Зарубежный опыт развития цифрового здравоохранения: обзор технологических решений и комплексных систем

Введение. Цифровое развитие, подкрепленное государственными инициативами, ведет к достижению целей: повышению качества медицинских услуг, улучшению результатов лечения и сокращению расходов.

Цель исследования: осмысление и упорядочивание зарубежных практик внедрения цифровых решений в медицину для дальнейшего развития российской политики в этой области.

Материалы и методы. Методология исследования базируется на применении общенаучных методов и анализе ведущей рецензируемой литературы из международных баз данных Medline, PubMed и eLIBRARY за период 1985–2024 гг. В рамках исследования было проанализировано 150 источников, из которых были отобраны 69 статей. Поиск осуществлялся по ключевым словам, связанным с цифровой трансформацией здравоохранения, что обеспечило репрезентативную выборку научных материалов по изучаемой проблематике.

Результаты. По результатам исследования установлено, что цифровое здравоохранение демонстрирует значительный позитивный потенциал, выражающийся в повышении доступности, эффективности и персонализации медицинской помощи, благодаря развитию телемедицины, мобильных приложений и технологий на основе искусственного интеллекта. В то же время выявлено, что внедрение цифровых технологий сопровождается серьезными негативными последствиями, главными из которых являются усугубление социального неравенства и возникновение цифровой эксклюзии уязвимых групп населения ввиду разрыва в доступе к технологиям и уровне цифровой грамотности в обществе.

Заключение. Таким образом, внедрение цифрового здравоохранения, помимо повышения доступности и эффективности медицинской помощи, системно усугубляет социальное неравенство, поэтому правительствам рекомендуется разрабатывать и реализовывать комплексную государственную политику, направленную на минимизацию цифрового разрыва путем развития инклюзивной инфраструктуры, преодоления алгоритмических смещений и внедрения целевых программ поддержки для уязвимых групп населения.

1. Shuren J, Patel B, Gottlieb S. FDA regulation of mobile medical apps. JAMA. 2018;320(4):337-338. doi: 10.1001/jama.2018.8832

2. Haux R. Medical informatics: Past, present, future. Int J Med Inform. 2010;79(9):599-610. doi: 10.1016/j.ijmedinf.2010.06.003

3. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):E20. doi: 10.2196/jmir.3.2.e20

4. Khillar S. Difference between digital health and health informatics. Difference Between Similar Terms and Objects. 2020. Accessed October 16, 2025. http://www.differencebetween.net/technology/difference-between-digital-health-and-health-informatics/

5. Ahmadvand A, Kavanagh D, Clark M, Drennan J, Nissen L. Trends and visibility of “digital health” as a keyword in articles by JMIR Publications in the new millennium: Bibliographic–bibliometric analysis. J Med Internet Res. 2019;21(12):e10477. doi: 10.2196/10477

6. Eysenbach G. Celebrating 20 years of open access and innovation at JMIR Publications. J Med Internet Res. 2019;21(12):e17578. doi: 10.2196/17578

7. Inskip C. Developing library staff digital literacies. In: Reedy K, Parker J, eds. Digital Literacy Unpacked. Facet; 2018:139-152. doi: 10.29085/9781783301997.012

8. Norman CD, Skinner HA. eHealth literacy: Essential skills for consumer health in a networked world. J Med Internet Res. 2006;8(2):e9. doi: 10.2196/jmir.8.2.e9

9. Nouri S, Khoong EC, Lyles CR, Karliner L. Addressing equity in telemedicine for chronic disease management during the Covid-19 pandemic. NEJM Catalyst Innov Care Delivery. 2020;1:1-13. doi: 10.1056/CAT.19.1111

10. Tegegne MD, Tilahun B, Mamuye A, et al. Digital literacy level and associated factors among health professionals in a referral and teaching hospital: An implication for future digital health systems implementation. Front Public Health. 2023;11:1130894. doi: 10.3389/fpubh.2023.1130894

11. Shiferaw KB, Tilahun BC, Endehabtu BF. Healthcare providers’ digital competency: A cross-sectional survey in a low-income country setting. BMC Health Serv Res. 2020;20(1):1021. doi: 10.1186/s12913-020-05848-5

12. Taryudi T, Mutiar A, Supriatin E, Lindayani L. Digital media literacy level among nurses in urban area of Indonesia. Int Public Health J. 2021;13(2):213-218.

