Digital health interventions have the potential to revolutionise the quality, access, and efficiency of healthcare in the future, and the achievement of universal health coverage (UHC) across the globe. While regulation thereof is vital, the question of how to do so is challenging given the ever-evolving technology and countries’ individual challenges.

The WHO’s new guidelines explain that digital health interventions allow health workers to expand their range of tasks as well as take on tasks previously assigned to higher-level workers.

This is what makes the first guidelines on digital health interventions released by the World Health Organization (WHO) such an important step forward. “Harnessing the power of digital technologies is essential for achieving UHC,” said WHO director-general Dr Tedros Adhanom Ghebreyesus. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”

THE 10 RECOMMENDATIONS

Consulting with experts from around the world the WHO has reviewed evidence on digital technologies over the past two years in order to produce recommendations on key ways such tools may be used for maximum impact on health systems and people’s health. The new recommendations focus on 10 ways countries can use digital health technology (accessible via mobile phones, tablets, and computers) to improve people’s health and essential services.

The recommendations include:

  • Birth notification via mobile devices
  • Death notification via mobile devices
  • Stock notification and commodity management via mobile devices
  • Client-to-provider telemedicine
  • Provider-to-provider telemedicine
  • Targeted client communication via mobile devices
  • Health worker decision support via mobile devices
  • Digital tracking of clients’ health status and services (digital tracking) combined with decision support
  • Digital tracking combined with:

1. Decision support
2. Targeted client communication

  • Digital provision of training and educational content to health workers via mobile devices/ mobile learning.

While recommendations 1-9 were recommended ‘only in specific contexts or conditions’, recommendation 10 did not have any caveats.

BENEFITS FOR HEALTHCARE WORKERS

The guidelines explain that digital health interventions allow health workers to expand their range of tasks as well as take on tasks previously assigned to higher-level workers. “This can be experienced as satisfying and fulfilling, both for those to who tasks are shifted, as well as to those from who tasks are shifted,” the WHO reported.

“Health workers working in rural and remote contexts particularly appreciate the efficiency of digital health technologies as these allow them to offer services through the device. Health workers are likely to perceive digital health technologies to be more efficient because of the increased speed with which they allow them to work.

These technologies are also likely to save travelling time for health workers in both urban and rural settings, allowing them to spend more time with their clients in urban areas or to provide services remotely to clients in rural areas. Health workers may appreciate the portability of digital health technologies because this allows them to be flexible, to work when convenient, and not have to be office-bound to access information,” the guidelines stated.

“Health workers, particularly lay health workers in low and middle-income settings, also perceive digital health technologies as allowing them to better coordinate the delivery of care through connecting them to other people and sectors in the health system and to clients and communities.”

HEALTHCARE WORKERS CONCERNS

According to the guidelines many health workers, particularly in rural and remote areas, experience logistical challenges when using digital health technologies, including poor network connectivity and access to electricity to charge their mobile phones. “In some instances, poor connectivity also results in client dissatisfaction because it creates delays in receiving health services,” the WHO stated.

“Health workers want easy-to-use, reliable equipment and ongoing technical support. They also feel that the use of these technologies can be expanded to a wider range of settings, services and illnesses. However, health workers often report usability issues, and poor integration with other digital systems. Although the introduction of digital health interventions into existing healthcare systems may be important, this requires many changes and may be difficult to achieve. For instance, institutional support and local champions may be considered important for ensuring integration into existing systems, but staff reorganisation and the breakdown of existing partnerships may undermine this support.”

Other concerns included:

  • Problems with the design of the programmes or device
  • The confidentiality of medical information and data security
  • The need for sufficient training of systems to ensure staff acceptance and understanding.

LOCAL CONTEXT

It’s important to recognise that when it comes to digital health interventions one size does not fit all. “Digital interventions depend heavily on the context and ensuring appropriate design,” said Dr Garrett Mehl, WHO scientist in digital innovations and research.

“This includes structural issues in the settings where they are being used, available infrastructure, the health needs they are trying to address, and the ease of use of the technology itself.”

GUIDELINES VITAL

The executive summary on the WHO guidelines warned that amid the heightened interest, digital health has been characterised by implementations rolled out in the absence of a careful examination of the evidence base on benefits and harms. The WHO stressed that the enthusiasm for digital health has also driven a proliferation of short-lived implementations and an overwhelming diversity of digital tools, with a limited understanding of their impact on health systems and people’s well-being.

“While recognising the innovative role that digital technologies can play in strengthening the health system, there is an equally important need to evaluate their contributing effects and ensure that such investments do not inappropriately divert resources from alternative, non-digital approaches,” the WHO said. “The use of digital technologies offers new opportunities to improve people’s health,” said Dr Soumya Swaminathan, chief scientist at WHO.

“But the evidence also highlights challenges in the impact of some interventions. If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate long-term improvements over the traditional ways of delivering health services.”

DIGITAL INTERVENTIONS VS EXISTING HEALTH SYSTEMS

While digital health, or the use of digital technologies for health, has become a salient field of practice for employing routine and innovative forms of information and communications technology (ICT) to address health needs, the WHO stressed that digital health interventions are not a substitute for functioning health systems, and that there are significant limitations to what digital health is able to address.

“Digital health is not a silver bullet,” said Bernardo Mariano, WHO’s chief information officer. “WHO is working to make sure it’s used as effectively as possible. This means ensuring that it adds value to the health workers and individuals using these technologies, takes into account the infrastructural limitations, and that there is proper coordination.” “This guideline represents the first of many explorations into the use of digital technologies and has only covered a fraction of the many aspects of digital health,” the WHO said.