Impacts of e-health on the outcomes of care in low- and middle-income countries: Where do we go from here? [Impacts de la télésanté sur les résultats sanitaires dans les pays à revenu faible et moyen: Quelle direction prendre?]
Bulletin of the World Health Organization
Veteran Affairs Ann Arbor Center for Clinical Management Research, Health Services Research and Development Center of Excellence, PO Box 130170, Ann Arbor, MI, 48113-0170, United States; School of Computing, National University of Singapore, Singapore; Assis Moura eHealth, São Paulo, Brazil; Harvard Medical School, Boston MA, United States; Earth Institute, Columbia University, New York NY, United States; Division of Health Sciences, University of Warwick, Coventry, United Kingdom; E-Health Resource Centre, The Aga Khan University, Nairobi, Kenya
E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients' self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.
developing world; health care; information and communication technology; information system; public health; article; automation; blood pressure regulation; chronic disease; clinical decision making; clinical practice; cost effectiveness analysis; decision support system; developing country; disease surveillance; e health system; electronic medical record; glycemic control; health care cost; health care quality; health care system; health services research; hospital information system; human; information service; low income country; mass communication; medical informatics; meta analysis (topic); middle income country; outcome assessment; picture archiving and communication system; quality adjusted life year; randomized controlled trial (topic); self care; text messaging; Developing Countries; Efficiency; Efficiency, Organizational; Electronic Health Records; Health Care Costs; Hospital Information Systems; Humans; Income; Outcome Assessment (Health Care); Socioeconomic Factors; Telemedicine; World Health