Digital Health Technologies in Pediatric Infectious Disease and the Perspective of Patients and Healthcare Professionals: A Review

Abstract

ABSTRACT

Background and Aims

Pediatric infectious diseases pose a global health challenge, causing 13.7 million deaths in 2019 and three million in children under four. Early recognition and management are vital, and challenges in effectively addressing this persist, particularly in resource‐limited areas. Digital health tools, such as telemedicine and mHealth, offer promising solutions. In this review, we aim to evaluate digital health applications in managing pediatric infectious diseases from patient and healthcare perspectives.

Methods

A literature search was conducted using PubMed, Google Scholar, and Scopus with keywords including “digital health,” “telemedicine,” and “pediatric infectious disease.” Studies published up to January 2024 were included and critically reviewed.

Results

Digital health technologies aid in real‐time monitoring and early diagnosis of infectious diseases, improving access to specialized care for pediatric populations. Tools like telemedicine and mHealth enhance communication between patients, caregivers, and physicians, facilitating shared decision‐making. Wearable devices and mobile applications enable proactive health management and timely interventions. Despite access challenges in resource‐limited settings, caregivers report benefits such as improved healthcare coordination, reduced delays in care, and better health outcomes for children.

Conclusion

Digital health shows promise in addressing pediatric infectious disease management, particularly in resource‐limited settings, enhancing outcomes through timely interventions and better communication.

Introduction

The global prevalence of infectious diseases, which disproportionately impact pediatric and other vulnerable populations, remains a significant concern [1]. These diseases entail considerable economic and public health burdens worldwide [2, 3]. Despite strides in child health, infectious diseases persist as a primary cause of morbidity and mortality among children. In 2019, infectious syndromes resulted in 13.7 million deaths worldwide, with 3 million occurring in children under 4 years old [4]. The prevalence of infectious diseases among children varies from region to region. According to the Children's Hospital of Philadelphia, in the year 2021, in 1.5 million deaths from ages 5 to 19 years old, approximately 37 out of 100 deaths were due to infectious diseases [5]. Although the incidence of hospitalization due to subgroups of infectious diseases amongst children had decreased in 12 years from 2002 to 2012 from 91.0 to 75.8 per 10,000 US children (p < 0.001), those due to skin infections had increased (67.6% increase; p < 0.001) [6]. This indicates that various types of infectious diseases can have different incidences and prevalence during the same time period. According to UNICEF, the leading “infectious cause of death” amongst children under 5 is pneumonia [7]. Although not for all diseases, but for community-acquired pneumonia (CAP), a study done in Spain found that the incidence of hospital admissions was higher in boys compared to girls with no differences in hospital outcomes [8]. With the increase in climate change, infectious diseases impact individual parts of the world uniquely. In China, climate change has led to increased dengue vector abundance (Aedes spp. mosquitoes) and transmission of dengue fever [9]. As climate change worsens, the World Health Organization (WHO) predicts that the cause of death due to diarrheal disease in children under 15 will be 48,000 and 33,000 deaths by 2030 and 2050, respectively, with the impact being most amongst South Asia and Eastern Africa [10]. Advancements in pediatric infectious disease management, predominantly through vaccinations against ailments like measles and varicella, have contributed to a decline in mortality and improvements in life quality [11]. However, persistent challenges are driven by factors such as high population density, insufficient healthcare access, and limited sanitation services in specific regions [12]. Personal hygiene practices and environmental factors further influence the prevalence of infectious diseases, underscoring the significance of robust public health interventions [13].

The collapse of public health services, particularly in resource-limited settings, poses a hindrance to the effective management of pediatric infectious illnesses. Inadequate access to healthcare exacerbates the transmission of communicable diseases, complicating efforts in identification and control [14]. Despite transformative changes in healthcare delivery over recent decades, the pursuit of universal access remains an ongoing global objective, grappling with disparities within and between nations.

Barriers to healthcare access, encompassing economic constraints, geographic location, and limited education, result in delayed diagnoses with severe consequences [12]. Missed appointments, influenced by factors like gaps in health insurance and transportation issues, detrimentally impact practice efficiency and patient outcomes [15]. Relocations further disrupt the continuity of care, impacting the behavioral, psychological, and social well-being of affected children [15].

