Implementations of health information technologies with consumers as users: Findings from a systematic review
Warren JR., Day KJ., Paton C., Warren DE., Mabotuwana TDS., Gu Y., Adnan M., Reedy W.
Background: A systematic review of evaluations of innovative eHealth implementations was funded by the New Zealand Ministry of Health to inform information strategy. A key trend of interest to the Ministry was person-centered healthcare, including systems where health consumers use health information technology (IT) directly. Herein we report, analyze and reflect on the review findings with respect to such systems. Objectives: To review the nature and extent of known successes of health IT with consumers as users. Methods: Queries for evaluations of innovative eHealth implementations were submitted to MEDLINE, EMBASE, PsycINFO, CINAHL and Business Source Premier for articles appearing between 2003 and early 2009 and filtered on inclusion criteria of reporting actual implementations (i.e., use), innovativeness, evaluation (interpreted generously) and scaleability. Substitutions were made where more recent superior studies of the same or closely related projects could be found. Results: 100 of 1413 retrieved articles met the inclusion criteria; 47 of these involved consumers as users of a component of the evaluated system. Systems that provided messaging between the patient and their regular care provider met with satisfaction and good uptake. There were improved chronic disease outcomes in 11 of 15 education/self-management systems and 2 of 3 home telemonitoring systems where measurement of such outcomes was reported; a further 3 systems targeting the family members of individuals with chronic conditions as principal users all showed positive well-being outcomes for the caregivers. Conclusions: There have been a number of demonstrated instances of clear successes in both uptake and outcome for health IT interventions involving consumers as users, particularly for chronic condition management. However, compelling demonstrations (in terms of methods and sample size) remain isolated. More study is needed to assess the transferability of the demonstrated successes to greater scale, diverse contexts of deployment and to other conditions. Better keywords and more systematic reporting, particularly with respect to implementation and evaluation status, would aid similar reviews in the future.