Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis

Abstract

An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.

Figure 1:. PRISMA trial profile

DHI=digital health intervention. *We used Covidence software to conduct this Review, and there is no option to record specific reasons for exclusion at screening stage.

Figure 2:. Progression of IDEAL stage of included studies over time, by outcome of interest

IDEAL=idea, development, exploration, assessment, and long-term follow-up.

Figure 3:. Coauthorship network and citation network

(A) Coauthorship network: each point (node) representing a unique author and each line (edge) representing coauthorship on a paper. Point size is weighted according to how important individual authors are as bridges between different papers (betweenness centrality). (B) Citation network: each point (node) represents an individual study and its IDEAL stage, and each arrow represents a citation of another included study. Arrow colour indicated whether the citation is of work on the same DHI (black) or on a different DHI (grey). DHI=digital health intervention. IDEAL=idea, development, exploration, assessment, and long-term follow-up.

Figure 4:. Quality of reporting according to IDEAL guidance, by IDEAL stage

IDEAL=idea, development, exploration, assessment, and long-term follow-up.

Figure 5:. Proportion of studies reporting according to the WHO framework, by IDEAL stage

IDEAL=idea, development, exploration, assessment, and long-term follow-up.