Effectively addressing these challenges necessitates a vigilant healthcare approach and tailored strategies.

Digital health comprises various classifications, such as mobile health (mHealth), health information technology (hIT), wearable devices, telehealth, telemedicine, and personalized medicine (PM) [16] (Figure 1) Within this spectrum, technologies such as telemedicine and telehealth assume a pivotal role in surmounting barriers to the management of pediatric infectious diseases [17]. These digital health solutions not only overcome geographical constraints but also amplify access to timely interventions. Through facilitating real-time communication for disease surveillance, they provide cost-effective alternatives, particularly benefitting vulnerable communities in low- and middle-income countries [18, 19]. The integration of these various digital health technologies aligns with the global objective of achieving universal access to healthcare. This holistic approach mitigates economic, geographic, and educational barriers, fostering continuity of care and ultimately enhancing pediatric health outcomes [20].

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The review aims to assess the escalating utilization of telemedicine programs in pediatric infectious disease management, emphasizing their pivotal role in diagnosis, treatment, disease surveillance, and healthcare delivery models. Through synthesizing this comprehensive information, the review seeks to underscore the substantial potential of telemedicine technologies in advancing pediatric care and healthcare strategies.

Methods

An extensive literature search was conducted across multiple databases, including PubMed, Google Scholar, and Scopus. The search employed a range of keyword combinations such as “digital health,” “telemedicine,” “healthcare access,” “pediatric infectious disease,” “mHealth,” and “virtual consultations.” The inclusion criteria focused on studies published up to January 2024, specifically targeting research on the implementation and impact of digital health technologies in pediatric infectious disease care. No restrictions were placed on study design to allow for a comprehensive selection of relevant literature. Each study was meticulously reviewed by the authors, who critically evaluated the methodologies and findings to extract insights aligned with the research objectives. The most pertinent results were incorporated into the manuscript, providing a detailed understanding of the application of digital health tools in this domain and the perspectives of key stakeholders.

Digital Health Technologies in Infectious Disease

The term “digital” in the context of health, medicine, or therapeutics signifies the integration of technology into these domains. The broader concept of “digital health” encompasses the utilization of technology to enhance healthcare and individual well-being, spanning various applications such as apps, wearable devices, fitness trackers, mobile mHealth, hIT, telemedicine, and remote patient monitoring (RPM) [21]. Several studies have been conducted on digital health in infectious diseases (Table 1).

Table 1 Summary of studies conducted on digital health technologies in the context of infectious disease.

Author	Title	Type of study	Conclusion
Hswen et al. 2017 [22]	Use of a digital health application for influenza surveillance in China	Observational study	The widespread use of digital health applications holds promise for early disease detection, monitoring, and timely treatment.
Herbeula et al. 2021 [23]	Early detection of dengue fever outbreaks using a surveillance app (Mozzify): Cross-sectional mixed methods usability study	Cross-sectional study	The App had the capability to detect likely outbreaks of disease in the Philippines.
Nyambayo et al. 2023 [24]	Efficacy and feasibility of SMS m-Health for the detection of adverse events following immunization (AEFIs) in resource-limited setting-The Zimbabwe stimulated telephone assisted rapid safety surveillance (Zm-STARSS) randomized control trial	Randomized controlled trial	The Zm-STARSS SMS system enhances AEFI detection compared to passive surveillance.
Raphael et al. 2019 [25]	Virtual telemedicine visits in pediatric home parenteral nutrition patients: A quality improvement initiative	Observational study	Telemedicine visits revealed areas for enhancement in the care of families recently discharged on home parenteral nutrition (HPN).
Matricardi et al. 2020 [26]	The role of mobile health technologies in allergy care: An EAACI position paper	Descriptive study	Mobile health technologies enhance healthcare accessibility for distant populations, fostering collaboration between patients and doctors, facilitating personalized care through electronic clinical diaries, and empowering patients with self-management tools.
Ahmed et al. 2022 [27]	Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review	Systematic review	There is limited evidence regarding accuracy of digital auscultation in diagnosis.
Chatterjee et al. 2001 [28]	Prospective study of telephone consultation and communication in pediatric infectious diseases	Prospective study	Telephone consultations played a vital role in Pediatric infectious diseases management.
Devrim et al. 2019 [29]	Reliability and accuracy of smartphones for pediatric infectious disease consultations for children with rash in the pediatric emergency department	Cross-sectional study	Messaging via a smartphone-based application for the transmission of pediatric rash images was useful for diagnosis, especially during nightshifts in emergency departments.
Hakim et al. 2021 [30]	Pre-coronavirus disease 2019 telehealth practices among pediatric infectious diseases specialists in the United States	Cross-sectional study	Before the COVID-19 pandemic many people had trouble adapting to telehealth. However, there was a strong interest to adopt the different modalities of telehealth.
Kalyoussef et al. 2023 [31]	Impact of COVID-19 pandemic on pediatric infectious disease telehealth practices in North America	Cross-sectional study	Telehealth use increased with high satisfaction rates during the COVID-19 Pandemic.
Umoren et al. 2020 [32]	In-hospital telehealth supports care for neonatal patients in strict isolation	Cross-sectional study	There were many beneficial effects of the use of inpatient telemedicine for patients needing isolation, such as for infectious viral illnesses.

