mapping the role of digital health technologies in

26

IMIA Yearbook of Medical Informatics 2021

© 2021 IMIA and Georg Thieme Verlag KG

Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the LiteratureBinyam Tilahun1, Kassahun Dessie Gashu1, Zeleke Abebaw Mekonnen1, 2, Berhanu Fikadie Endehabtu1, Dessie Abebaw Angaw3 1 Department of Health Informatics, Institute of Public Health, College of Medicine and Health

Sciences, University of Gondar, Gondar, Ethiopia2 Health System Directorate, Ministry of Health, Ethiopia 3 Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and

Health Sciences, University of Gondar, Gondar, Ethiopia

SummaryBackground: Coronavirus Disease (COVID-19) is currently spreading exponentially around the globe. Various digital health technologies are currently being used as weapons in the fight against the pandemic in different ways by countries. The main objective of this review is to explore the role of digital health technologies in the fight against the COVID-19 pan-demic and address the gaps in the use of these technologies for tackling the pandemic.Methods: We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The articles were searched using electronic databases including MEDLINE (PubMed), Cochrane Library, and Hinari. In addition, Google and Google scholar were searched. Studies that focused on the application of digital health technologies on COVID-19 prevention and control were included

in the review. We characterized the distribution of technological applications based on geographical locations, approaches to apply digital health technologies and main findings. The study findings from the existing literature were presented using themat-ic content analysis. Results: A total of 2,601 potentially relevant studies were generated from the initial search and 22 studies were included in the final review. The review found that telemedicine was used most frequently, followed by electronic health records and other digital technologies such as artificial intelligence, big data, and the internet of things (IoT). Digital health technologies were used in multiple ways in response to the COVID-19 pandemic, including screening and management of patients, methods to minimize exposure, modelling of disease spread, and supporting overworked providers.

Conclusion: Digital health technologies like telehealth, mHealth, electronic medical records, artificial intelligence, the internet of things, and big data/internet were used in different ways for the prevention and control of the COVID-19 pandemic in different settings using multiple approaches. For more effective deploy-ment of digital health tools in times of pandemics, development of a guiding policy and standard on the development, deploy-ment, and use of digital health tools in response to a pandemic is recommended.

KeywordsCOVID-19, digital health, pandemics, technology, review

Yearb Med Inform 2021:26-37 http://dx.doi.org/10.1055/s-0041-1726505

1 BackgroundIn recent decades, the world has seen a dramatic rise in global pandemics, from the Severe Acute Respiratory Syndrome (SARS) pandemic in 2003 to Avian Influenza in 2006, H1N1 influenza in 2009, Middle East Respi-ratory Syndrome (MERS) in 2012, Ebola in 2014, the appearance of the Zika virus in Latin America in 2015. These pandemics are inextricably bound up in modern so-cio-technical developments and processes of globalization [1-3]. In early 2020, the World Health Organization declared a new pan-demic, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2),

ment, surveillance, and outbreak control. Applications of digital health technologies like artificial intelligence, telehealth, mobile health, big data, 5G, and the Internet of Things (IoT) may be useful to support the control of a pandemic [5, 6].

Digital health technologies (DHTs) have played an important role in pandemics, aid-ing understanding of the disease, improving diagnostic tools, and controlling the spread of the infection [4]. DHTs bring health services directly to people’s homes and un-derserved communities that make health care more responsive and productive [6]. It has been reported that DHTs such as telehealth, when used for health surveys and data collec-

a previously unknown SARS virus variant [1, 4]. SARS-CoV-2 causes the infectious disease known as COVID-19. Characteris-tic of a pandemic in general, COVID-19 is spreading around the globe exponentially, causing considerable disruption not only on the health system but also on the world economy. Compared with SARS and MERS, COVID-19 spreads more rapidly owing to increased globalization, a longer incubation period, and asymptomatic transmission.

The management and control of pandem-ics represent a unique challenge to health systems because novel infectious diseases can be transmitted rapidly to others and thus require a focus on early detection and treat-

Published online: 2021-09-03


27

Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the Literature

tion, surveillance, health awareness-raising, and decision support systems from different sources can be used to prevent and control pandemics or outbreaks without disrupting the regular social order [7, 8]. The use of digital tools such as contact tracing apps to monitor outbreaks and their extent, and online consultations to help keep health pro-fessionals and patients safe while providing continued care are some of the ways that the potential of digital health has been harnessed during the COVID-19 pandemic [9].

The COVID-19 pandemic has chal-lenged health systems in many ways and it is critically important to fight COVID-19 effectively. In line with this, digital health solutions provide an opportunity to optimize time and human resources in the fight against the pandemic. These solutions facilitate communication between community mem-bers, hospitals, and health care providers [10]. Yet, there are few reviews for how DHTs contribute to pandemics, especially COVID-19. A rigorous scoping review that examines the role of DHT in preventing and controlling the COVID-19 pandemic is needed to examine how DHTs were rapidly deployed to support COVID-19 response.

We used a Population, Concept, and Context (PCC) framework developed by the Joanna Briggs Institute (JBI) to frame our primary research questions as follows:1. What is the available evidence on the

role of digital health technologies in the prevention and control of COVID-19?

2. What were the barriers that influence the practice of digital health technologies in the prevention and control of the COVID -19 pandemic?

To answer these questions, we aimed to map the evidence of digital health technologies on COVID-19 pandemic control and barriers during the application of these technologies.

2 MethodsOur scoping review aimed to map the available evidence on the role of DHTs, such as electronic health records, mHealth, telehealth, and artificial intelligence for preventing and controlling COVID-19.

This review was conducted within the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and it was guided by the Joanna Briggs Institute scoping review guidance [11].

2.1 Eligibility CriteriaSee Table 1.

2.2 Data Sources and Search StrategyA comprehensive search was performed on the following databases: MEDLINE (PubMed), Cochrane library, Hinari1, Google, and Google Scholar advanced da-tabases. Medical Subject Headings (MeSH) terms were used for searching and Boolean operators (AND, OR) were used to specify combinations of search terms. The follow-ing keywords and medical subject headings were used: • For coronavirus: COVID-19 OR “coro-

navirus pandemic” OR pandemic OR “public health epidemics” OR “global pandemics” OR “disease outbreaks” OR coronavirus OR “coronavirus 2019” OR “novel coronavirus disease 2019” OR SARS-CoV-2

1 Hinari Programme set up by World Health Organization together with major pub-lishers, enables low- and middle- income countries to gain access to one of the world’s largest collections of biomedical and health literature. (https://www.who.int/hinari/en/)

AND

• For digital health technologies: “health informatics” OR “clinical informatics” OR “(computer science, medical)” OR “health information technology” OR informatics OR “medical computer science” OR “medical records systems” OR “electronic health records” OR “bio-medical informatics community” OR telemedicine OR telemed OR “telehealth eHealth” OR mHealth OR “electronic health records” OR “electronic medical record” OR “patient-facing technology”

AND

• Prevention OR control OR Management.

