A Digitally Competent Health Workforce: Scoping Review of Educational Frameworks

1Over the last three decades, there has been considerable interest in the use of digital health to enhance the quality, efficiency, and safety of health care. Digital health and eHealth are often used interchangeably and broadly defined as “the use of information and communications technology in support of health and health-related fields”. An analysis of various digital health definitions revealed three distinct yet overlapping uses such as monitoring, tracking, and informing health (eg, mobile devices, mobile sensors and wearables, apps, social media); enabling health communication among various stakeholders (eg, telehealth, virtual consultations); and storing, managing, and utilizing health data (eg, electronic medical records, electronic medication systems). Digital health tools have the potential to provide health care workers with a holistic view of patients’ medical conditions through access to their health-related data and improved communication, regardless of distance and access. Furthermore, the use of digital technology in health care could potentially reduce turnaround times, resource use, medication errors, and adverse drug events; increase the use of preventive care; and enable greater adherence to clinical guidelines.

2Training and educating health care workers to be digitally competent is important for several reasons.

3First, with the growing use of digital technology in health care, the roles and responsibilities of the health workforce are transforming in an unprecedented manner, intensifying the need for capacity building and continuous professional development. For example, a recent review commissioned by the United Kingdom Secretary of State for Health and Social Care (ie, the Topol Review) reported that within the next two decades, the majority of jobs in the National Health Service (NHS) will have a digital component. Second, the importance and potential of remote care has been brought to light recently with the COVID-19 pandemic. Virtual consultation devices and electronic systems are indispensable tools used to diagnose and treat patients with potential COVID-19 infections as well as all other infections. Third, even though the current and next generation of practitioners may be seen as “digital natives”, surveys of health care workers show that they would appreciate more training on digital technology. Finally, improving digital literacy capabilities could lead to better adoption and implementation of digital services and technologies in health care settings. Similarly, poor digital health literacy was found to be the most common barrier to the digital transformation of health care, and thus, the adoption of health technologies has been gradual in countries such as the United States, Europe, and Australia. For the above-mentioned reasons, there is an increasing number of medical schools introducing digital health training into their curricula.

4Such training programs should be guided by a clear framework of digital health competencies suited for different health care worker groups, settings, contexts, seniority, and role. Although there is an increasing number of individual digital health competency frameworks and reviews focusing on a specific health care worker role or setting, there is a need for consolidation, analysis, and a comprehensive overview of existing frameworks for all health care worker groups. This includes frameworks that are specific for and those that are relevant across different health professions, roles, or settings. Such an overview is important to inform increasingly interdisciplinary teams working in medicine and health care and corresponding future training initiatives, policy development, and research.

5The objective of this review is to identify and analyze the available digital health competency frameworks, regardless of health profession, role, or setting. This scoping review takes into consideration the heterogeneity and complexity of this field, and we aim to identify (1) the intended applications of digital health competency frameworks; (2) the methodologies employed; (3) the targeted audience in terms of health professions and settings; and (4) the type of competencies included in the frameworks. By doing so, we aim to provide an in-depth analysis of the existing frameworks as well as identify potential gaps and propose recommendations for the development of future frameworks and digital health training initiatives.

6We followed the guidelines by the Joanna Briggs Institute in performing a literature review and guidelines by Tricco et al in creating a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. The protocol for this review was registered with the Open Science Framework. In this review, we used the World Health Organization’s definition of digital health as “the combination of e-health and m-health as well as emerging areas, such as the use of advanced computing sciences in big data, genomics and artificial intelligence”.

7We included studies and reports focusing on the development and reporting of a digital health competency framework for health care workers. In this review, a competency framework is defined as a repository or a model that identifies, enlists, structures, and organizes competencies into meaningful categories and that has been developed via a systematic methodology or a relevant, established organization. This definition was developed a priori by referring to the existing definitions and descriptions, and looking at the common features of formerly identified digital health competency frameworks applicable to health care workers. We included studies and reports on all health professions, including pre- and in-service, health care settings, and languages. Studies before January 2000 were excluded because digital health has evolved at a rapid pace, with substantial changes over the last two decades. The details of the inclusion and exclusion criteria are listed in Multimedia Appendix 1.

