Health informatics and digital health innovations

WHO recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use and equity considerations

Interesting Read (WHO Guideline Recommendations on Digital Interventions for Health System Strengthening: //apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf?ua=1

Also during the pandemic, Healthcare technology has played a crucial role in every phase like: testing, telling nearby people with covid, follow up, precautionary measures. Role of technology in healthcare has only made this pandemic to pass by connecting everyone to healthcare in efficient way.

Disparities in healthcare are still a concern, though implementation science can play an important role in achieving health equity but its application has not been applied across all populations and healthcare system. In the article “The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment “two conceptual frameworks (One from implementation science and one from healthcare disparities research) are integrated to develop Health Equity Implementation Framework

The framework was then applied to a historical healthcare disparity challenge—hepatitis C virus (HCV) and its treatment among Black patients seeking care in the US Department of Veterans Affairs (VA).It was concluded the framework is feasible for implementation scientists to design survey materials and interpret results and proposed framework  had also identified the barriers and facilitators specific to this vulnerable group.

Read here for more information 

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6417278/

//www.sciencedirect.com/science/article/pii/S2666693620300566

This article provides a rapid review of digital health technologies (DHI's) and examines how DHI's may improve CVD management and treatment in health disparity populations. The most common DHIs were telemedicine and mHealth, while decision support tools, patient portals, and Electronic Health Records were used less frequently. DHI's can aid in overcoming barriers in health disparity populations. For instance, When patients are unable to meet with clinicians in person because of distance to healthcare facilities, inability to miss work, or lack of transportation, telemedicine can fill an important gap. Patients can be monitored or treated remotely using telemedicine interventions. Additionally, patient-centered mHealth interventions may provide the opportunity to support behavior change and attenuate health disparities, as patients can receive real-time, personalized support.

The paper explicitly describes the Impact of a Culturally Tailored mHealth Medication Regimen Self-Management Program upon Blood Pressure among Hypertensive Hispanic Adults. The experimental group participants utilized a SMASH app which interfaced with a Bluetooth-enabled BP monitor for BP self-monitoring and an electronic medication tray. Medication trays provided a series of reminder signals to take medications (blinking light, intermittent chime, automated SMS/phone call). The combination of tactics that contributed to the success of the intervention included a real-time measure of Medication Adherence (MA), relevant biometric self-monitoring, integrated HCP engagement to provide timely titration changes. Health literacy was enhanced via SMS messages, audio, and video clips. The SMS messages were based upon the participant’s responses to a branch logic questionnaire, which identified their values, beliefs, and short/long term life goals.

Read More: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6479738/

 In this research article “Implementation Research Methodologies for Achieving Scientific Equity and Health Equity” three implementation methodologies have been reviewed to address the disparities and improve the health equity.

The first paradigm is to use existing data efficiently by incorporating epidemiological and simulation modelling in study design to analyze reasons and solutions of disparities.

The second paradigm focuses on the involvement of populations with a history of health disparities, such as multi-lingual, racial/ethnic minority, and low-income communities in new implementation research studies in prospective manner and in a proportion that is representative of the degree of the health disparity.

The third paradigm is to conduct implementation research exclusively on disadvantaged people and bring evidence based interventions to them . These three complementary paradigm are introduced with an objective to reduce health disparities among disadvantaged populations.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6428169/

“Implementation research is the scientific inquiry into questions concerning implementation—the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices (collectively called interventions).” It contemplates aspects of implementation, including the factors, process and results of implementation, including how to introduce potential solutions into a health system or how to promote their large-scale use and sustainability. This article provides a broad definition of implementation research and outlines key principles for how to do it.

//www.bmj.com/content/347/bmj.f6753

This article reframes elements of implementation science framework of Proctor et al. for inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes.

//bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4975-3#Sec1

Health informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. This paper extensively discusses the characteristics of health-related interventions known to produce IGI and explains why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. They provide examples in which health informatics interventions produced inequality because they were more accessible to, heavily used by, adhered to, or effective for those from socioeconomically advantaged groups. They also provide a brief outline of precautions that intervention developers and implementers can take to guard against creating or worsening inequality through health informatics.

Read more: //www.researchgate.net/publication/325321094_Good_intentions_are_not_enough_How_informatics_interventions_can_worsen_inequality

This is an interesting read "Towards an equitable digital public health; Promoting equity through health literacy perspective".

//academic.oup.com/eurpub/article/29/Supplement_3/13/5628050

The World Health Organization classifies ‘digital technologies’ used for health and health services into four distinct categories:

• Interventions for clients.

• Interventions for healthcare providers.

• Interventions for a health system or resource management.

• Interventions for data services. 

