WHO has recently launched its first-ever Guidelines on Digital Health. They come amid a growing concern that all may not be as it seems in the world of digital health. To address this, WHO developed its new guidelines over the past two years. It reviewed the evidence of digital health’s efficacy, looked at the technology globally, and consulted with experts internationally. The result: new recommendations that cover ten ways countries can use digital health technology via mobile phones, tablets and computers to help people with health issues.
What is Digital Health?
Digital health technologies include ‘mobile health’ and those that are accessible via mobile phones, tablets and computers, e.g., apps to track health. Equally, it can be text-reminders issued from a hospital’s digital-information system, used in part to track and remind patients of medical appointments. Their breadth is wide, and increasingly common.
More broadly the term also refers to the use of information and communications technology in support of health and health-related fields, including emerging areas of health technology, such as ‘big data’, genomics and artificial intelligence. Whether it is local or internationally based technology, they all aim to improve people’s health and essential health services.
However, amid growing global interest, digital health has also been characterised by an absence of careful examination of its benefits and harms. As the new guideline states, “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.”
Digital health—does it work?
To consider if digital-health works, the obvious place to start is to consult the evidence, but it is here that things begin to break-down. The effectiveness of research about new digital health services is far from clear, often contradictory, or simply missing.
It’s an issue that the international medical community has been aware of since the technology started becoming easily available. But given its new status, it has not been addressed internationally in a strongly structured way—hence the need for the new guideline.
The murkiness of current evidence came to the fore in the Guideline development process. It showed that too often, research projects focused on digital health are not rigorously designed to produce ‘strong’ evidence. The guideline development also revealed contradictions in many research projects’ designs, with on-point contradictions abound.
KIT’s Senior Advisor Hermen Ormel worked on the development of the guidelines. He says that research projects often show evidence that digital health interventions can have the desired impact, and they should complement or replace existing interventions to achieve better health outcomes; but the exact opposite is also true: other digital health interventions do not show evidence of an impact, or even show evidence of a negative impact. In short, much research in this emerging area of health services requires more work to show reliable results.
KIT Staff & the Guidelines
KIT is proud to have had staff-member Senior Advisor Hermen Ormel participate in the guideline’s development. His work at KIT covers sexual and reproductive health and rights (SRHR) and public health. And it is this work that helped inform his role as an expert member of the WHO Guideline Development Group.
The WHO Guideline Development Group were instrumental in establishing the breadth and depth of the guidelines, and also helped review the evidence of what is working and what isn’t—or where there is a lack of evidence altogether.
“Our group’s work entailed a thorough process of defining the scope of the Guideline,” Mr Ormel said, “Issues such as the digital health technologies it would review, assessing existing evidence, and commissioning systematic reviews of evidence were big parts of our tasks. Additionally, we also worked on developing the precise wording of the actual Guideline’s ‘recommendations on digital health interventions for health system strengthening’.”
Evidence-Based Digital Health Intervention Examples
With this in mind, the WHO Guideline Development Group focused the new guidelines on evidence-based recommendations. In the executive summary they “urge readers to recognize 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.”
The Guidelines do not attempt revolutionary recommendations. Rather, they encourage Member States to consider just ten examples of evidence-based, digital health recommendations, and acknowledge that adjustments based on the country’s context are always necessary. For example, simple effective measures are included as examples of evidence-based, digital health interventions:
- Sending mobile phone reminders to pregnant women to attend antenatal care appointments and for children to return for vaccinations
- Decision-support tools to guide health workers as they provide diagnosis, referrals and care (leading to e.g. improved medication adherence)
- Enabling individuals and health workers to communicate and consult on health issues from different locations (telemedicine) (leading to, for example, reduced mortality among individuals with heart-related conditions and improved exclusive breastfeeding).
A Word to the Wise about Digital Health
Despite the new useful recommendations, Mr Ormel does not think that Digital Health can replace real-life medical services anytime soon. His caution comes from three main areas:
“Digital health offers many opportunities. But it should—in my view—be used as an additional tool embedded in wider health-improvement strategies. It is not a stand-alone intervention,” Mr Ormel says.
“Also, the effectiveness of digital health interventions will almost always depend on the wider health system’s preparedness. Finally, such interventions can indeed help reduce gender and population inequities in accessing services. But we should be aware that they may sometimes exacerbate such inequities. For example, poor rural communities may not be included in new digital health services due to poverty (mobile phone access), or a lack of network coverage,” he said.
With the new WHO guidelines, the use, limitations, and evidence for effective digital health services are now on worldwide display.