The search was performed from October 09, 2020 to October 12, 2020. Additional relevant articles were identified by search-ing the reference lists of full-text articles studies published up to the last searched date of October 12, 2020, were included (Supplement File 1).

Initial searches were performed by an author (DA), who has experience in systematic reviews. Screening of titles, abstracts, and full texts was conducted independently by two authors (DA and KD). In this process, a second reviewer was blinded to the primary reviewer’s decision for selecting the articles; this helped to mit-igate the risk of bias during the assessment stages of the reviews. Any differences of opinion were discussed, and a consensus was reached; otherwise, a third reviewer (BT) was involved to arbitrate any issues that remained unresolved.

Table 1 Lists of the inclusion and exclusion criteria of studies for the scoping review

Inclusion criteria

Both quantitative and qualitative studies Studies related to the role of digital health technologies

to manage the COVID-19 pandemic Studies published in the English language Studies published in peer-reviewed journals

Exclusion criteria

Case reports Individual views or “perspective” pieces Literature reviews Studies published in a language other than English Studies published in preprint literature

28


Tilahun et al.

2.3 Data ExtractionTwo authors (DA and BF) extracted the data independently and compared the results. We extracted the following data from each study: author name, year of publication, country, types of digital health technology used, purpose(s) of applying digital health technology, service users, study design, approaches to applications of digital health technologies to address COVID-19, the study main findings, and barriers to imple-mentation or adoption (Table 1).

2.4 AnalysisBased on the methodological framework for scoping reviews [12], we were able to present our narrative account of findings in two ways. First, attention was given to the basic numerical analysis, and the distribution of the studies included in the review. We determined the distribution of electronic technologies used in COVID-19 prevention and control by geographical location. Second, the study findings from the existing literature were evaluated using thematic content analysis. Our narrative was then structured around the categories derived from the included study results or outcomes. These categories were: 1) types of commonly used digital health technologies, approaches or methods of application of digital health technologies for pandemic prevention and control; 2) the main role of the digital health technologies; and 3) barriers for the proper use of digital health technologies to prevent and control the pandemic.

3 ResultsThe initial search generated 2,601 articles. After duplicates were excluded, 2,431 articles remained. Titles and abstracts of the remaining articles were screened for potential eligibility. We excluded most of these potentially relevant papers (89.6%) based on a review of the title (n=1,188) or abstract (n=991). As a result, a total of 252 articles were eligible for full-text screening. After screening, 230 articles were excluded due to: lack of relevant information (n=74,

32.2%), for example, no information about DHTs rather provide information only about COVID-19 and other infectious diseases; electronic technologies applied for other types of disease such as HIV/AIDS, tuber-culosis, or diabetes mellitus (n=99, 43%); focus only on health information technology in general, such as for communication and academic education (n=36, 15.7%). Another 21 (9.1%) documents, representing per-spective articles or literature reviews were excluded (Figure 1).

3.1 Characteristics of Included Studies Of the 22 included studies 13 (59%) of them were from the USA [6, 13-24], three were from China [25-27], two were from Iran [28, 29] , Australia [16], Spain [30], Canada [31], and Taiwan [32] each contributed one (Table 2). The use of digital health technologies to combat COVID-19 was predominantly reported by North American studies (64%), followed by Asia (27%).

Fig. 1 Flow Diagram for the scoping review process adapted from the PRISMA statement by Moher and colleagues (2009)


29

Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the LiteratureTa

ble 2

Cha

racter

istics

of ind

ividu

al stu

dies in

clude

d in t

his sc

oping

revie

w.

Auth

or

Ye Q

Dean

F

Reev

es JJ

Lin C

Gong

M

Coun

try

China

USA

USA

Taiw

an

China

Type

s hea

lth

infor

mat

ics

mobil

e inte

rnet

big da

taclo

ud co

mputi

ng5G

+ te

lemed

icine

clinic

al inf

ormati

on

system

electr

onic

healt

h rec

ord

electr

onic

healt

h rec

ord (S

creen

ing

protoc

ols, S

ystem

Le

vel E

HR-Te

m-pla

tes)

COVID

-19 O

pera-

tiona

l Das

hboa

rdCo

mmun

icatio

n Ch

anne

lsArt

ificial

Intel

ligen

cePa

tient

Facin

g Tec

hnolo

gy

Cloud

-bas

ed he

alth

record

s

Cloud

-bas

ed

hardw

are

Meth

ods o

f app

licat

ion/a

ppro

ach

Provid

e a va

riety

of we

b-ba

sed se

rvices

for t

he

publi

c duri

ng th

e outb

reak,

includ

ing sc

reenin

g an

d con

sulta

tion s

ervice

s.Re

lease

offici

al sta

tistic

s abo

ut the

COVID

-19.

Apply

pred

ictive

mod

eling

and t

urning

point

pro

jectio

n, mo

nitor

crowd

activ

ity.

Assis

t the d

evelo

pmen

t of e

pidem

ic pre

venti

on

and c

ontro

l stra

tegies

.Int

ellige

ntly m

anag

e info

rmati

onFa

cilita

te cli

nical

mana

geme

nt rel

ated t

o CO

VID-1

9

Telep

hone

calls

direc

t ema

il, an

d EHR

mess

ag-

ing, a

ll befo

re in

perso

n enc

ounte

rs.A p

rotoco

lized t

riage

syste

m wa

s deve

loped

and

embe

dded

into

multip

le EH

R tem

plates

whic

h cou

ld be

rapid

ly up

dated

as sc

reenin

g guid

ance

evolve

d. In

order

to lim

it exp

osure

and r

eliev

e the

burde

n on

physi

cal h

ealth

care

locati

ons,

autom

ated

email

notifi

catio

ns w

ere se

nt to

patie

nts pr

ior to

the

ir clin

ic ap

point

ments

indic

ating

that

perso

ns

with

fever

and/

or ne

w co

ugh s

hould

call t

he

healt

h syst

em fo

r prop

er tria

ge be

fore p

resen

ting

to the

healt

hcare

facil

ity.

Integ

rate r

ecent

histor

y of tr

avel

to Ch

ina fro

m the

datab

ase o

f Cus

toms a

nd Im

migra

tion

Subm

it clai

ms to

the s

ingle-

paye

r plat

form

withi

n 24 h

ours.