8The search strategy was developed collaboratively and iteratively by the reviewers with support from an experienced medical librarian and was guided by the following: (1) the sensitivity of the search strategy to relevant articles identified from previous manual searches and (2) the total number of relevant results in the first few pages of results in Medical Literature Analysis and Retrieval System Online (MEDLINE) and EMBASE (Excerpta Medica dataBASE). The final MEDLINE search strategy (Multimedia Appendix 2) was translated to other databases. Subsequently, the following 6 databases were searched on November 8, 2019: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and the Cochrane Library. MEDLINE, EMBASE, ERIC, and PsycINFO were accessed via the Ovid platform, and CINAHL was accessed via EBSCOhost. We expected that there would be substantial unpublished work in this area, for which searches were performed using pertinent keywords (Multimedia Appendix 3) in OpenGrey, ResearchGate, and the first 10 pages of Google and Google Scholar. Websites of relevant professional associations (eg, International Medical Informatics Association [IMIA]), accreditation councils (eg, the US Accreditation Council for Graduate Medical Education [ACGME]), and key government websites (eg, Digital Health Canada, NHS Digital) were also searched (Multimedia Appendix 4).

9The reviewers screened the search results and assessed the full-text studies for inclusion. For the title and abstract screening, Covidence tool, a web-based software platform, and, for full-text screening, EndNote X8 were used. Subsequently, a data extraction form was used to record information from the selected full-text studies using Microsoft Excel. The form was developed to be in line with the research objectives and was piloted by reviewers on 3 studies. The form was further amended (Multimedia Appendix 5), and relevant data were extracted by reviewers. Each round of screening and data extraction process was performed by a pair of reviewers independently, and results were compared thereafter. Disagreements between reviewers were resolved by discussion, and where required, a third reviewer was engaged as an arbiter.

10We analyzed the identified digital health competency frameworks in terms of their coverage of health professions, education level (eg, preservice or in-service), geographical applicability (ie, local or organizational, regional, national, international), health care settings (eg, acute care, emergency care, primary care), and other comparable features such as source and methodology. In frameworks that did not specify their methodology, an additional internet search was performed to retrieve information on the methods employed for framework development. Following this, we narratively synthesized and described framework characteristics, the evolution of frameworks over time, and the structural composition of competencies.

11In addition, we performed a thematic analysis according to a list of steps proposed by Nowell et al to understand the types of digital health competency categories presented in the frameworks. From the included frameworks, 2 reviewers independently classified competency categories into overarching domains. Studies that did not publish the full version of the framework were excluded from the thematic analysis, together with competency categories that were aimed at non–health care workers in a health care setting or irrelevant to digital competencies. Frameworks with ambiguous categories were excluded unless pertaining category descriptions or competencies were provided. Frameworks with competency themes or statements, with no distinct categories, were also included in the analysis by carefully allocating them to the identified domains. In some cases, where a single competency statement or theme encompassed several components of a competency, it was allocated to more than one relevant domain. After discussion and consensus, the reviewers derived a consolidated list of identified domains and their definitions and the prevalence of each identified domain across the included frameworks.

12The search generated 14,229 articles, of which 14,091 were from database searches and 138 from gray literature. After duplicates were removed and screening was completed, 33 articles were deemed eligible for inclusion. Of these, 27 articles presented individual frameworks. The remaining 6 articles presented preliminary findings followed by finalized versions of their frameworks (Staggers et al; Egbert et al; Hubner et al), adding 3 more individual frameworks. As a result, a total of 30 frameworks are presented in this review (Figure 1), of which 16 were found through a gray literature search.

