Table 3.

Summary of papers mixing theoretical and empirical methods included: content and main results.

Authors (year)/country/type of study	Application/population/area	Objective	Time horizon of data analyzed	Number of participants/% female/age information	Technology/digital health intervention	Primary Outcome/s	PROMs or PREMs validated measures?	Summary of results (value elements by agent type)
								Positive or nonnegative effect/value (facilitators)	Negative effect/value (barriers)	Uncertain effect/value
Absolom et al. (2021) UK Prospective, randomized two-arm parallel group study	Valuing outcomes (patients) Cancer patients Oncology	Can we control better treatment- and disease-related symptoms during chemotherapy by introducing online monitoring with patient-reported outcome measures, uniquely combined with automated algorithm-driven severity-dependent patient advice?	January 22, 2015-June 11, 2018	508 79.9% mean = 56.0 (SD = 11.8)	eRAPID: eHealth Intervention During Chemotherapy. Immediate integration of the self-reports in electronic patient records (EPRs) facilitated clinical use.	PROMs: Symptom control measured by using the Functional Assessment of Cancer Therapy Scale-General Physical Well-Being subscale (FACT-PWB, scores 0–28, high scores 5 better symptoms)	YES	Patients: Improved physical well-being and self-efficacy in a patient population predominantly treated with curative intent, Healthcare system: does not increase hospital workload.
Burridge et al. (2017) UK Overview study	Home care Upper Limb poststroke spasticity patients Stroke care	This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.	Not mentioned	Not applicable Not applicable Not applicable	A web supporting program (LifeCIT): wearable sensors; M-Mark	Feasibility was assessed by retention and adherence (duration of C-Mitt wear, activities, and use of the Web site). The Wolf Motor Function Test (WFMT) and the Motor Activity Log (MAL) (a self-assessment tool that measures about amount and quality of use of the affected upper limb) PREMs: Views and experience of using the Web site and wearing the CMitt. Safety: measured by documentation of adverse and serious adverse events and reported following standard procedures for each rehabilitation center. The economic impact (use of health and social care) of the LifeCIT intervention compared with usual care was examined using the Client Service Receipt Inventory.	YES	Patients: Improvement of intensity and adherence to rehabilitation regimens.
Chau et al. (2019) China Conceptual framework and survey	Access to health care & health care services delivery Respondents with experience of healthcare wearable technology Unspecified	To gain knowledge in this area and provide meaningful managerial implications for practitioners and wearable device developers.	October 1st 2018, to January 5th 2019	171 45% mean = 26–30 years (ranging from 18 to 65)	Healthcare wearable devices assisting users to check their health status as well as planning their exercises	Adoption intention of healthcare wearable technology	YES	Patients: better adoption intention of healthcare wearable technology (explained by perceived usefulness, which is expalined by perceived convenience and perceived irreplaceability).		Moderation effects of: gender, usage experience, education level and income of consumers
Curtis et al. (2018) US Narrative review and description	Valuing outcomes (population-based) Seriously ill patient population Palliative care	We examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system.	2010–2015	105 43% mean = 65.5 (SD = 15.1)	Electronic Health Records	A summary of the strengths and weaknesses of the EHR. A discussion of opportunities and challenges.	NOT ALL	Patients and providers: Offer opportunities to identify seriously ill patients and assess palliative care quality metrics across large numbers of patients with serious illness.	Healthcare systems: Lack of interoperability across healthcare systems and, at times, within a single system; Providers: absence of systematic documentation of patient- and family-centered outcomes; and difficulties in capturing quality metrics information from data that were collected for other purposes.
Dack et al. (2019) UK Focus groups and Interview	Treatment (self-management) Diabetes patients Chronic diseases	To describe the development process and content of a digital self-management intervention for people with type 2 diabetes (HeLP-Diabetes) that has been found to achieve its target clinical outcome, the reduction of HbA1c, a measure of glycemic control.	2011–2016	20 patients with T2DM and 18 Health care professionals Patients: 40% ; Healthcare professionals: 61.1% Patients: mean age = 56.8 (range 36–77) Healthcare professionals: mean age = 49 (range 32–64)	A digital self-management intervention (HeLP-Diabetes)	PREMs: Questions regarding patients understanding of the condition, how to self-manage it, where to get information or how to get treatment	YES	Research and Healthcare systems: The use of participatory design principles to integrate theory and evidence can create acceptable and effective digital health interventions.
Faisal et al. (2020) Canada Mixed-methods approach	Treatment (adherence) Older adults, caregivers, and health care providers Unspecified	The aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and preferences.	August-December 2018	37 (20 older adults; 5 caregivers; 11 HCP) Older adults: 52%; Caregivers: 20%; HCP: 82% Older adults: mean = 75 (range 65–87); Caregivers: mean = 73 (range 69–79); HCP: not reported	Electronic medication adherence products	PREMs: Identification of themes regarding users’ experiences with focus on features, usefulness, and preferences		Providers: Health care providers should consider patient-related factors such as cognitive and functional capability to operate a device, medication regimens, and product features to choose the right product for the right patient. Stakeholders (Manufacturers): should consider the involvement of users in the beginning stages of product development for these technologies to ensure high acceptability, user friendliness, and affordability for end users. Stakeholders (Policy makers): should consider subsidizing the cost of electronic medication adherence products to make them affordable for people who are chronically ill and are on long-term therapies		Patients: The initial impression of complexity or simplicity impacted the overall impression and projected use of the product. In particular, preference for a particular electronic medication adherence product depends on multiple factors, including, but not limited to, the storage capacity, security, cost, and size of the device.
