@Article{info:doi/10.2196/66451,
author="Jia, Shafeng
and Zhu, Naifeng
and Liu, Jia
and Cheng, Niankai
and Jiang, Ling
and Yang, Jing",
title="Construction and Application of an Information Closed-Loop Management System for Maternal and Neonatal Access and Exit Rooms: Non Randomized Controlled Trial",
journal="JMIR Med Inform",
year="2025",
month="Apr",
day="7",
volume="13",
pages="e66451",
keywords="mother-infant same-room management",
keywords="information-based identity verification",
keywords="closed-loop management system",
keywords="newborn safety management",
abstract="Background: Traditional management methods can no longer meet the demand for efficient and accurate neonatal care. There is a need for an information-based and intelligent management system. Objective: This study aimed to construct an information closed-loop management system to improve the accuracy of identification in mother-infant rooming-in care units and enhance the efficiency of infant admission and discharge management. Methods: Mothers who delivered between January 2023 and June 2023 were assigned to the control group (n=200), while those who delivered between July 2023 and May 2024 were assigned to the research group (n=200). The control group adopted traditional management methods, whereas the research group implemented closed-loop management. Barcode technology, a wireless network, mobile terminals, and other information technology equipments were used to complete the closed loop of newborn exit and entry management. Data on the satisfaction of mothers and their families, the monthly average qualification rate of infant identity verification, and the qualification rate of infant consultation time were collected and statistically analyzed before and after the closed-loop process was implemented. Results: After the closed-loop process was implemented, the monthly average qualification rate of infant identity verification increased to 99.45 (SD 1.34), significantly higher than the control group before implementation 83.58 (SD 1.92) (P=.02). The satisfaction of mothers and their families was 96.45 (SD 3.32), higher than that of the control group before the closed-loop process was implemented 92.82 (SD 4.73) (P=.01). Additionally, the separation time between infants and mothers was restricted to under 1 hour. Conclusion: The construction and application of the information closed-loop management system significantly improved the accuracy and efficiency of maternal and infant identity verification, enhancing the safety of newborns. ",
doi="10.2196/66451",
url="https://medinform.jmir.org/2025/1/e66451"
}


@Article{info:doi/10.2196/62916,
author="Kostiuk, Marisa
and Moore, L. Susan
and Kramer, Seth E.
and Gilens, Felton Joshua
and Sarwal, Ashwin
and Saxon, David
and Thomas, F. John
and Oser, K. Tamara",
title="Assessment and Intervention for Diabetes Distress in Primary Care Using Clinical and Technological Interventions: Protocol for a Single-Arm Pilot Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="31",
volume="14",
pages="e62916",
keywords="diabetes care",
keywords="diabetes distress",
keywords="primary care",
keywords="healthcare chatbot",
keywords="artificial intelligence",
keywords="eConsult",
keywords="care pathways",
keywords="clinical workflows",
abstract="Background: Diabetes distress (DD) is a common emotional response to living with diabetes. If not addressed, DD can have negative impacts on diabetes management, including the progression to mental health conditions such as depression and anxiety. Routine screening and treatment for DD is recommended, with primary care being an ideal setting given that the majority of people with diabetes receive their diabetes care from primary care providers. However, consistent screening of DD does not routinely occur in primary care settings. Research is needed to understand how to effectively and feasibly integrate DD screening and treatment into routine diabetes care. Objective: This study aims to (1) design and implement individualized technology-supported DD workflows, (2) evaluate the primary outcome of determining the acceptability and feasibility of integrating technology-based workflows to provide treatment for DD, and (3) evaluate the secondary outcomes of changes in DD, depression, and anxiety (baseline, 3 months, and 6 months) in patients receiving screening and personalized treatment. Methods: In total, 30 English and Spanish-speaking primary care patients with either type 1 or type 2 diabetes will receive screening for DD during clinical visits and subsequent support from an artificial intelligence (AI)--based health care chatbot with interactive tailored messaging. In addition, the use of electronic consultation with a specialist or referral to a behavioral health provider could occur depending on the severity and source of DD. The use of electronic consultations allows providers convenient and timely asynchronous access to a range of specialty care providers. Health outcomes will be measured through changes in validated screening measures for DD, depression, and anxiety. Digital outcomes will be measured through surveys assessing user experience with technology and system usability, and by system performance data. Qualitative data on acceptability and satisfaction with the clinical workflows and technological interventions will be collected through interviews with patients and clinical providers. Descriptive statistics will summarize quantitative outcome measures and responses to closed-ended survey items, and rapid thematic and content analysis will be conducted on open-ended survey and interview data. Results: Workflows for screening and treating DD have been approved and clinical staff have received training on the process. Electronic surveys for screening measure collection have been created. Data from visit screeners will be entered into the electronic medical record during the medical appointment. Recruitment will begin late June-July 2024. Conclusions: This study is expected to demonstrate the feasibility and acceptability of integrating individualized workflows for DD into primary care. Improving clinical and digital interventions for addressing DD in primary care can provide alternative care options for busy clinical providers. This study is intended to deliver whole-person diabetes care to people with diabetes within a primary care setting. International Registered Report Identifier (IRRID): PRR1-10.2196/62916 ",
doi="10.2196/62916",
url="https://www.researchprotocols.org/2025/1/e62916"
}


@Article{info:doi/10.2196/63895,
author="J{\o}rgensen, Lee Natasha
and Merrild, Hoffmann Camilla
and Jensen, Bach Martin
and Moeslund, B. Thomas
and Kidholm, Kristian
and Thomsen, Laust Janus",
title="The Perceptions of Potential Prerequisites for Artificial Intelligence in Danish General Practice: Vignette-Based Interview Study Among General Practitioners",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="12",
volume="13",
pages="e63895",
keywords="general practice",
keywords="general practitioners",
keywords="GPs",
keywords="artificial intelligence",
keywords="AI",
keywords="prerequisites",
keywords="interviews",
keywords="vignettes",
keywords="qualitative study",
keywords="thematic analysis",
abstract="Background: Artificial intelligence (AI) has been deemed revolutionary in medicine; however, no AI tools have been implemented or validated in Danish general practice. General practice in Denmark has an excellent digitization system for developing and using AI. Nevertheless, there is a lack of involvement of general practitioners (GPs) in developing AI. The perspectives of GPs as end users are essential for facilitating the next stage of AI development in general practice. Objective: This study aimed to identify the essential prerequisites that GPs perceive as necessary to realize the potential of AI in Danish general practice. Methods: This study used semistructured interviews and vignettes among GPs to gain perspectives on the potential of AI in general practice. A total of 12 GPs interested in the potential of AI in general practice were interviewed in 2019 and 2021. The interviews were transcribed verbatim and thematic analysis was conducted to identify the dominant themes throughout the data. Results: In the data analysis, four main themes were identified as essential prerequisites for GPs when considering the potential of AI in general practice: (1) AI must begin with the low-hanging fruit, (2) AI must be meaningful in the GP's work, (3) the GP-patient relationship must be maintained despite AI, and (4) AI must be a free, active, and integrated option in the electronic health record (EHR). These 4 themes suggest that the development of AI should initially focus on low-complexity tasks that do not influence patient interactions but facilitate GPs' work in a meaningful manner as an integrated part of the EHR. Examples of this include routine and administrative tasks. Conclusions: The research findings outline the participating GPs' perceptions of the essential prerequisites to consider when exploring the potential applications of AI in primary care settings. We believe that these perceptions of potential prerequisites can support the initial stages of future development and assess the suitability of existing AI tools for general practice. ",
doi="10.2196/63895",
url="https://medinform.jmir.org/2025/1/e63895"
}


@Article{info:doi/10.2196/59801,
author="Park, Adam
and Jung, Young Se
and Yune, Ilha
and Lee, Ho-Young",
title="Applying Robotic Process Automation to Monitor Business Processes in Hospital Information Systems: Mixed Method Approach",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="7",
volume="13",
pages="e59801",
keywords="robotic process automation",
keywords="RPA",
keywords="electronic medical records",
keywords="EMR",
keywords="system monitoring",
keywords="health care information systems",
keywords="user-centric monitoring",
keywords="performance evaluation",
keywords="business process management",
keywords="BPM",
keywords="healthcare technology",
keywords="mixed methods research",
keywords="process automation in health care",
abstract="Background: Electronic medical records (EMRs) have undergone significant changes due to advancements in technology, including artificial intelligence, the Internet of Things, and cloud services. The increasing complexity within health care systems necessitates enhanced process reengineering and system monitoring approaches. Robotic process automation (RPA) provides a user-centric approach to monitoring system complexity by mimicking end user interactions, thus presenting potential improvements in system performance and monitoring. Objective: This study aimed to explore the application of RPA in monitoring the complexities of EMR systems within a hospital environment, focusing on RPA's ability to perform end-to-end performance monitoring that closely reflects real-time user experiences. Methods: The research was conducted at Seoul National University Bundang Hospital using a mixed methods approach. It included the iterative development and integration of RPA bots programmed to simulate and monitor typical user interactions with the hospital's EMR system. Quantitative data from RPA process outputs and qualitative insights from interviews with system engineers and managers were used to evaluate the effectiveness of RPA in system monitoring. Results: RPA bots effectively identified and reported system inefficiencies and failures, providing a bridge between end user experiences and engineering assessments. The bots were particularly useful in detecting delays and errors immediately following system updates or interactions with external services. Over 3 years, RPA monitoring highlighted discrepancies between user-reported experiences and traditional engineering metrics, with the bots frequently identifying critical system issues that were not evident from standard component-level monitoring. Conclusions: RPA enhances system monitoring by providing insights that reflect true end user experiences, which are often overlooked by traditional monitoring methods. The study confirms the potential of RPA to act as a comprehensive monitoring tool within complex health care systems, suggesting that RPA can significantly contribute to the maintenance and improvement of EMR systems by providing a more accurate and timely reflection of system performance and user satisfaction. ",
doi="10.2196/59801",
url="https://medinform.jmir.org/2025/1/e59801",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053771"
}


@Article{info:doi/10.2196/65932,
author="Li, Xuezhu
and Huang, Lifeng
and Zhang, Hui
and Liang, Zhanming",
title="Enabling Telemedicine From the System-Level Perspective: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="5",
volume="27",
pages="e65932",
keywords="telemedicine",
keywords="telehealth",
keywords="digital health",
keywords="success factors",
keywords="challenges",
abstract="Background: Telemedicine is a strategy for providing health care services remotely that improves service accessibility. Telemedicine has attracted growing research interest in the past 10 years, including systematic reviews that synthesize evidence to share experiences and enhance knowledge. However, most of the published systematic reviews have focused on synthesizing evidence from studies on telemedicine at the organizational level. A collected understanding of factors on the system level that influence the successful implementation and adoption of telemedicine needs to be developed, especially in regional and rural areas. Objective: This scoping review aims to explore key success factors and challenges that influence the implementation and adoption of telemedicine at the system level, particularly in regional and rural areas. Methods: This scoping review was conducted in accordance with the framework by Arksey and O'Malley and reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 5 databases (CINAHL, Cochrane, Medline, Ovid, and Scopus) were searched for research articles published in English between January 2010 and 2023, using the established inclusion criteria. Results: Of the 10,691 papers identified, 89 were included in this review, including 16 (17.98\%) studies conducted in regional and rural areas and 13 (14.61\%) in metropolitan areas. Another 13 (14.61\%) studies were conducted in both metropolitan areas and regional and rural areas. Overall, 6 categories with more than 70 key success factors, including system-level requirements (n=13, 18.40\%), economic considerations and funding (n=6, 8.70\%), technological requirements (n=6, 8.70\%), organizational requirements (n=19, 27.54\%), understanding and supporting clinicians (n=12, 17.39\%), and understanding and improving patients' perceptions (n=13, 18.84\%), were identified. Additionally, 5 categories containing over 50 challenges, including those related to system levels (n=11, 23.91\%), technological requirements (n=6, 13.04\%), organizational requirements (n=13, 28.26\%), clinicians (n=10, 21.74\%), and patients (n=6, 13.04\%), were identified. Among the identified factors, 11 (9.57\%) were specific to regional and rural areas. Conclusions: This scoping review confirms that the successful implementation of telemedicine requires collective efforts at both the system and organizational levels, including coordination and collaboration across different regions and organizations. It underscores the importance of establishing a national network that enhances public awareness of telemedicine and clarity in payment and benefit distribution models and strengthens data security protection measures. The review also highlights the necessity of addressing infrastructural deficiencies, including internet connectivity in regional and rural areas, and suggests the implementation of targeted incentives and support measures. The required collective efforts are detailed in the proposed framework that promotes popularizing telemedicine, enhancing the overall quality and efficiency of health care services, and achieving broader health equity. ",
doi="10.2196/65932",
url="https://www.jmir.org/2025/1/e65932",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053725"
}