Telehealth and Telemedicine

The terms telehealth and telemedicine are often used interchangeably, but they have subtle distinctions. Telehealth is a broader concept that encompasses a wide range of remote healthcare services, including clinical services, patient education, and health administration. On the other hand, telemedicine specifically refers to the provision of clinical services remotely [33].

Since the early 1900s, healthcare professionals have utilized the telephone to communicate with their patients [34]. Notable historical instances include a doctor in 1905 using the telephone to transmit a patient's heart sounds from a hospital to his laboratory. In 1924, the Radio News Magazine foresaw remote communication between doctors and patients, coining the term “radio doctor” and envisioning the use of a microphone and television [34, 35]. However, the universal adoption of real-time video in telemedicine occurred in 1959 after the University of Nebraska facilitated neurologic examinations across campus via interactive video communication [34]. By the 1960s, in one of the earliest significant applications of telemedicine, NASA had strategically placed medical observers at 18 sites across North America, Europe, Africa, and Australia to remotely monitor astronauts [36].

The expansion of telemedicine solutions has been rapid since the onset of the coronavirus disease 2019 (COVID-19) epidemic. In response to the pandemic, virtual visits through telemedicine in the United States saw a significant surge, increasing from 102.4 daily to 801.6 daily between March 2 and April 14, 2020—an impressive 683% rise [37]. This shift has proven instrumental in allowing healthcare providers to efficiently screen, diagnose, and treat pediatric infections while effectively minimizing the risk of viral or bacterial transmission.

Telehealth has also played a crucial role in the realm of vaccination. A notable strategy involves the use of text messaging to promote vaccinations, representing a novel and practical approach. In the United States, reminders were sent to children and adolescents to encourage influenza vaccination, and the delivery of a simple message was associated with a higher number of vaccinations compared to previous years [38].

Children frequently encounter difficulties in accessing specialized and subspecialized healthcare, and the potential benefits of telemedicine in addressing these challenges are evident. However, there is a dearth of comprehensive information on the efficient implementation of telemedicine to maximize its impact on pediatric patients and their families.

From the perspective of the pediatric patient, telemedicine offers the prospect of a doctor's consultation from the comfort of their home, potentially mitigating the intimidating and stressful nature of the traditional in-person experience [39]. Furthermore, caregivers may value the convenience of virtual consultations, alleviating the challenges associated with traveling with a sick child and the potential disruption to their work and daily routines [39, 40]. Virtual consultations also hold promise in facilitating enhanced communication among patients, caregivers, and multiple physicians simultaneously, thereby facilitating shared decision-making [41–43]. Physicians perceive telemedicine as an educational opportunity to manage pediatric diseases and raise awareness about specific conditions [40].

The applicability of telemedicine extends to both pre-hospitalization and post-hospitalization care, with studies demonstrating its acceptance as a safe alternative by healthcare providers and caregivers [44–47]. The individualized and self-efficacy-promoting nature of telemedicine contributes to reducing the overall burden of healthcare access. Caregivers express a preference for telemedicine due to its perceived independence, convenience, cost-effectiveness, comprehensiveness, and acceptability [48, 49]. Moreover, telemedicine supports caregiver decision-making and problem-solving, fostering the delivery of family-centered care. Caregivers' expressed intention to utilize telehealth services more frequently in subsequent instances underscores their satisfaction with this modality.

