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To date, the progress of countries and territories toward proactive, predictive, high performing digital health systems focused on supporting population health and wellness has been limited. As such, building on the knowledge, science and theoretical development HIMSS has desgined a framework to guide health system transformation. This is probably one of the most enjoyable reads of digital health, written through objective lenses and based on evidence, that our team has read lately. Thus, this post aims to provide a short summary of the framework that guides and informs health system strategy to advance digital health globally.
Global populations are emerging as informed consumers of healthcare rather than relying on prescribed care pathways which may not be aligned with personal health needs and goals. Consumer motivations are shifting as the rapid evolution of digital technologies has increased consumer demand for care personalized to the unique values, needs and life circumstances of people and populations Yet, there is a disconnect between the health and wellness tools consumers are using, and current healthcare systems which have not engaged people digitally to meaningfully connect to them in a way that supports and enables achievement of their personal health goals.
Digital health as an era
Digital health as an “era” is embedded in what is widely accepted as the fourth industrial revolution — the use of big data, analytics, and artificial intelligence, all of which are evolving across virtually every business sector. Digital health is now emerging in health systems, building on the strengths of the eHealth era where an enterprise approach to digital technologies has created the necessary foundational infrastructure.
Digital health is now emerging in health systems, building on the strengths of the eHealth era where an enterprise approach to digital technologies has created the necessary foundational infrastructure. Key themes evident in the evolution of information technology in health systems show important features of digital health that are clearly emerging: the emergence of consumerism, expansion and reach of personalized health data, the emergence of advanced analytics and algorithms. These themes are explored further in HIMSS' document cited above.
Currently, there is a poor fit between what formal health systems have to offer (i.e. dominant disease management focus), and what empowered consumers value and are seeking to achieve (i.e. health and wellness).
This “disconnect” has evolved for two reasons:
1) Health systems focus primarily on managing illness and disease using prescribed care pathways, rather than focusing on individual health and wellness goals where care pathways are adapted and personalized to person's health, wellness and quality of life goals (Snowdon, A. et al, 2014).
2) The majority of digital tools and platforms available online to consumers are not connected or interoperable with information infrastructure in formalized health systems, making it nearly impossible for consumers to reach out and connect, digitally, to health teams.
Essentially, what has now emerged are two, distinct and separate healthcare systems: the traditional system, which is institution-centric and prioritizes disease management; and, the consumer-based approach, where people select and engage online tools, wearables, and resources to create their own personalized strategy to manage their health and wellness, custom-designed to the needs, values, and goals of the individual.
Furthermore, despite significant attention to engaging patients in their care, findings suggest that patients continue to be viewed as “recipients” of care, and patient “engagement” efforts focus primarily on encouraging patient feedback on their experiences. Acknowledgement of individuals as the primary decision-maker and manager of their health and wellness is much less clearly defined in the literature to date. As such, 7 key themes are explored in the framework (p.9) that act as facilitators of the empowered consumer.
HIMSS carried out a critical analysis of digital health frameworks and models to identify the key concepts described as relevant features of digital health. This analysis profiles the key themes related to digital health — including governance and leadership, data infrastructure, analytics, person-enabled healthcare, and a focus on outcomes at the system level. The analysis resulted in the consolidation of concepts and themes into four key dimensions that define digital health, described as follows:
Person-enabled healthcare health offers strategies for how an individual can manage risks to support their health and wellness within their unique values and life circumstances to promote overall quality of life.
Predictive analytics - A central feature of predictive analytics contributes to what is described as “learning” health systems, whereby robust analytics track health outcomes to enable systems to learn and define the care delivery strategies that achieve best outcomes and the conditions under which best outcomes are achieved for every individual and population.
Governance and workforce -Strongly linked to performance and strategy is the integrity, capacity, and sustainability of the health workforce, which is critical to ensuring people and populations have secure connectivity to care teams, and data is accessible across the journey of care.
Interoperability is foundational for data to be accessible to individuals and providers, enabled by digital technologies to translate data into information, knowledge and insights to inform decisions.
The consistency in the patterns of concepts emerging in the literature serve to validate these four dimensions which are proposed as the foundation for a digital health framework. All these themes are explored, explained and visuals are provided for thorough elaboration. We recommend accessing the document for best overview - it's well written and fascinating.
To support health system strategy to advance digital health transformation, a HIMSS developed a measurement tool — the Digital health Indicator (DHI) – to measure and document progress toward a digital health system. The Digital Health Indicator measures progress toward a digital health ecosystem. An ecosystem that connects clinicians and provider teams with people, enabling them to manage their health and wellness using digital tools in a secure and private environment whenever and wherever care is needed. Operational and care delivery processes are outcomes-driven, informed by data and real-world evidence to achieve exceptional quality, safety and performance that is sustainable.
The Digital Health Framework and DHI tool are anticipated to serve as a strategic guide to advance transformation of current health systems, toward digital health systems which prioritize health and wellness for people and populations.