Research Article: Evaluating eHealth Interventions: The Need for Continuous Systemic Evaluation

Date Published: August 18, 2009

Publisher: Public Library of Science

Author(s): Lorraine Catwell, Aziz Sheikh

Abstract: In the first in a series of three articles on evaluating eHealth, Aziz Sheikh and Lorraine Catwell outline the background to the series and discuss the importance of evaluating the widespread investments in and adoption of information communication technology in health care.

Partial Text: There is now considerable interest internationally in exploiting the potential of information communication technology (ICT) systems to improve the quality, safety, and efficiency of health care. Given that the adoption of ICT systems by health care providers is some 25 to 30 years behind many other private and public sectors [1], there is an understandable sense of urgency with which these eHealth initiatives are now being commissioned, developed, and deployed, typically at considerable expense [2]–[5]. The American Recovery and Reinvestment Act of 2009 [6], which includes $34 billion to incentivise health care professionals to “use a certified EHR (electronic health record) technology in a ‘meaningful manner’,” is a recent high-profile example of the sums of money that are being invested in eHealth [7].

In the past, the term “medical technology” was often used to describe the set of techniques, drugs, equipment, and procedures used by health care professionals to deliver medical care to individuals. ICT deployments would historically therefore have been considered under this heading [14]. Today, eHealth is the term more commonly used in relation to ICT deployments in health care; although there have been several attempts to define eHealth (see Box 1 for some examples), there is still no universal agreement on the precise meaning of this term.

As has been the case in many other sectors, it is widely believed the introduction of ICT systems within health care, combined with the necessary social (i.e., organisational and behavioural) changes [31], will substantially reduce costs and improve efficiency [10]; it is also anticipated that eHealth will lead to a reduction in the high number of patients who are inadvertently harmed by medical errors and violations [12].

As noted above, a number of governments around the world are currently engaging in truly epic programmes to roll out eHealth interventions as quickly as possible throughout the health care sector [32]. However, it is of concern that, in this rush, relatively little time, thought, or resources have been devoted to assessing the potential risks associated with eHealth interventions [11]–[13],[33]–[36].

In order to maximise benefits and minimise risks, eHealth interventions need to be subject to the same independent scrutiny as any other health care intervention prior to implementation, i.e., they need to be suitably evaluated. Such evaluations need to begin with a clear description of a problem or need; for example, the need to improve access to health care information for both professionals and patients. A chain of reasoning then must take place that leads from the statement of the problem or need to the formulation of a possible solution (see Box 3) [37]. If any part of that chain is missing, it is highly probable that a poor-quality solution, or even a wrong solution, will be developed. As noted above, in the context of health care the implications of such failures may be particularly profound [11]–[13], but an evaluation programme capable of evaluating each part of this chain will help ensure that the right solution is developed and delivered for the need, whilst also recognising the importance of local contextual considerations.

eHealth interventions have considerable potential to transform the health sector, hopefully for the better. As with any other intervention, however, the risk of harm exists, so policymakers, commissioners, clinicians, and patients alike need to remain aware of this possibility. If we are to maximise the benefits associated with eHealth interventions whilst minimising risks, we must be able simultaneously to evaluate eHealth interventions while they are being designed, developed, and deployed [20].



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