Desig

ned H

ongh

u Hyb

rid Sy

stem

(HHS

) for

the

colle

ction

, integ

ration

, stan

dardi

zatio

n, an

d an

alysis

of CO

VID-1

9-rel

ated d

ata fro

m mu

ltiple

sourc

es, w

hich i

nclud

es a c

ase r

eport

ing sy

stem,

dia

gnos

tic la

bs, e

lectro

nic m

edica

l reco

rds, a

nd

socia

l med

ia on

mob

ile de

vices.

Aim

/pur

pose

To un

derst

and t

he ac

tions

take

n by t

he he

alth

inform

atics

comm

unity

in Ch

ina du

ring t

he

COVID

-19 o

utbrea

k and

to de

velop

a he

alth

inform

ation

tech

nolog

y fram

ework

for e

pi-de

mic r

espon

se ba

sed on

healt

h info

rmati

on

techn

ology

–rela

ted m

easu

res an

d meth

ods

To ex

plore

the ne

ed of

natio

nal h

ealth

inf

ormati

on te

chno

logy o

n prev

entio

n and

co

ntrol

of CO

VID-1

9

Descr

ibing

the i

mplem

entat

ion of

tech

nolog

-ica

l sup

port

impo

rtant

for op

timizi

ng cl

inica

l ma

nage

ment

of the

COVID

-19 p

ande

mic

supp

orting

the h

ealth

syste

ms ef

forts

to pre

-pa

re for

the c

urren

t pan

demi

c the

chall

enge

s as

socia

ted w

ith th

e risk

Integ

rating

recen

t hist

ory of

trav

el to

China

fro

m the

datab

ase o

f Cus

toms a

nd Im

mi-

gratio

n to s

upple

ment

the N

HI’s

centra

lized

clo

ud-b

ased

healt

h reco

rds.

To ill

ustra

te ho

w ne

w me

dical

inform

atics

techn

ologie

s may

enab

le eff

ective

contr

ol of

the pa

ndem

ic thr

ough

the d

evelo

pmen

t an

d suc

cessfu

l 72-

hour

deplo

ymen

t of th

e Ho

nghu

Hyb

rid Sy

stem

(HHS

) for

COVID

-19

in the

city

of Ho

nghu

in H

ubei,

China

.

Main

findin

g

Healt

h info

rmati

on te

chno

logies

play

a ve

ry im

porta

nt rol

e in

respo

nding

to th

e COV

ID-1

9 epid

emic.

Inform

ation

tech

nolog

y was

used

at al

l stag

es of

the ep

idemi

c, su

ch as

pred

iction

of ep

idemi

c tren

ds, tr

ackin

g of c

lose c

ontac

ts,

and r

emote

diag

nosis

Th

ey re

comm

end t

hat H

ealth

infor

matic

s com

munit

ies in

all

coun

tries s

hould

reac

t quic

kly an

d mak

e full

use o

f hea

lth

inform

ation

tech

nolog

y to r

espon

d to t

he ep

idemi

c.

Healt

h info

rmati

on te

chno

logy w

ould

involv

e a co

llecti

on of

int

ercon

necte

d hea

lth ca

re no

des,

with

each

node

repre

sentin

g a

healt

h care

orga

nizati

on us

ing an

elect

ronic

healt

h reco

rd (H

ER)

healt

h info

rmati

on ex

chan

ges (

HIEs

) can

facil

itate

the co

llecti

on,

excha

nge,

and a

nalys

is of

clinic

al an

d adm

inistr

ative

data

betw

een h

ealth

care

organ

izatio

ns an

d clin

ician

s

The e

lectro

nic he

alth r

ecord

and a

ssocia

ted te

chno

logies

are v

ital

and r

equis

ite to

ols in

supp

orting

outbr

eak m

anag

emen

t that

shou

ld be

leve

raged

to th

eir fu

ll pote

ntial.

Medic

al pro

viders

wou

ld be

aware

of pa

tients

’ trav

el his

tory w

hen

they m

ade a

n app

ointm

ent o

r cam

e in

Inform

ation

that

let cl

inicia

ns an

d Taiw

an CD

C trac

k or t

race b

ack

all do

ctor v

isits.

The H

HS ha

s bee

n obs

erved

to be

effec

tive a

nd fe

asibl

e for

COVID

-19 s

urveil

lance

and c

ontro

l.It

helpe

d stre

ngthe

n the

check

point

s on t

he fu

ll cha

in of

COVID

-19 c

ontro

l, inc

luding

“earl

y test

, earl

y rep

ort, e

arly

isolat

ion, a

nd ea

rly tr

eatm

ent”

durin

g the

outbr

eak

Barri

ers

Not m

entio

ned i

n the

stud

y

Not m

entio

ned i

n the

stud

y

The n

eed t

o fre

quen

tly

adjus

t buil

d to m

eet

rapidl

y evo

lving

req

uirem

ents

comm

unica

tion,

and a

dopti

on, a

nd

to co

ordina

te the

ne

eds o

f mult

iple

stake

holde

rs

Not m

entio

ned i

n the

stud

y

Not m

entio

ned i

n the

stud

y

30


Tilahun et al.Tab

le 2 c

ontin

ued

Chara

cteris

tics of

indiv

idual

studie

s inclu

ded i

n this

scop

ing re

view.

Auth

or

Ye J

Katzo

w MW Sm

ith A

Hoffm

an

Coun

try

USA

USA

Austr

alia

USA

Type

s hea

lth

infor

mat

ics

Artific

ial in

tellig

ence,

Tel

emed

icine

or te

le-he

alth,

Mobil

e hea

lth,

Big da

ta, 5G

, and

the

Intern

et of

Thing

s

Telem

edici

ne

Telem

edici

ne

(teleh

ealth

)

Teleh

ealth

Meth

ods o

f app

licat

ion/a

ppro

ach

Form

ing a

multis

ource

platf

orm th

at int

egrat

es da

ta mo

nitori

ng, e

xchan

ge, c

onve

rgenc

e, an

d fee

dbac

k mech

anism

s for

the pa

ndem

ics

Not c

learly

men

tione

d

Not d

escrib

ed in

the s

tudy

Not d

escrib

ed in

the s

tudy

Aim

/pur

pose

Asses

sing t

he ro

le of

healt

h tech

nolog

y and

in-

forma

tics i

n a gl

obal

publi

c hea

lth em

ergen

cy:

Practi

ces an

d Imp

licati

ons F

rom th

e COV

ID-1

9 Pa

ndem

ic

To gi

ve he

alth c

are se

rvice

of the

child

ren

at the

ir hom

e to s

treng

then s

tay ho

me an

d ke

eping

socia

l dist

ancin

g

To ill

ustra

te the

use o

f teleh

ealth

for c

aring

, co

nsult

ing an

d scre

ening

patie

nts du

ring

COVID

-19 w

here

clinic

al ser

vice i

s not

well

organ

ized

To de

scribe

the u

se of

teleh

ealth

and i

denti

fy-ing

publi

c poli

cy ba

rriers

to the

imple

menta

tion

of tel

ehea

lth (r

eimbu

rseme

nt, pr

ivacy/

cyber-

securi

ty, lia

bility

, licen

sure,

tech

nolog

y acce

ss,

and a

rtifici

al int

ellige

nce (

AI))