However, the integration of telemedicine into pediatric care is not without challenges. Concerns about patient safety and provider confidence in conducting comprehensive assessments through video visits may impede widespread adoption [42]. Challenges include issues related to technology quality and reliability, patient and doctor privacy, implementation costs, accessibility, time constraints, limitations in conducting physical examinations, and deficiencies in requisite tools [50, 51]. Additionally, studies highlighting an increased prescription of antibiotics for pediatric patients in telemedicine consultations, deviating from guideline-concordant antibiotic management, have raised concerns among professional organizations like the American Academy of Pediatrics (AAP) and the American Telemedicine Association [52].

mHealth

mHealth is the use of mobile applications or wearable devices with wireless communication abilities to improve the delivery of healthcare services [53]. Robert Istepanian was the first to introduce the term mhealth in 2006, defining it as “emerging mobile communications and network technologies for healthcare” [54]. In the early 2000s, mobile communication was limited to texting and calling. Patients could reach out to their doctors for real-time feedback. The advent of smartphones, marked by the release of the first iPhone in 2007 and the first Android in 2008, brought internet access and browsers to the general public. The introduction of app stores paved the way for mobile applications, including those in healthcare, leading to the development of medical, health, and wellness apps. The rise of public empowerment has fueled the growth of healthcare apps, with the most popular ones being those that monitor health indicators. These apps gather data from wearable devices, which can be synced automatically [55].

Widespread availability and cost-effectiveness, coupled with recent technological advancements, have expedited the incorporation of mHealth applications into the healthcare sector [54]. Mobile health applications allow patients and/or their caregivers to participate in health services through a wide range of functionalities such as health education, appointment reminders, recording or tracking health indicators, and summarizing their own health [55].

As per IQVIA, there are over 350,000 mHealth apps in the app stores in 2021, with disease management apps accounting for over 47% of all mHealth apps [56]. The evidence for the benefits of mHealth apps is becoming more substantial, although its complete potential cannot be fully achieved unless mHealth interventions are seamlessly integrated into the existing functions of the health system [56, 57].

mHealth technologies have been recognized as a more affordable and simpler approach to providing high-quality healthcare services to patients in low-and middle-income countries with unstable health systems, high prevalence of tropical diseases, high rates of infectious diseases, and high mortality rates. Studies in some low- and middle-income countries have revealed that, in this era of SARS-CoV-2, digital health technologies such as mobile health applications have been used in all contexts for screening, diagnosis, risk assessment, and tracking of real-time transmissions. The adoption of mHealth applications could reduce the spread of SARS-CoV-2 and other infectious diseases in overcrowded emergency rooms and enhance patient care [58].

Caregiver perspectives on the usage of mHealth in healthcare settings are influenced by several concerns, with data breaches, hacking, and unauthorized access to sensitive information being primary worries. The potential for automatic installation of malicious programs is also identified as a significant issue. These apprehensions are anticipated to impede the growth of mHealth, and data security and privacy concerns are expected to undermine the positive attitudes of patients and caregivers [55, 59]. The security challenges associated with mHealth technologies raise questions about the safety and confidentiality of patient information, potentially impacting the acceptance and adoption of these technologies among caregivers.

On the other hand, healthcare professionals express a parallel set of concerns regarding the utilization of mHealth in healthcare settings. Similar to caregivers, they highlight data breaches, hacking, and unauthorized access as major impediments to the widespread adoption of mHealth. The fear of sensitive information being compromised poses a significant challenge. Despite these concerns, the COVID-19 pandemic has accelerated the use of mHealth mobile applications. Government and nongovernmental organizations actively promoted the use of these applications for various purposes, such as risk assessment, home monitoring, contact tracing, training, self-management of symptoms, information sharing, and decision-making during the COVID-19 pandemic [59]. The rapid transition to telemedicine during the COVID-19 pandemic posed particular challenges for pediatric healthcare systems, as they had to swiftly adapt to new technologies, potentially impacting medication adherence and self-management practices [60].

