How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report

• Published in: Value in health Vol. 25; no. 9; pp. 1469 - 1479
• Main Authors: Burrell, Anita, Zrubka, Zsombor, Champion, Annette, Zah, Vladimir, Vinuesa, Laura, Holtorf, Anke-Peggy, Di Bidino, Rossella, Earla, Jagadeswara Rao, Entwistle, Joanna, Boltyenkov, Artem Tarasovic, Braileanu, George, Kolasa, Katarzyna, Roydhouse, Jessica, Asche, Carl, Redekop, Ken, Pfeiffer, Colin, Le, Long, Janodia, Manthan, Sharkawy, Menna, Şaylan, Mete, Lee, Sang-Soo, Glynn, Sean, Ganguli, Arijit, Badawy, Sherif, Carvalho, Luiz Sérgio, Ernst, Fredric, Seal, Brian, van Steen, Cecile, Patel, Naiya, Lee, Hailey, Doe, Abigail, Strouss, Lisa, Angelillo, Luigi, Patel, Chad, Paul, Sanjoy
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2022
• Subjects: definition; digital health; electronic health; Internal Medicine; mobile health; outcomes research; Public Health; systematic review; telehealth; telemedicine; telemedicine; digital health; mobile health; telehealth; electronic health; definition; outcomes research; systematic review
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2022.04.1730

This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article. PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of “definition.” Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores. The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms. To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes. •Although multiple reviews of digital health-related definitions have been undertaken, there is still a lack of clarity around the terms in use. Without clear definitions, the understanding about what should be included in an evidence summary of a particular health technology may vary and hinder the design or interpretation of comparative effectiveness research and, ultimately, decision making.•This scoping review revealed that despite the existence of seminal definitions of umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine), a plethora of new definitions have been developed over time. Even after applying text analyses, the definitions of umbrella terms are too general and do not specify the functional domain of interventions or outcomes that the respective technologies deliver to patients.•Umbrella terms should be accompanied with operational definitions that specify the patient population and clinical condition, intervention, comparator technology, outcomes, timing, and healthcare setting under consideration. To improve the evaluation of digital health, an international classification system with functional categories related to the domains of effect and patient outcomes for digital health technologies is needed to establish a standard terminology for stakeholders involved in the development, use, and assessment of such technologies.