Scaling an eHealth (be it, mHealth, EHR, telehealth or telemedicine) programme needs more than management. Most essentially, it is about engineering scale – to address the inevitable need for constant technology improvements and upgrades, without this, eHealth projects frustratingly struggle to scale and sustain.
That eHealth can transform how quality healthcare is effectively and efficiently delivered and accessed, is no longer disputed. Such transformation could bring about healthcare cost reduction or minimisation for patients, citizens, healthcare providers and governments.
The ubiquity of mobile phones/Smartphones, the increasing use of tablet computers and rising availability of broadband telecommunication, portends that citizens, health workers, patients and service providers can all benefit from digital health revolution.
Engineering inadequacies can limit progress. Observation of numerous small-scale experimental projects in clinics and hospitals has confirmed this. Whether a full realisation of benefits will materialise depends on how the physical technologies employed for eHealth services’ development and delivery are locally maintained, adapted and upgraded.
I have become more convinced that implementing eHealth shares much with engineering a physical infrastructure. Though, eHealth’s foundational technology is digital in nature, the civil and mechanical engineering involved in building a large-scale infrastructure such as the Crossrail, resonates. Such engineering involves dealing with and managing complexities and risks. Sourcing for and nurturing talents and fostering innovation, were key lessons that I took from a presentation on Crossrail, delivered at the Royal Academy of Engineering in September 2013. Engineering eHealth to scale requires incremental technology improvements and replacements.
The unavoidable and unforeseen technology breakdowns, downtimes, inappropriateness and incompatibilities that bedevils eHealth engineering, call for instituting timely actions. Computing, telecommunication and biomedical hardware or devices and software need adaptation to users’ preferences and to ambient demands, before optimal utilisation can be attained. Regular technology maintenance and upgrading, in response to demanding environments and fastidious users, are necessary to generate further and deeper utilisation in clinics and hospitals.
When predominantly small-scale projects, struggle to spread organisationally and geographically, and expand and improve functionally; utilisation often remains low. As technology adaptation, maintenance and upgrading are inadequate.
Functional scalability of hardware and software needs competent and readily available engineering and technical skills. Without these, organisational spread in hospitals’ departments and specialties flounder. Users become disgruntled, when inadequate technical troubleshooting, frustrates continuous and productive utilisation. Thus, eHealth projects often encounter setbacks and hiccups. They neither scale nor sustain, as instrumental institutional supports, from disgruntled users, unimpressed financiers and embattled policymakers, filter away.
Projects and pilots either remain small-scales or become defunct. As a consequence, geographic scalability to other clinics and hospitals within a health system, region or country rarely materialise, as promises remain unfulfilled and benefits often not realised at scale.
In these unfavorable circumstances, engineering and technical skills to adapt, maintain and upgrade technologies are essential. Despite the enormous benefits that eHealth promises, an inadequacy of engineering skills, continue to stifle large-scale implementation. Governments, hospitals and companies need to invest in engineering capacity building.
A recommendation is to invest into eHealth engineering skills development and innovation.
In hospitals, existing biomedical technicians’ and engineers’ skills can be upgraded through training and workshops in order to speedily provide technology support services.
Small and medium technology companies can be incentivised by policymakers to provide invest and innovate. Moreover, such companies can provide repairs, maintenance and upgrading of eHealth hardware and software.
Universities and institutes must be endowed and funded to carry out relevant multidisciplinary research and development activities, to support technology adaptations and improvements.
Engineering to scale is essential to both realise and maximise benefits from eHealth investments and implementations.