13In terms of methodology, 14 frameworks employed literature review as an initial step, subsequently finalizing the frameworks through the use of expert consultations (n=5), focus group discussions (n=3), Delphi methodology (n=5), or expert surveys. In total, 11 other frameworks used one or a combination of methodologies (ie, Delphi, expert discussions, workshops, surveys) to reach consensus, largely by engaging various experts such as informaticists, health professionals, educators, and academics. Of the remaining frameworks, 2 used only literature review to select relevant competencies, and 3 frameworks were built on the foundation of other published frameworks. In addition, the frameworks were developed by a team of authors from a single university or institute (eg, University of Minnesota, School of Nursing), by an international- or national-level organization (eg, IMIA, Australian Health Informatics Council [AHIEC]), or by means of a collaborative effort to produce frameworks such as Technology Informatics Guiding Education Reform (TIGER) and Health Information Technology Competencies (HITCOMP).

14In terms of geographical relevance, 15 frameworks were country-specific, 1 was specific to the European Union region, 5 were applicable globally, and the remaining did not specify (n=9). In terms of health care settings, 4 were developed for remote care delivery, 1 framework each for hospitals, acute care, and homecare, while the remaining frameworks either were applicable to all health care settings (n=5) or did not specify (n=18). In terms of health professions, 14 frameworks targeted nurses, 4 targeted doctors, of which one also included dentists, and 1 framework each targeted psychiatrists, dietitians, and public health professionals; 9 frameworks targeted health care workers in general, of which 5 specified the inclusion of administrative, information technology (IT) support, and health informatics specialist roles, and 1 specified the inclusion of allied health professionals. Among the nursing frameworks, 7 were meant for in-service nurses, 5 for preservice nursing students, and 2 for both. Of the 4 medicine-focused frameworks, one focused on in-service doctors, another on preservice medical students, and 2 on both. The framework characteristics and summary of the findings of the included studies are presented in Table 1 and Table 2, respectively. Additional details of the included studies are presented in Multimedia Appendix 6.

15The digital health competency frameworks have drawn upon each other and have incrementally advanced the recommendations made in this area, as presented in Figures 2 and 3. The initial work of Staggers et al, which targeted nurses at 4 levels of practice, has been reproduced and adapted to suit different nursing roles (eg, nurse leaders, nurse practitioners), health professions (eg, dietitians), and even geographical settings (eg, Taiwan, Canada; Figure 2). In another instance, to propose competencies for nurse leaders, Collins et al expanded and reorganized competency categories from Westra and Delaney, which initially drew inspiration from the framework by Staggers et al. The framework by Staggers et al was updated 10 years later by Chang et al with 42 new competencies.

16Another commonly referenced framework is that by Egbert et al (Figure 3). This framework identified 24 core competency areas and conducted a survey with experts to rank the most relevant competency areas for nurses in Austria, Switzerland, and Germany. The same survey with 24 core competency areas was then sent to multiple countries to put forth international recommendations for nursing informatics, widely known as the TIGER framework. The TIGER framework grouped the core competency areas into 6 overarching domains (ie, data, information and knowledge, information exchange and information sharing, ethics and legal issues, systems life cycle management, management in informatics, biostatistics, and medical technology) and ranked the most relevant competencies for nursing internationally. Subsequently, the TIGER framework prompted its 2.0 version to include a wider spectrum of health care workers, and inspired the work by Thye et al where interprofessional competencies were identified.

17One framework that was accessible through an open-source internet-based database is the HITCOMP Tool and Repository. HITCOMP was produced by the eHealth Workforce Development Workgroup as part of the EU*US eHealth Work Project. Its overall goal was to map, quantify, and project the needs of a digitally competent workforce. This tool covers the digital competencies required in acute care settings for 5 broad roles of health care workers, similar to the TIGER framework version 2.0 (ie, direct patient care; administration; engineering or information, communication, and technology; informatics; and research or biomedicine). In comparison with the other included frameworks, the HITCOMP framework has the highest number of competencies at 1025.

18Other frameworks that inspired the development of subsequent frameworks include the IMIA, which was adapted by the AHIEC to create national informatics standards for Australian health professionals, health informaticians, and specialists; the frameworks by Barakat et al and the Academy of Medical Royal Colleges, which were adapted by Van Houwelingen et al to develop a telehealth framework aimed at nurses; and the telepsychiatry framework by Hilty et al, which laid the foundation for telebehavioral health competencies by Maheu et al.

