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This study examines the development of the connected health (CH) research landscape with a view to providing an overview of the existing CH research. The research field of CH has experienced rapid growth coinciding with increasing pressure on health care systems to become more proactive and patient centered.
This study aimed to assess the extent and coverage of the current body of knowledge in CH. In doing so, we sought to identify specific topics that have drawn the attention of CH researchers and to identify research gaps, in particular those offering opportunities for further interdisciplinary research.
A systematic mapping study that combined scientific contributions from research in the disciplines of medicine, business, computer science, and engineering was used. Overall, seven classification criteria were used to analyze the papers, including publication source, publication year, research type, empirical type, contribution type, research topic, and the medical condition studied.
The search resulted in 208 papers that were analyzed by a multidisciplinary group of researchers. The results indicated a slow start for CH research but showed a more recent steady upswing since 2013. The majority of papers proposed health care solutions (77/208, 37.0%) or evaluated CH approaches (49/208, 23.5%). Case studies (59/208, 28.3%) and experiments (55/208, 26.4%) were the most popular forms of scientific validation used. Diabetes, cancer, multiple sclerosis, and heart conditions were among the most prevalent medical conditions studied.
We conclude that CH research has become an established field of research that has grown over the last five years. The results of this study indicate a focus on technology-driven research with a strong contribution from medicine, whereas the business aspects of CH have received less research attention.
A variety of terms and concepts exist that describe the use of technology in health including
Connected Health encompasses terms such as wireless, digital, electronic, mobile, and tele-health and refers to a conceptual model for health management where devices, services or interventions are designed around the patient’s needs, and health related data is shared, in such a way that the patient can receive care in the most proactive and efficient manner possible. All stakeholders in the process are connected by means of timely sharing and presentation of accurate and pertinent information regarding patient status through smarter use of data, devices, communication platforms, and people.
The European Network for the Joint Evaluation of Connected Health Technologies defines the CH vision as “a paradigm shift looking after the individual and community health in a process that speaks to the health journey of the person, through the entire lifespan, leveraging a variety of technologies to do so” [
Given the recent growth in CH research, we set out to map its evolution up to the present day. We use a systematic mapping study to chart the research landscape combining scientific contributions from the research disciplines of medicine, business, computer science, and engineering. Although previous CH reviews do exist, they are confined to descriptions of how CH solutions are being used in specific conditions such as cancer [
This paper followed a systematic mapping study method [
The method was used to examine the body of existing research conducted by researchers in medicine, business, computer science, and engineering to understand the nature of research conducted in the area of CH. A systematic mapping study was found to be suitable for this task as it provided a high-level framework for combining interdisciplinary research efforts as well as an analytical framework that spanned disciplinary boundaries.
The aim of this study was to present an overview of the available publications pertinent to CH. Following the systematic mapping study method, the study was guided by a set of mapping questions.
Systematic mapping process.
Mapping questions.
ID | Questions | Rationale |
MQa1 | Which publication channels are the main targets for CHb research? | To identify where CH research can be found and to identify targets for publication of future studies |
MQ2 | How has the frequency of studies related to CH changed over time? | To identify the publication trends over time of CH literature |
MQ3 | What are the research types of CH studies? | To explore the different types of research reported in the literature concerning CH |
MQ4 | Are CH studies empirically validated? | To discover whether research on CH has been validated through empirical studies |
MQ5 | What are the approaches that were reported in CH research? | To discover the CH approaches reported in the existing CH literature |
MQ6 | What are the main topics and conditions in CH literature? | To identify the research areas and health conditions discussed in papers |
aMQ: mapping question.
bCH: connected health.
As CH is inherently interdisciplinary, our goal was to use the systematic mapping method to study research contributions on the topic across disciplines. We, therefore, searched papers from the most recognized scientific literature databases in each of the chosen disciplines.