@Article{info:doi/10.2196/65549,
author="Lv, Chen
and Gong, Yi-Hong
and Wang, Xiu-Hua
and An, Jun
and Wang, Qian
and Han, Jing
and Chen, Xiao-Feng",
title="Correlation Between Diagnosis-Related Group Weights and Nursing Time in the Cardiology Department: Cross-Sectional Study",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="4",
volume="13",
pages="e65549",
keywords="diagnosis-related groups",
keywords="nursing time",
keywords="workload",
keywords="human resources",
keywords="nursing",
abstract="Background: Diagnosis-related group (DRG) payment has become the main form of medical expense settlements, and its application is becoming increasingly extensive. Objective: This study aimed to explore the correlation between DRG weights and nursing time and to develop a predictive model for nursing time in the cardiology department based on DRG weights and other factors. Methods: A convenience sampling method was used to select patients who were hospitalized in the cardiology ward of Beijing Chest Hospital between April 2023 and April 2024. Nursing time was measured by direct and indirect nursing time. To determine the distributions of nursing time based on different demographics, a Pearson correlation was used to analyze the relationship between DRG weight and nursing time, and a multiple linear regression was used to determine the influencing factors of total nursing time. Results: A total of 103 subjects were included in this study. The DRG weights were positively correlated with direct nursing time (r=0.480; P<.001), indirect nursing time (r=0.394; P<.001), and total nursing time (r=0.448; P<.001). Moreover, age was positively correlated with the 3 nursing times (direct: r=0.235; indirect: r=0.192; total: r=0.235; all P<.001). The activities of daily living (ADL) score on admission was negatively correlated with the 3 nursing times (direct: r=?0.316; indirect: r=?0.252; total: r=?0.301; all P<.001). In addition, the nursing level on the first day of admission was positively correlated with the 3 nursing times (direct: r=0.333; indirect: r=0.332; total: r=0.352; all P<.001). Furthermore, the multivariate analysis found that the nursing level on the first day of admission, complications or comorbidities, DRG weight, and ADL score on admission were the influencing factors of nursing time (R2=0.328; F5,97=69.58; P<.001). Conclusions: DRG weight showed a strong correlation with nursing time and could be used to predict nursing time, which may assist in nursing resource allocation in cardiology departments. ",
doi="10.2196/65549",
url="https://medinform.jmir.org/2025/1/e65549"
}


@Article{info:doi/10.2196/63610,
author="Seo, Woosuk
and Jain, Shruti
and Le, Vivian
and Li, Jiaqi
and Zhang, Zhan
and Singh, Hardeep
and Pasupathy, Kalyan
and Mahajan, Prashant
and Park, Young Sun",
title="Designing Patient-Centered Interventions for Emergency Care: Participatory Design Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="12",
volume="9",
pages="e63610",
keywords="emergency department",
keywords="participatory design",
keywords="patient",
keywords="technology",
keywords="intervention",
abstract="Background: Emergency departments (EDs) are high-pressure environments where clinicians diagnose patients under significant constraints, including limited medical histories, severe time pressures, and frequent interruptions. Current ED care practices often inadequately support meaningful patient participation. Most interventions prioritize clinical workflow and health care provider communication, inadvertently overlooking patients' needs. Additionally, patient-facing technologies in EDs are typically developed without meaningful patient input, leading to solutions that may not effectively address patients' specific challenges. To enhance both patient-centered care practices and the diagnosis process in EDs, patient involvement in technology design is essential to ensure their needs during emergency care are understood and addressed. Objective: This study aimed to invite ED patients to participatory design sessions, identify their needs during ED visits, and present potential design guidelines for technological interventions to address these needs. Methods: We conducted 8 design sessions with 36 ED patients and caregivers to validate their needs and identify considerations for designing patient-centered interventions to improve diagnostic safety. We used 10 technological intervention ideas as probes for a needs evaluation of the study participants. Participants discussed the use cases of each intervention idea to assess their needs during the ED care process. We facilitated co-design activities with the participants to improve the technological intervention designs. We audio- and video-recorded the design sessions. We then analyzed session transcripts, field notes, and design sketches. Results: On the basis of ED patients' feedback and evaluation of our intervention designs, we found the 3 most preferred intervention ideas that addressed the common challenges ED patients experience. We also identified 4 themes of ED patients' needs: a feeling of inclusion in the ED care process, access to sources of medical information to enhance patient comprehension, addressing patient anxiety related to information overload and privacy concerns, and ensuring continuity in care and information. We interpreted these as insights for designing technological interventions for ED patients. Therefore, on the basis of the findings, we present five considerations for designing better patient-centered interventions in the ED care process: technology-based interventions should (1) address patients' dynamic needs to promote continuity in care; (2) consider the amount and timing of information that patients receive; (3) empower patients to be more active for better patient safety and care quality; (4) optimize human resources, depending on patients' needs; and (5) be designed with the consideration of patients' perspectives on implementation. Conclusions: This study provides unique insights for designing technological interventions to support ED diagnostic processes. By inviting ED patients into the design process, we present unique insights into the diagnostic process and design considerations for designing novel technological interventions to enhance patient safety. International Registered Report Identifier (IRRID): RR2-10.2196/55357 ",
doi="10.2196/63610",
url="https://formative.jmir.org/2025/1/e63610"
}


@Article{info:doi/10.2196/57231,
author="Lopes, Jo{\~a}o
and Guimar{\~a}es, Tiago
and Duarte, J{\'u}lio
and Santos, Manuel",
title="Enhancing Surgery Scheduling in Health Care Settings With Metaheuristic Optimization Models: Algorithm Validation Study",
journal="JMIR Med Inform",
year="2025",
month="Feb",
day="11",
volume="13",
pages="e57231",
keywords="health care",
keywords="surgery scheduling problem",
keywords="metaheuristic model",
keywords="model optimization",
keywords="surgery scheduling",
keywords="artificial intelligence",
abstract="Background: Health care is facing many challenges. The recent pandemic has caused a global reflection on how clinical and organizational processes should be organized, which requires the optimization of decision-making among managers and health care professionals to deliver care that is increasingly patient-centered. The efficiency of surgical scheduling is particularly critical, as it affects waiting list management and is susceptible to suboptimal decisions due to its complexity and constraints. Objective: In this study, in collaboration with one of the leading hospitals in Portugal, Centro Hospitalar e Universit{\'a}rio de Santo Ant{\'o}nio (CHUdSA), a heuristic approach is proposed to optimize the management of the surgical center. Methods: CHUdSA's surgical scheduling process was analyzed over a specific period. By testing an optimization approach, the research team was able to prove the potential of artificial intelligence (AI)--based heuristic models in minimizing scheduling penalties---the financial costs incurred by procedures that were not scheduled on time. Results: The application of this approach demonstrated potential for significant improvements in scheduling efficiency. Notably, the implementation of the hill climbing (HC) and simulated annealing (SA) algorithms stood out in this implementation and minimized the scheduling penalty, scheduling 96.7\% (415/429) and 84.4\% (362/429) of surgeries, respectively. For the HC algorithm, the penalty score was 0 in the urology, obesity, and pediatric plastic surgery medical specialties. For the SA algorithm, the penalty score was 5100 in urology, 1240 in obesity, and 30 in pediatric plastic surgery. Together, this highlighted the ability of AI-heuristics to optimize the efficiency of this process and allowed for the scheduling of surgeries at closer dates compared to the manual method used by hospital professionals. Conclusions: Integrating these solutions into the surgical scheduling process increases efficiency and reduces costs. The practical implications are significant. By implementing these AI-driven strategies, hospitals can minimize patient wait times, maximize resource use, and enhance surgical outcomes through improved planning. This development highlights how AI algorithms can effectively adapt to changing health care environments, having a transformative impact. ",
doi="10.2196/57231",
url="https://medinform.jmir.org/2025/1/e57231"
}


@Article{info:doi/10.2196/57847,
author="Bamgboje-Ayodele, Adeola
and Boscolo, Adrian
and Burger, Mitchell
and Hutchings, Owen
and Shaw, Miranda
and Shaw, Tim
and Tariq, Amina
and Naicker, Sundresan
and McPhail, Steven
and Baysari, Melissa",
title="Health IT Implementation and the Impact of the COVID-19 Pandemic on Clinician-IT Dynamics: Qualitative Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="11",
volume="27",
pages="e57847",
keywords="health IT",
keywords="implementation",
keywords="COVID-19 pandemic",
keywords="process evaluation",
keywords="sociotechnical factors",
keywords="virtual hospital",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic necessitated the rapid development and implementation of health ITs to support health care delivery. Health IT implementation is difficult at the best of times, due to complex sociotechnical challenges that vary across contexts and settings; however, it is currently unclear how the pandemic impacted health IT implementation processes. The aim of this study was to explore the impact of the pandemic on health IT implementation processes, including pre- and postimplementation phases, and identify the sociotechnical factors that shaped health IT implementation during an unprecedented circumstance. Objective: This study aimed to explore the impact of the pandemic on HIT implementation processes, including pre- and postimplementation phases, and identify the socio-technical factors that shaped health IT implementation during an unprecedented circumstance. Methods: Participants were from one of two teams: (1) health care staff members (doctors, nurses, nurse unit managers, and support staff members) from a virtual hospital in Australia; and (2) IT professionals within the broader health care organization assigned to the hospital. Participants took part in an interview or focus group from July to November 2022. Participants were asked to describe the process used for rapid health IT design and implementation during the COVID-19 pandemic. Qualitative data were analyzed thematically. Results: A total of 15 participants took part in the study. Both internal and external team structures, and the communication pathways that underpinned these, were reported to influence the health IT lifecycle, which in turn impacted outcomes, particularly when perceived normal ways of working were challenged during the pandemic. Across the pre-post lifecycle, preimplementation processes were viewed to be most impacted by the COVID-19 pandemic. Participants reported that their roles and responsibilities changed during health IT implementations in the pandemic, impacting co-design processes and highlighting the need for health IT implementation processes to cater for new work and the redistribution of existing work. Conclusions: Our study uncovered the negative impact of the COVID-19 pandemic on team structures, communication pathways, and health IT preimplementation processes (project management and co-design). While health care organizations are keen to transition beyond the ways of working during the pandemic, it is imperative to learn from the health IT implementation successes and failures that occurred in the pandemic via process evaluations. Our evaluation offers learnings for research (an adapted interdisciplinary team communication framework), practice (the need for health care organizations to review their communication structures, IT staff skills, and proposed processes), and education (the need for better education and training of IT professionals working in clinical settings on health concepts) on health IT implementations as the world transitions to the ``new norm.'' ",
doi="10.2196/57847",
url="https://www.jmir.org/2025/1/e57847"
}


