N101 Nursing Informatics AY 2024-2025

Going through the health systems goals and challenges with their respective outcomes rooted from the eHealth vision, one can argue that all of the propositions are ideal in achieving desired health outcomes for eHealth. The improvisations that each component runs down are the best targets that truly represents an effective and accessible eHealth program. But as perfect as these projected outcomes are, they’re only as good as they sound only in the absence of circumstances that can impede the actual accomplishment and mobilization of such objectives. In a meta-analysis conducted by Tossaint-Schoenmakers et al. (2021), three factors were synthesized and deemed important for the success of eHealth integration into the organizational structure and daily care processes— role of the care benefactor, technology, and deployment of human resources. Each of these factors play a very pivotal role towards the success of eHealth, such that noncompliance could negatively affect the entire structure of eHealth from its organization, processes, up until its outcomes. The challenge of commitment with the involved healthcare personnel also poses a threat in ensuring an effective and efficient development of eHealth systems. Likewise, the lack of interoperability among various health information systems create a widening gap not only among the supposed beneficiaries but also within those that supposedly manage them for better utilization and application (Qureshi et al., n.d.). 

REFERENCES:

Qureshi, M., Farooq, A., Muhammad, & Qureshi, M. (n.d.). Current eHealth Challenges and recent trends in eHealth applications. https://arxiv.org/pdf/2103.01756

Tossaint-Schoenmakers, R., Versluis, A., Chavannes, N., Talboom-Kamp, E., & Kasteleyn, M. (2021). The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. Journal of Medical Internet Research, 23(5), e27180. https://doi.org/10.2196/27180

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EHealth outcomes are achieved through collaborative work between several health systems. Its emerging accessibility to different geographical areas also increases the demand for healthcare services. A major challenge that I can perceive is people's digital illiteracy. Many have access to various health information, but only a few can understand and apply it to their lives. In fact, according to an article by Abarca (2023), the Philippines has the highest number of digitally illiterate people. The spread of misinformation and disinformation is apparent, which leads to people seeking inappropriate health behaviors, such as self-medicating. When it comes to eHealth services, they may or may not be able to effectively utilize the tools provided for them, as they tend to seek the “easier” way of giving solutions to their health problems.

Thus, this disregards the vision of eHealth when it comes to more equitable and responsive healthcare. If we only improve the access to eHealth for those in remote and disadvantaged areas, we are not sure if they can understand what we are providing for them. If we are only after widespread access to eHealth services and we are not doing something after the digital illiteracy of the community, we are not providing them quality care that is the same as the physical presence of healthcare providers.

Reference: Abarca, C. (2023, September 19). Ph is no. 1 in digital illiteracy, no. 2 in online child abuse – execs. INQUIRER.net. https://newsinfo.inquirer.net/1833725/ph-is-no-1-in-digital-illiteracy-no-2-in-online-child-abuse-execs

The eHealth outcome is a noble pursuit that advocates for widespread access to health through technology; be that as it may, several challenges such as digital literacy and technological concerns still impede this goal's fulfillment.

In an article by Evio & Bonito (2024), the barriers encountered were multi-dimensional. Starting from individual characteristics, digital competence and resistance to change were the common barriers as many of the health workers that use eHealth in their respective institutions found it difficult to adapt to the technology because of their lower digital literacy than their younger counterparts. Content-related factors such as eHealth design, complexity, and reliability also caused difficulties (Evio & Bonito, 2024).

Similarly, in Marcelo et al.'s (2022) study which focused on the factors influencing the usage of RxBox, common themes of criticism on the telemedicine device experience include age and device issues. These criticisms stemmed from the users' lack of readiness to accept the new technology attributed to their age and lack of digital literacy background. Negative reports about the service was also a concern as the device had instances of technical issues (Marcelo et al., 2022).

With that said, it is clear that the barriers to the eHealth outcome are multifaceted; however, the most apparent challenges based on available literature point to disinclination to change and technological and design issues. Thus, this requires multisectoral effort starting from good governance to appropriate training.



