Developing HTA designs for e-health: a systematic review of reviews

Summary

• Norwegian Center for E-health Research (NSE) is commissioned to assess e-health within an HTA framework in collaboration with national and international bodies
• A systematic review is in progress addressing methodologies used for e-health assessments within HTA traditions, challenges which are summarized and proposals for further development to the benefit of different healthcare stakeholders
• The purpose is to build capacities for adapting HTA methodologies to the dynamic and complex field of e-health.
• The review is a result of the project «HTA for ICT» within NSE (https://ehealthresearch.no/en/projects/health-technology-assessment)
• 1. Ekeland A.G., Bowes, A. and Flottorp S.: "Effectiveness of Telemedicine: a Systematic Review of Reviews" Int J Med Inform. 2010 Nov;79(11):736-71. doi: 10.1016/j.ijmedinf.2010.08.006. (2010)
• 2. Ekeland, A.G., Bowes, S. and Flottorp, S.: "Methodologies for Assessing Telemedicine: a Systematic Review of Reviews" Int J Med Inform. 2012 Jan;81(1):1-11. doi: 10.1016/j.ijmedinf.2011.10.009. Epub 2011 Nov 21.

Background

The review is an update of a systematic review undertaken in the EC study: Methodologies for Assessing Telemedicine in 2010, with the purpose of proposing timely and relevant approaches in a rapidly changing field.

HTA approaches were not specifically addressed in those reviews, even if data were available. In 2016, the project "HTA for ICT" initiated a follow up study in order to take stock of the development in the field since the previous reviews.

HTA of e-health is focussed as well as a comparison with results from the 2010 review.

Methods

A review of systematic reviews according to a protocol listing explicit methods, selection criteria, data collection and quality assessment procedures

A qualitative analysis of the reviews included, sensitized by broad methodological positions, in the previous reviews these included positivist and naturalistic approaches

The analysis focus on methodologies as reported in the primary studies included in the reviews and methodological recommendations made by the review authors

Preliminary results

In the 2009 revew, 1593 titles/abstracts were identified and 80 papers were included. Of these, we identified 13 HTA reports or papers.

In 2016, the same search returned 6426 titles/abstracts. Based upon abstracts, 800 papers are included for full text reading and further selection.

Based upon selection from the abstracts of 400 of these 800 titles, 3 – 5 HTA-reports were identified.

This indicates that HTA of e-health and telemedicine has not increased during the last 5 years, even if communication technologies and organisational arrangements are defined as health technologies.

Conclusions

ICTs in health care are increasingly used and assessed in systematic reviews since 2009.

HTA attention is reduced since 2009.

It is timely to increase HTA attention to e-health as ICT is defined as health technologies

References

1. Ekeland A.G., Bowes, A. and Flottorp S.: "Effectiveness of Telemedicine: a Systematic Review of Reviews" Int J Med Inform. 2010 Nov;79(11):736-71. doi: 10.1016/j.ijmedinf.2010.08.006. (2010)
2. Ekeland, A.G., Bowes, S. and Flottorp, S.: "Methodologies for Assessing Telemedicine: a Systematic Review of Reviews" Int J Med Inform. 2012 Jan;81(1):1-11. doi: 10.1016/j.ijmedinf.2011.10.009. Epub 2011 Nov 21.