What are the aims of the implementation of e-solutions in healthcare? Review of the relevant practical studies

Introduction

The development of medical science has been always related to the progress of other technological and scientific discoveries. Computer sciences, telecommunication and electronic inventions were developed parallel to new medical procedures. EHealth (defined as medicine supported by electronic processes and communication tools), mobile health (mhealth, supported by mobile technology), ICT (information and communication technology) and telemedicine technologies are not merely new fashionable concepts but the tools which are increasingly used in healthcare since the late 1970s. These technologies goes along with the way how medical services are provided. Practitioners and researchers pointed some benefits which are related to technological development in their field. These improvements require a great expenses as well as scientific involvement by healthcare providers and governmental agencies. Public spending spurs new technology which nonetheless requires an evaluation of the outcomes. As long as 30 years ago the European Commission started to support eHealth initiatives, providing around 500 million euro for approximately 400 projects between 1988 and 2003 [1]. Investment in eHealth is still increasing, with 197.5 million euro are to be spent in years 2018-2020 [2].

Although the above-described are only complementary to the basic healthcare functions (prevention, diagnosis, treatment and rehabilitation), the impact of eHealth on the organization of medical services is substantial. The exact assessment of the impact of a given eHealth solution on actual improvement requires deployment of adequate methodological tools. The complete research process on eHealth and telemedicine consists of five stages: concept development, service design, pre-implementation, implementation and post-implementation analysis [3]. The contemporary knowledge upon eHealth use needs systematic evaluation.

Material and methods

Google Scholar database was Boolean searched with various of keywords combination: “eHealth”, “research”, “effectiveness”,  "healthcare",  “study”  “patient”, “value”, “project”,  “data”, “disease”. E-scholar database was chosen due to its unique characteristic, including multidisciplinary and widely open for diversified editors, direct open access of the full-text of numerous articles. Studies published since 2015 were screened. The top most five cited articles were selected from every search for further evaluation (synthesis), taking into account how long given article was accessible. The inclusion criteria were as follows: clinical trials, cases reports and reviews of original trials. The extraction of the declared aim and methodological approach was performed than the process of aggregation into broader categories was performed. The complete review of articles was presented together with the specific application of given study.

Results

Following study search and selection, 28 articles were included in the review synthesis. The selection process revealed a broad spectrum of interest among eHealth of their authors. The aims of studies were identified, the results of review were presented according to the area of interest.

Out of 28 studies, 15 (53.6%) had 1 specific research aim, 8 (28.6%) had 2 aims and 5 (17.8%) were designed to find out 3 aims. The most popular research question was healthcare effectiveness. The definition of “healthcare” was defined very broadly in the reviewed articles, including health promotion, education, diagnosis, treatment and rehabilitation. Secondly, articles focused on patients’ perception and attitude towards new technological solutions in healthcare delivery. The 3^rd and 4^th goals of the analyzed articles were professional perceptions of eHealth solutions and improving their quality through better data collection and aggregation. On the other hand, only 1 paper focused on the safety of the patients’ care. Along with the identification of the aims of the studies we paid attention on what kind of research was undertaken to present it in the given article. The most common was qualitative study while randomised controlled trials were rare way to study the phenomenon of eHealth.

Discussion

Health education and promotion

The development of internet continues to bring an exponential increase in information including health promotion. Furthermore, it is challenging for the reader to verify the quality and accuracy of the available data. Therefore, granting public access to seemingly valuable information is not an efficient way to increase awareness of health risks or to support individuals in making healthy choices. Thus it is not surprising that one of the principal aims of eHealth studies is assessing the actual response to the delivered information [6,13]. 

Early diagnosis - interviews

Web questionnaires are a useful and time-saving tool to gather information and perhaps a replacement of the telephone or face-to-face interview. This can be applied on the level of provider and improve communication with patients before their scheduled appointments. Moreover, online surveys could target larger group of individuals. A few studies aimed at improving the quality of such tools [19].

Table 1. Aims of the reviewed studies.

Patient - provider communication process 

In many countries patient-oriented care became the new goal of the both public and private healthcare providers. Specifically, one of the most important values to patients is a so-called “good communication” with health care providers. We know intuitively that this element of patient-oriented care could be possibly facilitated by ICT tools. The question whether implementing such ICT solutions is reasonable. It was proved that this aim is nearly impossible to achieve without an appropriate engagement of healthcare providers [30].

Treatment and rehabilitation

Organising home-based care can be difficult due to logistics, possible costs and obstacles to quality supervision at the same time. In this field, telemedicine became an accepted solution which facilitates the healthcare process while keeping cost under control. There are numerous examples of successful implementations of such projects [6,9,16,20]. Parallel to their achievements, there is a constant need to evaluate the new solutions. Technologies can replace some of the problems related to the so-called “human factor” and improve work [5,24]. However Black et al. indicated that there is gap between the postulated benefits and the expectations of ICT solutions. The future eHealth technologies need evaluation [32]. Of the numerous studies published so far, only two systematic reviews on eHealth and two on mHealth were validated by Cochrane Groups [33–35]. One of the emerging challenges is the quality of introducing and management of health information system, which requires basic technological knowledge from both the managerial and non-managerial staff. Moreover, systematic evaluation and interpersonal abilities engage more personnel. 

Conclusions

Though eHealth obviously involves technology, the attitude of healthcare providers looking to implement such solutions should be holistic and not merely technologically and economically focused [36]. Economic evaluation of any eHealth technology is still evolving and therefore needs  standardization. While the evaluation of pharmaceutical substance can be easily based on randomized control trial, in the field of eHealth it is more complex and thus demanding [37]. The most important part of research assessing the implementation of an e-solution in any healthcare organisation is to clearly define the aim [38].

Summarizing, we currently face the rapid increase of the reports on eHealth solutions. The process of planning further projects in this field should be preceded by a careful revision of current achievements. It would be more beneficial if future studies address real problems of healthcare. This review revealed that most of studies about eHealth attempted to assess more than one problem.