The papers of the study were retrieved from 7 databases of scientific literature, namely, (1) Institute of Electrical and Electronics Engineers Xplore Digital Library, (2) Association for Computing Machinery Digital Library, (3) ScienceDirect, (4) SpringerLink, (5) MEDLINE and PubMed, (6) Business Source Complete (EBSCO), and (7) ABI and INFORM Collection (ProQuest), with the help of the corresponding search engines. The search was performed in October 2018. Different search strings were proposed and discussed over the course of joint meetings to arrive at a set of primary keywords. Two of the authors tested different strings of potential keywords such as “Connect Health,” “Connecting Health,” “Connect-Health,” or “Connecting-Health.” After evaluating the search results, the authors agreed to proceed using the following search strings: (“Connected” AND “Health”) OR (“Connected” AND “-” AND “Health”).
The search was applied to the title, abstract, and keywords to include relevant papers. On the basis of our methodology, we included a wide selection of papers on the first iteration and thereafter relied upon the inclusion criteria and EC to identify the relevant literature [
The search results that were retrieved from the 7 chosen search engines were merged in a single list and saved in a spreadsheet document. Duplicate entries were removed based on the digital object identifier (DOI) and the intertitle lexical distance (the Levenshtein metric was used to measure the lexical distance) with the help of a custom Python script [
The final list of papers was distributed to all authors for analysis. On the basis of the area of expertise, pairs of authors were assigned to analyze papers retrieved from each database. A total of 3 areas of expertise were identified as follows: technical (computer science and engineering), medical, and business. Each pair of authors reviewed the title, abstract, and keywords and made a recommendation as to whether that paper should be included or excluded. Discrepancies across coding teams were resolved through further scrutiny of the paper.
The inclusion criteria were limited to studies that discussed CH. In total, 240 papers were identified after the removal of duplicates, whereas 32 papers were excluded after meeting at least one of the following exclusion criteria: EC1—papers that focus on CH comorbidities, that is, the paper discusses the connection between health conditions, not CH as a concept; EC2—papers that focus on law; EC3—papers that focus on medical procedures only, without connection to CH; and EC4—papers that focus on evaluating climate but not in relation to CH.
Study selection process. ACM: Association for Computing Machinery; DB: database; DOI: digital object identifier; IEEE: Institute of Electrical and Electronics Engineers.
The selected studies were analyzed to collect information that would give answers to the MQs according to the data extraction strategy outlined in
Data extraction strategy.
Mapping questions | Description of classification categories |
MQa1 | Publication source and publication channel |
MQ2 | Publication year |
MQ3 | Research types [ |
MQ4 | Empirical types [ |
MQ5 | Contribution types: method—a manner of procedure and steps taken to acquire knowledge in CH; tool-based technique—a technique based on a software tool to accomplish CH tasks; model—a system representation that allows CH to be investigated through a hierarchical structure; framework—a real or conceptual structure intended to serve as a support or guide for CH; other—the remainder of CH approaches. This includes CH studies of approach not fitting other classes, along with very rare approaches that have been grouped in this category to facilitate abstraction and visualization. The approaches grouped herein are feasibility study, field research, process, guideline, and network analysis |
MQ6 | Main topics and medical conditions |
aMQ: mapping question.
bCH: connected health.
MQ6 comprised 2 parameters: the topic of the paper and the medical condition examined within it. With regard to the topic of the paper, we did not have a predefined list of topics but relied on an open coding process where the researchers conducting the analysis selected a descriptive word for the topic of the paper. To identify the main topics of the included papers, the authors relied on the title, abstract, and keywords. After compiling all topic words, we curated the topic list to come up with a consistent list (eg, using the same word for
The synthesis method used was based on the following steps: (1) enumerating the number of papers per publication channel and the number of papers per bibliographic source per year; (2) enumerating the primary studies that are classified in each MQ’s response; (3) presenting visualizations for the classification results, which have been used in the analysis; and (4) presenting a narrative summary to discuss the principal findings.
This section describes the results related to the systematic MQs presented in
Publication trend per year−total number of connected health papers published per year; the number of papers reported for the year 2018 only includes papers published until October 2018, with a projection of estimated papers based on linear extrapolation (presented as superimposed gray line).
