Lisette Van Gemert-pijnen*, University of Twente, Enschede, Netherlands Hans C. Ossebaard*, RIVM (National Institute for Public Health and the Environment), Bilthoven, Netherlands Nicol Nijland*, University of Twente, Enschede, Netherlands Track: Practice Presentation Topic: Science 2.0/Collaborative Science Presentation Type: Oral presentation Submission Type: Panel Presentation Building: LKSC Conference Center Stanford Room: Paul Berg Auditorium Date: 2011-09-17 03:15 PM – 04:00 PM Last modified: 2011-08-15

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eHealth technologies may contribute to solve some serious challenges to global health and health care. As of yet the impact of eHealth technologies on healthcare practice is rather small compared to investments and professional expectation. In our research we have identified five major clusters of causes: a) inadequate research methods, b) lack of knowledge about the process of technological innovation, c) a skewed medical expert-driven approach to eHealth technologies, and d) the use of inapplicable old world theories on human behavior. These causes often lead to the development of high tech solutions that are nevertheless unsuitable for use in a complex health care environment or in patients’ social situations. Moreover, expert-driven technologies tend to focus on ill management rather than on patients’ wellbeing in real life thereby neglecting the primary goals of care. This accounts for ceiling effects and drop-out rates among users that eventually reduce the impact of eHealth technologies on a range of possible health outcomes. We have constructed an evidence-based holistic framework to develop technologies in order to improve the measurable impact. It accounts for most observed lacuna and deficiencies and comprises human centered, context sensitive and practical principles that are both effective and useful for all stakeholders. These principles are: multidisciplinary in action, development as co-creation, the social nature of technology, integration of development, implementation and evaluation. The framework is published as an on line eHealth wiki in order to share knowledge and information on how to improve the impact of eHealth technologies in a collaborative effort of researchers, developers, policymakers, and healthcare professionals. In the panel presentation we will elaborate on the framework and for the first time publicly demonstrate the possibilities of the wiki to contribute to better outcomes in eHealth. We will show three cases in which the framework (eHealth wiki) has been applied, and we will show the benefits of the holistic approach as catalyst to innovate healthcare.
Methods
A narrative literature review on current eHealth frameworks for development, implementation and evaluation was carried out. The evaluation criteria for the review are the theoretical backgrounds of the frameworks, the focus of the frameworks, the visions on participatory development, the theoretical foundations and conditions for developing technologies that are desired, applicable and feasible. Using techniques from business modeling and concepts from human centered design we have selected effective principles that form the components of the framework, which is a framework-in-progress by definition. Finally we have tested the framework against three research cases.
Results
The framework is published as an open eHealth wiki with accompanying methods and instruments in order to share knowledge and information on how to improve the impact of eHealth technologies in a collaborative effort of researchers, developers and healthcare professionals. This academic enterprise allows for permanent improvement of the framework while testing it against a wide array of cases in research and care. Technology is no stand-alone device, but a catalyst for innovations, a new way of thinking on how to support healthcare via technology in a Digital Society. Better adherence to safe behavior via co-creation. Better implementation via stakeholders’ involvement /investment. Staff, patients can manage IT; participation=motivation. eHealth wiki, instruments to judge the perceived value of eHealth interventions (overall impact ). eHealth-education-roadmap (students & caregivers, developers). Due to the holistic approach and cyclic nature of the framework it can be evaluated by its own working principles for creating a fit between human, organization and technology via a participatory development process, value-creation via business modeling, and the social and persuasive nature of technology. The 'summative' evaluation is aimed at a multi-level measurement of the impact on health conditions, care organization and adherence to eHealth technology. The observed situation, casu quo obstacles for technological innovations in a system under pressure, is not specific to the area of health and health care. The framework is in principle translatable to other social engineering areas like improving performance in education or innovation management in e-governance.
Conclusions
The central theme of the panel discussion will be if the adoption of the framework by the international research community could lead to improved impact of eHealth technologies. The first issue is the extent of flexibility of the framework: will it work in diverse settings? What are the challenges in other fields using wiki’s (semantic-wiki) for collaborative development of guidelines for medical practice, sharing knowledge of best-practices (research-wiki), disruptive wiki’s (ebuss-wiki) to create innovative structures for healthcare based on business modeling. The second issue is how to inspire the collaborative use of the wiki and transplant it to a variety of research areas in eHealth.