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2019 ITU Kaleidoscope Academic Conference

review conducted in Bangladesh utilizing Arksey and 3. RESULTS
O’Malley’s framework to map digital health initiatives due
to scarcity of prior synthesis on the topic [12,14,15]. It is a In total, 20 digital health solutions were identified through
method that is used widely in scoping reviews because it our review that were implemented between 1993 to 2017. In
maintains a rigorous process for transparency, replicability 1993, an integrated health management information system
and reliability of study findings. The study was designed to (HMIS) was introduced in Nepal by the government marking
answer the following research questions: 1) who are the the first e-health effort in the country [18]. A decade later the
subsisting digital health actors in Nepal, and 2) what private sector initiated the first telemedicine system
spectrum of services are being covered through digital health (HealthNet Nepal) which was a collaborative telehealth
initiatives? effort between Om Hospital Research Center and the Apollo
Hospital in India [18,19]. This was followed by a three-city
Our study first identified grey literature on digital health telemedicine program by a social enterprise in 2006 [19,20].
initiatives, then assessed them according to the WHO Health Next, a formal government led telehealth program with a
Systems Framework [16]. Relevant literature was identified budget of approximately Rs. 20 million (NPR) was
using two sets of keywords: one for journal articles and the established offering telehealth services to 25 districts [19,21].
other for grey literature. For journal articles, the keywords Specialized telehealth programs were also established,
were adopted from prior systematic reviews on digital health primarily in the non-governmental sector, to provide
solutions as shown in Table 1 [17]. For additional sources, a healthcare for epilepsy diagnosis, treatment of severe wasp
Google search using specific keywords was conducted. For stings or dermatological consultations [22,23,24]. Beyond
newspaper articles, the NewsBank database was utilized. telehealth programs, collaborative projects between the
The initial search yielded 316 articles on Google scholar, 72 Government of Nepal (GoN) and development partners have
articles on PubMed, and 274 articles via NewsBank. A been established over time [24,25,27,28]. These efforts have
screening tool was developed to ensure selected documents entailed bolstering population-health surveillance efforts
focused on digital health solutions in Nepal and provided with the migration of HMIS to the District Health
details on the organization or project associated with its Information System (DHIS)-2 platform, expansion of HMIS
implementation. After the screening process, a total of 31 e-reporting from facilities, Smart Health Nepal initiative, and
documents dating from 2005 to 2017 were selected for projects exploring the feasibility of mobile data collection
charting. Types of documents selected are journal articles, from frontline workers in remote areas [18].
newspaper articles, websites, presentations slides,
conference briefings, organizational reports and blog posts. Table 2 – Digital health solutions in Nepal (1993-2016)
Selected documents were systematically charted by three
research assistants followed by ongoing quality assurance Status Name Launch
audits by the lead authors to ensure uniformity and rigor in Year
the charting process. The charting was done under the I/NGOs (11, 55%)
following themes addressing the WHO health system * Nepal Wireless Telemedicine Program 2006
building blocks, organizational profile, program overview, √ Dhulikhel Hospital Telemedicine Program 2011
financial profile, human resource, services, monitoring and
evaluation framework, sustainability plan, and future * USAID Health for Life 2013
direction. Once the charting process was completed, the * Nick Simon Institute Celemedicine 2013
research team analyzed the charted information looking for Program
common traits and themes under each charting category [16]. √ Golden Community eHealth Nepal 2015
Program
Table 1 – Digital health solutions search keywords √ Possible Health CHW Mobile Reporting 2015
Trial
Database/Search Keywords √ Medicine Du Monde Telecom Sans 2015
engine Frontiere Surveillance Project

PubMed mHealth, mobile phone, phone, √ Maiti Nepal mHealth Capacity Building 2015
SMS, text message, mobile Projects
device, telemedicine, cell √ Dhulikhel Hospital Epilepsy Diagnosis 2016
phone, mobile health, mobile Application
applications, cell phones √ One Heart Worldwide Maternal Health 2016
Google mobile health, mHealth, mHealth Project
electronic health, eHealth,
mobile phones and health, (?) CHEST Project by CHEST Nepal 2017
Nepal, technology Public (6, 30%)
Google scholar mHealth, mobile phone, SMS, * HMIS 1993
text messages, mobile devices, * Hello Health, Rural Telemedicine 2010
telemedicine, cell phone, Program
mobile health, cell phones, √ RCM-MP 2015
mobile applications
* m4ASRH 2015
* DHIS-2 2016

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