Main

findin

gs

Throu

gh co

mbini

ng he

alth t

echno

logy a

nd he

alth c

are sy

stems

, dia

gnosi

s effic

iency

and p

atien

ts’ m

edica

l exp

erien

ces ca

n be i

mprov

ed

Remo

te sh

aring

of hi

gh-q

uality

med

ical re

sourc

es an

d rea

l-tim

e inf

ormati

on in

terac

tion c

an al

so be

achie

ved

The e

stabli

shme

nt of

an in

tegrat

ed in

tellig

ent h

ealth

care

system

for

COVID

-19 p

ande

mic p

reven

tion a

nd co

ntrol

will a

lso pr

ovide

a po

sitive

refer

ence

for th

e desi

gn an

d dev

elopm

ent o

f sub

seque

nt int

ellige

nt he

alth c

are pl

atform

s for

other

publi

c hea

lth cr

ises

The u

se of

remote

cons

ultati

on re

duces

the o

ccurre

nce o

f on-

site d

iag-

noses

, whic

h also

save

s PPE

, and

redu

ces th

e risk

of in

fectio

n spre

ad

caused

by th

e tran

sfer o

f diag

nosed

patie

nts to

the s

uperi

or ho

spital

s.

The a

pplic

ation

of te

lemed

icine

was

the o

ne he

alth t

echno

logy

that p

rotect

s pati

ents

to co

me th

e hos

pital

and d

ecrea

se co

ntact

of cli

nician

s with

the p

atien

t.

This

reduc

ed th

e psy

cholo

gical

stres

s of t

he pa

tients

in th

e CO

VID

-19

pand

emics

For t

his in

fectio

us pa

ndem

ic tel

ehea

lth pr

ovide

rapid

ly de

ploy l

arge

numb

ers of

prov

iders

Facil

itate

triage

so th

at fro

nt-lin

e prov

iders

are no

t ove

rwhe

lmed

wi

th ne

w pre

sentat

ions

Supp

ly cli

nical

servic

es wh

en lo

cal c

linics

or ho

spita

ls are

dama

ged

or un

able

to me

et de

mand

Decre

ase t

he ris

k of c

ommu

nicab

le dis

eases

whic

h are

trans

mitte

d by

perso

n-to-

perso

n con

tact.

Teleh

ealth

also

prov

ide ca

re for

non-

infect

ed pe

ople

durin

g an

infect

ious p

ande

mic.

Teleh

ealth

enco

urage

healt

h res

earch

ers to

use t

he in

creas

ed

data

provid

ed by

teleh

ealth

servi

ces t

o trai

n AI s

oftwa

re tha

t can

fur

ther i

mprov

e not

only

the te

lehea

lth se

rvice

s, res

earch

, but

also i

ncrea

se ot

her c

linica

l care

and h

ealth

care

opera

tions

acce

ss du

ring C

OVID

-19

Barri

ers

Not m

entio

ned i

n the

stud

y

Limite

d Eng

lish

profic

iency

Intern

et int

errup

tion

Inacce

ssibil

ity of

sm

art ph

one

Limite

d tele

medic

ine

servic

e

Clinic

ian’s

unwi

ll-ing

ness

to ad

opt

teleh

ealth

due t

o lim

ited t

elehe

alth

traini

ng in

med

ical,

nursi

ng an

d allie

d he

alth p

rereg

istra-

tion c

urricu

la


31

Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the LiteratureTab

le 2 c

ontin

ued

Chara

cteris

tics of

indiv

idual

studie

s inclu

ded i

n this

scop

ing re

view.

Auth

or

Bryn

e MD

Moaz

zami

Villeg

as

Esfeh

ani

RJ Chav

is A

Annis

T

Coun

try

USA

Iran

Spain

Iran

USA

USA

Type

s hea

lth

info

rmat

ics

Telem

edici

ne

Telem

edici

ne

Telem

edici

ne

(web

-bas

ed

softw

are)

Teleh

ealth

(mhe

alth)

Meth

ods o

f app

licat

ion/a

ppro

ach

Not d

escrib

ed in

the s

tudy

Not d

escrib

ed in

the s

tudy

A new

telec

onsu

ltatio

n prot

ocol

was i

mplem

ented

to

tend t

he pa

tients

with

resp

irator

y diffi

cultie

s an

d/or

comp

atible

with

the d

iseas

e prov

oked

by

COVID

-19,

at the

hosp

ital e

merge

ncy s

ervice

(H

ES)

propo

sed w

eb-b

ased

softw

are th

at pro

vides

a vir

tual w

orksp

ace f

or tw

o kind

s of u

sers,

includ

ing

speci

alists

A COV

ID-1

9–sp

ecific

remo

te pa

tient

monit

oring

so

lution

(GetW

ell Lo

op) w

as of

fered

to pa

tients

wi

th CO

VID-1

9 sym

ptoms

mHea

lth Fa

irview

was

integ

rated

as ac

adem

ic he

althc

are sy

stem

with

12 ho

spital

s (2,0

71

beds)

, 56 p

rimary

care

clinics

, 100

speci

alties

, an

d 34,0

00 em

ploye

es loc

ated i

n the

urba

n Twi

n Cit

ies ar

ea

Aim

/pur

pose

Descr

ibing

the i

mport

ance

of tel

ehea

lth to

pre

vent

and c

ontro

l the C

OVID

-19 p

ande

mic

Enab

ling p

atien

ts to

conn

ect w

ith th

eir he

alth-

care

provid

er at

a dist

ance

using

telem

edici

ne

to red

uce h

ealth

care

provid

er bu

rnout

durin

g CO

VID-1

9

To ev

aluate

the e

ffecti

vene

ss of

a tele

cons

ulta-

tion p

rotoc

ol wi

th pa

tients

who

had r

espira

tory

sympto

ms in

the r

educ

tion o

f the c

onsu

mptio

n of

perso

nal p

rotect

ive eq

uipme

nt (P

PE) i

n a

hosp

ital e

merge

ncy s

ervice

(HES

) duri

ng th

e CO

VID-1

9 pan

demi

c

To hig

hligh

t the i

mport

ance

of eff

ective

disea

se con

trol a

nd ca

se tra

cing,

to red

ucing

the

pressu

re on

the m

edica

l staf

f and

healt

h care

wo

rkers

to im

prove

their

med

ical ju

dgme

nt an

d perf

orman

ce ab

ilities

, and

educa

ting t

he

physi

cians

who

have

not p

reviou

sly en

counte

red

COVID

-19 c

ases a

nd ar

e not

familia

r with

their

clin

ical a

nd ra

diolog

ical p

resen

tation

s

Preve

ntion

of ex

posu

re to

COVID

-19 i

n a m

edica

lly co

mplex

patie

nt wi

th a m

ild

presen

tation

by ap

plying

telem

edici

ne

To ev

aluate

early

lesso

ns fro

m a r

emote

pa

tient

monit

oring

enga

geme

nt an

d ed

ucati

on te

chno

logy s

olutio

n for

patie

nts

with

coron

aviru

s dise

ase 2

019 (

COVID

-19)

sym

ptoms

.

