Figure 1
The potential of digital health interventions for CVD. © World Heart Federation.
Figure 2
Selected roadblocks and solutions to implement digital health interventions, based on the WHO/ITU framework. © World Heart Federation.
Table 1
Barriers and possible solutions.
| DESCRIPTION OF ROADBLOCK | SOLUTION | |
|---|---|---|
| Leadership and governance | ||
| National guidelines and strategies | Lack of national guidelines and eHealth strategy. | Establish national or regional eHealth guidelines and strategy. |
| Stakeholder engagement | Poor involvement of critical national stakeholders. | Inclusive engagement with stakeholders by policymakers, including representatives of patients, practitioners, payers, industry and civil society. |
| Monitoring and evaluation standards. | Lack of clear monitoring and evaluation standards. No repeated monitoring of effectiveness, reach and impact of interventions. | Clear national standards for monitoring and evaluation of DHIs. Long-term monitoring of effectiveness and implications of digital health interventions. ‘unexpected effects’ registry. |
| Legislation, policy and compliance | ||
| National legislation on data security and access | Lack of national guidelines on data security and access. Local institutional guidelines are not harmonized. | Explicit national guidelines on data access and security. Promote harmonization of policies between institutions. |
| Lack of regulatory approval or guidance | Lack of regulatory standards; poor health technology assessment (HTA) standards. | Improve HTA and regulatory standards. |
| Strategy and investment | ||
| Reimbursement | Unclear reimbursement pathways for digital technologies. | Clear reimbursement strategy for DHI. Include economic evaluations in the design phase. |
| Long-term investment strategy | Lack of long-term investment strategy for sustainability of digital technologies. | Include long-term investment strategy as part of national guidelines. |
| Services and applications | ||
| Contextualisation | Intervention not adapted to the local context. | Perform a structured and holistic needs and context assessment before designing and implementing interventions. Health system assessment frameworks might be helpful tools. |
| Poor usability and design | Non-user focused design. | Employ user-centred and co-design principles. Include end-users (practitioners/patients) early in the design phase. |
| Infrastructure | ||
| National or regional digital infrastructure | No clear investment in national or regional digital infrastructure. | Investing in digital health infrastructure should be included as a national policy priority. |
| Healthcare provider systems | Local infrastructure does not allow the integration of new DHI. | Applications should be flexible and available in on- and offline modes. |
| Standards and interoperability | ||
| Data structure standards | National and international differences in data collection, storage and definitions standards. | Promote collective definitions and data storage formats. Emphasise implementation of open data platforms. |
| Health workforce | ||
| Poor needs assessment | Poor understanding of the health workforce needs. | Include clear health system and needs assessment in the design phase of DHIs. |
| Data literacy | Lack of understanding of DHI. | Provider education on the use of digital technology. |
| Low acceptability | Lack of perceived effectiveness and use of DHIs. | Inclusive technology design and education of use. |
| Patients | ||
| Poor digital literacy and skills | Lack of understanding of DHI (literacy), or not having physical capabilities to interact with DHI. | Patient education on the use of digital technology, context specific adaptations of technology to match patients’ physical abilities. |
| Low acceptability | Lack of perceived effectiveness and use of DHIs. | Inclusive technology design, education of use and user acceptance, usefulness and engagement evaluation alongside clinical trials and related research. |
Figure 3
NCD nurse using mPower Health CDSS in a government health facility, reproduced with permission from the Centre for Chronic Disease Control (CCDC), New Delhi, India.
Figure 4
CONNECT smartphone application. Reproduced from NPJ Digit Med. 2020; 3. Redfern J, Coorey G, Mulley J, et al., A digital health intervention for cardiovascular disease management in primary care (CONNECT) randomized controlled trial.