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Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

2012; World Health Organization; Volume: 90; Issue: 5 Linguagem: Inglês

10.2471/blt.11.099069

1564-0604

John D. Piette, KC Lun, Lincoln Moura, Hamish Fraser, Patricia Mechael, John Powell, Shariq Khoja,

Telemedicine and Telehealth Implementation

Evidence collectionWe focused on evidence for the impact of e-health in three areas identified by prior reviews: (1) systems facilitating clinical practice; (2) institutional systems, and (3) systems facilitating care at a distance. 3,4ystems facilitating clinical practice include electronic medical record systems, picture archiving and communication systems for managing digital medical images, and laboratory information systems that automate laboratory workflow and reporting.Institutional systems include systems for health information and management, early disease warning and disaster management.These systems aggregate data from health facilities and patients to create community-wide views of disease trends and clinical activity. 11,12Systems facilitating care at a distance include the use of a short message service (SMS) or other text messaging to improve outcomes through patient reminders; between-visit monitoring and/or health education; videoconferencing facilities for live consultations and asynchronous communication between clinicians, and automated telephone calls with recorded messages (sometimes called interactive voice response calls).Multiple systematic reviews have been conducted on some of these e-health approaches, whereas the rest are barely Abstract 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 healthsystem 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.