Wearable Devices

A notable limitation of mHealth applications has traditionally been their reliance on manual data entry. However, the advent of wearable devices has significantly mitigated this obstacle. Wearable devices trace their roots back to ancient times, with examples such as the first spectacles in the 13th century, the inaugural pocket watch in the 16th century, and the initial smart ring in the 17th century. The inception of the first smartwatch featuring an integrated calculator occurred in 1975, credited to Pulsar. Fast-forwarding to 2014, Fitbit introduced an innovative smartwatch capable of tracking various metrics like sweating, sleep stages, temperature, calorie intake, and heart rate. In 2015, the Apple Watch was launched, highlighting the notion that other activity trackers were not optimally designed for measuring vital signs in patients [61].

Users of fitness bands and smartwatches can now effortlessly track their exercise routines and automatically sync data such as speed, location, respiratory rate, blood oxygen, heart rate, blood pressure, and energy expenditure [55, 62]. Additionally, wearable technology has proven effective in accurately estimating stress and anxiety levels through heart rate variability data [63]. The continuous data collection and remote monitoring capabilities of wearables offer users comprehensive insights throughout the day, providing dynamic and intelligent analyses of multiple health indicators to support medical treatment [62].

According to a study to evaluate the use of wearable devices among US citizens, 30% use wearable devices, and 82% are willing to share the health data from their wearable devices with their care providers [64]. Increased access to long-term user data can help healthcare providers understand and monitor individual health concerns and facilitate a more tailored treatment path, highlighting the enormous ability of wearable devices to transform healthcare [65]. In a study at the University Children's Hospital Basel, Switzerland, a multi-sensor wearable device demonstrated high acceptance and feasibility among healthcare workers, parents, and pediatric patients with infectious conditions. Despite minor data gaps, the device reliably measured heart rate and oxygen saturation, highlighting its potential utility in infectious disease monitoring, even though body temperature was underestimated by approximately 1.7°C [66].

The utilization of wearable devices and sensors for RPM brings significant advantages to both patients and legal health guardians. This technology offers real-time monitoring and early diagnosis, which is particularly beneficial for conditions such as pediatric and congenital heart diseases [67]. Facilitating timely intervention contributes to improved health outcomes, prevention of illnesses, and a reduction in associated hospitalization expenses, minimizing the need for onsite consultations [68]. Furthermore, these devices promote patient autonomy and independence by eliminating the necessity for an operator [69, 70].

While many existing wearable devices provide valuable support for individuals with disabilities, a substantial portion of patients with physical, sensory, and cognitive limitations may face challenges in fully accessing these services. There is a pressing need for an inclusive design and development process that addresses the unique requirements of these patients [71]. The growing recognition of these benefits has attracted considerable attention from researchers, entrepreneurs, and tech giants in recent years [72].

Healthcare providers find that wearable devices contribute to enhanced continuous patient monitoring, reducing reliance on invasive therapies [69]. The responsibility lies in evaluating the precision of data from these devices and making data-driven decisions to minimize errors, ultimately lowering the risk of unnecessary testing and medical interventions. This approach is pivotal for improving patient safety and addressing concerns in healthcare delivery [73]. Similar to the mHealth apps, data security and privacy are major concerns for wearable devices as these devices store a huge amount of data [74]. Limitations in the reliability of data, lack of user-friendly platforms, and technological barriers like poor battery life, equipment safety, cost, and efficiency are other limitations of wearable mHealth technology [62].

hIT

Documentation requirements for clinician-patient encounters and interactions have changed over time. While the primary purpose of clinical documentation was originally to serve as a reminder to colleagues and oneself, concerns about malpractice litigation led to the transformation of the chart note into the official record of care provided by the clinician [75]. hIT tools, including electronic health records (EHRs), patient portals, and telemedicine models, can improve patient safety, increase patient engagement, and improve the implementation of clinical guidelines for populations that experience health disparities, such as minorities, the socioeconomically disadvantaged, and underserved rural populations [76, 77]. During the 1960s, EHRs saw their inception in academic centers within the United States. A notable early example is the Computer Stored Ambulatory Record (COSTAR) at Massachusetts General Hospital. In the 1970s, the US Department of Military Affairs introduced the Veteran Health System (VHA), an EHR system granting access to veterans' records. By 2008, only 10% of US hospitals had embraced EHRs, encountering challenges in the transition to digital records. The landscape changed with the HITECH Act of 2009, incentivizing healthcare practices to adopt EHRs. To ensure standards and compliance, EHR technology standards were established by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator [78].

