WHO Guidance For Digital Health Applications
Providers have encountered questionable solutions due to the rise of digital technology claiming to tackle healthcare issues. The issue of coping with new and innovative technology is one that healthcare stakeholders regularly face as they fight to stay up with developments.
Fortunately, digital health has been on the world’s leading public health organization radar. In April 2019, the World Health Organization released guidance for digital health applications. These evidence-based guidelines are the first step in assisting governments in increasing the scale of their digital interventions.
WHO rigorously examined information on digital technologies and collaborated with experts from around the world two years before issuing these guidelines. Their purpose: provide suggestions on how to make the best use of these technologies for optimal effect on health systems and public health.
The guidelines cover the efficacy of each intervention and crucial aspects such as acceptability, practicality in different contexts, gender, equity, and rights, and the use of resources associated with the intervention.
Digital Health Technologies
Digital health technologies use computing platforms, networking, software, and sensors. Mobile health (mHealth), health informatics, wearables, telehealth, telemedicine, and personalized medicine comprise this broader digital health category.
In a press release, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said, “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health.”
WHO has created the Digital Health Atlas to support governments in coordinating technology investments, a worldwide online repository where suppliers can register their digital health operations.
The guidelines emphasize the significance of creating welcoming places for training, dealing with insecure technology, regulations to safeguard individuals’ privacy, and governance and coordination to ensure that these technologies integrate well across the health system, avoiding a scattered implementation.
Implementation in Health
The key target audiences for these guidelines are Ministries of Health public health practitioners and other stakeholders who will benefit from knowing which digital health interventions have an evidence base to address health system needs.
It also acts as a roadmap for inventors of digital health devices; given the limits of present technologies, the WHO believes these companies can do more to demonstrate that their products improve current healthcare practices.
WHO chief scientist Soumya Swaminathan said in a statement that “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,”
These new guidelines focus on digital health interventions based on smartphones or other mobile devices. While based on various digital interventions, the recommendations contribute to health system demands in diverse but interconnected ways.
A summary of the digital health interventions are as follows:
- 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 decision support and targeted client communication
- Digital provision of training and educational content to health workers via mobile devices/mobile learning
Those who want to implement these technologies must consider fundamental factors such as local needs, intended users, and the whole ecosystem consisting of the information, communication, and technology plus a supporting environment.
WHO envisions a future in which clinical, public health, and data-use recommendations benefit everyone throughout the world equally and instantly. For this reason, it has released some tools to support digital health research and implementation over the years. These include:
- the mHealth Assessment and Planning for Scale (MAPS) toolkit.
- a handbook for Monitoring and Evaluation of Digital Health.
- mechanisms to harness digital health to end TB.
Why It Matters
With the advent of smartphone use and machine learning analytics, half of the world’s population now has access to a device that has the potential to profoundly alter our approach to the global health crisis. Hence digital health can play a critical role in supporting health systems, as witnessed particularly in light of the COVID-19 pandemic.
Although digital health has remarkable potential to help with issues like distance and access, it faces many fundamental constraints as other healthcare treatments. For these reasons, experts believe that digital health is not a “silver bullet.”
Bernardo Mariano, WHO’s Chief Information Officer, adds that “WHO is working to make sure it is 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.”
Therefore, these guidelines can help governments and policymakers develop a roadmap to introduce and scale digital health interventions to improve population health outcomes.
Research Situation
Sections in the WHO guideline describe the overarching research gaps that emerged from the guideline process. These are areas where the guideline authors considered the available evidence low or extremely low level of certainty or confidence or found no direct evidence.
WHO identifies particular research gaps for each recommendation, along with example research issues. It further advises that rigorous procedures should be used to answer these research questions.
Insights For Researchers
WHO’s guidance for digital health applications affirms that any digital health product or technology should be designed and applied following the principles of digital development.
According to studies, WHO’s criteria for research have the following key implications:
Study designs will change over time. The most popular strategy for clinical trials — control and randomization — has been commonly used to evaluate digital applications in healthcare. Now digital health will clearly require innovative trial designs based on the following:
- desired outcome measures
- targeted populations
- technology used
- structural levels influenced by digital applications
- adaptability and flexibility of digital applications
- end-user skills
- interactions and interdependencies between various digital and non-digital components
The importance of safety and efficacy cannot be overstated. According to the WHO, analyzing the safety of digital apps, including the potential of any unintended consequences, is a key need in digital health research. Concerns about data privacy and security influence the use of digital technologies and the design and execution of studies involving these tools.
The acceptability and feasibility of the project must be improved. According to the WHO, patient and physician acceptance of digital health informs its use in research and practice. This perspective aligns with the patient-centric approach in clinical research, where digital health may equip, enable, and empower individuals to take charge of their own health.
Measuring knowledge, attitudes, and behaviors is a good idea. The WHO has identified some significant gaps in patient and healthcare professional knowledge, attitudes, and behaviors related to digital health.
Value will be added by cost-effectiveness. The WHO recommends that long-term expenses be assessed, including “accounting for equipment amortization and maintenance, as well as the ongoing user assistance necessary.”
