Guiding principles for evaluating eHealth initiatives are published today (Tuesday 2 November) by researchers behind the evaluation of the Government’s controversial Summary Care Record programme.
The guidelines authored by Professor Trish Greenhalgh - an academic GP from Barts and The London School of Medicine and Dentistry - and published in the Public Library of Science Medicine aim to open an informed debate on ways of knowing in eHealth evaluation.
Healthcare depends increasingly on information and communications technologies such as electronic patient records, telemedicine and remote monitoring devices in patients' homes. Such technologies have traditionally been tested in experimental trials in which a 'technology on' group was compared to a 'technology off' group and success was measured in terms of the difference between the groups.
Professor Greenhalgh however argues that on-off experiments are invariably artificial and cannot capture the complex interplay of social, political and practical influences which affect the adoption and use of eHealth technologies. Therefore whilst technology might "work" in an experimental setting, in reality it may fall victim to resistance from medical or nursing staff, a change in policy wind, the passions of civil liberties protesters or the fact that real patients are not as carefully selected as the kind of person who volunteers for trials.
Greenhalgh adds; "For too long academics, civil servants and government have colluded in perpetuating the fiction that eHealth technologies can be assessed one-dimensionally in terms of their technical properties. In reality, such technologies often have important social, political and ethical dimensions because they profoundly affect our lives, our civil liberties and our ability to access healthcare. Robust evaluations of e-Health technologies must balance engagement with these complexities with scientific objectivity."
The authors of the guidelines invite PLoS Medicine readers to join what they consider to be an urgently needed debate on the relative merits of ‘scientific’ and ‘social practice’ approaches to evaluation, and consider the extent to which eHealth evaluation is in need of a paradigm shift.
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‘Why Do Evaluations of eHealth Programmes Fail? An Alternative Set of Guiding Principals’ is published in the Public Library of Science Medicine on 2nd November 2010.
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