Main

findin

g

Teleh

ealth

was

a cru

cial to

ol du

ring t

he ea

rly ph

ases

of the

pan-

demi

c and

allow

ed, in

mos

t cas

es, fo

r the

clos

ing of

some

servi

ce de

livery

gaps

and a

s a fin

ancia

l life

boat

for he

alth c

are pr

actic

es.

For p

atien

ts, pa

rticula

rly th

ose a

t high

risk b

ecaus

e of c

hronic

co

nditio

ns, te

lehea

lth m

ay ha

ve be

en th

eir on

ly me

ans o

f follo

w-up

an

d sup

port.

The a

pplic

ation

of te

lemed

icine

by he

alth c

are pr

ovide

rs red

uces

the

major

caus

es of

psych

ologic

al dis

tress

amon

g hea

lthca

re wo

rkers

are

includ

ing lo

ng w

ork ho

urs, s

leep d

isturb

ances

, deb

ilitati

ng fa

tigue

, an

d the

risk o

f gett

ing in

fectio

n and

put th

eir fa

mily

at ris

k of a

life

-threa

tening

cond

ition a

t large

durin

g this

COVID

-19 P

ande

mic.

The p

ossib

ility o

f pati

ent-d

octor

sprea

d has

been

redu

ced

The u

se of

the PP

Es ha

s bee

n opti

mize

d, an

d

The m

aking

of de

cision

s has

been

strea

mline

d in t

he fir

st sta

ge of

ca

re of

susp

ected

COVID

-19 p

atien

ts.

The a

pplic

ation

of w

eb-b

ased

softw

are re

duces

clos

e con

tact o

f he

alth c

are pr

ovide

rs wi

th the

patie

nt

Minim

ize bu

rnout

of ca

re pro

viders

Minim

ize m

is dia

gnos

is of

COVID

susp

ected

cases

By us

ing su

ch te

lemed

icine p

latfor

ms, th

e exp

erien

ce of

the sp

eciali

sts

will b

e prov

ided f

or ev

ery su

spicio

us pa

tient

in ev

ery un

equip

ped c

enter

manif

estati

on us

ing te

lemed

icine

A tele

healt

h exa

mina

tion o

f a pa

tient

presen

ting w

ith a

less

comm

on an

d thu

s une

xpect

ed co

ronav

irus d

iseas

e-201

9 sym

ptom

preve

nted t

he ex

posu

re of

the he

althc

are te

am in

an ac

adem

ic ge

neral

paed

iatric

s clin

ic

Patie

nts ha

ve be

en ex

treme

ly gra

teful

and p

ositiv

e abo

ut the

ir exp

e-rie

nce u

sing t

he to

ol an

d fee

l it ha

s help

ed th

em st

ay sa

fe at

home

.

This

demo

nstra

tes w

hat c

an be

acco

mplis

hed t

hroug

h a sh

ared

impe

rative

and e

ffecti

ve pa

rtners

hips b

etwee

n ind

ustry

, and

he

althc

are de

livery

Barri

ers

Befor

e the

pa

ndem

ic, the

lack

of a r

eimbu

rseme

nt inc

entiv

e had

limite

d int

erest

in inv

esting

in

teleh

ealth

appli

ca-tio

ns or

the tra

ining

ne

eded

to us

e the

m

Not d

escrib

ed in

the

study

Not d

escrib

ed in

the

study

Not d

escrib

ed in

the

study

Not m

entio

ned i

n the

stud

y

32


Tilahun et al.Tab

le 2 c

ontin

ued

Chara

cteris

tics of

indiv

idual

studie

s inclu

ded i

n this

scop

ing re

view.

Auth

or

Russ

SC

Wosik

J

Lam

P

Joshi

AU

Coun

try

USA

USA

Cana

da

USA

Type

s hea

lth

infor

mat

ics

Teleh

ealth

(Tele

EM)

Teleh

ealth

(sma

rt ph

one a

nd ta

blets

Telem

edici

ne N

etwork

vir

tual c

are pl

atform

an

d tele

phon

e for

remind

er

Teleh

ealth

Meth

ods o

f app

licat

ion/a

ppro

ach

Using

both

synch

ronou

s vide

o and

telep

honic

too

ls for

comp

lex or

critic

ally i

ll pati

ents.

TeleE

M ph

ysicia

n via

video

to co

nsult

and g

ive

care

the pa

tients

at th

eir ho

me

e-con

sult,p

atien

t intia

ted m

essag

ing,te

lepho

n vis

it and

vidio

visit

Ho

me pe

riphe

ral de

vices

were

used

with

certa

in pa

tients

to fa

cilita

te rem

ote vi

sits (

blood

pressu

re ma

chine

s and

cuffs

)

The C

OVID

-19 E

xpan

sion t

o Outp

atien

ts (CO

VIDEO

) prog

ram w

as de

velop

ed at

the h

ealth

ca

re Ce

ntre,

Toron

to, O

ntario

, to pr

ovide

ongo

ing

care

for ou

tpatie

nts di

agno

sed w

ith CO

VID-1

9.

Teleh

ealth

care

clinicia

ns pr

imari

ly tra

ined i

n em

ergen

cy me

dicine

, inter

nal m

edicin

e and

fami

ly me

dicine

follo

wed a

patie

nt de

cision

pathw

ay

to ris

k stra

tify pa

tients

into

three

grou

ps: ho

me

quara

ntine

no te

sting

, hom

e qua

rantin

e with

ou

tpatie

nt CO

VID-1

9 test

ing an

d refe

rral fo

r in-

perso

n eva

luatio

n in t

he ED

, for s

ympto

matic

an

d pote

ntiall

y uns

table

patie

nts.

