An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study

Background The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. Objective This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. Methods A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. Results Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. Conclusions The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development programs.

attention to these core principles. It is important that eHealth is considered in the context of delivering quality care rather than a series of new innovations that stand alone from practice.

About the eHealth capability statements
The eHealth capability statements have been built using the best available evidence from the literature and informed by the experiences and knowledge of healthcare workers, educators, and systems leaders. Statements align with capability expectations for entry-level clinical positions, therefore, levels of mastery are not specified. The capability statements are not intended to set a rigid curriculum for eHealth, rather, to provide a key resource and common standards for the review, development, and alignment of profession-specific curricula to ensure high-quality and consistent student learning experiences. Attaining competence will ideally involve embedding eHealth within problem-based, case-based and practice-based learning experiences, and incorporate digital simulations and co-design projects.
Performance elements provide a starting point to describe how successful learning might be demonstrated. These are intended to guide the development of learning outcomes or assessment criteria that best match with the specific learning outcomes and activities of the discipline specific curriculum adopted. Ideally, the capability statements will be integrated with the performance or competency-based assessment of the relevant professional competency-based occupational standards.

Definitions of eHealth
Within the Australian health context, the terms eHealth and digital health are used somewhat interchangeably with reference to the application of digital information and communication technologies and systems in the delivery of health services and practice of health and wellness. Definitions of eHealth are encompassing of, but not limited to, the use of digital technologies and systems to: -Collect, manage, analyze, and apply digital health data. For example, electronic health record data, population health data, biobanks, patientreported experiences and outcomes, consumer-generated data, administration and claims data.
-Monitor, track, and inform health and wellness. For example, mobile devices (e.g., smartphones, tablets, and clinical devices), mobile sensors and wearables, apps, social media, and online information; -Facilitate communicative encounters between health stakeholders. For example, web-conferencing, SMS and push notifications from apps, patient storytelling through dedicated portals and social media platforms, and via virtual or simulated therapy tools; and 2 -Collect, manage, analyze, and apply digital health data. For example, electronic health record data, population health data, biobanks, patientreported experiences and outcomes, consumer-generated data, administration and claims data.

Assumed knowledge and skills
It is assumed that all graduate healthcare professionals will have the following basic professional skills and therefore these are not specifically referenced in the capability statements: KNOWLEDGE. An understanding of: The key components of digital health systems at personal, local, state, and national levels within the Australian health context. For example, electronic health records and electronic medication systems.

2.
The range, purpose and functions of various digital health technologies and systems used for the communication of health related information. For example, telehealth, secure messaging, web-based platforms, social media, apps, sensors, and monitors.

3.
The fundamentals of digital health legislation, policy and ethics, including privacy and security, data governance, and professional conduct.

4.
Governance of clinical information systems and the various stakeholders, positions, and privileges associated with the use of digital health technologies and systems.

5.
The advantages and potential challenges of contemporary digital health technologies and systems, including the transience, interoperability, and limitations of technologies that are in place and the inherent risks that these may pose.

PERFORMANCE ELEMENTS. Demonstrates ability to:
1. Be able to use computers and other devices competently to practice in a fully digital healthcare environment, including databases, word processing, apps, and online systems.

1.
Access and navigate digital health technologies and systems relevant to scope of professional role.

2.
Comply with national, state, and organizational legislation when using digital health technologies and systems.

3.
Use digital health technologies and systems professionally and ethically while maintaining privacy and professional boundaries. For example, appropriate use of email, secure messaging, social media, and digital images.

Capability Statement 2. Clinical Practice and Applications
4 LEARNING OBJECTIVE.
Integrate digital health into clinical practice to deliver safe and quality care, including provision of best practice models of care.

KNOWLEDGE. A knowledge of:
1. The impact of digital health on healthcare practice, patient safety, and the quality of care, including the potential for both positive and negative impacts on clinical practice and patient outcomes. For example, the impact of various digital health methods on service access, care coordination, and personalized and precision healthcare.
2. The impact of technology on communication within healthcare. For example, supporting digital or virtual teams.
3. The potential of digital health to support current practice and transform healthcare delivery by enabling new models of care. For example, the capacity of electronic health records, web-based consultations, and remote monitoring to enable integrated care, models of selfmanagement, virtual care, and shared care.
4. The role of digital health in consumer engagement, including the impact of digital literacy and consumer-centred technologies and systems for health and wellness. For example, the impact of self-monitoring, digital information seeking, personally-controlled health records, consumer-centred apps, and patient portals.
5. The impact of digital health on the role of the health professional, including the changing dynamics between health care providers and consumers. For example, the roles of health professionals and consumers as partners and coaches in digital monitoring, data driven shared decision making, and social networking.

PERFORMANCE ELEMENTS. Demonstrates ability to:
1. Use digital health appropriate to professional role, duties, and scope of practice in the provision of safe and quality care. For example, utilize electronic health records, medication systems, imaging systems, referral tools, and discharge summaries in the delivery of coordinated care.
1. Use digital health to support relationships and strategic communication with and between providers, teams, consumers, and the public. For example, utilize web-conferencing, secure messaging, and social media in networking, mentoring, consumer advocacy.
2. Access, aggregate, and cross-reference data from various sources, including those that do not readily interface, to generate a comprehensive clinical picture or summary of care, particularly at the point of transitions in care where system interoperability may not exist.
3. Engage in continuous critical appraisal of digital health and apply sound clinical decision making when technologies or systems are inappropriate, inaccurate, disrupted, or non-functional. 4. Maintain a consumer-centred approach to practice when using digital health. For example, consider consumer digital literacy levels, assess 5 issues, preferences, and personal goals when using or prescribing digital health interventions.
5. Access and critically evaluate digital information, including appraisal of clinical data and health information within digital technologies and systems. For example, perform continuous appraisal of the quality and validity of digital health data contained within electronic health records, websites, and clinical decision support systems.
6. Critically evaluate digital health interventions, such as hardware, apps, software, web-based portals etc., to establish the evidence-base, as well as the benefits or risks to quality care and patient safety.
7. Create evidence-based digital health resources using digital information and multimedia. For example, use digital images and infographics for consumer information or personal and professional development.

LEARNING OBJECTIVE
Use data and data analysis to inform, deliver, and improve health and health care practice at individual, team, and systems levels.
KNOWLEDGE. An understanding of: 6