13. Kuek A, Hakkennes S. Healthcare staff digital literacy levels and their attitudes towards information systems. Health Informatics J. 2020;26(1):592-612. doi: 10.1177/1460458219839613

14. Nguyen LHT, Vo MTH, Tran LTM, et al. Digital health literacy about COVID-19 as a factor mediating the association between the importance of online information search and subjective well-being among university students in Vietnam. Front Digital Health. 2021;3:739476. doi: 10.3389/fdgth.2021.739476

15. Secginli S, Erdogan S, Monsen KA. Attitudes of health professionals towards electronic health records in primary health care settings: A questionnaire survey. Inform Health Soc Care. 2014;39(1):15-32. doi: 10.3109/17538157.2013.834342

16. Brewer LC, Jenkins S, Lackore K, et al. mHealth intervention promoting cardiovascular health among African-Americans: Recruitment and baseline characteristics of a pilot study. JMIR Res Protoc. 2018;7(1):e31. doi: 10.2196/resprot.8842

17. Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: Promises and barriers. PLoS Med. 2016;13(2):e1001953. doi: 10.1371/journal.pmed.1001953

18. Salehi E, Mehrabi M, Fatehi F, Salehi A. Virtual reality therapy for social phobia: A scoping review. Stud Health Technol Inform. 2020;270:713-717. doi: 10.3233/SHTI200253

19. McBain L, Morgan D. Telehealth, geography, and jurisdiction: Issues of health care delivery in Northern Saskatchewan. Can Woman Stud. 2005;24(4):123-129.

20. Honarbakhsh S, Sporton S, Monkhouse C, Lowe M, Earley MJ, Hunter RJ. Remote clinics and investigations in arrhythmia services: What have we learnt during coronavirus disease 2019? Arrhythm Electrophysiol Rev. 2021;10(2):120-124. doi: 10.15420/aer.2020.37

21. Ricci RP, Morichelli L, Quarta L, et al. Long-term patient acceptance of and satisfaction with implanted device remote monitoring. Europace. 2010;12(5):674-679. doi: 10.1093/europace/euq046

22. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare. 2018;24(1):4-12. doi: 10.1177/1357633X16674087

23. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med. 2021;181(3):388-391. doi: 10.1001/jamainternmed.2020.5928

24. Yellowlees P, Shore JH, eds. Telepsychiatry and Health Technologies: A Guide for Mental Health Professionals. Washington, D.C.: American Psychiatric Assoc. Publ.; 2018.

25. Schulze LN, Stentzel U, Leipert J, et al. Improving medication adherence with telemedicine for adults with severe mental illness. Psychiatr Serv. 2019;70(3):225- 228. doi: 10.1176/appi.ps.201800286

26. Sunjaya AP, Chris A, Novianti D. Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): A systematic review. Trends Psychiatry Psychother. 2020;42(1):102-110. doi: 10.1590/2237-6089-2019-0024

27. Aref-Adib G, McCloud T, Ross J, et al. Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: A systematic review. Lancet Psychiatry. 2019;6(3):257-266. doi: 10.1016/S2215-0366(18)30302-X

28. Andrews G, Basu A, Cuijpers P, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord. 2018;55:70-78. doi: 10.1016/j.janxdis.2018.01.001

29. Eberly LA, Khatana SAM, Nathan AS, et al. Telemedicine outpatient cardiovascular care during the COVID-19 pandemic: Bridging or opening the digital divide? Circulation. 2020;142(5):510-512. doi: 10.1161/CIRCULATIONAHA.120.048185

30. Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: How COVID-19’s telemedicine expansion could exacerbate disparities. J Am Acad Dermatol. 2020;83(5):e345-e346. doi: 10.1016/j.jaad.2020.07.043

31. Valmaggia LR, Day F, Rus-Calafell M. Using virtual reality to investigate psychological processes and mechanisms associated with the onset and maintenance of psychosis: A systematic review. Soc Psychiatry Psychiatr Epidemiol. 2016;51(7):921-936. doi: 10.1007/s00127-016-1245-0

