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Comment & Response
February 2014

Technical Difficulties and Evaluating e-Health Interventions

Author Affiliations
  • 1Radboud University Medical Center, Nijmegen, the Netherlands
JAMA Intern Med. 2014;174(2):304-305. doi:10.1001/jamainternmed.2013.12753

To the Editor The recent Research Letter by Kakkar and Jacobson1 shows yet another e-health intervention that failed to live up to the initial expectations. e-Health interventions are often portrayed as a method to revolutionize health care, leading to higher quality, lower costs, and better patient outcomes. However, actual results of e-health are somewhat disappointing, sometimes increasing costs.2 e-Health has weak evidence of effectiveness on patient outcomes and has consistently low uptake despite considerable implementation efforts.3,4 Does this mean that we should refrain from further investment in e-health? On the contrary, we believe that if we want to give e-health a fair chance, we should rethink the development process and increase investments in e-health. If we compare the development cycle of e-health to the development cycle of pharmaceuticals, we see that pharmaceuticals are often developed for decades,5 going through various stages of trial and error from preclinical stages to phase 0 to 3 trials, whereas e-health interventions are often developed and implemented in 1 stage within a few years. Currently, e-health interventions do not go through such a development process. e-Health interventions are not tested and retested, and investigators often rush to pragmatic trials including large and heterogeneous populations, which in turn makes finding an effect unlikely. e-Health interventions are thus evaluated for their effectiveness without sufficient knowledge of the efficacy.

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