A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations

Abstract

Background: Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. Objectives: This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. Methods: A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. Results: There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. Conclusions: Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.

Implementation barriers for mHealth for non-communicable diseases prevention and management in low and middle income countries: a scoping review and field-based views from implementers

“…The information in this paper echoes implementation challenges from other papers [42][43][44] but they add an NCDs perspective. The two systematic reviews on impact of mHealth on NCDs show modest and variable results 45,46 ; and the scoping review in this paper points to implementation information being a missing link.…”

Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings

“…Little is known about the values and expectations stakeholders have regarding mHealth implementation [7]; this information needs to be brought forth and examined. Previous implementation research has focused on implementation frameworks and strategies [8-10], including frameworks specifically related to mHealth [11,12] and frameworks related to the definition and use of specific implementation strategies [10]. Substantial work has also been done to create tools to assess organizational readiness for change [13].…”

Targeting ethical considerations tied to image-based mobile health diagnostic support specific to clinicians in low-resource settings: the Brocher proposition

“…The stakeholders emphasized that patient authorization must remain a prerequisite to any mHealth intervention, something that is particularly critical in imagebased consultation [14,20,[31][32][33]. Datamore or bettermust not take precedence over patient [9], and uncertainties experienced by point-of-care workers [15,18,34,35], in relation with patients and other system users, must be dealt with.…”