@Article{info:doi/10.2196/63377,
author="Giebel, Denk Godwin
and Raszke, Pascal
and Nowak, Hartmuth
and Palmowski, Lars
and Adamzik, Michael
and Heinz, Philipp
and Tokic, Marianne
and Timmesfeld, Nina
and Brunkhorst, Frank
and Wasem, J{\"u}rgen
and Blase, Nikola",
title="Problems and Barriers Related to the Use of AI-Based Clinical Decision Support Systems: Interview Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="3",
volume="27",
pages="e63377",
keywords="decision support",
keywords="artificial intelligence",
keywords="machine learning",
keywords="clinical decision support system",
keywords="digitalization",
keywords="health care",
keywords="technology",
keywords="innovation",
keywords="semistructured interview",
keywords="qualitative",
keywords="quality assurance",
keywords="web-based",
keywords="digital health",
keywords="health informatics",
abstract="Background: Digitalization is currently revolutionizing health care worldwide. A promising technology in this context is artificial intelligence (AI). The application of AI can support health care providers in their daily work in various ways. The integration of AI is particularly promising in clinical decision support systems (CDSSs). While the opportunities of this technology are numerous, the problems should not be overlooked. Objective: This study aimed to identify challenges and barriers in the context of AI-based CDSSs from the perspectives of experts across various disciplines. Methods: Semistructured expert interviews were conducted with different stakeholders. These included representatives of patients, physicians and caregivers, developers of AI-based CDSSs, researchers (studying AI in health care and social and health law), quality management and quality assurance representatives, a representative of an ethics committee, a representative of a health insurance fund, and medical product consultants. The interviews took place on the web and were recorded, transcribed, and subsequently subjected to a qualitative content analysis based on the method by Kuckartz. The analysis was conducted using MAXQDA software. Initially, the problems were separated into ``general,'' ``development,'' and ``clinical use.'' Finally, a workshop within the project consortium served to systematize the identified problems. Results: A total of 15 expert interviews were conducted, and 309 expert statements with reference to problems and barriers in the context of AI-based CDSSs were identified. These emerged in 7 problem categories: technology (46/309, 14.9\%), data (59/309, 19.1\%), user (102/309, 33\%), studies (17/309, 5.5\%), ethics (20/309, 6.5\%), law (33/309, 10.7\%), and general (32/309, 10.4\%). The problem categories were further divided into problem areas, which in turn comprised the respective problems. Conclusions: A large number of problems and barriers were identified in the context of AI-based CDSSs. These can be systematized according to the point at which they occur (``general,'' ``development,'' and ``clinical use'') or according to the problem category (``technology,'' ``data,'' ``user,'' ``studies,'' ``ethics,'' ``law,'' and ``general''). The problems identified in this work should be further investigated. They can be used as a basis for deriving solutions to optimize development, acceptance, and use of AI-based CDSSs. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.62704 ",
doi="10.2196/63377",
url="https://www.jmir.org/2025/1/e63377",
url="http://www.ncbi.nlm.nih.gov/pubmed/39899342"
}


@Article{info:doi/10.2196/58575,
author="Marino, Antonio Carlos
and Diaz Paz, Claudia",
title="Smart Contracts and Shared Platforms in Sustainable Health Care: Systematic Review",
journal="JMIR Med Inform",
year="2025",
month="Jan",
day="31",
volume="13",
pages="e58575",
keywords="health care",
keywords="smart contracts",
keywords="blockchain",
keywords="security",
keywords="privacy",
keywords="supply chain",
keywords="patient centricity",
keywords="system trust",
keywords="stakeholders",
abstract="Background: The benefits of smart contracts (SCs) for sustainable health care are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentralization, immutability, and traceability introduced in health care. Nevertheless, more studies need to explore the role of SCs in this sector based on the frameworks propounded in the literature that reflect business logic that has been customized, automatized, and prioritized, as well as system trust. This study addressed this lacuna. Objective: This study aimed to provide a comprehensive understanding of SCs in health care based on reviewing the frameworks propounded in the literature. Methods: A structured literature review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. One database---Web of Science (WoS)---was selected to avoid bias generated by database differences and data wrangling. A quantitative assessment of the studies based on machine learning and data reduction methodologies was complemented with a qualitative, in-depth, detailed review of the frameworks propounded in the literature. Results: A total of 70 studies, which constituted 18.7\% (70/374) of the studies on this subject, met the selection criteria and were analyzed. A multiple correspondence analysis---with 74.44\% of the inertia---produced 3 factors describing the advances in the topic. Two of them referred to the leading roles of SCs: (1) health care process enhancement and (2) assurance of patients' privacy protection. The first role included 6 themes, and the second one included 3 themes. The third factor encompassed the technical features that improve system efficiency. The in-depth review of these 3 factors and the identification of stakeholders allowed us to characterize the system trust in health care SCs. We assessed the risk of coverage bias, and good percentages of overlap were obtained---66\% (49/74) of PubMed articles were also in WoS, and 88.3\% (181/205) of WoS articles also appeared in Scopus. Conclusions: This comprehensive review allows us to understand the relevance of SCs and the potentiality of their use in patient-centric health care that considers more than technical aspects. It also provides insights for further research based on specific stakeholders, locations, and behaviors. ",
doi="10.2196/58575",
url="https://medinform.jmir.org/2025/1/e58575"
}


@Article{info:doi/10.2196/62704,
author="Raszke, Pascal
and Giebel, Denk Godwin
and Abels, Carina
and Wasem, J{\"u}rgen
and Adamzik, Michael
and Nowak, Hartmuth
and Palmowski, Lars
and Heinz, Philipp
and Mreyen, Silke
and Timmesfeld, Nina
and Tokic, Marianne
and Brunkhorst, Martin Frank
and Blase, Nikola",
title="User-Oriented Requirements for Artificial Intelligence--Based Clinical Decision Support Systems in Sepsis: Protocol for a Multimethod Research Project",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="30",
volume="14",
pages="e62704",
keywords="medical informatics",
keywords="artificial intelligence",
keywords="machine learning",
keywords="computational intelligence",
keywords="clinical decision support systems",
keywords="CDSS",
keywords="decision support",
keywords="sepsis",
keywords="bloodstream infection",
abstract="Background: Artificial intelligence (AI)--based clinical decision support systems (CDSS) have been developed for several diseases. However, despite the potential to improve the quality of care and thereby positively impact patient-relevant outcomes, the majority of AI-based CDSS have not been adopted in standard care. Possible reasons for this include barriers in the implementation and a nonuser-oriented development approach, resulting in reduced user acceptance. Objective: This research project has 2 objectives. First, problems and corresponding solutions that hinder or support the development and implementation of AI-based CDSS are identified. Second, the research project aims to increase user acceptance by creating a user-oriented requirement profile, using the example of sepsis. Methods: The research project is based on a multimethod approach combining (1) a scoping review, (2) focus groups with physicians and professional caregivers, and (3) semistructured interviews with relevant stakeholders. The research modules mentioned provide the basis for the development of a (4) survey, including a discrete choice experiment (DCE) with physicians. A minimum of 6667 physicians with expertise in the clinical picture of sepsis are contacted for this purpose. The survey is followed by the development of a requirement profile for AI-based CDSS and the derivation of policy recommendations for action, which are evaluated in a (5) expert roundtable discussion. Results: The multimethod research project started in November 2022. It provides an overview of the barriers and corresponding solutions related to the development and implementation of AI-based CDSS. Using sepsis as an example, a user-oriented requirement profile for AI-based CDSS is developed. The scoping review has been concluded and the qualitative modules have been subjected to analysis. The start of the survey, including the DCE, was at the end of July 2024. Conclusions: The results of the research project represent the first attempt to create a comprehensive user-oriented requirement profile for the development of sepsis-specific AI-based CDSS. In addition, general recommendations are derived, in order to reduce barriers in the development and implementation of AI-based CDSS. The findings of this research project have the potential to facilitate the integration of AI-based CDSS into standard care in the long term. International Registered Report Identifier (IRRID): DERR1-10.2196/62704 ",
doi="10.2196/62704",
url="https://www.researchprotocols.org/2025/1/e62704"
}


@Article{info:doi/10.2196/58271,
author="Savaria, Virginie
and Queenton, Johanne
and Carrier, Annie",
title="Decentralized Management of Home Care Services for Seniors: Protocol for a Participatory Action Research",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="17",
volume="14",
pages="e58271",
keywords="health system",
keywords="decentralization",
keywords="management",
keywords="home care services",
keywords="seniors",
keywords="collaboration",
abstract="Background: The centralization of decision-making power in the public health care system has a negative impact on the practice of professionals and the quality of home care services (HCS) for seniors. To improve HCS, decentralized management could be a particularly promising approach. To be effective, strategies designed to incorporate this management approach require attention to 3 elements: autonomy of local stakeholders, individual and organizational capacities, and accountability for actions and decisions. Not many studies have focused on strategies for integrating decentralized and collaborative management at the local level in HCS. Objective: The overall aim of this study is to coconstruct HCS management strategies and explore decentralized practices in the day-to-day work of low-level managers and professionals. The specific objectives, in collaboration with local HCS stakeholders, are to (1) identify concrete and achievable strategies for decentralized management, and (2) describe factors (facilitators and obstacles) that could potentially influence their integration. Methods: This participatory action research involves a cyclical process. Before initiating the cycles, a preliminary stage consists of forming a steering committee composed of managers (n=3), professionals (n=3), seniors (n=3), informal caregivers (n=3), and the research team (n=3). This committee will facilitate multistakeholder consultation to coconstruct local management strategies based on a real-life problem identified by the committee. The steering committee will also guide the research process. The first cycle will consist of establishing an initial plan of decentralized management strategies. During the observation phase, meetings of 4 homogeneous focus groups, including managers, professionals, seniors, and informal caregivers, will be held. During the reflection phase, a thematic analysis will be carried out, and data will be interpreted and validated by the steering committee. Then, in the action phase, results will be presented to managers and professionals so that they can coconstruct a plan of decentralized management strategies to prioritize. The second cycle will explore the factors involved. The observation, reflection, and action phases will be repeated. Ultimately, the results of the 2 cycles will be integrated in a model coconstructed by the steering committee. Results: Data collection is in progress; the partnership officially began on February 1, 2024, and the plan is to continue data collection through 2025. The steering committee will validate the data to ensure that they are accurate and that the results reflect the reality of local stakeholders. Conclusions: By identifying decentralized and collaborative management strategies at the local level as well as factors to facilitate their integration in HCS, this approach can be used for other decentralized management projects in different areas of the health care system. This study will give decision makers insight into strategies aimed at improving the management of their institution, which will enhance seniors' well-being and the quality of their health care services. International Registered Report Identifier (IRRID): DERR1-10.2196/58271 ",
doi="10.2196/58271",
url="https://www.researchprotocols.org/2025/1/e58271"
}


