Planning – Macro Level
PLANNING
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 planning phase describes the early pre-implementation stage of digital health where the solution is conceptualized and designed. Actions at this phase will include determining service type and target users, identification of team members, community leaders and partners, regulatory and resource requirements. The aim is to establish a solid foundation for implementation, health system impact and long-term sustainability. Engaging should also be considered during this early phase. The key questions for this phase are:
- What are we doing and why?
- What should we be considering?
- Who do we involve/How do we involve them?
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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 tools and services to attain long and healthy lives.
TOOLKIT RESOURCES
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Stakeholder Engagement
DEFINITION
This involves identification and meaningful partnership with any individuals, groups or institutions that can influence or be impacted by the at any timepoint, including the target populations (care providers, patients, families), in order to facilitate uptake and acceptance. Within a healthcare organization this would also include administrative staff, and individuals or groups who are responsible for policy and decision making.
The involvement or exclusion of certain groups at the planning impacts implementation success, uptake and long-term sustainability. Some people may fill multiple roles in their capacity as stakeholders. Engagement should be approached as a means not an end, recognizing engagement as a continuum. The goal is to ensure that the right and necessary people are involved early on in the process and their input/influence is recognized.
TOOLKIT RESOURCES
- IAP2 Spectrum of Public Participation (document download)
- Derek H. T. Walker, Lynda Margaret Bourne, and Arthur Shelley, “Influence, Stakeholder Mapping and Visualization,” Construction Management and Economics 26, no. 6 (June 2008): 645–58
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Value Proposition
DEFINITION
This refers to promises that the vendor or proponent makes about what benefits the user can expect to receive from a digital health solution and considers how this solution may be different from others in the market. It includes short or long-term value that purchasers, users and beneficiaries hope to attain by implementing and maintaining the particular digital health solution. A value proposition also addresses issues of sustainability in terms of how the technology was procured (technology supply model), the client-supplier relationship, and the extent that other solutions can be substituted if needed.
TOOLKIT RESOURCES
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Appropriateness
DEFINITION
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.
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Feasibility
DEFINITION
This is the ability of the digital health solution to work as intended and the extent to which it can be used successfully in each setting.
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Costs
DEFINITION
The financial, infrastructural and operational needs to facilitate digital health implementation. It encompasses the direct and indirect financial resources required to develop, implement and sustain the digital health solution, and the implications of these for overall system performance.
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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Data Privacy and Security
DEFINITION
This includes the National, regional, and territorial standards for data sharing and management (e.g., PHIPA, PIPEDA, OCAP), including data governance agreements between institutions and provinces/territories. Security covers the ability to protect the integrity and use of the data captured, and to ensure only authorized access to the digital health solution. For instance, privacy impact assessments (PIAs) on a proposed digital solution can identify any real or potential impacts on an individual’s privacy.
TOOLKIT RESOURCES
FURTHER READING
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Interopability and Portability
DEFINITION
Interoperability can be defined as the ability of digital health solutions to “talk to each other” (i.e., information access, exchange, and use) and work with other technologies within the system in a seamless and coordinated manner. Depending on the complexity and use case of a digital solution, interoperability may be foundational, structural, semantic, or organisational.
TOOLKIT RESOURCES
FURTHER READING
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Contextual Factors
DEFINITION
This encompasses the wider institutional, sociocultural, and economic environment of digital health implementation at the macro, meso, and micro levels that can act to enable or constrain implementation.
TOOLKIT RESOURCES
FURTHER READING
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Regulatory Compliance
DEFINITION
This is the adherence and compliance to benchmarks, regulations, or policy as it relates to digital health technologies and the data collected from its use. It is accompanied by evidence of endorsement, certification, accreditation, or recommendation by relevant regulatory bodies.