For researchers, therefore, there is a need for evidence-based digital health interventions, the results of which may be used to support regulatory evaluations and recommendations, as well as labeling claims, when measured in clinical trials.
People-Centered Approach
In its Global Strategy for Digital Health, the WHO pushes for patient-centered care (PCC) and people-centered health systems enabled by digital health. The people-centered approach highlights the necessity of encouraging people to participate in self-care.
This approach places the person at the core of the service and treats them as its center. Hence, the spotlight is on the individual and what they can accomplish, rather than their illness or impairment.
Through the adoption and use of digital health technology in scaling up and strengthening health service delivery, this strategic goal places individuals at the center of digital health.
While the concept is appealing, WHO affirms that healthcare providers and policymakers must commit to making this cultural transition in practice, and systems must be willing to adopt and establish creative models that support and practice people-centered approaches.
However, this approach has its obstacles and includes significant adjustments, notably in how care is given and how patients and clinicians interact. Despite the challenges, the benefits of PCC are clear, and it represents a significant opportunity for improving health outcomes.
Furthermore, the World Health Organization has produced pertinent studies and papers addressing the concerns and challenges of today’s struggling healthcare systems, particularly regarding putting people at the center of healthcare delivery.
- The importance of mental health issues — The World Health Report 2001.
- Patient-centredness as a core competency of health workers — The Challenge of Chronic Conditions: Preparing a Health Care Workforce for the 21st Century, 2005.
- Being patient-centered as a key dimension of health care quality — Quality of Care: A Process for Making Strategic Choices in Health Systems, 2006.
Digital Medicine
From consumer-oriented monitoring apps to telemedicine and electronic health records, digital medicine encompasses a broad spectrum of technologies. Digital medicines are intended to inform mobile and web-based applications that a patient has taken a specified medicine dose at a specific time.
WHO recommends that these strategies supplement rather than replace traditional services. They should only be used if patient safety, privacy, traceability, accountability, and security can all be monitored.
Shaping The Future Of Global Health
The World Health Report 2003 reviewed global health status and critical health issues. It exemplifies a scenario where a Japanese girl born in Japan may expect to live for approximately 85 years. In Sierra Leone, a female born simultaneously has a 36-year life expectancy.
On the one hand, the Japanese girl will be vaccinated, receive proper nourishment and appropriate education. Although she may develop chronic ailments during her life, excellent treatment and rehabilitation facilities are accessible.
On the other hand, the Sierra Leonean girl has a slim chance of receiving vaccines and is likely to be underweight throughout her childhood. She’ll most likely marry while she’s a teenager and give birth to six or more children without the help of a trained delivery attendant.
Looking at these cases, the WHO emphasizes that the global health community’s most important responsibility is to bridge the gap between such disparate lives, and these can be achieved through strengthening health systems.
The report presents strong solutions to design a healthier, more equitable future based on experience and successes. Additionally, it outlines the following to be the minimum requirements that every health care system should meet equitably. These are:
- access to quality services for acute and chronic health needs
- effective health promotion and disease prevention services
- appropriate responses to new threats as they emerge
The main conclusion is that meaningful health progress depends on improved health systems focused on primary care. While significant improvements in health for everybody are within reach, according to the report, success hinges on collaboration between governments, international organizations, the commercial sector, and civil society to establish more robust health systems.
Hyfe’s Contribution To Digital Health Technology
Cough tracking has long been acknowledged as a valuable medical tool in patient care and public health. Still, technology has, until recently, lagged behind the demand for effective cough monitoring solutions.
Hyfe is one of the companies keeping pace with the changes coming to global health, particularly in respiratory care. Its strategy is to develop evidence-based, AI-driven, scalable acoustic diagnostic and monitoring systems to help save lives, eradicate disease, and prevent the next pandemic.
Hyfe was developed to use acoustic epidemiology to revolutionize healthcare systems and enhance global health. Right now Hyfe offers two apps: a consumer-facing version called “Hyfe Cough Tracker” and a research-oriented version designed for clinical trials.
During consultations, clinicians can utilize the Hyfe App to acquire a comprehensive picture of their patient’s health, assess their cough, and return illness risk scores that guide follow-up tests and resource allocation for high-risk patients. Want to learn more? Visit their website: www.hyfe.ai
References
Global strategy on digital health 2020–2025. World Health Organization, Geneva2020 https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf
Jandoo T. WHO guidance for digital health: What it means for researchers. Digit Health. 2020 Jan 8;6:2055207619898984. doi: 10.1177/2055207619898984. PMID: 31949918; PMCID: PMC6952850. https://pubmed.ncbi.nlm.nih.gov/31949918/
https://www.who.int/health-topics/digital-health#tab=tab_
WHO Guideline: recommendations on digital interventions for health system strengthening.
https://www.who.int/publications-detail-redirect/9789241550505
McCann, Lisa & Maguire, Roma. (2020). Implementation of Digital Health Interventions in Practice. 10.1007/978–3–030–60697–8_10. https://www.researchgate.net/publication/348246648_Implementation_of_Digital_Health_Interventions_in_Practice
