eHealth: big questions, short answers

Quality, appropriateness, safety, efficacy – I have encountered countless presentations, publications, messages of concern, questions and statements of uncertainty when it comes to these aspects of digital health interventions (DHIs).

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Quality, appropriateness, safety, efficacy – I have encountered countless presentations, publications, messages of concern, questions and statements of uncertainty when it comes to these aspects of digital health interventions (DHIs). Concern ranges across the sector from end-users to policy-makers. And rightfully so – we have swiftly stumbled upon an era of personalised digital healthcare and we seem to either be creating the norms and rules on the go, or to completely lag behind as small research-based DHI projects deal with the whims of tech-giants.

But who should be concerned with these aspects of eHealth?

Answering this question may shed light on clinicians’ common concern: ‘To recommend, or not to recommend an app for that?’  

Surely similar questions have been posed since Hippocrates. As medicine formed, evolved and adopted the scientific method, a line was drawn between superstition and intervention; responsibilities and regulation were established. The treatment of serious diseases required extensive research and regulation, while treatment of the common cold remained with the patients and thus ranges from hot tea and balms to a bottle of whiskey: to each their own.

Similarly with eHealth, the severity of the problem dictates the complexity of the DHI and the need for regulation. Consumers should expect that serious eHealth interventions are developed and published by experts in the area, undergo rigorous trials and are scrutinised by competent regulatory bodies before hitting the market. In reality, regulatory bodies do not yet exist, conducting rigorous trials in eHealth is harder than anticipated and any developer who uses Google as their health information source can pose as an ‘expert’ with no repercussions.

While a little research can go a long way, as consumers we tend to research less when it comes to entrusting our health to an app then, say, when we shop for car insurance. Thankfully, our research does not need to be too labour-intensive.

Here are three helpful tips:

  1. eHealth quality, appropriateness and safety are carefully scrutinised by reputable organisations and initiatives like Kids Helpline, Head to Health, Reachout, VicHealth and many more. Recommended DHIs are listed on their websites in the form of libraries. Utilising these sites can remove the need for concern and provide plentiful information;
  2. Peer-reviewed papers covering particular eHealth areas are published regularly and can provide further insight, albeit hardly keeping up with the agility of the market. Many of these publications are open-access, meaning they are available to the public;
  3. When those resources cannot provide an answer, clinicians and consumers need to critically evaluate the content and take a detailed look into the credentials and legitimacy of the developer. Reliable developers make it a point to showcase their expertise as part of the DHI description, developer portal, or within the information section of the intervention itself. If you come across inappropriate DHI content, no developer information, or a suspicious source – do not use or recommend!    

Efficacy trials, which aim to test the ability of a DHI to produce the desired effect, are mostly left in the hands of the developers. However, due to high cost and time-consuming implementation, the current ‘gold standard’ – randomised controlled trials (RCTs) lag behind the agility of technological development and are only applied to a small percentage of DHIs globally. Reputable developers who lack the means to conduct efficacy trials may rely on ensuring the utmost quality of the incorporated information and extensive feedback from end users and stakeholders. Until the paradigm-shift leads to the development of better gold standards and regulation or accreditation, the best source of information sits with the aforementioned field experts and a better education and understanding of quality norms amongst clinicians and end users.

While many questions remain unanswered, DHIs are becoming more user-friendly, accurate, effective and reliable by the day. We should approach them with common sense, curiosity and understanding as they hold a huge potential for increasing health and wellbeing.

Thankfully, there is a growing wealth of resources available to aid us in making the right choices. At least until we are able to leave those decisions to AI.

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Stoyan Stoyanov

Stoyan has worked in the area of digital health (eHealth) and adolescent mental health at Queensland University of Technology and the University of Queensland since 2012. He was part of the team which developed the Mobile App Rating Scale (MARS) and has been involved in the conceptualisation, development and evaluation of at least six Digital Health Interventions (DHIs). He is currently doing a PhD on the topic. Stoyan holds a Masters of Research (Psych) from the University of Manchester, UK and a BA(Psych) from Sofia University, Bulgaria. He has recently accepted a new professional role as a senior researcher at yourtown / Kids Helpline.

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