Digital health benefits evaluation frameworks: building the evidence to support Australia's National Digital Health Strategy

Abstract

D igital health technologies and services are significant contributors to the transformation of health care delivery. It has been estimated that 80% of technology projects fail 1 due to uncertainty, abandonment and lack of organisational willingness to adopt. 2 In response to the high failure rate, the discipline of benefits management has emerged, with the aim of measuring and optimising the value of digital health initiatives. The development and application of benefits management has received some attention, 3 but owing to the infancy of the discipline there has been limited assessment of methodological frameworks and their application.In this article, we describe the framework that is being used to measure and quantify the benefits of the My Health Record system in Australia. We consider the strengths and limitations of this framework in the context of existing frameworks, and its ability to demonstrate digital health system benefits. We also identify priority areas for further development of digital health benefit evaluation frameworks. Further, we provide an overview of the approach to digital health system benefits evaluation in Australia, in the context of the My Health Record system. The National Digital Health Strategy and the My Health Record systemA role of the Australian Digital Health Agency has been to lead the development of the National Digital Health Strategy, to lay the foundations for a safe, seamless and secure health system. 4 This strategy comprises seven priority areas to be achieved by 2022. A key strategic priority is to provide health information whenever and wherever it is needed, and this is underpinned by the My Health Record system. My Health Record is a secure online summary of health information which can be accessed by people and their health care providers, and is patient-controlled. It is a personal health record, enabling people to access, manage and share their health information with their clinicians using a range of privacy controls. This functionality includes the ability to decline access to specific documents, set a control to restrict access to the entire record, see an audit trail of any organisations that have accessed the record, and block organisations from viewing the record. The record can contain summary information from general practice, hospital, pharmacy and other health care settings. It may also contain results of investigations, plus documents that patients create themselves (such as advance care plans and personal notes). In addition, it can provide access to Medicare documents such as Medicare Benefits Schedule and Pharmaceutical Benefits Scheme information, the Australian Immunisation Register and the Australian Organ Donor Register. The Australian Digital Health Agency's benefits evaluation frameworkA multimethod evaluation framework has been developed to comprehensively evaluate the benefits of the My Health Record system. It draws on approaches that have been used overseas and assesses the range of clinical contexts in which the system is used.Connect...

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“…these services also reduce costs through improvements such as patient self-management and digital health records. In australia, medication misadventure costs aUd 1.2 billion (australian dollars) each year and digital health records were able to reduce duplicate pathology tests by 18% per week (Biggs et al, 2019). access to health workers, digital health has been increasingly explored as a mechanism to improve conditions in underserved regions (WHO, 2010).…”

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“…Researchers are starting to apply more innovative trial designs to deal with this challenge and focus specifically on implementation trial designs [ 141 ], although more experience and work is required to apply such methods across services or across a system. The incompatibility between RCTs and health systems research is particularly relevant in the context of MoCs with a strong eHealth component [ 142 ], where evaluation approaches other than effectiveness designs are recommended and supported by guiding frameworks [ 76 , [143] , [144] , [145] , [146] ]. These evolving frameworks could feasibly be applied beyond eHealth, with many of the guiding principles already reflected in a framework developed to specifically guide evaluation of musculoskeletal MoCs [ 126 ].…”

“…The framework also suggests that evaluation should not be based on single outcomes, but consider a multidimensional approach to defining ‘success’, ‘performance’ or ‘benefit’, achieved through mixed-methods approaches that consider outcomes relevant to the consumer (e.g. PROMs and PREMs) and the health system [ 126 , 145 ]. The importance of emphasising qualitative research exploring stakeholders' perceptions and attitudes towards implementation feasibility, acceptability and sustainability is widely proposed [ 36 , 148 ].…”