The difficulty in making an assessment on the relationship between diffusion and uptake of digital technologies associated with health and the effects on healthy equity at the population level is partly a result of the diverse social determinants of health that may be studied leading to different results. With the current technological growth and diverse health solutions, it is important to assess the ongoing initiatives for their reach and usability. Digital literacy is a pivotal aspect to reach health equity. While there is considered acceptance of digital health technologies in urban areas, there is a need to focus research also towards the rural, marginalized population with limited access and resources. Digital literacy drives can be instrumental to achieve equity. Currently, India has 'Pradhan Mantri Digital Swaksharta Abhiyan' targetted towards achieving digital literacy but according to an article in The Hindu, The Ministry of Electronics and Information Technology (MeitY) says it would require more funds for the digital literacy program to train around six-crore people in rural areas under the Pradhan Mantri Gramin Digital Saksharta Abhiyan (PMGDISHA) that envisages making one individual digitally literate in every rural household. Allocating adequate resources and upscaling the Digital literacy drives is of immediate concern.

//www.pmgdisha.in/

In the current scenario for example the recent happening of pandemic has been seen to affect racial and ethnic minorities disproportionally. The paper addressed below, shows how implementation science can help address disparities by guiding the equitable development and deployment of preventive interventions, testing, and, eventually, treatment and vaccines. They discuss three ways in which implementation science can inform these efforts:

(1) quantify and understand disparities;

(2) design equitable interventions; and

(3) test, refine, and retest interventions.

Read more: //pubmed.ncbi.nlm.nih.gov/33111032/

Health Informatics performs the junction between the information technology and delivery of health care system. It is more responsive and predictive to enhance preparedness for action at health level, used in various sectors such as clinical research, public health, consumer health, biomedical data, genomic data and so on. With the help of informatics, health professionals can share insightful discoveries and information through video-conferences, tale-medicine etc. For example; with the use of Robotics arms, one doctor simultaneously can performs more than one operation. Another example; we can deliver expertise services in rural or hilly area by telemedicine.

We can use this technology to streamline processes. It will reduced inequality in healthcare and greatly minimizes the risk of preventable medical errors and significantly increases quality of care. The informatics awareness and equality in access is also needed for its successful adoption.

Read more: //nhsrcindia.org/health-informatics

Health equity means right of best health at best condition. Unfortunately, In India there are many social and environmental factors can limit a person’s access to and continued use of good health practices and healthcare like gender, racial, ethnicity, no access to education etc. 

I would like to share one very good podcast here for the reference, how technology is helping for health equity.

//www.mobihealthnews.com/news/north-america/himsscast-addressing-health-inequities-technology-and-entrepreneurship //www.mobihealthnews.com/news/north-america/himsscast-addressing-health-inequities-technology-and-entrepreneurship  

In the article “Harnessing Implementation Science to Increase the Impact of Health Disparity Research: three phases of disparity research were discussed, detecting (Phase 1), understanding (Phase 2), and reducing (Phase 3).  Incorporating implementation science frameworks into Phase 2  and Phase 3 studies design could widen the scope of disparity research.

The Article emphasized that  Implementation science tool can be used to recognize factors causing disparities and for this more cross collaboration between health disparity researchers and implementation scientist is needed to achieve health equity.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC5639697/

There has been a huge growth in Digital Health innovations and it has definitely accelerated growth and impact on population health. However, it is also a known fact that under resourced populations are still far away from accessing technology-based innovations. Most of the technological innovations are based on intellectuality of the researcher’s group or policy makers however, there is very less or nil participation was ensured from community side, which is very much needed to ensure strong acceptability and address health inequities. Technology should reach to all the people who are in need it should not be just for people who have resources available. This paper provides some of the case studies, which displays contextually tailored, socio technical mobile health interventions designed with community members to address health inequities using community-engaged research approaches.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6996775/

@kamalpreet

This was an informative read which very well explained the role of Implementation science in achieving health equity. Applying implementation science frameworks like the Consolidated Framework for Implementation Research (CFIR) having five domains could actually help disparities research widen its scope. Following is the description of its domains:

1. The first CFIR domain can influence the adoption of clinical intervention which is the intervention characteristics which include the strength of evidence, relative advantage, complexity, and adaptability.
2. The next domain of the CFIR is the outer setting which has a broader social, political, and economic context.
3. The domain of inner setting in which the clinical intervention is implemented has structural characteristics, relationships, implementation readiness
4. The fourth domain includes the characteristics of the individuals involved in implementation -knowledge, efficacy, skills.
5. The final domain is the implementation process taken to facilitate a clinical intervention’s use.

While CFIR emphasizes patient and provider influence on intervention uptake, it also recognizes healthcare organization, community, and policy level influences as critical factors for reducing disparities which are also acknowledged by health disparities researchers.