New WHO Digital Health Guidelines Assess “Appropriateness” Of Technology Options

The World Health Organization’s new guidelines on digital health highlight the value of digital health technologies in helping to close health system gaps, while emphasising that they do not replace investments in health system infrastructure. The guidelines assess the appropriateness of a range of digital health technologies and provide recommendations on making informed investments in these technologies and how best to integrate them into health systems.

The new WHO guidelines, Recommendations on Digital Interventions for Health System Strengthening, released today, present recommendations that “examine the extent to which digital health interventions, primarily available via mobile devices, are able to address health system challenges along the pathway to UHC [universal health coverage].”

“Harnessing the power of digital technologies is essential for achieving universal health coverage,” WHO Director-General Dr Tedros Adhanom Ghebreyesus (Dr Tedros), said in a press release. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”

The recommendations cover a range of technologies in the areas of birth and death notification by mobile device, stock notification and commodity management by mobile device, telemedicine between clients and providers, digital tracking of patients’ health status and services by mobile device, and health worker training and decision support by mobile device.

“By reviewing the evidence of different digital interventions against comparative options, as well as assessing the risks,” the guidelines aim “to equip health policy-makers and other stakeholders with recommendations and implementation considerations for making informed investments into digital health interventions.”

“Digital interventions depend heavily on the context and ensuring appropriate design,” Dr Garrett Mehl, WHO scientist in digital innovations and research, said in the release. “This includes structural issues in the settings where they are being used, available infrastructure, the health needs they are trying to address, and the ease of use of the technology itself.”

The guidelines emphasise 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. Digital health interventions should complement and enhance health system functions through mechanisms such as accelerated exchange of information, but will not replace the fundamental components needed by health systems such as the health workforce, financing, leadership and governance, and access to essential medicines.”

The guidelines also clearly prioritise the needs of vulnerable communities, stating that implementation of the recommendations “should not exclude or jeopardize the provision of quality non-digital services in places where there is no access to the digital technologies or [where] they are not acceptable or affordable for target communities.”

“Digital health is not a silver bullet,” Bernardo Mariano, WHO’s chief information officer, said in the release. “WHO is working to make sure it’s 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.”

Due to the rising interest in digital health technologies in recent years, many have been “rolled out in the absence of a careful examination of the evidence base on benefits and harms,” which, according to the guidelines, has “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.”

“While recognizing the innovative role that digital technologies can play in strengthening the health system,” the guidelines conclude that “there is an equally important need to evaluate their contributing effects and ensure that such investments do not inappropriately divert resources from alternative, non-digital approaches.”

The term “digital health” was introduced to encompass the previously applied terms eHealth (using information and communications technologies) and mHealth (using mobile technologies), while also incorporating emerging new technologies such as the advanced computing of “big data,” genomics and artificial intelligence.

The guidelines were developed based upon the World Health Assembly Resolution on Digital Health, which was unanimously approved by WHO member states in 2018. According to the guidelines, this resolution “demonstrated a collective recognition of the value of digital technologies to contribute to advancing universal health coverage (UHC) and other health aims of the Sustainable Development Goals (SDGs).”

In March 2019, WHO also announced a plan to create a new Department of Digital Health, “to enhance WHO’s role in assessing digital technologies and support Member States in prioritizing, integrating and regulating them,” according to the release.

Image Credits: WHO.

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