@Article{info:doi/10.2196/62764,
author="Ford, L. Katherine
and Laur, Celia
and Dhaliwal, Rupinder
and Nasser, Roseann
and Gramlich, Leah
and Allard, P. Johane
and Keller, Heather
and ",
title="Spread and Scale of the Integrated Nutrition Pathway for Acute Care Across Canada: Protocol for the Advancing Malnutrition Care Program",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="31",
volume="13",
pages="e62764",
keywords="malnutrition",
keywords="nutrition screening, nutrition assessment",
keywords="hospital",
keywords="malnutrition care",
keywords="nutrition",
keywords="acute care",
keywords="clinicians",
keywords="mixed-methods design",
keywords="decision making",
keywords="mentor-champion model",
keywords="virtual training",
keywords="peer support",
keywords="virtual community of practice",
abstract="Background: A high proportion of patients admitted to hospital are at nutritional risk or have malnutrition. However, this risk is often not identified at admission, which may result in longer hospital stays and increased likelihood of death. The Integrated Nutrition Pathway for Acute Care (INPAC) was developed to provide clinicians with a standardized approach to prevent, detect, and treat malnutrition in hospital. Objective: The purpose of this study was to determine if the Advancing Malnutrition Care (AMC) program can be used to spread and scale-up improvements to nutrition care in Canadian hospitals. Methods: A prospective, longitudinal, mixed methods design is proposed to evaluate the spread and scale of INPAC best practices across Canadian hospitals using a mentor-champion model. Purposive and snowball sampling are used to recruit mentors and hospital champions to participate in the AMC program. Mentors are persons with experience improving nutrition care in a clinical setting and champions are health care providers with a commitment to implementing best care practices. Mentors and champions are trained digitally on their roles and activities. Mentors meet with champions in their area monthly to support them with making practice change. Champions created a site implementation team to target practice change in a specific area related to malnutrition care and use AMC program-specific tools and resources to implement improvements and collect site information through quarterly audits of patient charts to track implementation of nutrition care best practices. An online community of practice is held every 3-4 months to provide further implementation resources and foster connection between mentors and champions at a national level. A prospective evaluation will be conducted to assess the impact of the program and explore how it can be sustainably spread and scaled across Canada. Semistructured interviews will be used to gain a deeper understanding of mentor and champion experiences in the program. The capabilities, opportunities, and motivations of behavior model will be used to evaluate behavior change and the Kirkpatrick 4-level framework will facilitate assessment of barriers to change. Aggregated chart audits will assess the impact of implemented care practices. Descriptive analyses will be used to describe baseline mentor and champion and hospital characteristics and mentor and champion experiences; Friedman test will describe these changes over time. Directed content analysis will guide interpretation of interview data. Results: Data collection began in September 2022 and is anticipated to end in June 2025, at which time data analysis will begin. Conclusions: Evaluation of the AMC program will strengthen decision-making, future programming, and will inform program changes that reflect implementation of best practices in nutrition care while supporting regional mentors and hospital champions. This work will address the sustainability of AMC and the critical challenges related to hospital-based malnutrition, ultimately improving nutrition care for patients across Canada. International Registered Report Identifier (IRRID): DERR1-10.2196/62764 ",
doi="10.2196/62764",
url="https://www.researchprotocols.org/2024/1/e62764"
}


@Article{info:doi/10.2196/60017,
author="Knight, Jo
and Chandrabalan, Vardhan Vishnu
and Emsley, A. Hedley C.",
title="Visualizing Patient Pathways and Identifying Data Repositories in a UK Neurosciences Center: Exploratory Study",
journal="JMIR Med Inform",
year="2024",
month="Dec",
day="24",
volume="12",
pages="e60017",
keywords="health data",
keywords="business process monitoring notation",
keywords="neurology",
keywords="process monitoring",
keywords="patient pathway",
keywords="clinical pathway",
keywords="patient care",
keywords="EHR",
keywords="electronic health record",
keywords="dataset",
keywords="questionnaire",
keywords="patient data",
keywords="NHS",
keywords="National Health Service",
abstract="Background: Health and clinical activity data are a vital resource for research, improving patient care and service efficiency. Health care data are inherently complex, and their acquisition, storage, retrieval, and subsequent analysis require a thorough understanding of the clinical pathways underpinning such data. Better use of health care data could lead to improvements in patient care and service delivery. However, this depends on the identification of relevant datasets. Objective: We aimed to demonstrate the application of business process modeling notation (BPMN) to represent clinical pathways at a UK neurosciences center and map the clinical activity to corresponding data flows into electronic health records and other nonstandard data repositories. Methods: We used BPMN to map and visualize a patient journey and the subsequent movement and storage of patient data. After identifying several datasets that were being held outside of the standard applications, we collected information about these datasets using a questionnaire. Results: We identified 13 standard applications where neurology clinical activity was captured as part of the patient's electronic health record including applications and databases for managing referrals, outpatient activity, laboratory data, imaging data, and clinic letters. We also identified 22 distinct datasets not within standard applications that were created and managed within the neurosciences department, either by individuals or teams. These were being used to deliver direct patient care and included datasets for tracking patient blood results, recording home visits, and tracking triage status. Conclusions: Mapping patient data flows and repositories allowed us to identify areas wherein the current electronic health record does not fulfill the needs of day-to-day patient care. Data that are being stored outside of standard applications represent a potential duplication in the effort and risks being overlooked. Future work should identify unmet data needs to inform correct data capture and centralization within appropriate data architectures. ",
doi="10.2196/60017",
url="https://medinform.jmir.org/2024/1/e60017"
}


@Article{info:doi/10.2196/60244,
author="Declerck, Jens
and Vandenberk, Bert
and Deschepper, Mieke
and Colpaert, Kirsten
and Cool, Lieselot
and Goemaere, Jens
and Bov{\'e}, Mona
and Staelens, Frank
and De Meester, Koen
and Verbeke, Eva
and Smits, Elke
and De Decker, Cami
and Van Der Vekens, Nicky
and Pauwels, Elin
and Vander Stichele, Robert
and Kalra, Dipak
and Coorevits, Pascal",
title="Building a Foundation for High-Quality Health Data: Multihospital Case Study in Belgium",
journal="JMIR Med Inform",
year="2024",
month="Dec",
day="20",
volume="12",
pages="e60244",
keywords="EHR",
keywords="electronic health records",
keywords="health data",
keywords="data quality dimensions",
keywords="data quality assessment",
keywords="secondary use",
keywords="data quality framework",
keywords="fit for purpose",
keywords="Belgium",
keywords="data quality",
keywords="framework",
keywords="case study",
keywords="hospital",
keywords="variability",
abstract="Background: Data quality is fundamental to maintaining the trust and reliability of health data for both primary and secondary purposes. However, before the secondary use of health data, it is essential to assess the quality at the source and to develop systematic methods for the assessment of important data quality dimensions. Objective: This case study aims to offer a dual aim---to assess the data quality of height and weight measurements across 7 Belgian hospitals, focusing on the dimensions of completeness and consistency, and to outline the obstacles these hospitals face in sharing and improving data quality standards. Methods: Focusing on data quality dimensions completeness and consistency, this study examined height and weight data collected from 2021 to 2022 within 3 distinct departments---surgical, geriatrics, and pediatrics---in each of the 7 hospitals. Results: Variability was observed in the completeness scores for height across hospitals and departments, especially within surgical and geriatric wards. In contrast, weight data uniformly achieved high completeness scores. Notably, the consistency of height and weight data recording was uniformly high across all departments. Conclusions: A collective collaboration among Belgian hospitals, transcending network affiliations, was formed to conduct this data quality assessment. This study demonstrates the potential for improving data quality across health care organizations by sharing knowledge and good practices, establishing a foundation for future, similar research. ",
doi="10.2196/60244",
url="https://medinform.jmir.org/2024/1/e60244"
}


@Article{info:doi/10.2196/57786,
author="Neunaber, Timo
and Mortsiefer, Achim
and Meister, Sven",
title="Dimensions and Subcategories of Digital Maturity in General Practice: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="19",
volume="26",
pages="e57786",
keywords="digital health",
keywords="eHealth",
keywords="digital maturity",
keywords="maturity assessment",
keywords="primary care",
keywords="general practice",
keywords="general practitioner",
keywords="qualitative research",
keywords="expert interviews",
keywords="interview",
keywords="explorative",
keywords="dimension",
keywords="subcategory",
keywords="expert",
keywords="care provider",
keywords="content analysis",
abstract="Background: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. Objective: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. Methods: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and R{\"a}diker using MAXQDA software (VERBI GmbH). Results: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. Conclusions: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed. ",
doi="10.2196/57786",
url="https://www.jmir.org/2024/1/e57786",
url="http://www.ncbi.nlm.nih.gov/pubmed/39699948"
}


@Article{info:doi/10.2196/65646,
author="Hans, Patricius Felix
and Kleinekort, Jan
and Boerries, Melanie
and Nieters, Alexandra
and Kindle, Gerhard
and Rautenberg, Micha
and B{\"u}hler, Laura
and Weiser, Gerda
and R{\"o}ttger, Clemens Michael
and Neufischer, Carolin
and K{\"u}hn, Matthias
and Wehrle, Julius
and Slagman, Anna
and Fischer-Rosinsky, Antje
and Eienbr{\"o}ker, Larissa
and Hanses, Frank
and Teepe, Wilhelm Gisbert
and Busch, Hans-J{\"o}rg
and Benning, Leo",
title="Information Mode--Dependent Success Rates of Obtaining German Medical Informatics Initiative--Compliant Broad Consent in the Emergency Department: Single-Center Prospective Observational Study",
journal="JMIR Med Inform",
year="2024",
month="Dec",
day="17",
volume="12",
pages="e65646",
keywords="biomedical research",
keywords="delivery of health care",
keywords="informed consent",
keywords="medical informatics",
keywords="digital health",
keywords="emergency medical services",
keywords="routinely collected health data",
keywords="data science",
keywords="secondary data analysis",
keywords="data analysis",
keywords="biomedical",
keywords="emergency",
keywords="Germany",
keywords="Europe",
keywords="prospective observational study",
keywords="broad consent",
keywords="inpatient stay",
keywords="logistic regression analysis",
keywords="health care delivery",
keywords="inpatients",
abstract="Background: The broad consent (BC) developed by the German Medical Informatics Initiative is a pivotal national strategy for obtaining patient consent to use routinely collected data from electronic health records, insurance companies, contact information, and biomaterials for research. Emergency departments (EDs) are ideal for enrolling diverse patient populations in research activities. Despite regulatory and ethical challenges, obtaining BC from patients in ED with varying demographic, socioeconomic, and disease characteristics presents a promising opportunity to expand the availability of ED data. Objective: This study aimed to evaluate the success rate of obtaining BC through different consenting approaches in a tertiary ED and to explore factors influencing consent and dropout rates. Methods: A single-center prospective observational study was conducted in a German tertiary ED from September to December 2022. Every 30th patient was screened for eligibility. Eligible patients were informed via one of three modalities: (1) directly in the ED, (2) during their inpatient stay on the ward, or (3) via telephone after discharge. The primary outcome was the success rate of obtaining BC within 30 days of ED presentation. Secondary outcomes included analyzing potential influences on the success and dropout rates based on patient characteristics, information mode, and the interaction time required for patients to make an informed decision. Results: Of 11,842 ED visits, 419 patients were screened for BC eligibility, with 151 meeting the inclusion criteria. Of these, 68 (45\%) consented to at least 1 BC module, while 24 (15.9\%) refused participation. The dropout rate was 39.1\% (n=59) and was highest in the telephone-based group (57/109, 52.3\%) and lowest in the ED group (1/14, 7.1\%). Patients informed face-to-face during their inpatient stay following the ED treatment had the highest consent rate (23/27, 85.2\%), while those approached in the ED or by telephone had consent rates of 69.2\% (9/13 and 36/52). Logistic regression analysis indicated that longer interaction time significantly improved consent rates (P=.03), while female sex was associated with higher dropout rates (P=.02). Age, triage category, billing details (inpatient treatment), or diagnosis did not significantly influence the primary outcome (all P>.05). Conclusions: Obtaining BC in an ED environment is feasible, enabling representative inclusion of ED populations. However, discharge from the ED and female sex negatively affected consent rates to the BC. Face-to-face interaction proved most effective, particularly for inpatients, while telephone-based approaches resulted in higher dropout rates despite comparable consent rates to direct consenting in the ED. The findings underscore the importance of tailored consent strategies and maintaining consenting staff in EDs and on the wards to enhance BC information delivery and consent processes for eligible patients. Trial Registration: German Clinical Trials Register DRKS00028753; https://drks.de/search/de/trial/DRKS00028753 ",
doi="10.2196/65646",
url="https://medinform.jmir.org/2024/1/e65646"
}


