Impact – Macro Level
Impact
Macro Overview
The macro level refers to activities at the federal, provincial, and territorial levels of governance and includes governmental funding agencies and pan-Canadian health organizations. At this level policies and regulations are set that influence the rest of the healthcare landscape (e.g., the meso and micro levels). The impact phase involves the collection and analysis of indicators to assess the overall impacts of digital health on the quintuple aim outcomes: improved patient experience, improved provider experience, improved patient (population) outcomes, equity, and reduced per capita cost of care that are associated with the intervention to inform related policies or investments as well as long term planning, growth, and scale. Digital health end-users may include patients, informal caregivers, and clinicians. Other healthcare stakeholders also include end-users not directly involved in the delivery of health care, such as healthcare administrators, digital health designers, policy makers, and researchers. An evaluation conducted in the Impact phase generally seeks to answer these kinds of questions:
- What are the results/outcomes?
- What changes have been triggered?
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Equity
DEFINITION
Health equity implies that everyone has a fair opportunity to attain long and healthy lives and that no one is disadvantaged from achieving this potential irrespective of their social, economic, geographic, demographic, racial or ethnic grouping.
Digital Health Equity is achieved when all people have equal opportunity to access, use and benefit from digital health to attain long and healthy lives.
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Sustainability
DEFINITION
This is the process by which the digital health solution and the practices and policies that support it become institutionalized or integrated within the structures and systems for health care delivery.
The long-term effects of a program on outcomes after a program is completed or the “continued use of program components and activities for the continued achievement of desirable program and population outcomes”.
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Patient Experience
DEFINITION
This relates to a broad spectrum of dimensions, domains and constructs that explore the human health care experiences beyond the clinical encounter. It highlights the central role of the patient but also includes interactions among patients, families, care partners and the health care providers.
The experience of the end-user (patient) as they interact with a digital health technology or service. The usefulness, ease-of-use, and competency of working with eHealth services. How user-friendly is it?
FURTHER READING
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Provider Experience
DEFINITION
This is related to the well-documented link between provider experience and the quality of care provided and experienced by patients. And by extension, the provider experience can have an impact on the overall performance of the health system.
Ensuring that the solution does not contribute negative experiences in the delivery of care due to:
- Inefficient workflows
- Uncoordinated communication
- Information overload (e.g., too many notifications, alerts, etc.)
TOOLKIT RESOURCES
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Cost Implications
DEFINITION
This can be related to both cost savings (cost-effectiveness, resource allocation, reduction in unnecessary health care utilization, etc.) and time savings (efficiency).
When considering cost per capita or other monetary outcomes, economic evaluations help to inform decision makers about the relative value for money of those interventions against specified alternatives.
FURTHER READING
- Jang Y, Lortie MA, Sanche S. Return on Investment in Electronic Health Records in Primary Care Practices: A Mixed-Methods Study. JMIR Med Inform 2014;2(2):e25
- Valuing National Effects of Digital Health Investments: An Applied Method
- McGrail KM, Ahuja MA, Leaver CA. Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study. J Med Internet Res 2017;19(5):e177
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Health Outcomes
DEFINITION
This involves assessing both the short-term clinical outcomes and longer-term change in the health status of patients that can be attributed to digital health solutions.