32. Koskina A, Campbell IC, Schmidt U. Exposure therapy in eating disorders revisited. Neurosci Biobehav Rev. 2013;37(2):193-208. doi: 10.1016/j.neubiorev.2012.11.010

33. Fernández-Álvarez J, Di Lernia D, Riva G. Virtual reality for anxiety disorders: Rethinking a field in expansion. Adv Exp Med Biol. 2020;1191:389-414. doi: 10.1007/978-981-32-9705-0_21

34. Bouchard S. Could virtual reality be effective in treating children with phobias? Expert Rev Neurother. 2011;11(2):207-213. doi: 10.1586/ern.10.196

35. Botella C, Fernández-Álvarez J, Guillén V, García-Palacios A, Baños R. Recent progress in virtual reality exposure therapy for phobias: A systematic review. Curr Psychiatry Rep. 2017;19(7):42. doi: 10.1007/s11920-017-0788-4

36. Andersson C, Johnson AD, Benjamin EJ, Levy D, Vasan RS. 70-year legacy of the Framingham Heart Study. Nat Rev Cardiol. 2019;16(11):687-698. doi: 10.1038/s41569-019-0202-5

37. Yao R, Zhang W, Evans R, Cao G, Rui T, Shen L. Inequities in health care services caused by the adoption of digital health technologies: Scoping review. J Med Internet Res. 2022;24(3):e34144. doi: 10.2196/34144

38. Larrazabal AJ, Nieto N, Peterson V, Milone DH, Ferrante E. Gender imbalance in medical imaging datasets produces biased classifiers for computer-aided diagnosis. Proc Natl Acad Sci U S A. 2020;117(23):12592-12594. doi: 10.1073/pnas.1919012117

39. Holst C, Sukums F, Radovanovic D, Ngowi B, Noll J, Winkler AS. Sub-Saharan Africa – the new breeding ground for global digital health. Lancet Digit Health. 2020;2(4):e160-e162. doi: 10.1016/S2589-7500(20)30027-3

40. van Kessel R, Wong BLH, Clemens T, Brand H. Digital health literacy as a super determinant of health: More than simply the sum of its parts. Internet Interv. 2022;27:100500. doi: 10.1016/j.invent.2022.100500

41. Pham Q, El-Dassouki N, Lohani R, Jebanesan A, Young K. The future of virtual care for older ethnic adults beyond the COVID-19 pandemic. J Med Internet Res. 2022;24(1):e29876. doi: 10.2196/29876

42. Robotham D, Satkunanathan S, Doughty L, Wykes T. Do we still have a digital divide in mental health? A five-year survey follow-up. J Med Internet Res. 2016;18(11):e309. doi: 10.2196/jmir.6511

43. Saeed SA, Masters RM. Disparities in health care and the digital divide. Curr Psychiatry Rep. 2021;23(9):61. doi: 10.1007/s11920-021-01274-4

44. Kaihlanen AM, Virtanen L, Buchert U, et al. Towards digital health equity – a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era. BMC Health Serv Res. 2022;22(1):188. doi: 10.1186/s12913-022-07584-4

45. Goedhart NS, Dedding C. The context of digital inequalities in Amsterdam. In: Bon A, van den Nieuwenhuijzen D, Akkerman H, eds. Digital Divide, Citizenship and Inclusion in Amsterdam: Participatory Action Research. Amsterdam: Pangea; 2020:5-17.

46. Watts G. COVID-19 and the digital divide in the UK. Lancet Digit Health. 2020;2(8):e395-e396. doi: 10.1016/S2589-7500(20)30169-2

47. Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: How informatics interventions can worsen inequality. J Am Med Inform Assoc. 2018;25(8):1080- 1088. doi: 10.1093/jamia/ocy052

48. Israel BA, Eng E, Schulz AJ, Parker EA, eds. Methods in Community-Based Participatory Research for Health. San Francisco: Jossey-Bass; 2005. Accessed December 25, 2025. http://ndl.ethernet.edu.et/bitstream/123456789/31011/1/Barbara%20A.%20Israel.pdf

49. Unertl KM, Schaefbauer CL, Campbell TR, et al. Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations. J Am Med Inform Assoc. 2016;23(1):60-73. doi: 10.1093/jamia/ocv094

50. Butcher CJ, Hussain W. Digital healthcare: The future. Future Healthc J. 2022;9(2):113-117. doi: 10.7861/fhj.2022-0046

51. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low- and middle-income countries: A systematic review. PLoS Med. 2012;9(6):e1001244. doi: 10.1371/journal.pmed.1001244

52. Otambo P, Nyandieka L, Kariuki J, et al. Implementation of Universal Health Coverage program in Kisumu County, Kenya: Importance of social marketing strategies. Soc Sci Humanit Sustain Res. 2020;1:22.

