WHF Roadmap for digital health interventions in cardiology

Cardiovascular diseases (CVD) account for a significant, and growing, global healthcare burden with more than 500 million people affected worldwide.² There are many options in managing CVD, however the delivery of optimal care is complicated due to constraints in healthcare workforce, financing, availability and affordability of CVD medicine and service delivery.

Such DHIs have the potential to improve healthcare for cardiovascular diseases, by empowering patients and healthcare organisations, improving long-term patient outcomes, improving patient care experience and reducing healthcare costs.³

However, due to poor context-specific design and a lack of proper evaluation standards, DHIs are often perceived as ineffective and lack recommendation in current guidelines. Robust qualitative, quantitative and economic evaluation and development of implementation strategies, especially for complex DHIs, are essential for their success. 

The main barriers for the successful implementation of DHIs can be divided into different categories:

1. healthcare system, including a lack of national privacy regulations and regulatory approval standards, inadequate digital infrastructure and insufficient reimbursement frameworks, 
2. healthcare provider, in terms of both a lack of digital literacy and misperception of the effectiveness of DHIs, 
3. patient-related, including their age, local gender norms, socioeconomic factors, lack of digital and health literacy, misperception of effectiveness of DHIs and limited user-specific design adaptations and 
4. technological factors, such as no context-specific adaptation of technology, lack of interoperability, insufficient usability and design and limited national and institutional infrastructure.

During the design process of digital health interventions, it is therefore important that the content and functionality of a DHI is aligned with the goal of the intervention. Digital applications also need to be optimised for their intended use and their implementation environment, therefore national strategies, reimbursement policies and digital infrastructure are key factors for long term success of DHIs. See World Health Organisation Guideline Recommendations⁴ and European Society of Cardiology e-Cardiology Working Group Position Paper² for further information.  

Successful implementation of DHIs also relies on good leadership and governance, high-quality legislation and policies, a clear investment and reimbursement strategy, a supportive digital healthcare infrastructure, clear interoperability and data standards, and a healthcare workforce educated on digital technologies (as suggested in the National eHealth Strategy Toolkit from the World Health Organisation and International Telecommunication Union 2012).⁵

The World Health Federation Roadmap for Digital Health in Cardiology¹ analyses each of these barriers in detail and provides context-specific solutions as well as DHI examples that have been successfully implemented in real world settings.