BACKGROUND
Digital health technologies (DHTs) offers a unique opportunity to address some of the major challenges facing the healthcare systems around the world. However, the implementation of DHTs raise some concerns such as the limited understanding of their real impact on health systems and people’s well-being or the potential risks derived of their use. In this context, health technology assessment (HTA) is one of the main tools that health systems can use to appraise evidence and determine the value of a given DHT. Nevertheless, due the nature of DHTs experts highlight the need to reconsider the frameworks used in traditional HTA.
OBJECTIVE
The main purpose of our scoping review (ScR) was to identify the methodological frameworks that are used worldwide for the assessment of digital health technologies (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework that is based on the most frequently described domains in the literature.
METHODS
The scoping review was performed in accordance with the guidelines established in the PRISMA-ScR. We searched in 7 database for peer-reviews and grey literature published between January 2011 and December 2021. The retrieved references was screened using Rayyan in a single-blind manner by 2 independent authors and data extraction was done using ATLAS.ti software. The same software was used for thematic analysis that was performed following the steps described by Thomas and Harden.
RESULTS
The systematic search retrieved 3.061 references (2.238 unique), of which 26 were included. These, in turn, synthesized 102 frameworks designed for the assessment of DHTs. The methodological frameworks identified revealed great heterogeneity between them due to their different structures, approaches and items to be considered in the assessment of DHTs. Also, we identify different wording to refer to similar concepts. Through thematic analysis we reduced this heterogeneity. Regarding the analysis, in the first phase emerged 176 provisional codes related to different assessment items. In the second one, these codes were clustered in 86 descriptive themes that, in turn, were grouped in the third phase in 61 analytical themes and were organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions and level 3 formed by 11 sub-dimensions. From this 61 analytical themes we developed a proposal of a methodological framework for DHTs assessment.
CONCLUSIONS
There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of DHTs. Through a ScR we identified 26 references including 102 frameworks and tools for the assessment of DHTs. The thematic analysis of those 26 references led to the definition of 12 domains, 38 dimensions and 11 sub-dimensions that should be considered in dHTA.
CLINICALTRIAL
Segur-Ferrer J, Molto-Puigmarti C, Pastells-Peiro R, Vivanco-Hidalgo RM. Methodological Frameworks and Dimensions to Be Taken Into Consideration in Digital Health Technology Assessment: Protocol for a Scoping Review. JMIR Res Protoc. 2022;11(10):e39905.