Aim

/pur

pose

To ou

tline c

urren

t May

o Clin

ic str

ategie

s harn

ess-

ing te

lehea

lth so

lution

s for

COVID

-19 e

merge

ncy

prepa

redne

ss an

d acut

e eme

rgenc

y care

. Mi

nimize

front-

line p

rovide

r exp

osure

and

cons

erve p

erson

al pro

tectiv

e equ

ipmen

t

Adop

ting o

f teleh

ealth

, or t

he en

tire sp

ectrum

of

activ

ities u

sed to

deliv

er ca

re at

a dist

ance

for th

e thre

e pha

ses (1

) stay

-at h

ome o

utpa-

tient

care,

(2) i

nitial

COVID

-19 h

ospit

al su

rge,

and (

3) po

st-pa

ndem

ic rec

overy

To de

velop

and t

est th

e fea

sibilit

y of a

virtu

al ca

re pro

gram

for se

lf-iso

lating

outpa

tients

dia

gnos

ed w

ith CO

VID-1

9

To de

sign a

time-s

ensit

ive, p

ractic

al, ef

fectiv

e an

d inn

ovati

ve sc

aleup

of te

lehea

lth se

rvices

as

a res

pons

e to t

he de

mand

for C

OVID

-19

evalu

ation

and t

esting

Main

findin

g

In the

hand

s of a

ll acu

te ca

re pro

viders

for c

onsu

ltatio

n, tel

ehea

lth

tools

are he

lping

to lim

it dise

ase s

pread

, redu

ce HC

W exp

osure

, an

d con

serve

valua

ble PP

E at e

merge

ncy d

epart

ment

servic

e

Virtua

l pati

ent w

aiting

room

s, pri

vacy

and s

ecurity

, and

easy

sched

uling

were

impo

rtant

when

evalu

ating

a pla

tform

Redu

cing v

irus t

ransm

ission

, stre

tching

huma

n and

tech

nical

resou

rces,

and p

rotect

ing pa

tients

and h

ealth

care

worke

rs in

the

inpati

ent c

are se

tting

The u

se of

virtua

l care

in m

edici

ne ha

s beco

me an

attra

ctive

str

ategy

to m

inimi

ze un

neces

sary

patie

nt tra

vel to

healt

h care

ins

titutio

ns fo

r med

ical c

are an

d has

a un

ique a

pplic

ation

in

patie

nts w

ho re

quire

self-

isolat

ion

In ad

dition

to th

e care

prov

ided t

o the

patie

nt, po

tentia

l ben

efits

of a v

irtual

care

progra

m inc

lude t

he ab

ility f

or he

alth c

are

provid

ers to

plan

for a

safe

and c

ontro

lled h

ospit

al tra

nsfer

for

those

show

ing si

gns o

f clin

ical d

eterio

ration

, and

the a

bility

to

reduc

e furt

her c

ommu

nity s

pread

by in

formi

ng pu

blic h

ealth

of

any h

ouseh

old co

ntacts

with

symp

toms.

There

has b

een a

decre

ased

rate

of ref

erral

to a h

igher

level

of ca

re. d

ue to

:(1)

an in

creas

ed nu

mber

of tel

ehea

lth pa

tient

visits

for

stab

le an

d non

-critic

al ca

re, an

d (2)

clini

cians

, whil

e foll

owing

a p

athwa

y, are

moti

vated

to ke

ep st

able

patie

nts so

cially

dis

tanced

and q

uaran

tined

at ho

me

Barri

ers

Not d

escrib

ed in

the

study

Not d

escrib

ed in

the

study

Unab

le to

comme

nt on

the l

ong-

term

sustai

nabil

ity of

such

a p

rogram

As th

e num

ber o

f pa

tients

diag

nosed

wi

th CO

VID-1

9 con

tinue

s to i

ncrea

se,

the CO

VIDEO

prog

ram

will i

nevit

ably

becom

e more

time-

and l

abou

r inten

sive,

patie

nt an

d phy

sician

rel

ated f

actors

(old

peop

le ma

y not

comfor

table

for te

ch-no

logy..

., the

inab

ility

of fam

ily m

embe

rs or

careg

ivers

to ass

ist

owing

to se

lf-iso

lation

req

uirem

ents,

inc

rease

numb

er of

patie

nts ov

er tim

e

Not d

escrib

ed in

the

study


33

Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the LiteratureTab

le 2 c

ontin

ued

Chara

cteris

tics of

indiv

idual

studie

s inclu

ded i

n this

scop

ing re

view.

Auth

or

Reiss

AB

Barne

y A

Song

X

Coun

try

USA

USA

China

Type

s hea

lth

infor

mat

ics

Teleh

ealth

Telem

edici

ne

(wea

rables

smart

ph

one a

ccesso

ries)

Telem

edici

ne

Meth

ods o

f app

licat

ion/a

ppro

ach

The p

hysic

al exa

m co

nduc

ted vi

rtuall

y is p

atien

t/ca

regive

r facil

itated

via v

ideo o

bserv

ation

The p

atien

t or a

nothe

r mem

ber o

f hou

sehold

may

tak

e as m

any v

ital s

igns a

s poss

ible,

includ

ing te

m-pe

rature

, bod

y weig

ht, bl

ood p

ressur

e, he

art ra

te.

At co

mmun

ity: p

sycho

logica

l con

sultin

g, on

-line

cli

nic co

nsult

ing, u

pdati

ng in

forma

tion o

n CO

VID-1

9.

At pa

tient:

scree

ning l

atent

severe

patie

nts,

cons

ulting

.

Medic

al sta

ff: tra

ining

, pan

el dis

cussi

on, p

sycho

-log

ical c

onsu

lting,

quali

ty im

prove

ment

Aim

/pur

pose

To de

scribe

telem

edici

ne ap

proac

h for

COVID

-19 a

s prac

ticed

in th

e offic

es of

physi

cians

affili

ated w

ith a

major

urba

n me

dical

center

To as

sess l

ive in

terac

tive t

eleme

dicine

durin

g the

COVID

-19 p

ande

mic t

o prov

ide m

edica

l scr

eenin

g and

asses

smen

t rem

otely

To de

scribe

the r

apid

imple

menta

tion o

f tel

emed

icine

with

in an

adole

scent

and y

oung

ad

ult (A

YA) m

edici

ne cl

inic i

n resp

onse

to the

CO

VID-1

9 pan

demi

c

To de

scribe

the r

ole of

telem

edici

ne du

ring t

he

COVID

-19 e

pidem

ic in

China

Main

findin

g

The t

elehe

alth p

latfor

m all

ows f

or de

livery

of ca

re wh

ile m

ain-

tainin

g the

physi

cal d

istan

cing n

ecessa

ry to

preve

nt the

sprea

d of

COVID

-19 i

nfecti

ous d

iseas

e

Provid

ers no

ted th

at tel

emed

icine

seem

ed ac

ceptab

le to

Adole

scent

and y

oung

adult

who

gene

rally

had c

ompe

tence

with

electr

onic

comm

unica

tions

platf

orms a

nd w

elcom

ed th

e co

nven

ience

of me

eting

with

prov

iders

remote

ly

Telem

edici

ne ac

tivitie

s avo

id clo

se co

ntact

and d

ecrea

se the

laten

t CO

VID-1

9 infe

ction

chan

ce

Barri

ers

Not d

escrib

ed in

the

study

Not d

escrib

ed in

the

study

34


Tilahun et al.