Bubble graphs associating the empirical types with the research types (left) and the approaches (right) of the included connected health studies. The vertical axis (empirical type) is shared between the two graphs. The size and shade of each bubble represents the absolute frequency of connected health papers belonging to a given pair of empirical type and research type (left) or approach (right); absolute frequencies less than 5 are not typed inside the bubble because of space limitations. The horizontal and vertical axes labels are accompanied by the relative frequency (ie, percentage) of the class.
The majority of the CH papers were published in scientific journals (139/208, 66.8%), whereas 32.9% (68/208) were published in scientific conferences.
Publication sources that have published 2 or more connected health papers.
Publication source | References | Number of published papers |
Studies in Health Technology and Informatics | Topaz and Pruinelli (2017) [ |
14 |
Journal of Medical Systems | Wen (2013) [ |
9 |
Telemedicine and eHealtha | Ford et al (2018) [ |
7 |
JMIR mHealth and uHealth | Wang et al (2018) [ |
7 |
Health Affairs (Millwood) | Frist (2014) [ |
4 |
JMIRb | Sperrin et al (2016) [ |
4 |
QJMc: An International Journal of Medicine | Caulfield (2013) [ |
4 |
Journal of Diabetes Science and Technology | Watson et al (2008) [ |
4 |
Journal of the American Academy of Audiology | Saunders and Jacobs (2015) [ |
3 |
JMIR Research Protocols | Mountford et al (2018) [ |
2 |
International Journal of Medical Informatics | Giunti et al (2018) [ |
2 |
Maturitas | Chouvarda et al (2015) [ |
2 |
JMIR Human Factors | Harte et al (2017) [ |
2 |
Journal of Personalized Medicine | Agboola and Kvedar (2012) [ |
2 |
Revue de l'infirmiere | Warnet (2017) [ |
2 |
In the 31st International Symposium on computer-based medical systems | Barbosa et al (2018) [ |
2 |
In the 14th International Conference on Telecommunications | Starič et al (2017) [ |
2 |
In Proceedings of the International Workshop on Software Engineering in Healthcare Systems | Carroll and Richardson (2016) [ |
2 |
BMCd Medical Informatics and Decision Making | Allaert et al (2017) [ |
2 |
In the First International Conference on Connected Health: Applications, Systems, and Engineering Technologies | Sinharay et al (2016) [ |
2 |
Journal of Evaluation in Clinical Practice | Barr et al (2012) [ |
2 |
American Journal of Hospice and Palliative Medicine | Aktas et al (2015) [ |
2 |
aeHealth: electronic health.
bJMIR: Journal of Medical Internet Research.
cQJM: Quarterly Journal of Medicine.
dBMC: BioMed Central.
Frequencies of the main topics associated with the reviewed articles; main topics with a single occurrence have not been included because of space limitations (N=208).
Topics | Frequency (%) |
Health care | 16 (7.6) |
Disease management | 13 (6.2) |
Telemedicine/telehealth | 11 (5.2) |
Electronic health/mobile health | 9 (4.3) |
Monitoring | 8 (3.8) |
Security | 8 (3.8) |
Consumer health informatics | 7 (3.3) |
Sensors | 6 (2.8) |
Information and communication technologies challenges | 5 (2.4) |
Personal health devices | 4 (1.9) |
Education | 3 (1.4) |
Usability | 3 (1.4) |
Medical education | 3 (1.4) |
Innovation | 3 (1.4) |
User-centered design | 3 (1.4) |
Interoperability | 3 (1.4) |
The internet of things | 3 (1.4) |
Software engineering | 2 (0.9) |
Privacy | 2 (0.9) |
Medication adherence | 2 (0.9) |
Lifestyle coaching | 2 (0.9) |
Ageing | 2 (0.9) |
Personalization | 2 (0.9) |
Service delivery | 2 (0.9) |
Elderly | 2 (0.9) |
Frequencies of the target conditions associated with the reviewed articles; of note, only 77 of the reviewed articles have been mapped to a target condition (N=208).