hIT has been crucial in helping pediatric patients with cancer, diabetes, infections, and other conditions to become engaged participants in their own care by supporting and guiding them through their care [79–81]. Since the majority of EHRs were not created with the notion of collecting pediatric data, special certification requirements for pediatric EHRs were developed in the 21st century, and these standards cover a wide range of topics such as growth charts, weight-based dosage, data segmentation, tracking vaccination history, and flags for specific medical needs [82]. In response to the COVID-19 pandemic, Shanghai's designated hospitals for pediatric patients implemented a comprehensive hIT approach, including internet-based tools, face recognition, critical illness warnings, remote consultations, and electronic medical records [83]. This integration facilitated efficient management, with no fatalities or hospital-acquired infections reported. This highlights the pivotal role of hIT in enhancing infectious disease response and patient care.

From the viewpoint of patients or legal health guardians, EHRs expedite the accessibility of a patient's health information to themselves and authorized caregivers while simultaneously offering robust protection against unauthorized disclosure [84]. Granting patients complete access to EHRs empowers them to identify errors, fosters data accuracy, and improves the overall quality of care.

From the perspective of healthcare providers, EHRs represent more than just digital medical record charts; they serve as platforms supporting effective communication, appropriate clinical interventions, quality enhancements, and patient safety [85]. However, concerns associated with hIT usage include insufficient information addressing all patient questions and concerns, potential workflow disruptions due to a potential influx of patient queries, anxiety stemming from unrestricted access to sensitive information, information fragmentation, data overload leading to clinician fatigue and frustration, limited face-to-face conversations, challenges in developing and maintaining hIT systems, and issues related to data security and privacy [84, 86–88].

PM

PM involves tailoring screening, diagnostic, and treatment strategies to align with an individual's specific disease profile. This approach relies on identifying genetic, epigenomic, and clinical data to enhance our comprehension of how a person's unique genomic makeup predisposes them to certain diseases. It's crucial to clarify that PM isn't a therapy customized for an individual patient but rather a treatment plan designed for a specific group of individuals [89, 90]. Since the times of Hippocrates, PM has been in use. Blood, phlegm, yellow bile, and black bile have now been replaced with the A, T, G, and C building blocks of DNA, which have helped medicine advance [91]. With time, in 1969, the concept of a personalized health record (PHR) emerged in an academic journal of Germany. This was a step forward into the future for patients to know how to manage their illnesses [92].

Advancements in hIT, particularly the implementation of EHRs for processing and storing patient data, have significantly increased the acceptance of PM among physicians. This technology plays a key role in the prevention, diagnosis, and treatment of diseases by efficiently managing and leveraging patient information [93]. Further advancements in PM may replace the conventional trail-and-error approach to prescribing medications, where doctors may switch patients to different medications if the initial treatment is not sufficiently effective. This conventional practice can result in adverse side effects, drug interactions, potential disease progression, and patient dissatisfaction [89], which could be mitigated with a PM approach.

A variety of genetic loci determining susceptibility to infectious illnesses, including HIV, tuberculosis, hepatitis, and malaria, have been uncovered through genome-wide association studies (GWAS) [94]. Customized antiviral and antibiotic treatments for pediatric illnesses are more effective due to genetic and molecular traits, enhancing therapeutic efficacy and combating drug resistance. A recent example of effective PM showed that children with recurrent infections who received a 3-month treatment with bacterial vaccine-immunostimulant combinations made from bacterial lysates either from species isolated from patients' own exudates (auto-vaccines) showed a significant reduction in the frequency, intensity, and consequences of Acute Otitis Media episodes after 6 months [95].

From the standpoint of patients or legal health guardians, the advent of PM brings expectations of improved treatment outcomes, enhanced understanding of health information, and early, targeted diagnoses for various disorders, ultimately promoting better treatment results [22, 96]. Patients not only perceive precision medicine as advantageous for their own well-being but also recognize its potential benefits for family members, aiding in the prediction and management of genetic disorders through personalized therapies [23]. A study by Ahmed et al. highlighted privacy and data security as the predominant concern among patients, encompassing worries about data security, confidentiality, reidentification risks, data management flow, and unauthorized data access [24].

