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). This phase relates to full scale implementation of the digital health solution in real-world settings based on what has been planned at the Macro level. Implementation should take a staggered approach to allow for incremental learning, feedback cycles and modification of the technology or implementation strategy as needed. This also allows for adjusting personnel and clinical or administrative routines, if needed. A clear plan for data collection, monitoring and tracking of key metrics of interest should have been established in the planning phase. Evaluating and reflecting in the implementing phase broadly seeks to answer these questions:
- What does implementation rollout look like in real-world settings?
- What (if any) changes (intended and un-intended) have occurred as a result of implementation?
- What have we learnt so far and how can we revise policy, practice, or implementation in response to these lessons?
- What are the short (6months-2years), medium (2-4years) or long-term (>4years) outcomes of the digital health solution?
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.
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.
- Contextual Factors
Acceptability is “a multi-faceted construct that reflects the extent to which people delivering or receiving healthcare using a digital health solution consider it to be appropriate based on anticipated or experienced cognitive and emotional responses to the intervention”.
This is related to the fit, relevance, and compatibility of the digital health solution for a given setting, provider or patient, to address a specific health condition. Digital health solutions should be clinically relevant and tailored to align with the comfort, needs and preferences of target end user and beneficiaries.
It includes ensuring an optimum fit between the solution, policy priorities for health and health system resources to drive population-level outcomes.
Efficiency refers to optimal use of available resources (financial & human) to achieve set goals of a digital health solution.
It can also refer to how well a digital health solution or tool is designed. Poor user interface design can reduce efficiencies increasing the likelihood of data or inputting errors. E.g. too many menus, alerts, high proficiency required to use.