REFERENCES:

Evio, B. D., & Bonito, S. R. (2024). Formative Evaluation of the Implementation of eHealth in the Philippines: A Qualitative Study. Acta Medica Philippina, 58(12), Article 12. https://doi.org/10.47895/amp.v58i12.9289

Marcelo, P. G. F., Magtubo, K. M. M., Ang, M. A. C., Cruz, N. D., Macabasag, R. L. A., Pascual, P. J. C., Hamoy, G. L., Umali, M. J. P. S., Nisperos, G. A., Juban, N. R., Fabia, J. G., Santos-Fabia, A. D. F., Gaspar, M. J. P. O., Sison, L. G., & Pasco, P. M. D. (2022). Factors Affecting Adoption of a Telemedicine Device by Primary Care Health Workers in the Philippines. Acta Medica Philippina, 56(11), Article 11. https://doi.org/10.47895/amp.vi0.3709

One of the key obstacles to achieving successful eHealth outcomes is the challenge of integrating digital technologies into healthcare systems that are primarily designed for face-to-face care. The problem is exacerbated by insufficient ICT infrastructure, making the adoption of eHealth more difficult. Additionally, as Granja et al. note, time and space limitations, along with disruptions to traditional care practices, can hinder the seamless incorporation of these technologies. If eHealth systems are not well-tailored to fit the specific workflows and organizational structures of healthcare settings, they risk overburdening healthcare professionals rather than easing their workload. For eHealth solutions to be effective, care processes must be adjusted, human resources must be efficiently managed, and continuous coordination and communication are essential throughout the implementation process. Without these critical adaptations, the desired benefits of eHealth may not be fully realized.

References: 

• Granja, C., Janssen, W., & Johansen, M. A. (2018). Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. Journal of Medical Internet Research, 20(5), e10235. https://doi.org/10.2196/10235
• Tossaint-Schoenmakers, R., Versluis, A., Chavannes, N., Talboom-Kamp, E., & Kasteleyn, M. (2021). The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. Journal of Medical Internet Research, 23(5), e27180. https://doi.org/10.2196/27180

A major global challenge to achieving eHealth outcomes lies in overcoming barriers related to infrastructure, workflow integration, and realizing the desired results. The Donabedian Structure-Process-Outcome (SPO) framework highlights the need for strong organizational structures, effective processes, and measurable outcomes for eHealth to succeed. However, many countries face significant obstacles in these areas.

Structurally, the lack of reliable internet access, advanced medical equipment, and skilled personnel often hinders eHealth integration, especially in low- and middle-income nations. Even in well-resourced countries, resistance to adopting new technologies and digital literacy issues can impede progress. Process-wise, health care workers need proper training to integrate eHealth into their daily workflows, but many systems, already under strain, lack the capacity to provide this support.

The Philippines is a prime example of how these challenges manifest. In rural areas, poor internet connectivity and outdated infrastructure prevent the effective deployment of telemedicine and electronic health records. Overworked and undertrained health workers, especially in public hospitals, struggle to adapt to these digital solutions. Additionally, low health care spending limits the ability to realize the long-term benefits of eHealth, such as improved efficiency and access.

Reference:

Tossaint-Schoenmakers, R., Versluis, A., Chavannes, N., Talboom-Kamp, E., & Kasteleyn, M. (2021). The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. Journal of medical Internet research, 23(5), e27180. https://doi.org/10.2196/27180

A major challenge to the achievement of eHealth outcomes is the lack of digital literacy. While digital literacy can be acquired through education, the existing generational and digital divides within society pose significant problems.

According to Campanozzi et al. (2023), the effectiveness of telemedicine outcomes is highly dependent on digital literacy. This is because digital literacy encompasses a range of skills, including basic computer skills, navigating health information, online safety and responsible use of social media. 

A deficiency in any of these areas can significantly hinder an individual's ability to fully utilize eHealth services.For instance, someone lacking basic computer skills may struggle to schedule appointments, access electronic health records, or participate in virtual consultations. Similarly, individuals with limited health literacy may be overwhelmed by online health information, leading to confusion, misinterpretation, and potentially harmful health decisions. Addressing the digital literacy gap is crucial for maximizing the potential of eHealth. 

Reference: 

Campanozzi LL, Gibelli F, Bailo P, Nittari G, Sirignano A, Ricci G. The role of digital literacy in achieving health equity in the third millennium society: A literature review. Front Public Health. 2023 Feb 20;11:1109323. doi: 10.3389/fpubh.2023.1109323. PMID: 36891330; PMCID: PMC9986277.