating global progress towards Universal health coverage and sustainable development goals (SDG).

The Tanahashi framework published by WHO in 1978 provides a time-tested model of understanding health system performance gaps and how they prevent the intended coverage, quality and affordability of health services to individuals. The cascading model nicely illustrates how health systems lose performance because of challenges at successive levels, each dependent on the previous level. Health system challenges – such as geographical inaccessibility, low demand for services, delayed provision of care, low adherence to clinical protocols and costs to individuals/ patients – contribute to incremental losses in health system performance that cumulatively impact on the health of individuals. These shortfalls limit the ability to close the gaps in coverage, quality and affordability, and undermine the potential role of digital health. 

@mahimakaur

We all live in a digital age, with its impact on all the facets of our lives, however, for those who were still a bit distant with respect to digitization, the speed to adopt the digital lifestyle was accelerated by the COVID-19 pandemic. On the similar context, the scope and demand of digital health has increased tremendously during these critical times. Digital technologies can help the health systems in meeting the challenges of access, affordability and inequity, and can be specifically helpful in resource constrained settings to maintain the health and well-being of the populations by customized interventions.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7231431/

Lack of legal regulations and guidelines supporting the comprehensive use of Digital Health Interventions has been the greatest obstacle for the digital transformation of Public Healthcare systems. But this recent development by WHO is likely to bring improvement and changes in this regard as it has offered an opportunity to address the gaps related to how efficient an intervention will be and will also provide actionable insights for the same. With the proposed evidence-based guidelines for digital health interventions, WHO has critically played a leadership role in projecting the best practices for policymakers and governments as the nine recommendations on digital interventions for health system strengthening will definitely scale the digitized health systems. These guidelines on Digital Health Interventions also aims to equip health policy-makers and various other stakeholders with various recommendations for making informed investments into digital health interventions. This will also help in harnessing the power of digital health interventions for achieving the Sustainable Development Goals.

The guidelines have included the perspective of multi-stakeholders’ as the interventions available are from the view of patients/clients, clinicians, and healthcare providers and workers. So government and policymakers can identify with the principle of multi-stakeholder perspective. In addition to this to make their Digital Healthcare Systems more robust, they can come up with stakeholder engagement as well so as to have a strong efficient system.  This is essential as it is crucial to ensure an in-depth assessment of the potential impact from multiple perspectives for the successful implementation of Digital Health Interventions.

Through the WHO Guidelines, the intervention of targeted client communication is understood as the recommendations directed the ability of digital health solutions through health event alerts to specific population group based on health status, targeted alerts and reminders to patients and providing diagnostics result to them. This would give the policymakers a vision for a concept of a robust targeted client communication system in Digital Health Intervention systems.

There is also the recommendation of Clinical decision support systems that assist health workers in making diagnosis and treatment decisions. Using the algorithms to support health care service according to care plans and clinical protocols and in combination with health worker’s knowledge, the Health Worker Decision System development can be utilized towards an efficient informed decision-making system for better health outcomes.

The concept of Supply chain Management is also included in the guideline including managing inventory and distribution of health commodities and notifying stock levels of medical commodities. This concept should be one of the key components of Digital Health Interventions as it will ensure management and coordination of logistics which is an essential component for any successful healthcare system.

The guidelines given by WHO, are definitely beneficial in understanding the various aspects of ensuring digital health such as data confidentiality and privacy, education/training for users, targeted client communication, creating digital systems for death and birth notification and stock and commodity management. The recommendations given are very useful in drafting new technological concepts, which can improve the health outcomes.

However, in the developing country like India, where the 70% population live in rural settings and their access to healthcare setting is still a major challenge. The issues, which are very prominent in India such as absence of requisite infrastructure, lack of internet facility access, if people have access to internet the speed is very slow and lack of healthcare professionals have to be taken care of well before implementing any technology. Definitely, Mobile technology is an effective way to connect with rural population but the use of mobile technology is limited to younger and educated generation and the people who are not educated will not be able to take advantages of mobile health interventions. Still many people cannot even read simple messages.

