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E-health applications: a black box for patients and care providers

IT in healthcare: despite its many potential benefits, relatively few patients or care providers actually make use of it. This is according to Floor Sieverink, who will be awarded a PhD by the University of Twente’s Faculty of Behavioural, Management and Social Sciences on Thursday 14 December. Her doctoral thesis is entitled Opening the Black Box of eHealth.

eHealth applications, such as patient platforms or patient portals, offer people with chronic disorders the opportunity to get more involved in their own care. For example, they can view and share their own data with their care providers, be educated about their disorder, work on their personal health goals, put short questions to care providers, or get in touch with their peers. The platforms can make it easier for users to communicate with their care providers. In turn, the care providers can gain a better understanding of their patients’ health if they have access to data that the patients have collected about themselves. Any health complaints can then be identified sooner and treated.

Implementation process

Floor Sieverink notes that, despite these potential benefits, few people actually make use of patient platforms, so there is not much evidence to show whether these eHealth applications are really effective. As a result, large-scale implementation often proves difficult. Most evaluations view the platforms as stand-alone technologies that are primarily intended for patients. “These evaluations are often restricted to an experimental study which mainly indicates whether an application has helped the patient. However, the implementation of a patient platform is a complex process involving important roles for care providers and for existing healthcare processes”, says Ms Sieverink. “Evaluations like this give no details of how the technology was perceived by users or of how this affected its actual use. Thus, they cannot explain why certain effects were or were not found. As a result, the application is still something of a black box.”

Log data

In an effort to open up this black box, Floor Sieverink argues that there should be a ‘holistic approach to evaluation’. This approach should take account of the technology, the users and the context in which the application is being implemented. Her PhD thesis focuses on the process evaluation used when implementing platforms for patients with type 2 diabetes mellitus, chronic heart failure or COPD (e-Vita). She tackled this using a ‘mixed methods design’ in which she collected qualitative and quantitative data sets and analysed them separately. The results were then combined. Log data was examined to find out how e-Vita was used over the longer term. In addition, focus groups were set up to determine how care providers plan to use the platform in their daily activities. Finally, care providers were interviewed and potential end-users performed usability tests, to understand how patients and care providers perceived the implementation process and the use of the platform.

Development cycles

The results of the study show that, while the care providers involved endorse the potential of patient platforms, they need training and support to actually incorporate such platforms into their daily routine. It is only when this added value of the platform becomes clear that care providers can actually motivate patients to use the platform. “After all, patient platforms do not implement themselves”, says the University of Twente’s health researcher. She feels that it is vital to involve all end users in this eHealth development at an early stage, to facilitate the process. This will create added value and facilitate the actual implementation. Short and iterative development cycles play a crucial part in identifying problems at an early stage of development, thus increasing the chances of successful implementation.

Advanced research methods

According to Ms Sieverink, the mixed methods design she adopted proved to be of great added value when evaluating the implementation of a platform for patients with diabetes, chronic heart failure or COPD. “This approach has helped us to understand how people actually use the platform and why it is not being more widely used. If the evaluation had focused purely on the effectiveness of an application in an experimental study, then we would not have obtained these results. This study, which involved the use of advanced research methods, is our contribution towards Opening the Black Box of eHealth.”