@Article{info:doi/10.2196/51219,
author="Wang, Zhong
and Hu, Fangru
and Su, Jie
and Lin, Yuyao",
title="Information Source Characteristics of Personal Data Leakage During the COVID-19 Pandemic in China: Observational Study",
journal="JMIR Med Inform",
year="2024",
month="Dec",
day="10",
volume="12",
pages="e51219",
keywords="public health emergency",
keywords="privacy leakage",
keywords="characteristics of information sources",
keywords="COVID-19",
keywords="China",
keywords="information source",
keywords="data privacy",
keywords="public health",
keywords="leakage",
abstract="Background: During the COVID-19 pandemic, in the period of preventing and controlling the spread of the virus, a large amount of personal data was collected in China, and privacy leakage incidents occurred. Objective: We aimed to examine the information source characteristics of personal data leakage during the COVID-19 pandemic in China. Methods: We extracted information source characteristics of 40 personal data leakage cases using open coding and analyzed the data with 1D and 2D matrices. Results: In terms of organizational characteristics, data leakage cases mainly occurred in government agencies below the prefecture level, while few occurred in the medical system or in high-level government organizations. The majority of leakers were regular employees or junior staff members rather than temporary workers or senior managers. Family WeChat groups were the primary route for disclosure; the forwarding of documents was the main method of divulgence, while taking screenshots and pictures made up a comparatively smaller portion. Conclusions: We propose the following suggestions: restricting the authority of nonmedical institutions and low-level government agencies to collect data, strengthening training for low-level employees on privacy protection, and restricting the flow of data on social media through technical measures. ",
doi="10.2196/51219",
url="https://medinform.jmir.org/2024/1/e51219"
}


@Article{info:doi/10.2196/52516,
author="Sussex, Jon
and Atherton, Helen
and Abel, Gary
and Clark, Christopher
and Cockcroft, Emma
and Leach, Brandi
and Marriott, Christine
and Newbould, Jennifer
and Pitchforth, Emma
and Winder, Rachel
and Campbell, John",
title="Supporting Patients' Use of Digital Services in Primary Health Care in England: Synthesis of Evidence From a Mixed Methods Study of ``Digital Facilitation''",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="4",
volume="11",
pages="e52516",
keywords="web-based health services",
keywords="primary care",
keywords="digital facilitation",
keywords="evidence synthesis",
keywords="medical practitioners",
keywords="digital services",
keywords="digital intervention",
keywords="mixed methods study",
keywords="scoping review",
keywords="ethnography",
abstract="Background: General medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined ``digital facilitation'' as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services. Objective: We report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study's objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions. Methods: Our study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package's results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders. Results: Triangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them. Conclusions: Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions. ",
doi="10.2196/52516",
url="https://humanfactors.jmir.org/2024/1/e52516"
}


@Article{info:doi/10.2196/59619,
author="Ware, Anna
and Blumke, Terri
and Hoover, Peter
and Arreola, David",
title="Calculating Optimal Patient to Nursing Capacity: Comparative Analysis of Traditional and New Methods",
journal="JMIR Nursing",
year="2024",
month="Nov",
day="22",
volume="7",
pages="e59619",
keywords="nurse scheduling",
keywords="nurse",
keywords="patient ratio",
keywords="nursing hours per patient day",
keywords="NHPPD",
keywords="nursing administration",
keywords="workload",
keywords="comparative analysis",
keywords="nursing",
keywords="staffing",
keywords="nurse staffing",
keywords="registered nurses",
keywords="nurse assistants",
keywords="staff allocation",
keywords="patient capacity",
abstract="Background: Optimal nurse staffing levels have been shown to impact patients' prognoses and safety, as well as staff burnout. The predominant method for calculating staffing levels has been patient-to-nurse (P/N) ratios and nursing hours per patient day. However, both methods fall short of addressing the dynamic nature of staffing needs that often fluctuate throughout the day as patients' clinical status changes and new patients are admitted or discharged from the unit. Objective: In this evaluation, the Veterans Affairs Palo Alto Health Care System (VAPAHCS) piloted a new dynamic bed count calculation in an effort to target optimal staffing levels every hour to provide greater temporal resolution on nurse staffing levels within the Veterans Health Administration. Methods: The dynamic bed count uses elements from both the nursing hours per patient day and P/N ratio to calculate current and target staffing levels, every hour, while balancing across nurse types (registered nurses to nurse assistants) to provide improved temporal insight into staff allocation. The dynamic bed count was compared with traditional P/N ratio methods of calculating patient capacity at the VAPAHCS, to assess optimal patient capacity within their acute care ward from January 1, 2023, through May 25, 2023. Descriptive statistics summarized patient capacity variables across the intensive care unit (ICU), medical-surgical ICU, and 3 acute care units. Student t tests (2-tailed) were used to analyze differences between patient capacity measures. Results: Hourly analysis of patient capacity information displayed how the dynamic bed count provided improved temporal resolution on patient capacity. Comparing the dynamic bed count to the P/N ratio, we found the patient capacity, as determined by the P/N ratio, was, on average, higher than that of the dynamic bed count across VAPAHCS acute care units and the medical-surgical ICU (P<.001). For example, in acute care unit 3C, the average dynamic bed count was 21.6 (SD 4.2) compared with a P/N ratio of 28.6 (SD 3.2). This suggests that calculating patient capacity using P/N ratios alone could lead to units taking on more patients than what the dynamic bed count suggests the unit can optimally handle. Conclusions: As a new patient capacity calculation, the dynamic bed count provided additional details and timely information about clinical staffing levels, patient acuity, and patient turnover. Implementing this calculation into the management process has the potential to empower departments to further optimize staffing and patient care. ",
doi="10.2196/59619",
url="https://nursing.jmir.org/2024/1/e59619"
}


@Article{info:doi/10.2196/52817,
author="Nadav, Janna
and Kaihlanen, Anu-Marja
and Kujala, Sari
and Keskim{\"a}ki, Ilmo
and Viitanen, Johanna
and Salovaara, Samuel
and Saukkonen, Petra
and V{\"a}nsk{\"a}, Jukka
and Vehko, Tuulikki
and Heponiemi, Tarja",
title="Factors Contributing to Successful Information System Implementation and Employee Well-Being in Health Care and Social Welfare Professionals: Comparative Cross-Sectional Study",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="21",
volume="12",
pages="e52817",
keywords="implementation",
keywords="health information systems",
keywords="client information systems",
keywords="stress",
keywords="healthcare professionals",
keywords="social welfare professionals",
keywords="clinician well-being",
keywords="workplace stress",
abstract="Background: The integration of information systems in health care and social welfare organizations has brought significant changes in patient and client care. This integration is expected to offer numerous benefits, but simultaneously the implementation of health information systems and client information systems can also introduce added stress due to the increased time and effort required by professionals. Objective: This study aimed to examine whether professional groups and the factors that contribute to successful implementation (participation in information systems development and satisfaction with software providers' development work) are associated with the well-being of health care and social welfare professionals. Methods: Data were obtained from 3 national cross-sectional surveys (n=9240), which were carried out among Finnish health care and social welfare professionals (registered nurses, physicians, and social welfare professionals) in 2020?2021. Self-rated stress and stress related to information systems were used as indicators of well-being. Analyses were conducted using linear and logistic regression analysis. Results: Registered nurses were more likely to experience self-rated stress than physicians (odds ratio [OR] --0.47; P>.001) and social welfare professionals (OR --0.68; P<.001). They also had a higher likelihood of stress related to information systems than physicians (b=--.11; P<.001). Stress related to information systems was less prevalent among professionals who did not participate in information systems development work (b=--.14; P<.001). Higher satisfaction with software providers' development work was associated with a lower likelihood of self-rated stress (OR --0.23; P<.001) and stress related to information systems (b=--.36 P<.001). When comparing the professional groups, we found that physicians who were satisfied with software providers' development work had a significantly lower likelihood of stress related to information systems (b=--.12; P<.001) compared with registered nurses and social welfare professionals. Conclusions: Organizations can enhance the well-being of professionals and improve the successful implementation of information systems by actively soliciting and incorporating professional feedback, dedicating time for information systems development, fostering collaboration with software providers, and addressing the unique needs of different professional groups. ",
doi="10.2196/52817",
url="https://medinform.jmir.org/2024/1/e52817"
}


@Article{info:doi/10.2196/56473,
author="Alomar, Dalia
and Almashmoum, Maryam
and Eleftheriou, Iliada
and Whelan, Pauline
and Ainsworth, John",
title="The Impact of Patient Access to Electronic Health Records on Health Care Engagement: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e56473",
keywords="electronic health records",
keywords="personal health record",
keywords="health care engagement",
keywords="empowerment",
keywords="patient experience",
keywords="patient satisfaction",
keywords="health care services",
keywords="systematic review",
abstract="Background: Health information technologies, including electronic health records (EHRs), have revolutionized health care delivery. These technologies promise to enhance the efficiency and quality of care through improved patient health information management. Despite the transformative potential of EHRs, the extent to which patient access contributes to increased engagement with health care services within different clinical setting remains a distinct and underexplored facet. Objective: This systematic review aims to investigate the impact of patient access to EHRs on health care engagement. Specifically, we seek to determine whether providing patients with access to their EHRs contributes to improved engagement with health care services. Methods: A comprehensive systematic review search was conducted across various international databases, including Ovid MEDLINE, Embase, PsycINFO, and CINAHL, to identify relevant studies published from January 1, 2010, to November 15, 2023. The search on these databases was conducted using a combination of keywords and Medical Subject Heading terms related to patient access to electronic health records, patient engagement, and health care services. Studies were included if they assessed the impact of patient access to EHRs on health care engagement and provided evidence (quantitative or qualitative) for that. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement were followed for study selection, data extraction, and quality assessment. The included studies were assessed for quality using the Mixed Methods Appraisal Tool, and the results were reported using a narrative synthesis. Results: The initial search from the databases yielded 1737 studies, to which, after scanning their reference lists, we added 10 studies. Of these 1747 studies, 18 (1.03\%) met the inclusion criteria for the final review. The synthesized evidence from these studies revealed a positive relationship between patient access to EHRs and health care engagement, addressing 6 categories of health care engagement dimensions and outcomes, including treatment adherence and self-management, patient involvement and empowerment, health care communication and relationship, patient satisfaction and health outcomes, use of health care resources, and usability concerns and barriers. Conclusions: The findings suggested a positive association between patient access to EHRs and health care engagement. The implications of these findings for health care providers, policy makers, and patients should be considered, highlighting the potential benefits and challenges associated with implementing and promoting patient access to EHRs. Further research directions have been proposed to deepen our understanding of this dynamic relationship. ",
doi="10.2196/56473",
url="https://www.jmir.org/2024/1/e56473"
}


