During the COVID-19 pandemic, there was increased usage of digital tools in the healthcare sector, yet inequalities in access and utilisation of these technologies were also highlighted. Despite the growing availability of digital tools, several barriers still restrict their optimal use (Vien and Phu). Subsequently, this article will describe some key features of digital health tools. For this purpose, we will outline a case study focusing on patients with diabetes. We will examine the limitations of implementing such tools on a large scale, as well as the evolving dynamics of digital health tools in the future.
Digital Health
Electronic health (eHealth) is here to stay and will become increasingly important in the diagnosis, management, and treatment of patients in the coming years. The European Commission, along with other policymakers and stakeholders, considers eHealth a significant priority in the healthcare sector. A roadmap for developing eHealth applications is based on studying and addressing six key challenges:
1. Requirements: Defining technical specifications and standards for the smooth operation of an eHealth system.
2. Users: Identifying users and systems that will have access to the digital healthcare system.
3. Data: Determining the data managed by the system, how these data are linked within the system, and the ways they will be generated.
4. Interoperability: Developing methods and technologies for secure and efficient connection of all system elements.
5. Benefits and outcomes: Defining the benefits and improvements in healthcare services through the implementation of each digital health tool. In addition to describing the benefits, it is crucial to extensively discuss the expected outcomes from the implementation and application of digital health tools.
6. Access: Simultaneously, ensuring that with the implementation of each eHealth tool, all individuals, regardless of their socioeconomic status, will have access to and benefit from eHealth services.
For example, in the case of developing an electronic monitoring system for patients with diabetes, current approaches in patient care have limitations that lead to ongoing unmet medical needs, many of which can be overcome with the use of digital tools. One element is the increasing number of individuals developing diabetes at a rate that does not correspond to the availability of healthcare professionals, especially endocrinologists (Iyengar et al.). This shortage of specialists disproportionately affects individuals with diabetes living in remote or rural areas. Additionally, visits to healthcare professionals are brief, requiring them to make complex decisions quickly, often based on suboptimal information such as haemoglobin (HbA1c) levels and sporadic glucose measurements (Klonoff et al.).
From the perspective of individuals with diabetes, they need to balance personal risks such as severe hypoglycemia or diabetic ketoacidosis, as well as the time and cost of managing diabetes self-care. Managing diabetes poses a significant burden on individuals living with the condition, their families, healthcare professionals, and healthcare systems. Self-management strategies can be complex and impose significant psychological burdens on both individuals and families. Although the increasing availability of digital tools that assist in tasks such as blood glucose monitoring and insulin dose calculation is recognized, multiple persistent barriers continue to hinder their optimal use.
The current state of digital health in diabetes can be considered to be supported by four pillars (the 4 “Ds”): drugs, devices, data, and decision support. There are many barriers to creating an effective digital ecosystem for diabetes, such as compliance with medication, the need for self-monitoring, examination of other significant biological indicators (e.g., weight, blood pressure, heart rate, and body temperature), integration of data from devices with electronic health records (EHRs), data ownership and communication, access and health inequalities, lack of data integration from multiple sources, and the need for analysis by both patients and physicians (Kerr et al.).
For digital health to be successful, all stakeholders must possess the appropriate skills and equipment. However, an effective eHealth service requires a digitally literate population capable of using information and communication technologies to find, evaluate, create, and communicate information, necessitating both cognitive and technical skills (Welcome to ALA’s).
Digital illiteracy
As digital health is essential, we must not forget that millions of people cannot benefit from this change. Digital illiteracy is a very real and common problem in medically significant segments of the population. In ageing developed countries like Greece, care must be provided to an increasing number of patients, while trained personnel are scarce, workload is high, and healthcare costs are steadily rising (OECD, 2023). Challenges related to digital illiteracy affect the elderly, individuals with multiple chronic diseases, adults with low levels of education and income, as well as ethnic minorities. How a person acquires, processes, and uses information depends not only on digital literacy skills but also on previous life experiences and support networks, all shaped by culture.
A crucial element in the acceptance of each digital tool is the user interface design and user experience, which take these factors into account, including the requirement for real-time passive data collection. Therefore, to build a fair digital ecosystem that provides equitable access and support to individuals from diverse backgrounds, it is imperative to clearly define the primary goals of such a system. Electronic health tools could be part of the solution to this complex problem if implemented effectively.
Limit the barriers
One observed phenomenon is that clinicians are not adequately trained to use electronic health records, and medical schools are only beginning to adapt their educational programs towards the digital future of healthcare. A first step, therefore, is to raise awareness among clinicians regarding digital literacy and its manifestation, not only in vulnerable groups but also in society as a whole. Simultaneously, offering specialised electronic health education for patient groups is crucial. However, even when patients are educated, anticipated technical issues with applications may discourage their use. Offering long-term support within a help service framework is essential to prevent abandonment.
Before implementing an electronic health tool, it’s important to assess the digital literacy level of the patient category. This can be done by evaluating the type of technologies already used by the patient (e.g., email address, applications, browser), the type of device the patient is familiar with (e.g., none, tablet, desktop computer), and whether the patient can use these technologies without assistance. When implementing electronic health, the introduction of an alternative analog pathway for patients unwilling or unable to participate in the digitization of healthcare should be included. An effective example is a phone call to the patient if setting up a connection for video consultations is not possible (Metting and Hage).
Conclusions
Despite the increasing use of electronic health records, low digital health literacy can create barriers to accessing and understanding healthcare information. Many obstacles remain to be overcome and questions to be answered before a connected digital ecosystem can be developed. However, a unified system will personalise and enhance the performance of existing technologies and treatments to improve outcomes for users. It will also help overcome health disparities by providing broader access to technology, support, and knowledge. If achieved, a connected digital health ecosystem has the potential to reduce the burden of care for patients, healthcare professionals, and healthcare systems.