The digital health assessment provides a framework that can be used to assess key elements of an existing information system to help identify opportunities and gaps along the four critical steps of the patient pathway:
This allows mapping of needs along the entire pathway to match with existing and potential digital health solutions and informing how to select, adapt and implement appropriate digital health solution(s). The assessment can either focus on all steps in the TB patient pathway or on a specific step (e.g. “treatment“).
While the focus of the assessment is on national TB programme activities, broadening the scope of work to include the overall health sector and other key health programmes (e.g. HIV, maternal health care) can provide insights into (digital) solutions that might already be offered to others
Digital Health Assessment
A Digital Health Assessment consist of five sequential building blocks:
Country situational assessment
Digital health activities framework
Gaps and needs analysis of the patient pathway (step)
Digital health agenda and/or technology implementation road map
1. Country situational assessment
The country situational assessment follows a standardized approach to collect key information about the country context in which the DAT intervention will be implemented. Components include the country’s administrative structure; prevalence and incidence of the most common diseases; health system structure, TB programme activities and delivery of services by administrative level, laboratory, recording and reporting processes and procedures; infrastructure for information and communication technologies (ICT), including relevant information systems and human resources. Per specific step of the patient pathway more detailed information can be included.
When proposing to implement digital adherence technologies to support TB treatment adherence, current delivery mechanisms for TB treatment; roles and responsibilities of health providers; availability, coverage and accessibility of required technology and/or devices should be some of the areas for which information can be gathered from treatment guidelines, field assessments, opinion leader interviews and focus group discussions with key stakeholders that include patient advocacy and action groups at both the global and country level.
2. Stakeholder framework
A stakeholder framework shows all relevant persons and organizations and describes their roles and contributions to the patient pathway and/or digital technologies. This will ensure that the right persons will be engaged from the beginning of implementation and that the technology can be integrated into current workstreams and processes. In addition, this will help to identify where gaps exists and if new partnerships with organizations might be beneficial for planned digital health activities.
3. Digital Health Activities framework
A digital health activities framework can be used to show which digital health solutions are currently employed in-country and in which step(s) of the patient pathway. The framework considers existing digital health solutions in other health programmes and provides a summary of previous digital health programmes, including their status, level of utilization, results achieved, and which partners and organizations have been involved.
4. Gaps and needs analysis
The information collected in the previous steps, supplemented with observations and meetings during field visits, will help to identify gaps in the patient pathway. Field visits should follow the trajectory of a typical patient along the care pathway. All operational processes as well as information systems and the reporting processes are to be observed and described.
An in-country workshop can facilitate presentation of initial observations and visualization of the processes to in-country participants involved in providing TB care and treatment. This gives a good profile of the weaknesses in the current system, as well as the prioritization of gaps and needs in which digital health solutions like DAT could play a role.
5. Digital health agenda and/or technology implementation roadmap
Once the prior steps are completed, it should provide the necessary background information to identify opportunities and approaches to develop a broad country digital health agenda and/or to develop an implementation roadmap to address a specific need by implementation of a certain digital technology.
Country Digital Health Agenda
If the aim is to develop a country digital health agenda, this last step starts by systematically identifying country-specific “digital health questions” from the gap analysis. These questions are then rigorously and transparently prioritized before they are disseminated to all key stakeholders involved in digital health technologies.
Implementation of digital technology
If the aim of the digital health assessment is the latter, the potential role of certain digital health technologies will first have to be assessed and compared to determine their ability to strengthen the health system by improving their effectiveness, efficiency or their quality, and very commonly, a combination of these dimensions. Furthermore, necessary adaptations to the core technology and data utilization strategies will need to be determined.