3.2 What Is the Available Evidence for the Role of Digital Health Technologies for Preventing and Controlling Coronavirus Pandemic?3.2.1 Purpose of Digital Health Technologies Applied for COVID-19 PandemicDifferent digital health technologies were applied by health care providers for dif-ferent purposes to prevent and control the COVID-19 pandemic at the community and health care facility levels. These technologies were categorized as telemedicine, Electronic Health Record, Artificial Intelligence, and Internet of Things. In this scoping review, the most frequently used technologies were telemedicine, including telehealth and mHealth [6, 15-24, 27-31], and electronic health records [13, 14, 26, 32]. Less fre-quently used technologies include artificial intelligence [6, 13], 5G+ [6, 25], and the Internet of Things [6] (Table 2).

3.2.2 Telemedicine and mHealthPhysicians, infectious disease epidemiolo-gists, medical students, and others used tele-medicine-based technologies to manage care and to prevent and control the COVID-19 pandemic in the following ways:• To give health care to the children in their

home and to support stay-home orders and to maintain social distancing [15];

• To care for, consult with, and to screen patients during the COVID-19 pandemic where clinical service is not well orga-nized [16] ;

• To identify barriers to the implementation of telehealth during the control of the COVID-19 pandemic [17];

• To enable patients to connect with their healthcare provider at a distance using telemedicine to reduce health care pro-vider burnout during COVID-19 [29] ;

• To evaluate the effectiveness of a tele-consultation protocol with patients who had respiratory symptoms in the face of reduction of the availability of personal protective equipment in a hospital emer-gency service during the COVID-19 pandemic [30];

• To highlight the importance of effective disease control and contact tracing, to

reducing the pressure on the medical staff and health care workers, to improve their medical judgment and performance abilities, and to educate physicians and other health professionals who have not previously encountered COVID-19 cases and who are not familiar with the clinical and radiological presentations of the dis-ease [28];

• To outline current health care strategies for harnessing telehealth solutions for COVID-19 emergency preparedness and acute emergency care and minimize front-line provider exposure and to conserve personal protective equipment [21];

• To adopt telehealth for the entire spec-trum of activities used to deliver care at a distance for the three phases of stay-at-home: (1) outpatient care, (2) initial COVID-19 hospital surge, and (3) post-COVID recovery [22];

• To develop and test the feasibility of a vir-tual care program and automated e-mail notifications for self-isolating outpatients diagnosed with COVID-19 [31];

• To assess live, interactive telemedicine during the COVID-19 pandemic to provide remote medical screening and assessment [24].

3.2.3 Electronic Health Records (EHRs)Countries used EHRs for different purposes. These included:• Using cloud-based or locally maintained

EHRs to document and integrate the re-cent history of travel from customs and immigration databases to supplement, in turn, centralized cloud-based health records maintained by national health institutes [13, 32];

• Using EHRs to explore the need for national digital health technology on prevention and control of COVID-19 and to illustrate how new digital information technologies can enable effective control of the pandemic, such as realized in the development and successful 72-hour de-ployment of the Honghu Hybrid System for COVID-19 in the city of Honghu in Hubei [14, 26];

• Creating a protocolized triage system was developed and embedded into multiple EHR templates which could be rapidly

updated as screening guidance evolved [13]. Another example was the Honghu Hybrid System for the collection, inte-gration, standardization, and analysis of COVID-19-related data from multiple sources, which includes a case reporting system, diagnostic labs, electronic med-ical records, and social media on mobile devices [26].

3.2.4 Artificial Intelligence (AI) and Internet of Things (IoT)To manage, prevent, and control the COVID-19 pandemic; health care providers used AI and IoT for the following purposes:• To understand the actions taken by the

health informatics community in China during the COVID-19 outbreak and developing a digital health technology framework for epidemic response based on digital health technology-related mea-sures and methods by using IoT [25];

• To support health system efforts to pre-pare for the current pandemic challenges associated with the risk by using AI [13];

• To assess the role of digital health tech-nology in a global Public Health Emer-gency by using both AI and IoT [6];

• Managing information and facilitat-ing clinical management related to COVID-19 including screening and con-sultation services, predicting modelling and turning point projection (6)

3.3 What Was the Additional Importance of Using Digital Health Technologies for the Prevention and Control of COVID-19?3.3.1 Exchanging Health Information and Minimizing Pandemic ExposureThe applications of DHTs had contributed to exchanging information and preventing exposure of health care providers and pa-tients to COVID-19. Telemedicine activities avoid close contact and decrease the latent COVID-19 infection chance, limit disease spread, reduce health care workers exposure, minimize patient-doctor spread, and help to streamline decisions made in the first stage of care of suspected COVID-19 patients [21,


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27]. Patient-facing telemedicine platforms included a COVID-19 information page, which updated the latest information in real-time, including providing community patients with symptom information through online clinic consultation services, instruc-tions for quarantine processes at home, personal protection applications, and when to seek medical attention [19, 21, 27, 30].

3.3.2 Early Test, Isolation, and Treatment During the OutbreakThrough combining health technology and health care systems, remote sharing of high-quality medical resources and real-time information interaction can be achieved [6]. In addition, diagnostic efficiency and disease course can be improved. Using electronic health record components such as screening protocols, system-level EHR-templates, COVID-19 operational dashboards, and communication channels, rapid screening processes, and laboratory testing, clinical decision support, and patient-facing technol-ogy related to COVID-19 were achieved [6, 13]. Digital health technologies such as tele-medicine network virtual care platforms and cloud-based hardware helped strengthen the checkpoints on the full chain of COVID-19 control, including “early test, early report, early isolation, and early treatment” during the outbreak [25, 28, 31].

3.3.3 Remote Consultation and Reducing Psychological StressThe application of telemedicine by health care providers reduces the major causes of psychological distress among healthcare workers by reducing long work hours, sleep disturbances, debilitating fatigue, and fear of getting an infection that could also put their family at risk of infection. Furthermore, it protects patients who otherwise might come to the hospital and thus decreases contact with health care providers [15, 29].