@Article{info:doi/10.2196/52675,
author="Willcockson, Ursula Irmgard
and Valdes, Herman Ignacio",
title="Unintended Consequences of Data Sharing Under the Meaningful Use Program",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="14",
volume="12",
pages="e52675",
keywords="electronic health records",
keywords="EHR",
keywords="medical record",
keywords="interoperability",
keywords="health information interoperability",
keywords="clinical burden",
keywords="Medicare",
keywords="Medicaid",
keywords="reimbursement",
keywords="data science",
keywords="data governance",
keywords="data breach",
keywords="cybersecurity",
keywords="privacy",
doi="10.2196/52675",
url="https://medinform.jmir.org/2024/1/e52675"
}


@Article{info:doi/10.2196/64575,
author="Brooks Carthon, Margo J.
and Brom, Heather
and Amenyedor, Eyram Kelvin
and Harhay, O. Michael
and Grantham-Murillo, Marsha
and Nikpour, Jacqueline
and Lasater, B. Karen
and Golinelli, Daniela
and Cacchione, Z. Pamela
and Bettencourt, P. Amanda",
title="Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="12",
volume="13",
pages="e64575",
keywords="serious mental illness",
keywords="health care disparities",
keywords="Medicaid",
keywords="evidence-based practice",
keywords="implementation science",
keywords="socioeconomic disparities in health",
abstract="Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective: This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods: This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ?18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results: This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions: We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration: ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID): DERR1-10.2196/64575 ",
doi="10.2196/64575",
url="https://www.researchprotocols.org/2024/1/e64575"
}


@Article{info:doi/10.2196/58780,
author="Farooq, Munawar
and Al Jufaili, Mahmood
and Hanjra, K. Faisal
and Ahmad, Shabbir
and Dababneh, Hanna Emad
and Al Nahhas, Omar
and Bashir, Khalid",
title="Bystander Response and Out-of-Hospital Cardiac Arrest Outcomes (Bro. Study) in 3 Gulf Countries: Protocol for a Prospective, Observational, International Collaboration Study",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="12",
volume="13",
pages="e58780",
keywords="out-of-hospital cardiac arrest",
keywords="cardiac arrest outcomes",
keywords="bystander response",
keywords="cardiopulmonary resuscitation",
keywords="CPR",
keywords="automated external defibrillator",
keywords="AED",
keywords="survival to discharge",
keywords="emergency medical services",
keywords="prehospital care",
keywords="Utstein style",
abstract="Background: : Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. Objective: This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. Methods: This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri--cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Results: Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Conclusions: Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/58780 ",
doi="10.2196/58780",
url="https://www.researchprotocols.org/2024/1/e58780"
}


@Article{info:doi/10.2196/54415,
author="Cho, Jaeso
and Han, Yeon Ji
and Cho, Anna
and Yoo, Sooyoung
and Lee, Ho-Young
and Kim, Hunmin",
title="Enhancing Clinical History Taking Through the Implementation of a Streamlined Electronic Questionnaire System at a Pediatric Headache Clinic: Development and Evaluation Study",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="8",
volume="12",
pages="e54415",
keywords="electronic questionnaire system",
keywords="electronic questionnaire",
keywords="history taking",
keywords="medical history",
keywords="headache",
keywords="migraine",
keywords="neuralgia",
keywords="pediatric",
keywords="paediatric",
keywords="infant",
keywords="neonatal",
keywords="toddler",
keywords="child",
keywords="youth",
keywords="adolescent",
abstract="Background: Accurate history taking is essential for diagnosis, treatment, and patient care, yet miscommunications and time constraints often lead to incomplete information. Consequently, there has been a pressing need to establish a system whereby the questionnaire is duly completed before the medical appointment, entered into the electronic health record (EHR), and stored in a structured format within a database. Objective: This study aimed to develop and evaluate a streamlined electronic questionnaire system, BEST-Survey (Bundang Hospital Electronic System for Total Care-Survey), integrated with the EHR, to enhance history taking and data management for patients with pediatric headaches. Methods: An electronic questionnaire system was developed at Seoul National University Bundang Hospital, allowing patients to complete previsit questionnaires on a tablet PC. The information is automatically integrated into the EHR and stored in a structured database for further analysis. A retrospective analysis compared clinical information acquired from patients aged <18 years visiting the pediatric neurology outpatient clinic for headaches, before and after implementing the BEST-Survey system. The study included 365 patients before and 452 patients after system implementation. Answer rates and positive rates of key headache characteristics were compared between the 2 groups to evaluate the system's clinical utility. Results: Implementation of the BEST-Survey system significantly increased the mean data acquisition rate from 54.6\% to 99.3\% (P<.001). Essential clinical features such as onset, location, duration, severity, nature, and frequency were obtained in over 98.7\% (>446/452) of patients after implementation, compared to from 53.7\% (196/365) to 85.2\% (311/365) before. The electronic system facilitated comprehensive data collection, enabling detailed analysis of headache characteristics in the patient population. Most patients (280/452, 61.9\%) reported headache onset less than 1 year prior, with the temporal region being the most common pain location (261/703, 37.1\%). Over half (232/452, 51.3\%) experienced headaches lasting less than 2 hours, with nausea and vomiting as the most commonly associated symptoms (231/1036, 22.3\%). Conclusions: The BEST-Survey system markedly improved the completeness and accuracy of essential history items for patients with pediatric headaches. The system also streamlined data extraction and analysis for clinical and research purposes. While the electronic questionnaire cannot replace physician-led history taking, it serves as a valuable adjunctive tool to enhance patient care. ",
doi="10.2196/54415",
url="https://medinform.jmir.org/2024/1/e54415"
}


@Article{info:doi/10.2196/64270,
author="O'Dwyer, Brynn
and Jaana, Mirou
and Hui, Charles
and Chreim, Samia
and Ellis, Jennifer",
title="Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="5",
volume="10",
pages="e64270",
keywords="COVID-19",
keywords="surveillance",
keywords="technology",
keywords="digital contact tracing",
keywords="qualitative",
keywords="hospitals",
keywords="Reach, Effectiveness, Adoption, Implementation, and Maintenance framework",
keywords="RE-AIM",
abstract="Background: Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. Objective: This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Methods: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children's Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29\%), occupational health and safety specialists (8/21, 38\%), and HCWs (7/21, 33\%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). Results: The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital's capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs' standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Conclusions: Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies. ",
doi="10.2196/64270",
url="https://publichealth.jmir.org/2024/1/e64270"
}


@Article{info:doi/10.2196/56898,
author="Mustafa, Khairiyah Noor
and Ibrahim, Roszita
and Aizuddin, Noor Azimatun
and Aljunid, Mohamed Syed
and Awang, Zainudin",
title="Critical Success Factors and Acceptance of the Casemix System Implementation Within the Total Hospital Information System: Exploratory Factor Analysis of a Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="29",
volume="8",
pages="e56898",
keywords="critical success factors",
keywords="exploratory factor analysis",
keywords="Casemix system",
keywords="acceptance",
keywords="Total Hospital Information System",
abstract="Background: The health care landscape is evolving rapidly due to rising costs, an aging population, and the increasing prevalence of diseases. To address these challenges, the Ministry of Health of Malaysia implemented transformation strategies such as the Casemix system and hospital information system to enhance health care quality, resource allocation, and cost-effectiveness. However, successful implementation relies not just on the technology itself but on the acceptance and engagement of the users involved. Objective: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health's Total Hospital Information System (THIS). Methods: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study's minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach $\alpha$ assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp). Results: This study obtained 106 valid responses, equivalent to an 84.8\% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P<.001). Principal component analysis identified 9 components explaining 84.07\% of the total variance, surpassing the minimum requirement of 60\%. In total, 9 unique slopes indicated the identification of 9 components through EFA. While no new components emerged from the other 7 constructs, only the organizational factors construct was divided into 2 components, later named organizational structure and organizational environment. In total, 98\% (41/42) of the items had factor loadings of >0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach $\alpha$ ranged from 0.914 to 0.969, demonstrating high reliability. Conclusions: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals. ",
doi="10.2196/56898",
url="https://formative.jmir.org/2024/1/e56898",
url="http://www.ncbi.nlm.nih.gov/pubmed/39470697"
}


@Article{info:doi/10.2196/60402,
author="Fernando, Manasha
and Abell, Bridget
and McPhail, M. Steven
and Tyack, Zephanie
and Tariq, Amina
and Naicker, Sundresan",
title="Applying the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability Framework Across Implementation Stages to Identify Key Strategies to Facilitate Clinical Decision Support System Integration Within a Large Metropolitan Health Service: Interview and Focus Group Study",
journal="JMIR Med Inform",
year="2024",
month="Oct",
day="17",
volume="12",
pages="e60402",
keywords="medical informatics",
keywords="adoption and implementation",
keywords="behavior",
keywords="health systems",
abstract="Background: Computerized clinical decision support systems (CDSSs) enhance patient care through real-time, evidence-based guidance for health care professionals. Despite this, the effective implementation of these systems for health services presents multifaceted challenges, leading to inappropriate use and abandonment over the course of time. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework, this qualitative study examined CDSS adoption in a metropolitan health service, identifying determinants across implementation stages to optimize CDSS integration into health care practice. Objective: This study aims to identify the theory-informed (NASSS) determinants, which included multiple CDSS interventions across a 2-year period, both at the health-service level and at the individual hospital setting, that either facilitate or hinder the application of CDSSs within a metropolitan health service. In addition, this study aimed to map these determinants onto specific stages of the implementation process, thereby developing a system-level understanding of CDSS application across implementation stages. Methods: Participants involved in various stages of the implementation process were recruited (N=30). Participants took part in interviews and focus groups. We used a hybrid inductive-deductive qualitative content analysis and a framework mapping approach to categorize findings into barriers, enablers, or neutral determinants aligned to NASSS framework domains. These determinants were also mapped to implementation stages using the Active Implementation Framework stages approach. Results: Participants comprised clinical adopters (14/30, 47\%), organizational champions (5/30, 16\%), and those with roles in organizational clinical informatics (5/30, 16\%). Most determinants were mapped to the organization level, technology, and adopter subdomains. However, the study findings also demonstrated a relative lack of long-term implementation planning. Consequently, determinants were not uniformly distributed across the stages of implementation, with 61.1\% (77/126) identified in the exploration stage, 30.9\% (39/126) in the full implementation stage, and 4.7\% (6/126) in the installation stages. Stakeholders engaged in more preimplementation and full-scale implementation activities, with fewer cycles of monitoring and iteration activities identified. Conclusions: These findings addressed a substantial knowledge gap in the literature using systems thinking principles to identify the interdependent dynamics of CDSS implementation. A lack of sustained implementation strategies (ie, training and longer-term, adopter-level championing) weakened the sociotechnical network between developers and adopters, leading to communication barriers. More rigorous implementation planning, encompassing all 4 implementation stages, may, in a way, help in addressing the barriers identified and enhancing enablers. ",
doi="10.2196/60402",
url="https://medinform.jmir.org/2024/1/e60402"
}