19Across the included digital health competency frameworks, the number of competency categories, subcategories, and competencies ranged from 3 to 33, 10 to 39, and 15 to 1025, respectively. The wide range of reported competencies reflects the scale and specificity of the frameworks. For example, the framework with 15 competencies was focused on telepsychiatry training for psychiatry residents, while a framework with 318 competencies was intended for nurses at 4 different levels of practice. Frameworks with multiple categories or subcategories had a larger number of competencies. For example, the eHealth competency framework by the Academy of Medical Royal Colleges presented 20 categories and included 418 competencies.

20The primary objective of the frameworks was to guide the development of digital health curricula or training initiatives. Thus, 20 frameworks listed specific competencies (eg, knows how to use medical information systems for retrieval of patient data), 6 frameworks cited case studies or provided examples for integration of competencies into curricula or training programs, and 3 frameworks ranked the most relevant competency areas, while the remaining 2 frameworks proposed only broad competency domains. Furthermore, in 12 frameworks, proficiency level in a digital health area or competency was presented according to the hierarchy of a profession or according to the depth of a skill that can be acquired by a health care worker role. For example, Chang et. al presented competencies according to nursing staff seniority level (ie, a beginning nurse, an experienced nurse, an informatics specialist, an informatics innovator). Conversely, AHIEC assigned each competency a level of 1 to 6 (ie, 1: Remembering; 2: Understanding; 3: Applying; 4: Analyzing; 5: Evaluating; 6: Creating), according to the revised Taxonomy of Learning Domain objectives by Bloom, to indicate the depth of a skill that can be acquired by a health care worker role.

21In addition, the structure of the included digital health competency frameworks varied. Competencies were organized either based on broad informatics categories (ie, computer skills, informatics knowledge, informatics skills) or a combination of informatics and noninformatics categories (ie, information systems concepts, management concepts, ethical or legal concepts) or based on health care worker roles (ie, communicator, collaborator, professional). Alternatively, competencies were sorted according to learning outcomes or statements. For example, the national guideline for Canadian registered nurses sorted competencies according to 3 overarching statements: (1) uses relevant information and knowledge to support the delivery of evidence-informed patient or client care; (2) uses IT in accordance with professional and regulatory standards and workplace policies; and (3) uses IT in the delivery of patient or client care.

22Through thematic analysis, we were able to classify the majority of the competency categories presented in the frameworks into 28 domains. These domains are defined in Textbox 1, details of the analysis are provided in Multimedia Appendix 7, and results of the analysis is presented in Multimedia Appendix 8. Competencies relating to the following domains were found to be prevalent in at least half of the included frameworks: informatics concepts and processes (22/30, 73%); health information and records management (19/30, 63%); communication (19/30, 63%); ethics, legal, or regulations (18/30, 60%); privacy and security (17/30, 57%); technical knowledge and support (15/30, 50%); and clinical care delivery (15/30, 50%). Conversely, competencies relating to medicines management (2/30, 7%); attitudes toward IT (4/30, 13%); IT advocacy (5/30, 17%); and public health (5/30, 17%) were found to be uncommon in digital health competency frameworks. Of the 28 identified domains, 20 (71%) were present in at least one-third of the frameworks (Multimedia Appendix 8).

23Administration and general management

24Use of administrative information technology (IT) applications to perform tasks and procedures, such as planning and delivery of services, business workflows, and human resource management

25Analysis

26Use of IT systems to perform analysis of data, including data visualization, evaluation, and reporting

27Attitudes toward IT

28Attitudes and cultural awareness toward the use of IT in patient care

29Clinical care delivery

30Utilization of IT for the support of clinical care and practice, including use of assistive technologies and electronic test requesting

31Communication

32Use of digital communications (eg, social media, email, etc) to enhance interpersonal skills and to aid in care delivery and decision-making process

33Decision support

34Use of IT for clinical practice decision support

35Documentation

36Use of IT for appropriate documentation tasks and processes, including knowledge of coding and terminologies

37Education and training

38Use of IT in education and training, including e-Learning, mobile learning, and simulation

