"Simplification, decentralization, proximity" - A critical analysis of the digital health framework in Portugal through expert interviews.

Background: The implementation of digital health tools and services encounters policy and governance challenges tied to a complex web of stakeholders and influencing factors. This study seeks analyse the digital health framework in Portugal, focusing on digital health policies and interventions.

Methods: Through a multifaceted approach, this study included the conduction of expert interviews, and an extensive assessment of publicly available official documents, thus allowing a thorough analysis of the national digital health framework. To consolidate all the information gathered, a SWOT analysis was subsequently performed.

Results: Eight experts involved with digital health in Portugal were interviewed. Seven key themes were identified and discussed alongside the data extracted from document analysis: 1) the digital health context in Portugal; 2) digital health services, tools, and infrastructure in Portugal: strengths and limitations; 3) budget and resources allocation towards digital health in Portugal; 4) digital health development in Portugal: current status and necessary steps; 5) Digital health accessibility and digital health literacy in Portugal; 6) COVID-19 pandemic and its impact on digital [health] tools usage; and 7) comparison of the digital health framework with other countries: lessons to learn.

Conclusions: As digital health has gained momentum in Portugal over the years, it is crucial to enhance governance and transparency, connect digital infrastructures, and promote data availability. These measures, along with a well-defined strategic vision, are essential for cultivating a robust digital health ecosystem.