Condition | Frequency (%) |
No (condition) | 131 (62.9) |
Diabetes | 12 (5.7) |
Ageing | 10 (4.8) |
Cardiovascular diseases | 10 (4.8) |
Cancer | 7 (3.3) |
Chronic diseases | 7 (3.3) |
Dementia | 4 (1.9) |
Multiple sclerosis | 3 (1.4) |
Stroke | 2 (0.9) |
Mental health | 2 (0.9) |
General health | 2 (0.9) |
Psychosis | 1 (0.4) |
Chronic skin disease (psoriasis, dermatology) | 1 (0.4) |
Vital signs | 1 (0.4) |
Stress | 1 (0.4) |
Renal conditions | 1 (0.4) |
Malaria | 1 (0.4) |
Hemodialysis | 1 (0.4) |
Dental issues | 1 (0.4) |
Arrhythmia | 1 (0.4) |
Obesity | 1 (0.4) |
Palliative care | 1 (0.4) |
Urinary incontinence | 1 (0.4) |
Epilepsy | 1 (0.4) |
Rheumatoid arthritis | 1 (0.4) |
Glaucoma | 1 (0.4) |
Blood transfusion service | 1 (0.4) |
Hearing issues | 1 (0.4) |
Environmental exposure | 1 (0.4) |
This section discusses the results and main findings of this study. First, each mapping question is discussed in its specific subsection. Finally, the limitations of this study are discussed.
Publication channels provide information about how research activities in CH have been established in the scientific community. The results of this study show that the majority of CH publications appear in peer-reviewed scientific journals (139/208, 66.8%). Although both journals and conferences aim to disseminate research and contribute to the development of a field, journals are typically considered more prestigious because of manuscript review criteria and acceptance practices. In addition, journals usually present more extended pieces of research work and contribute toward the establishment of a knowledge base for a field. Although the process of publication is longer compared with conferences, journals potentially have a larger impact in terms of visibility and audience reach [
The papers matching our inclusion criteria, while spanning a publishing period from 2000 to 2018, show that CH research has attracted increasing attention since 2013. A publication gap between 2001 and 2004 coincides with the infancy of the CH field, likely reflecting the fact that the evolution of CH research was a slow and gradual process underpinned by the fermentation of experts from different academic disciplines. Overall,
Our results show that CH researchers focused primarily on suggesting novel solutions or extending existing research to explain, identify, and provide details of the CH approach (77/208, 37.0%). The 23.5% (49/208) of papers that centered on evaluation also represent attempts to comprehend and develop previous research through evaluating a solution with a valid approach [
Our findings support the idea that over half of the CH studies are based on empirically informed approaches. More specifically, the majority of the solution proposals were empirically validated with case studies (59/208, 28.3%), followed by experiments (55/208, 26.4%), whereas 13.4% (28/208) used surveys. Case studies have been shown to be particularly suited to
The results for this MQ show that the majority of the included papers belong to other types of studies (66/208, 31.7%), which means that they used approaches that were not defined by our classification scheme. This finding could arise from a variety of factors. More than half of the included papers were from the medical discipline, a fact that has given rise to classification challenges, as reviewers were not able to fit them into one of the defined categories. Although mapping studies are common in the medical discipline [
The topic analysis shows that technical and medical disciplines dominate the research topics of the papers, with some references to related disciplines such as education or innovation research. The topic descriptions show a large body of papers discussing measurement-based monitoring with sensors and wearables. This reflects the fast development of body-worn sensors and wireless communication methods that allow the transfer and storage of large amounts of data for further analysis. Another body of papers focused on patient perspectives in CH solutions through a consumer viewpoint or user-centered design, which might reflect an increasing interest in patient empowerment and self-management solutions. The growth of CH as a research field might also reflect regulatory moves toward a data economy where rules for using personal data are clearer (eg, General Data Protection Regulation). Related topics included security, privacy, and interoperability issues. It has been suggested that leveraging interoperable CH technologies for chronic disease management can have multiple positive effects not only on patients but also on clinical outcomes, thus contributing, for example, to the promotion of outpatient care [
Diabetes, cancer, and chronic heart conditions dominate the medical conditions covered. This is unsurprising given that these are leading health problems on the global stage [
Owing to the interdisciplinary nature of our topic, we used an interdisciplinary team of researchers for analysis. Having researchers with different backgrounds could decrease inter-rater reliability, especially where we did not have a predefined list of values, as with the