39Ethics, legal, or regulations

40Knowledge of ethical, regulatory, compliance, and legal requirements relating to health IT

41Financial management

42Knowledge of financial and account management relating to IT applications, including billing and fiscal aspects

43Health information and records management

44Ability to access, collect, store, share, and manage digital health information; use of eHealth records; information and knowledge management

45Health care quality and safety

46Ensuring or improving the quality and safety of health care services with the use of IT

47Imaging

48Knowledge of biomedical imaging digital technologies

49Informatics concepts and processes

50Knowledge and skills in computer basics, information systems, and general health IT use

51Integration and interoperability

52Knowledge of integrated health IT applications, health information exchange, and interoperability standards, including coordination and collaboration aspects

53IT advocacy

54Play an active role in promoting the use of IT in health care environments

55Leadership and executive management

56Providing or enhancing executive leadership skills relating to the use of IT, including setting direction, strategic management, change management, stakeholder management, and governance

57Medicines management

58Management of digital medication records and use of order entry

59Patient access and engagement

60Promoting use of IT applications among patients and supporting or empowering patients for self-management, including patient access to patient health records

61Privacy and security

62Ensuring that digital data and health information are protected and kept confidential by following privacy and security procedures

63Project management

64Knowledge of project management software and associated terminologies

65Public health

66Use of IT to inform public health strategies

67Remote care

68Provision of care at a distance, including telehealth care, eHealth, mobile health, and related fields

69Research

70Appropriate use of IT for research support and innovations

71Risk management

72Managing IT-related risks

73Systems implementation

74Knowledge and skills about IT systems development, management, and implementation

75Technical knowledge and support

76Knowledge of technical aspects of IT systems, including software applications, testing, applied computer science, and IT maintenance and support capabilities

77Of the 30 digital health competency frameworks, 14 solely targeted nursing staff. The frameworks predominantly originated from high-income countries and were developed based on literature reviews, followed by expert discussions or a Delphi approach. More than half of the included frameworks, especially those providing national-level recommendations, were from gray literature sources. Most frameworks were published between 2016 and 2019, highlighting the growing interest in digital health competencies in recent years.

78The purpose of the retrieved digital health competency frameworks and the intended audience was clearly stated in most frameworks. The earliest frameworks and almost half of all the included frameworks were meant for nurses. This could be due to the significantly larger proportion of nurses in the health workforce. Nurses play a crucial role in supporting health care environments by being a constant point of contact between patients and doctors; thus, there are various aspects of digital capabilities that are required of them (eg, using staff scheduling systems, extracting data from clinical systems, navigating decision support systems). These nursing-focused frameworks have inspired subsequent works for other health care workers. For example, several competency areas subsumed under broad areas for nurses in the TIGER framework were marked as standalone competency areas (ie, communication, legal issues, interoperability and integration, and life cycle management) for a wider spectrum of health care workers in version 2.0 of the TIGER framework. Notably, only one framework was found for allied health professionals (ie, dietitians), which highlights the perceived lack of interest in educating and training this group of workers in digital health. However, the Health Informatics Society of Australia, now known as the Australasian Institute of Digital Health, highlighted the need to focus on allied health care workers as their involvement is becoming increasingly important in decision making to improve patient care and health outcomes. Furthermore, although there were frameworks for doctors and medical students collectively, only one framework was intended solely for undergraduate medical education. The framework was a national guideline for medical students in Canada briefly describing 25 eHealth competencies. Medical practice relies heavily on communication, which is now achieved through various digital means; thus, the skills to utilize a range of digital technologies should be comprehensive and included in medical education. Moreover, with the COVID-19 pandemic, doctors are required to handle patient consultations digitally. A 2018 survey conducted by European Medical Students’ Association revealed that a majority of medical students rated their eHealth skills to be “poor” or “very poor” and desired for adequate digital health literacy.