3.3.4 Reduce Crowding of Health Service and Care Provider BurnoutTelehealth was a crucial tool during the COVID-19 pandemic and allowed in most cases, for the closing of some service de-

livery gaps and as a financial lifeboat for health care practices [17]. It also increased other clinical care and healthcare operations access during COVID-19 [17, 18]. Devel-oping telemedicine platforms by using web-based software reduced close contact of health care providers with the patient, minimized exhaustion and burnout of care providers, and minimized misdiagnosis of COVID suspected cases [23, 28].

3.3.5 Digital Health Technologies to Assist Epidemiologists and Infectious Disease ProfessionalsIn addition to the specific types of digital health information technology modalities described above, our review found that the application of digital health technologies (DHTs) was important to controlling and preventing the COVID-19 pandemic. A study in China revealed that DHTs were effective for the prediction of epidemic trends, tracking of close contacts, and remote diagnosis of COVID-19 pan-demics. This will help public health decision-makers to develop COVID-19 pandemic prevention and control strategies [33, 34]. Additionally, these technologies will facilitate effective COVID-19 vaccine delivery by tracking vaccine individuals, managing the data, and maintaining the cold chain [34].

3.4 What Were the Barriers That Influence the Practice of Digital Health Technologies During COVID-19 Prevention and Control of the Pandemic?The COVID-19 pandemic has had an im-pact on public health infrastructure neces-sitating the development and use of digital health technologies. The need to frequently adjust this technology to meet rapidly evolving requirements, communication and adoption to coordinate the needs of multiple stakeholders for controlling and management of the pandemic pushed the need to use digital technologies even fur-ther. During the period covered by these reviews, some barriers reduced the effec-

tiveness of the prevention of COVID-19. These barriers are mainly centered in three categories: patients, health care providers, and financial issues [16, 18, 25].

Some of the commonest barriers were: clinician’s unwillingness to adopt tele-health due to limited telehealth training in medical, nursing and allied health pre-reg-istration curricula [16], the economic incentive for doctors (doctors and their staffs time), and for system integrators and device manufacturers to develop the technology [17]. The old people were not also comfortable with technologies, the inability of family members or caregivers to assist owing to self-isolation require-ments, increase the number of COVID-19 case over time, the lack of a reimbursement incentive, and economic incentives for health care providers. Additionally, limited English proficiency, internet service inter-ruption, and inaccessibility of smartphones were the barriers of digital technologies service to be effective for controlling and preventing the pandemics [15, 18, 31].

Various papers revealed that there are different barriers to apply DHTs proper-ly; such as lack of technical supporter, interference with a patient-provider rela-tionship, increased patient anxiety, cost of digital health equipment, and lack of integration of technology with clinical workflow [35, 36].

The current review showed that lim-ited English proficiency of the patients, internet interruption, inaccessibility of smartphone, limited telehealth training for health care providers were some barriers reduced the effectiveness of the digital health technologies. This is also supported by a WHO review in which disparities in digital literacy and access to equipment, broadband, and the internet are important for increasing the effectiveness of telemedicine on COVID- 19 pandemic prevention [37]. This indicates that there is a need for immediate action by responsible stakeholders to facilitate the application of electronic technologies to reduce the burden of the pandemics and to recover the normal life of the world people especially countries which do not have good health care system [38-40].

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4 Discussion Our aim in this review was three-fold: 1) to map the role of digital health technologies on prevention and control of the COVID-19 pandemic; 2) to understand how the digital technologies have been applied to prevent the pandemic; and 3) to investigate the main barriers to the use of these technologies for tracking the pandemic.

About two-thirds of published studies on digital technologies for preventing and controlling the COVID-19 pandemic were from North America followed by Asia. Furthermore, we found that there were no published studies from Africa and limited studies from Europe and Australia. Our review found that the most commonly used DHTs to track COVID-19 pandemics were: telehealth, mHealth, EHRs, AI, and IoT. This finding is supported by prior analyses in which these digital health technologies were used to control and manage the Ebola and Zika [41, 42] pandemics using similar approaches.

We found that the internet provides a variety of web-based services for the public during the outbreak, including video con-sultation, screening, and diagnosis. These services support the health care provider to identify a suspected case of COVID-19 and to provide medical and psychological advice to patients with the disease. Our review found that health care providers applied DHTs using different approaches for preventing and controlling coronavirus 2019. For instance, online clinic consulta-tion, updating information on COVID-19 for the community, video and telephone consultation, and a multi-source platform that integrated data monitoring, exchange, and feedback mechanisms for pandemics-re-lated issues.

This review suggests that digital health technologies like telehealth, EHRs, AI, IoT, and telemedicine platforms contributed to reducing COVID-19 exposure and transmis-sion from person to person by exchanging health information, early testing and diag-nosis, early isolation, early treatment during the outbreak, and remote consultation. This potentially helps to reduce burnout of health care providers, psychological stress, and overcrowding of health facilities. Also, it

facilitates real-time information interaction and provides support for data-driven deci-sion-making in the time of this pandemic and increasing susceptibility to COVID-19 especially for the elderly and those with comorbid conditions [9, 43].

As we have seen, elderly people who might not be comfortable with technologies, the inability of family members or caregivers to assist owing to self-isolation requirements, increase the number of COVID-19 case over time, the lack of a reimbursement incentive, and economic incentives for health care providers are the most common barriers that decreased the effectiveness of DHTs application for prevention and control of COVID-19.

To expand the DHTs for the next pan-demic, it is recommended that providing a variety of web-based services for the public during the outbreak, including screening and consultation service; forming a multisource platform that integrates data monitoring, exchange, convergence, and feedback mech-anisms for the pandemics-related parties, and offering COVID-19 specific remote patient monitoring solutions.

Though this review uses a comprehensive search strategy from various databases, scoping reviews are broad and provide an overview of existing literature regardless of quality, providing a broad and contex-tual overview in comparison to systematic reviews. A formal assessment of method-ological quality is not undertaken when con-ducting a scoping review and synthesis of the incorporating studies, nor is a demonstration of cause-and-effect relationships. Excluding grey literature and languages other than En-glish are additional limitations of the review.

5 ConclusionThe current scoping review showed that using DHTs are effective in the prevention and control of the COVID-19 pandemic. These digital health technologies are princi-pally used for the early test, report, isolation, treatment, exchanging information, remote consulting, reducing the overcrowding of health care facilities, minimizing burnout of health care providers, and model prediction

COVID-19. The lessons learned during the COVID-19 pandemic should be applied to future digital health technologies that seek to support health system response to a pandemic.

AcknowledgmentsThe authors would like to acknowledge Dr. Brian Dixon and Dr. John Holmes for their support throughout the production of this review article.

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Correspondence to: Binyam TilahunDepartment of Health InformaticsInstitute of Public HealthCollege of Medicine and Health SciencesUniversity of GondarGondar, EthiopiaE-mail: [email protected]

mapping the role of digital health technologies in

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