From the healthcare provider's perspective, although PM has the potential to enhance the clinical decision-making process and create precisely tailored therapies, many physicians lack familiarity with modern genetic technologies and admit to limited genomic literacy [23, 25]. Challenges arise in understanding and conveying genomic terminology, leading to reduced engagement and satisfaction among physicians. Integrating precision medicine results into daily clinical practice and conducting clinical trials present challenges, emphasizing the need for education and training programs for healthcare professionals [26, 27]. Establishing such programs can bring together experts from various disciplines, including genetics, bioinformatics, and clinical medicine.

Overview of common concerns related to digital health technologies (Figure 2).

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Challenges Associated With Usage of Digital Health Technologies

Integrating DHTs into clinical practice has great potential for enhancing healthcare delivery and streamlining day-to-day operations. However, realizing these benefits isn't as straightforward due to several challenges. Ethical concerns, operational roadblocks, and regulatory complications all stand in the way, each playing a role in how quickly and effectively these tools are adopted [28]. The COVID-19 pandemic has highlighted the critical importance of data sharing, the necessity for robust evaluation frameworks, and ethical considerations within the expanding domain of digital healthcare. Informed patient consent remains a significant challenge, particularly in ensuring transparency regarding data collection practices and third-party data access [29]. As healthcare increasingly relies on digital tools, individuals not only need basic health literacy but also the ability to understand and apply information from electronic sources known as digital health literacy. Without these skills, patients may struggle to interpret health data, use digital platforms effectively, or make informed decisions. These gaps can lead to poor engagement, and reduced adoption of digital health solutions, and may ultimately lead to worse health outcomes [30]. People with poor eHealth literacy are often older and more likely to have chronic health conditions. Likewise, those with less education are less engaged in eHealth activities, such as tracking their diet and exercise or communicating with healthcare providers online [31]. Additionally, people with impairments, physical, sensory, or cognitive limitations often face societal barriers that create de-facto disabilities, and digital health solutions can contribute to these barriers if not designed with accessibility in mind [32]. Geographical disparities also play a huge role in determining the usage of modern digitized technologies. A study by Aldosari et al. showed that South Asian communities face challenges like time constraints, safety, gender sensitivity, and so forth, that may restrict access to digital health services and often overlook social and cultural needs [97]. Certain regions also have different regulations regarding privacy concerns and data protection which could also affect the standardization of DHTs across the globe. Furthermore, the technological infrastructure in different countries depends on their level of development, as developed countries typically have more resources to invest in advancing DHTs [98].

Conclusion

In summary, this review underscores the transformative potential of digital health technologies in addressing the critical issues of early diagnosis and intervention in pediatric infectious diseases. The unique challenges posed by these diseases, especially in vulnerable populations, necessitate innovative solutions for prompt recognition and effective management. Research indicates that digital health applications can play a significant role in detecting and handling pediatric infectious diseases, particularly in settings with limited resources. However, it is essential to address hurdles such as data security, provider confidence, and seamless integration into clinical workflows to fully capitalize on their effectiveness. An approach strategically implementing digital health technologies has the potential to enhance patient outcomes, increase accessibility, and fortify the resilience of healthcare systems.

Author Contributions

Alen Sam Saji: conceptualization, visualization, writing–original draft, writing–review and editing. Aqsa Komel: conceptualization, writing–original draft, writing–review and editing. Muhammad Hamza Khan: conceptualization, writing–original draft, writing–review and editing, visualization. Shreesha Niraula: conceptualization, writing–original draft, writing–review and editing. Babar Naeem: conceptualization, writing–original draft, writing–review and editing. Areeba Ahsan: conceptualization, writing–original draft, writing–review and editing. Achit Kumar Singh: writing–review and editing. Anum Akbar: conceptualization, writing–original draft, writing–review and editing, supervision. All authors have read and approved the final version of the manuscript.

Acknowledgments

The authors have nothing to report.

Disclosure

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study. Anum Akbar had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

Transparency Statement

The lead author, Achit Kumar Singh, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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