79Most of the included frameworks are useful for application in education or practice, mainly owing to the specificity of competencies, the organization of competencies according to proficiency levels or health care worker roles, and the illustration of case studies and examples to be applicable to various settings. On the other hand, frameworks by Trangenstein et al and Jidkov et al presented only broad competency themes, as it was believed that exhaustive lists of competencies could lead to poor adoption. As the included digital health competency frameworks were heterogeneous in purpose, audience, and setting, it is challenging to determine a single framework as exemplary. Nevertheless, HITCOMP, which was developed via an iterative methodology, was found to be the most comprehensive framework, covering 21 out of the 28 identified competency domains, listing 1025 competencies, and targeting a wide audience of health care workers and medical specialties.

80The key thrust of work in this area involves competencies related to informatics, followed by eHealth, telehealth or telebehavioral or telepsychiatry, digital capability, and health IT competencies. This distinction may be superficial, given that the definitions and terminologies seem to overlap across frameworks and the nomenclatural differences do not necessarily convey differences in competencies. For example, the interprofessional eHealth framework developed by Thye et al utilized a range of informatics frameworks.

81Although frameworks often drew upon each other, there were considerable variations among the identified competencies. The Egbert et al framework identified the 5 most relevant competency areas (out of 24) for 5 nursing roles in Austria, Germany, and Switzerland. The TIGER framework used the same competency areas and methodology as Egbert et al and additionally reached out to experts worldwide for their inputs. The resulting relevant competency areas for a nurse in an IT management role, for example, varied considerably between both frameworks. For this role, competency areas, risk management and project management, ranked the top 5 internationally in the TIGER framework; however, it was only relevant in 1 out of 3 countries in the Egbert et al framework. In addition, eHealth, telematics, and telehealth, which were ranked as top 5 by Egbert et al for 2 out of 3 countries (ie, Germany and Austria), did not make it to the top 10 list in the TIGER framework. This suggests that the IT management role for nurses could be defined differently depending on each setting. Hence, a clear definition of the role is important to match the appropriate competency skills to a health care worker role.

82In our thematic analysis of the competencies included in the retrieved frameworks, we identified 28 competency domains. The most prevalent domain relates to competencies aimed at providing knowledge on informatics concepts and processes. Examples of these include basic computer knowledge, information systems concepts, and principles of informatics, which are fundamental skills to health care workers intending to maximize the use of digital technologies. The other common domains included the ability of health care workers to manage data from health information systems and records and to be well-versed in digital communications. Most of the health-related data today exist in digital form; therefore, it is imperative for health care workers to be able to understand the purpose, basic structures, use, and storage of electronic health records (EHRs). In addition, as digital health entails new forms of communication (eg, virtual consultations, email, chatbots), it is imperative for health care workers to be able to relate information accurately yet efficiently, timely, and delicately to patients, colleagues, and other collaborating stakeholders. Furthermore, the rise in the adoption and utilization of digital technologies has spurred new issues relating to the use of IT, which corresponds to the next two common domains of competencies (ie, ethics, legal, or regulations, and privacy and security). These domains stress the importance of health care workers’ adherence to legal and regulatory requirements and to keep up to date with privacy and security policies pertaining to the appropriate use of digital technologies.

83Some categories that were found in more recent frameworks, such as attitudes toward the use of IT, medication and prescription, IT advocacy, and public health, reflect the emerging trends in digital capabilities required by health care workers. For example, with the widespread adoption of EHRs and e-prescribing being a key functionality, it is imperative for physicians to be able to perform prescribing tasks efficiently and adapt to new features as systems continually evolve. In addition, as digital technologies have an increasing role in the management of health of communities and populations, frameworks have also started to incorporate competencies related to public health. Similarly, the acceptance of IT and its incorporation into everyday practice hinges on health care workers advocating for their use and being mindful of contextual factors and beliefs that would enable their use in different settings, such as high-income and low- and middle-income countries (LMICs). Other distinct domains such as leadership, administrative, managerial, and financial bring to attention that a digitally competent workforce should also be able to utilize technologies to oversee organizational-level aspects. It was also noted that competencies related to artificial intelligence, robotics, and social media, which are very relevant in current times, were not explicitly mentioned in the included frameworks. One possible explanation could be that some of these are subsumed under broader categories, for example, competencies regarding the use of social media could be part of the communication category, or that these digital areas have yet to be covered in digital health competency frameworks.