The differences in publication practices between the disciplines probably had an influence on how the results of MQ1 were interpreted, as the role of conference and journal publications differs between disciplines [
As the methodology of the systematic mapping study that we used in this research was originally developed in the context of software engineering, it is likely that some of the analysis parameters were less optimal in other disciplines. This is reflected, for example, in the large number of studies classified into the category
To limit the threat related to the identification of primary studies and to include as many relevant papers as possible, 2 of the authors ran several iterations to test different strings of keywords. The adoption of the final set of keywords was used as it returned the largest number of studies. However, the list of studies might be incomplete, as additional or different terms might have an impact on the final selection of papers [
Our search strategy and inclusion criteria have omitted studies that are referenced in grey literature. However, the literature search was conducted in the world’s most leading and comprehensive databases for scientific knowledge. Furthermore, to alleviate the threat of publications’ nonavailability because of subscription paywalls, we performed the initial screening using a combination of university libraries to improve our access to papers. To address validity threats because of duplication, duplicate entries were removed based on the DOI and the intertitle lexical distance with the help of a custom Python script, which was ultimately manually reviewed to ensure duplicate removal.
On the basis of our results, we can conclude that CH research is an established field of research. The interdisciplinary nature of the field can be seen especially in papers at the intersection of the medical and technical disciplines. The number of papers in the business research publication forums is still smaller. However, business-related themes are visible in topics of papers, such as consumer orientation and innovation research, although at a much smaller scale than the topics of more technical and medical nature. For CH to succeed, money needs to move differently around the health care system. Most developed health care systems continue to reimburse care in a
There is a growing need to involve and engage patients in their own care and, by extension, in the design of digital solutions to improve their efficacy. Tailored CH interventions may more effectively reach the intended audience in a meaningful way, but this requires in-depth understanding of the condition’s needs, barriers, and facilitators. The important role that health care professionals play in the health care system is in contrast with their lack of involvement in the design of CH. In the same vein, recent research suggests that health care professionals’ education in Europe is lacking in the area of health care information technologies [
Given that CH research has become far more widespread in the years since 2013, perhaps it is time to devote more research resources to the scalability of CH as reflected in empirical approaches that facilitate the use of larger populations.
We see our findings as the foundations of a research roadmap for CH researchers that challenge current thinking in health care. Such a research agenda would go beyond investigations into the feasibility of individual technical solutions to examine and develop ecosystems of stakeholders, technologies, and infrastructures that together form new kinds of systemic solutions. Such an agenda would require more focus on research that addresses interdisciplinary methodological questions alongside the creation of vocabularies and frameworks for researchers working in different disciplines to effectively collaborate and examine interdisciplinary research questions through joint methodological approaches.
Classification results for all the included papers.
BioMed Central
cancer: activating technology for connected health
connected health
connected health early stage researcher support system
Cooperation in Science and Technology
digital object identifier
exclusion criteria
electronic health
Journal of Medical Internet Research
mapping questions
personal health record
Quarterly Journal of Medicine.
This paper is based upon work from European Cooperation in Science and Technology (COST) Action ENJECT TD 1405, supported by COST.
This research has been supported by a grant from the Tatra banka Foundation (2018vs108).
MK and MI conceived, designed, led overall study conduct. MK and CM carried out the data collection and curation of visualizations. MK and MI and drafted the first version of the manuscript. All the authors except CM led analysis and interpretation of the data, NM proofread the final manuscript and suggested modifications. All authors read and approved the final manuscript.
None declared.