@Article{info:doi/10.2196/53705,
author="Sze, Ping Kai
and Fong, Wei Qi
and De Roza, Giovanna Jacqueline
and Lee, Sing Eng
and Tan, Yun Shu",
title="Exploring Physicians' Perceptions of Digital Health's Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="15",
volume="26",
pages="e53705",
keywords="patient-physician relationship",
keywords="patient communication",
keywords="trust",
keywords="primary care medicine",
keywords="digital health",
keywords="primary care",
keywords="longitudinal care",
keywords="policy",
keywords="implementation",
abstract="Background: Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. Objective: This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. Methods: This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. Results: We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised ``social and personal,'' ``technical and material,'' and ``organization and policy'' factors. Conclusions: The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship. ",
doi="10.2196/53705",
url="https://www.jmir.org/2024/1/e53705"
}


@Article{info:doi/10.2196/52411,
author="Faulkenberry, Grey
and Masizana, Audrey
and Mosesane, Badisa
and Ndlovu, Kagiso",
title="Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="9",
volume="13",
pages="e52411",
keywords="global health",
keywords="health information systems",
keywords="electronic health care records",
keywords="EHRs",
keywords="interoperability",
keywords="data flow",
keywords="access to information",
keywords="health information interoperability",
keywords="pediatric",
keywords="pediatrics",
keywords="infant",
keywords="infants",
keywords="clinical data",
keywords="mixed method",
keywords="Botswana",
keywords="health care information",
keywords="child health",
keywords="tuberculosis",
keywords="HIV",
keywords="eLearning",
keywords="survey",
keywords="health informatics",
keywords="communication",
abstract="Background: Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that ``there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level,'' seconded by the Botswana National eLearning strategy (2020), which states that ``there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating.'' Objective: The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. Methods: The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. Results: The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75\% (112/150) of health care professionals participating came from clinics, 20\% (30/150) from hospitals, and 5\% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. Conclusions: This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. International Registered Report Identifier (IRRID): DERR1-10.2196/52411 ",
doi="10.2196/52411",
url="https://www.researchprotocols.org/2024/1/e52411"
}


@Article{info:doi/10.2196/56263,
author="Suzumoto, Jun
and Mori, Yukiko
and Kuroda, Tomohiro",
title="Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study",
journal="JMIR Med Inform",
year="2024",
month="Oct",
day="9",
volume="12",
pages="e56263",
keywords="health information exchange",
keywords="audit log",
keywords="Japan",
keywords="HIE",
keywords="audit",
keywords="logs",
keywords="usage",
keywords="medical informatics",
keywords="rate",
keywords="hospitals",
keywords="electronic health record",
abstract="Background: Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown. Objective: This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan. Methods: We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker's profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type's monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE. Results: We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5\% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30\% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470?0.487) for hospitals, 0.243 (0.230?0.247) for medical clinics, and 0.030 (0.024?0.048) for dental clinics. In 51.9\% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8\% (921/3434) of hospitals, it was between 1 and 10, and in 3\% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487?0.529) for the most used HIE and 0.109 (0.0927?0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned. Conclusions: In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets. ",
doi="10.2196/56263",
url="https://medinform.jmir.org/2024/1/e56263"
}


@Article{info:doi/10.2196/57685,
author="Knox, Liam
and Coates, Elizabeth
and Griffiths, Alys
and Ali, Yasmin
and Hobson, Esther
and McDermott, Christopher",
title="Development and Evaluation of the Telehealth in Motor Neuron Disease System: The TIME Study Protocol",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="8",
volume="13",
pages="e57685",
keywords="motor neuron disease",
keywords="amyotrophic lateral sclerosis",
keywords="telehealth",
keywords="digital health",
keywords="process evaluation",
keywords="implementation",
keywords="co-production",
keywords="digital technology",
keywords="mhealth",
keywords="eHealth",
keywords="virtual medicine",
abstract="Background: For more responsive care provision for motor neuron disease and caregivers, a digital system called Telehealth in MND-Care (TiM-C) was created. TiM-C sends regular symptom questionnaires to users; their responses are sent to health care professionals (HCPs). To enable people with motor neuron disease to participate in research studies more easily, a parallel platform was developed from TiM-C, called Telehealth in MND-Research (TiM-R). TiM-R can advertise studies, collect data, and make them available to MND researchers. Objective: This study has 4 work packages (WPs) to facilitate service approval, codevelop the TiM systems, and evaluate the service. Each WP aims to understand (1) what helps and hinders the approval of the TiM-C system as a National Health Service; (2) what aspects of MND care and research are currently unmet and can be addressed through the TiM-C and TiM-R systems; (3) how TiM-C influences MND care, from the perspective of people with motor neuron disease, their caregivers, and HCPs; and (4) the costs and benefits associated with TiM-C. Methods: WP1 will use semistructured interviews with 10-15 people involved in the approval of TiM-C to understand the barriers and facilitators to governance processes. WP2 will use individual and group interviews with 25-35 users (people with motor neuron disease, caregivers, HCPs, MND researchers, and industry) of TiM-C and TiM-R to understand the current unmet needs of these user groups and how TiM services can be developed to meet these needs. WP3 will use a process evaluation involving 5 elements; local context, engagement, user experiences, service impact, and mechanisms of action. A range of methods, including audits, analysis of routine data, questionnaires, interviews, and observations will be used with people with motor neuron disease, caregivers, and HCPs, both those using the system and those who declined the service when invited. WP4 will use data collected through the process evaluation and known costs to conduct a cost-consequence and budget impact analysis to explore the cost-benefit of the TiM-C service. Most data collected will be qualitative, with thematic and framework analysis used to develop themes from transcripts and observations. Descriptive statistics or t tests and chi-square tests will be used to describe and analyze quantitative data. Results: This study has received ethical approval and has begun recruitment in 1 site. Further, 13 specialist MND centers will adopt TiM-C and the TIME study, beginning in July 2024. The study will conclude in November 2026 and a final report will be produced 3 months after the completion date. Conclusions: This study will facilitate the implementation and development of TiM-C and TiM-R and fully evaluate the TiM-C service, enabling informed decision-making among health care providers regarding continued involvement and contribute to the wider literature relating to how technology-enabled care services can affect clinical care. International Registered Report Identifier (IRRID): DERR1-10.2196/57685 ",
doi="10.2196/57685",
url="https://www.researchprotocols.org/2024/1/e57685"
}


@Article{info:doi/10.2196/55472,
author="Trinkley, E. Katy
and Maw, M. Anna
and Torres, Huebner Cristina
and Huebschmann, G. Amy
and Glasgow, E. Russell",
title="Applying Implementation Science to Advance Electronic Health Record--Driven Learning Health Systems: Case Studies, Challenges, and Recommendations",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="7",
volume="26",
pages="e55472",
keywords="learning health systems",
keywords="implementation science",
keywords="chronic care",
keywords="electronic health record",
keywords="evidence-based medicine",
keywords="information technology",
keywords="research and technology",
doi="10.2196/55472",
url="https://www.jmir.org/2024/1/e55472",
url="http://www.ncbi.nlm.nih.gov/pubmed/39374069"
}


@Article{info:doi/10.2196/45122,
author="Peiffer-Smadja, Nathan
and Descousse, Sophie
and Courr{\`e}ges, Elsa
and Nganbou, Audrey
and Jeanmougin, Pauline
and Birgand, Gabriel
and L{\'e}naud, S{\'e}verin
and Beaumont, Anne-Lise
and Durand, Claire
and Delory, Tristan
and Le Bel, Josselin
and Bouvet, Elisabeth
and Lariven, Sylvie
and D'Ortenzio, Eric
and Konat{\'e}, Issa
and Bouyou-Akotet, Karine Marielle
and Ouedraogo, Abdoul-Salam
and Kouakou, Affoue Gis{\`e}le
and Poda, Armel
and Akpovo, Corinne
and Lescure, Fran{\c{c}}ois-Xavier
and Tanon, Aristophane",
title="Implementation of a Clinical Decision Support System for Antimicrobial Prescribing in Sub-Saharan Africa: Multisectoral Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="7",
volume="26",
pages="e45122",
keywords="antimicrobial resistance",
keywords="implementation research",
keywords="Consolidated Framework for Implementation Research",
keywords="CDSS",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Suboptimal use of antimicrobials is a driver of antimicrobial resistance in West Africa. Clinical decision support systems (CDSSs) can facilitate access to updated and reliable recommendations. Objective: This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies. Methods: This qualitative study was conducted through 21 semistructured individual interviews via videoconference with health care professionals between September and December 2020. Participants were recruited using purposive sampling in a transnational capacity-building network for hospital preparedness in West Africa. The interview guide included multiple constructs derived from the Consolidated Framework for Implementation Research. Interviews were transcribed, and data were analyzed using thematic analysis. Results: The panel of participants included health practitioners (12/21, 57\%), health actors trained in engineering (2/21, 10\%), project managers (3/21, 14\%), antimicrobial resistance research experts (2/21, 10\%), a clinical microbiologist (1/21, 5\%), and an anthropologist (1/21, 5\%). Contextual factors influencing the implementation of eHealth tools existed at the individual, health care system, and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to the prescriber's clinical routine and structural constraints. Most of the participants stated that the CDSS should not only target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives, and other health care workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, the lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication, and disparity in health care coverage lead to inappropriate antimicrobial use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid eHealth ecosystem in their countries by establishing academic partnerships, developing physician networks, and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting a local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers, and creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa. Conclusions: These results suggest that a CDSS for antimicrobial prescribing adapted for nonspecialized prescribers could have a role in improving clinical decisions. They also confirm the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors, including social, political, and economic determinants. ",
doi="10.2196/45122",
url="https://www.jmir.org/2024/1/e45122",
url="http://www.ncbi.nlm.nih.gov/pubmed/39374065"
}


@Article{info:doi/10.2196/51198,
author="Tao, Youyou
and Zhu, Ruilin
and Wu, Dezhi",
title="Harnessing the Power of Complementarity Between Smart Tracking Technology and Associated Health Information Technologies: Longitudinal Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="1",
volume="8",
pages="e51198",
keywords="health IT",
keywords="smart tracking technology",
keywords="mobile IT",
keywords="health information exchange",
keywords="electronic health record",
keywords="readmission risk",
keywords="complementarity effects",
keywords="mobile phone",
abstract="Background: Smart tracking technology (STT) that was applied for clinical use has the potential to reduce 30-day all-cause readmission risk through streamlining clinical workflows with improved accuracy, mobility, and efficiency. However, previously published literature has inadequately addressed the joint effects of STT for clinical use and its complementary health ITs (HITs) in this context. Furthermore, while previous studies have discussed the symbiotic and pooled complementarity effects among different HITs, there is a lack of evidence-based research specifically examining the complementarity effects between STT for clinical use and other relevant HITs. Objective: Through a complementarity theory lens, this study aims to examine the joint effects of STT for clinical use and 3 relevant HITs on 30-day all-cause readmission risk. These HITs are STT for supply chain management, mobile IT, and health information exchange (HIE). Specifically, this study examines whether the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and whether symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Methods: This study uses a longitudinal in-patient dataset, including 879,122 in-patient hospital admissions for 347,949 patients in 61 hospitals located in Florida and New York in the United States, from 2014 to 2015. Logistic regression was applied to assess the effect of HITs on readmission risks. Time and hospital fixed effects were controlled in the regression model. Robust standard errors (SEs) were used to account for potential heteroskedasticity. These errors were further clustered at the patient level to consider possible correlations within the patient groups. Results: The interaction between STT for clinical use and STT for supply chain management, mobile IT, and HIE was negatively associated with 30-day readmission risk, with coefficients of --0.0352 (P=.003), --0.0520 (P<.001), and --0.0216 (P=.04), respectively. These results indicate that the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Furthermore, the joint effects of these HITs varied depending on the hospital affiliation and patients' disease types. Conclusions: Our results reveal that while individual HIT implementations have varying impacts on 30-day readmission risk, their joint effects are often associated with a reduction in 30-day readmission risk. This study substantially contributes to HIT value literature by quantifying the complementarity effects among 4 different types of HITs: STT for clinical use, STT for supply chain management, mobile IT, and HIE. It further offers practical implications for hospitals to maximize the benefits of their complementary HITs in reducing the 30-day readmission risk in their respective care scenarios. ",
doi="10.2196/51198",
url="https://formative.jmir.org/2024/1/e51198"
}