Harrington and Burge (2018) UK Mix of literature review and qualitative study (interviews)	Treatment Patients with chronic conditions Chronicity	The aim of this paper is to define operating principles and protocols in a variety of healthcare contexts where there is a specific focus on service transformation, enabled by a series of emerging manufacturing paradigms and novel business model concepts.	2016	Not mentioned Not mentioned Not mentioned	Disruptive digital technologies	A Digital value network: conceptual model development based on results from a literature review and interviews. The conceptual model includes: Technology intervention perspective - connecting digital pharma networks and e-healthcare systems. Integrated digital value networks focus on flow of goods, services, revenue, and knowledge between actors. Refined criteria and emerging protocols.		Manufacturers: Potential to enable localized and personalized medication manufacture.
Jenssen et al. (2016) US National Survey	Access to health care & health care services delivery Primary care patients Primary care	We assessed patient attitudes regarding technology use to communicate with their primary care team or to engage with other patients outside typical office settings.	November - December 2012	3064 49.8% 18–60	Digital Communication technologies	Attitudes on the use of digital technology (email, text messaging, and social media such as Facebook and Twitter) to communicate with primary care teams about health behavior goals and test results. We also assessed attitudes toward the use of digital technologies to engage with other patients in activities such as peer coaching.	YES	Providers: identifying patients that may be willing to adopt these technologies for healthcare	Providers: Physicians should not use demographic factors like age, race/ethnicity, or socioeconomic status as a proxy for attitudes toward the use of technology
Kern et al. (2020) UK Retrospective cohort study	Access to health care & health care services delivery (Secondary care) Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Ophtalmology	To report the implementation and initial results of a cloud-based referral platform to medical retina HES, which was developed to overcome the increasing demand on scarce ophthalmologist services by improving communication between opticians and ophthalmologists.	April 2018 to January 2019	107 53% mean =66.9 (SD = 18, range: 23–95)	A cloud-based referral platform	‘Urgent referral’ (HES appointment ≤4 weeks): all causes of choroidal neovascularisation including age related macular degeneration and myopia, referable oedema as in diabetic maculopathy and subretinal fluid as in central serous chorioretinopathy. “Routine referral” (HES appointment within 18 weeks referral to treatment time defined by the NHS13): all other nonurgent cases that needed further diagnostic or specialist evaluation and are not part of the category above. ‘No referral’ (yearly follow-up by optometrist): the absence of pathology classes described above.	Not applicable (does not measure PROMs or PREMs)	Healthcare systems: Can avoid unnecessary referrals	Health care system: High costs that accompany ophthalmic imaging equipment	Patients: Patient satisfaction is important and must be evaluated
Larsen et al. (2019) Denmark Intervention	Prevention Chronic patients at primary care Chronicity	The present paper examines individual characteristics and health-care usage of patients who took up the targeted preventive programs in response to their personal digital health profile.	May 2016 to December 2016.	2661 56% mean = 45.4	Personal digital health profile	Attendance to the preventive programs	YES	Patients and Healthcare systems: Motivating people with low self-efficacy to attend	Patients and healthcare systems: Not motivating patients who had not had a health check or visited their GP during the past years	Patients and Healthcare systems: May be beneficial for some groups of patients, but not for others, and should be supplemented by other options (such as waiting-room administered systems and outreach).
Mandelblatt et al. (2015) US Observational study	Access to health care & health care services delivery (Secondary care) Women with breast cancer Oncology	We developed and conducted preliminary evaluation of an algorithm to detect grade 3 and 4 toxicities using electronic data from a large integrated managed care organization.	2006–2009	1575 Not mentioned Most participants <65	Electronic medical records and administrative data	Having vs not having toxicity	Not applicable (does not measure PROMs or PREMs)	Providers and Patients: Identification of chemotherapy toxicity (potential to improving oncology care).
Schooley et al. (2020) US Mixed-methods approach (Survey and interviews)	Access to health care & health care services delivery (Secondary care) Patients who were counseled using a blended digital health education Chronicity	The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike.	October 2017 to May 2018	178 56.7% Aged 18 years or older	Integrated Digital Patient Education (mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside.)	Patient understanding, patient motivation for self-care, patient confidence in care decision making, clinician-patient communication, and patient's intention to follow instructions.	YES	Patients: 1-Improved understanding of educational content and chronic health conditions; 2-More motivation for self-care at home; 3-Feeling capable of making health care decisions with their doctors and on their own; 4-Pastients more likely to report their intention to follow their doctor's instructions.
Zhao et al. (2020) US Cross-sectional analysis using census data from acute care hospitals	Hospital/Clinical care Acute care patients Acute care	The aim of this study was to examine the association between alternative payment models (APMs), market competition, and telehealth provisions in the hospital setting.	2018	4257 (hospitals) Not applicable Not applicable	Telehealth	Provision rates of Telehealth services	Not applicable (does not measure PROMs or PREMs)	Health care systems: Competitive advantage for hospital providing telehealth services