84From this synthesis of digital health competency frameworks, we would like to propose recommendations for the development of future frameworks (Textbox 2). First, an iterative methodology that includes literature review and consultations with local and international experts is ideal for a comprehensive framework. Second, it is encouraged for upcoming frameworks to explore competency areas that appeared in more recent frameworks, to cover upcoming digital health areas (ie, health apps, artificial intelligence, autonomous decision-support systems), and to be open to future revisions to be up to date with technological developments. For example, HITCOMP is projected to continue mapping and aligning competencies with the curriculum and other major initiatives. Finally, the lack of a comprehensive and international framework applicable to allied health professionals and LMICs warrants the development of frameworks that include these populations and settings. For example, only the TIGER framework includes case studies of LMICs, such as China, India, and Nigeria.

85Methodology:

86Literature review, followed by consultations or Delphi study with local experts, followed by engagement with international experts

87Content:

88Explore new competency areas that appeared in recent frameworks (ie, attitudes and advocacy toward the use of information technology (IT), medication management, public health)

89Update competencies based on technological innovations and adoption and emerging evidence (ie, health apps, artificial intelligence, autonomous decision-support systems)

90Include essential interprofessional competencies (ie, informatics concepts and processes, health information management, communication, ethics, legal, or regulations, and privacy and security)

91Target audience or setting to include:

92Allied health professionals

93Low- and middle-income countries

94Application:

95Provide case studies of integration into curricula or training programs or examples of application in practice

96The findings from this review can also inform and guide future training initiatives on digital health. When designing an educational or training program, it may not be possible to cover numerous competencies presented in a framework; rather, the program should focus on a specific set of competencies suitable for a particular group of health care workers, role, level of seniority, geographical, and health care setting. However, the identified competency domains prevalent in more than half of the included frameworks (ie, informatics concepts and processes, health information management, communication, ethics, legal, or regulations, and privacy and security) should be considered essential interprofessional competencies and thus should be incorporated into training and education efforts for any health care worker group. In addition, several digital competencies presented in the included frameworks may already be covered within the existing curriculum. For example, competencies within the Analysis and Research category may have been integrated within epidemiology training and evidence-based medicine education, respectively. Therefore, educators should consider integrating digital health training within existing parts of the curriculum and teaching it in an applied manner as much as possible. For example, the use of EHRs could be incorporated into the internal medicine curriculum.

97To our knowledge, this is the first consolidation and analysis of existing digital health competency frameworks regardless of the role of health care workers. We performed a thorough search, including several databases and gray literature sources. Our analysis also provides a comprehensive overview of the types of competencies presented in digital health competency frameworks, which will aid in the training and education of health care workers to be digitally competent in relevant areas. Some weaknesses must be kept in mind when interpreting the findings of this review. Although a substantial number of frameworks from gray literature were included, some could have been missed, potentially national guidelines and standards from LMICs. In addition, when performing the thematic analysis, there were frameworks with vague competency categories and overlaps among some categories, leading to differences in opinions during the classification process. However, the 2 reviewers used their expertise to develop and clearly define the domains and allocate categories from frameworks into these domains, first independently and then through a consensus discussion, to reduce bias and classify as appropriately as possible. Although the reviewers aimed to make the classification process as transparent and reproducible as possible, it must be noted that there could be alternate ways of interpreting and classifying and that categorization may differ in the future with the new advances in digital health.

98Of the 30 frameworks included in this scoping review, a majority target nurses, originate from high-income countries, and have been developed using an iterative approach. Our analysis of digital health competency frameworks can help inform the development of future digital health training programs for health care workers. Existing frameworks largely focus on the development of basic IT skills, proficiency in managing health-related information and digital communications, and awareness of ethical, legal, privacy, and security implications relating to IT. Future frameworks and training programs need to take into consideration the evolving nature of digital health and have to be able to incorporate upcoming digital trends, such as artificial intelligence and robotics. There is also a need for frameworks focusing on LMICs, medical students, and allied health professionals.