With the continuously growing population and increasing rates of non-communicable diseases in India, without digital intervention it would be very difficult to manage. Thus, Digital Health technology definitely provides a way, which can definitely improve health outcomes of the people through ensuring better access via mobile app and tele consultation, ensuring better communication between providers and patients, ensuring regular supply of stocks and commodities, ensuring increased knowledge and awareness and so on. Digital Health policy of India is the first step in this direction but it needs many evaluation studies to know the ground situation so that before implementing any technology proper evidences are there to support decisions.

Therefore, India needs a health technology, which can serve needs of all not in isolation. One of the article is given below which describes about challenges in rural settings of India.

//www.researchgate.net/publication/346075484_Digital_Health_Evolution_and_propagation_in_Rural_Healthcare_in_India_A_Review

Rohitashwa

WHO recommends the following 9 digital health interventions¹: 

1. Birth notification via mobile devices
2. Death notification via mobile devices
3. Stock notification and commodity management via mobile devices
4. Client-to-provider telemedicine
5. Provider-to-provider telemedicine
6. Targeted client communication (TCC) across five population groups
7. Health worker decision support via mobile devices (CDSS)
8. Digital tracking of patients’/clients’ health status and services via mobile devices
9. Provision of training to health workers via mobile devices (mLearning)

I am not sure how many of them we are, as a country, already implementing and what are our future plans to implement them. If someone has an answer to these questions then it would be useful to know. It will be good if we can discuss these digital interventions one by one where we can quote a live example or project where it has been used. This will also help us in understanding the importance and utility of each of these interventions. If these guidelines are not implemented or not being used somewhere, guidelines would remain guidelines always and would never become a part of the actual project. 

India is joining digital revolution and it has brought great benefits such as electronic health records, digital epidemiology and mobile health applications. However, with proliferation of technologies many ethical issues also arise. The article, “Ethical challenge of digital health technologies: Aadhaar  India” has highlighted unique challenges in handling the big data particularly in low and middle income countries. Linking the digital health data with Aadhaar identification data can result in the privacy breach of patients as low and middle income countries do not have strong data protection laws. With digitization of health system strong and effective health protection laws should also be implemented to preserve the sensitive health information. 

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7133485/

Could Digital Health be a Tool for Health System Strengthening?

Digital Health (DH) could be used as tools to strengthen health systems. Variables such as improvement of overall governance and stewardship of health services facilitating adoption of sustainable digital solutions, and integrating with wider government systems are required.  Resilient health systems and communities as well as good access to the social, economic and environmental determinants of health are also needed.

DH should have an appropriate DH governance framework, and should be implemented within the broader framework of resilient health systems, communities and access to the social, economic and environmental determinants of health.

Read more: //www.frontiersin.org/articles/10.3389/fpubh.2019.00341/full

Digital health interventions (DHI) have a great potential to help address the healthcare issues such as access to healthcare services. However, DHIs also share similar challenges faced by health system interventions such as poor governance, inadequate training, limited equipment and infrastructure. Thus, these considerations also need to be addressed in addition to the requirements introduced by digital health.

The proposed DHI recommendations contribute to the needs of the healthcare systems in diverse but interlinked ways.

For health system leaders, the recommendation on digital stock notification intends to ensure availability of commodities at the point of care. From patients’ perspectives, this would able them to have prompt access to the health-related information and services. Similarly, the healthcare workers need to be accessible and follow good healthcare practices to deliver high quality care through mLearning and decision support interventions.

@ashishjoshi

Digital health (DH) has been recognized as a building block for universal health coverage and sustainable development goals. It can accelerate health system reforms, contributing to good quality, efficient, and accessible patient-centred health care.

Although many countries are implementing solutions like digital disease surveillance systems, electronic health records, social health insurance payments, they still lack a holistic approach to DH. Good DH governance is imperative for its successful implementation and sustainability throughout the healthcare systems. Good governance is also a basis for coordination between stakeholders and policies that may enable effective DHIs for functioning of health systems and maximize health outcomes.