53. Jahnel T, Dassow HH, Gerhardus A, Schüz B. The digital rainbow: Digital determinants of health inequities. Digit Health. 2022;8:20552076221129093. doi: 10.1177/20552076221129093

54. Lioret S, Campbell KJ, McNaughton SA, et al. Lifestyle patterns begin in early childhood, persist and are socioeconomically patterned, confirming the importance of early life interventions. Nutrients. 2020;12(3):724. doi: 10.3390/nu12030724

55. Cheng C, Beauchamp A, Elsworth GR, Osborne RH. Applying the electronic health literacy lens: Systematic review of electronic health interventions targeted at socially disadvantaged groups. J Med Internet Res. 2020;22(8):e18476. doi: 10.2196/18476

56. Kontos E, Blake KD, Chou WYS, Prestin A. Predictors of ehealth usage: Insights on the digital divide from the Health Information National Trends Survey 2012. J Med Internet Res. 2014;16(7):e172. doi: 10.2196/jmir.3117

57. Fortuna K, Barr P, Goldstein C, et al. Application of community-engaged research to inform the development and implementation of a peer-delivered mobile health intervention for adults with serious mental illness. J Participat Med. 2019;11(1):e12380. doi: 10.2196/12380

58. Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49(6):599-604. doi: 10.1097/MLR.0b013e31820bf86e

59. Sempionatto JR, Lasalde-Ramírez JA, Mahato K, Wang J, Gao W. Wearable chemical sensors for biomarker discovery in the omics era. Nat Rev Chem. 2022;6(12):899-915. doi: 10.1038/s41570-022-00439-w

60. Widemalm M, Hjärthag F. The forum as a friend: Parental mental illness and communication on open Internet forums. Soc Psychiatry Psychiatr Epidemiol. 2015;50(10):1601-1607. doi: 10.1007/s00127-015-1036-z

61. Gliddon E, Barnes SJ, Murray G, Michalak EE. Online and mobile technologies for self-management in bipolar disorder: A systematic review. Psychiatr Rehabil J. 2017;40(3):309-319. doi: 10.1037/prj0000270

62. Naslund JA, Marsch LA, McHugo GJ, Bartels SJ. Emerging mHealth and eHealth interventions for serious mental illness: A review of the literature. J Ment Health. 2015;24(5):321-332. doi: 10.3109/09638237.2015.1019054

63. Sander L, Ebert DD, Baumeister H. Internet- and mobile based psychotherapy for depression. Fortschr Neurol Psychiatr. 2017;85(1):48-58. (In German.) doi: 10.1055/s0042-123540

64. Díaz Pérez E, Flórez Lozano J.A. Virtual reality and dementia. RevNeurol. 2018;66(10):344. (In Spanish.) doi: 10.33588/rn.6610.2017438

65. Gough N, Brkan L, Subramaniam P, et al. Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS One. 2020;15(2):e0223029. doi: 10.1371/journal.pone.0223029

66. Scherr S, Haim M, Arendt F. Equal access to online information? Google’s suicide-prevention disparities may amplify a global digital divide. New Media Soc. 2019;21(3):562-582. doi: 10.1177/1461444818801010

67. Doherty G, Coyle D, Matthews M. Design and evaluation guidelines for mental health technologies. Interact Comput. 2010;22(4):243-252. doi: 10.1016/j.intcom.2010.02.006

68. Mohr DC, Burns MN, Schueller SM, Clarke G, Klinkman M. Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. Gen Hosp Psychiatry. 2013;35(4):332-338. doi: 10.1016/j.genhosppsych.2013.03.008

69. Valencia-García R, García-Sánchez F. Natural language processing and human–computer interaction. Comput Stand Interfaces. 2013;35(5):415–416. doi: 10.1016/j.csi.2013.03.001