@Article{info:doi/10.2196/49691,
author="Tarver, L. Willi
and Savoy, April
and Patel, Himalaya
and Weiner, Michael
and Holden, J. Richard",
title="Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="30",
volume="11",
pages="e49691",
keywords="health information technology",
keywords="mobile devices",
keywords="nursing and nursing systems",
keywords="outpatient care",
keywords="SEIPS 2.0",
keywords="work-system analysis",
abstract="Background: Industrywide, primary care nurses' work is increasing in complexity and team orientation. Mobile health information technologies (HITs) designed to aid nurses with indirect care tasks, including charting, have had mixed success. Failed introductions of HIT may be explained by insufficient integration into nurses' work processes, owing to an incomplete or incorrect understanding of the underlying work systems. Despite this need for context, published evidence has focused more on inpatient settings than on primary care. Objective: This study aims to characterize nurses' and health technicians' perceptions of process inefficiencies in the primary care setting and identify related work system factors. Methods: Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, we conducted an exploratory work system analysis with a convenience sample of primary care nurses and health technicians. Semistructured contextual interviews were conducted in 2 sets of primary care clinics in the Midwestern United States, one in an urban tertiary care center and the other in a rural community-based outpatient facility. Using directed qualitative content analysis of transcripts, we identified tasks participants perceived as frequent, redundant, or difficult, related processes, and recommendations for improvement. In addition, we conducted configuration analyses to identify associations between process inefficiencies and work system factors. Results: We interviewed a convenience sample of 20 primary care nurses and 2 health technicians, averaging approximately 12 years of experience in their current role. Across sites, participants perceived 2 processes, managing patient calls and clinic walk-in visits, as inefficient. Among work system factors, participants described organizational and technological factors associated with inefficiencies. For example, new organization policies to decrease patient waiting invoked frequent, repetitive, and difficult tasks, including chart review and check-in using tablet computers. Participants reported that issues with policy implementation and technology usability contributed to process inefficiencies. Organizational and technological factors were also perceived among participants as the most adaptable. Suggested technology changes included new tools for walk-in triage and patient self-reporting of symptoms. Conclusions: In response to changes to organizational policy and technology, without compensative changes elsewhere in their primary care work system, participants reported process adaptations. These adaptations indicate inefficient work processes. Understanding how the implementation of organizational policies affects other factors in the primary care work system may improve the quality of such implementations and, in turn, increase the effectiveness and efficiency of primary care nurse processes. Furthermore, the design and implementation of HIT interventions should consider influential work system factors and their effects on work processes. ",
doi="10.2196/49691",
url="https://humanfactors.jmir.org/2024/1/e49691"
}


@Article{info:doi/10.2196/55350,
author="Zigdon, Avi
and Zwilling, Moti
and Zigdon, Ofek
and Reges, Orna",
title="Health Maintenance Organization--mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="30",
volume="26",
pages="e55350",
keywords="HMO-mHealth",
keywords="mHealth",
keywords="face-to-face",
keywords="digital health",
keywords="digital health apps",
keywords="eHealth",
keywords="HMO-mHealth adoption",
keywords="health care",
keywords="mHealth adoption",
keywords="mobile phone",
keywords="HMO",
keywords="health maintenance organization",
abstract="Background: Health maintenance organization--mobile health (HMO-mHealth) services have a direct impact on patients' daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. Objective: This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Methods: Israeli adults aged ?18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. Results: A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68\%; male: 2025/6321, 32\%). Approximately 80.9\% (5115/6321) to 88.2\% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3\% (3498/6321), 52.2\% (3301/6321), and 46.9\% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95\% CI 0.67-0.83; P<.001 and OR 0.82, 95\% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95\% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95\% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95\% CI 1.02-1.22; P<.02 to OR 1.38, 95\% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. Conclusions: HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups. ",
doi="10.2196/55350",
url="https://www.jmir.org/2024/1/e55350"
}


@Article{info:doi/10.2196/48294,
author="Fesshaye, Berhaun
and Pandya, Shivani
and Kan, Lena
and Kalbarczyk, Anna
and Alland, Kelsey
and Rahman, Mustafizur S. M.
and Bulbul, Islam Md Mofijul
and Mustaphi, Piyali
and Siddique, Bakr Muhammad Abu
and Tanim, Alam Md Imtiaz
and Chowdhury, Mridul
and Rumman, Tajkia
and Labrique, B. Alain",
title="Quality, Usability, and Trust Challenges to Effective Data Use in the Deployment and Use of the Bangladesh Nutrition Information System Dashboard: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="30",
volume="26",
pages="e48294",
keywords="digital health",
keywords="nutrition",
keywords="data for decision-making",
keywords="health information systems",
keywords="information system",
keywords="information systems",
keywords="LMIC",
keywords="low- and middle-income countries",
keywords="nutritional",
keywords="dashboard",
keywords="experience",
keywords="experiences",
keywords="interview",
keywords="interviews",
keywords="service",
keywords="services",
keywords="delivery",
keywords="health care management",
abstract="Background: Evidence-based decision-making is essential to improve public health benefits and resources, especially in low- and middle-income countries (LMICs), but the mechanisms of its implementation remain less straightforward. The availability of high-quality, reliable, and sufficient data in LMICs can be challenging due to issues such as a lack of human resource capacity and weak digital infrastructure, among others. Health information systems (HISs) have been critical for aggregating and integrating health-related data from different sources to support evidence-based decision-making. Nutrition information systems (NISs), which are nutrition-focused HISs, collect and report on nutrition-related indicators to improve issues related to malnutrition and food security---and can assist in improving populations' nutritional statuses and the integration of nutrition programming into routine health services. Data visualization tools (DVTs) such as dashboards have been recommended to support evidence-based decision-making, leveraging data from HISs or NISs. The use of such DVTs to support decision-making has largely been unexplored within LMIC contexts. In Bangladesh, the Mukto dashboard was developed to display and visualize nutrition-related performance indicators at the national and subnational levels. However, despite this effort, the current use of nutrition data to guide priorities and decisions remains relatively nascent and underused. Objective: The goal of this study is to better understand how Bangladesh's NIS, including the Mukto dashboard, has been used and areas for improvement to facilitate its use for evidence-based decision-making toward ameliorating nutrition-related service delivery and the health status of communities in Bangladesh. Methods: Primary data collection was conducted through qualitative semistructured interviews with key policy-level stakeholders (n=24). Key informants were identified through purposive sampling and were asked questions about the experiences and challenges with the NIS and related nutrition dashboards. Results: Main themes such as trust, data usability, personal power, and data use for decision-making emerged from the data. Trust in both data collection and quality was lacking among many stakeholders. Poor data usability stemmed from unstandardized indicators, irregular data collection, and differences between rural and urban data. Insufficient personal power and staff training coupled with infrastructural challenges can negatively affect data at the input stage. While stakeholders understood and expressed the importance of evidence-based decision-making, ultimately, they noted that the data were not being used to their maximum potential. Conclusions: Leveraging DVTs can improve the use of data for evidence-based decision-making, but decision makers must trust that the data are believable, credible, timely, and responsive. The results support the significance of a tailored data ecosystem, which has not reached its full potential in Bangladesh. Recommendations to reach this potential include ensuring a clear intended user base and accountable stakeholders are present. Systems should also have the capacity to ensure data credibility and support ongoing personal power requirements. ",
doi="10.2196/48294",
url="https://www.jmir.org/2024/1/e48294",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348172"
}


@Article{info:doi/10.2196/60293,
author="Hu, Zhengyong
and Wang, Anran
and Duan, Yifan
and Zhou, Jiayin
and Hu, Wanfei
and Wu, Sizhu",
title="Toward Better Semantic Interoperability of Data Element Repositories in Medicine: Analysis Study",
journal="JMIR Med Inform",
year="2024",
month="Sep",
day="30",
volume="12",
pages="e60293",
keywords="data element repository",
keywords="FAIR",
keywords="ISO/IEC 11179",
keywords="metadata",
keywords="semantic interoperability",
abstract="Background: Data element repositories facilitate high-quality medical data sharing by standardizing data and enhancing semantic interoperability. However, the application of repositories is confined to specific projects and institutions. Objective: This study aims to explore potential issues and promote broader application of data element repositories within the medical field by evaluating and analyzing typical repositories. Methods: Following the inclusion of 5 data element repositories through a literature review, a novel analysis framework consisting of 7 dimensions and 36 secondary indicators was constructed and used for evaluation and analysis. Results: The study's results delineate the unique characteristics of different repositories and uncover specific issues in their construction. These issues include the absence of data reuse protocols and insufficient information regarding the application scenarios and efficacy of data elements. The repositories fully comply with only 45\% (9/20) of the subprinciples for Findable and Reusable in the FAIR principle, while achieving a 90\% (19/20 subprinciples) compliance rate for Accessible and 67\% (10/15 subprinciples) for Interoperable. Conclusions: The recommendations proposed in this study address the issues to improve the construction and application of repositories, offering valuable insights to data managers, computer experts, and other pertinent stakeholders. ",
doi="10.2196/60293",
url="https://medinform.jmir.org/2024/1/e60293",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348178"
}


@Article{info:doi/10.2196/53370,
author="Sood, Ishaana
and Sabherwal, Shalinder
and Mathur, Umang
and Jain, Elesh
and Bhadauria, Madhu
and Agrawal, Deepshikha
and Khurana, Ashi
and Mittal, Vikas
and Mahindrakar, Avinash
and Govindahari, Vishal
and Kulkarni, Sucheta
and Nischal, K. Ken",
title="Harnessing Generalizable Real-World Ophthalmic Big Data: Descriptive Analysis of the Bodhya Eye Consortium Model for Collaborative Research",
journal="Online J Public Health Inform",
year="2024",
month="Sep",
day="30",
volume="16",
pages="e53370",
keywords="anthropological and genomic heterogeneity",
keywords="big data",
keywords="consortium",
keywords="collaborative research",
keywords="generalizability",
keywords="global health impact",
keywords="North India",
abstract="Background: Eye care organizations and professionals worldwide are increasingly focusing on bridging the gap between population health and medical practice. Recent advances in genomics and anthropology have revealed that most Indian groups trace their ancestry to a blend of 2 genetically distinct populations: Ancestral North Indians, who share genetic affinities with Central Asians, Middle Easterners, Caucasians, and Europeans; and Ancestral South Indians, genetically distinct from groups outside the Indian subcontinent. Studies conducted among North Indian populations can therefore offer insights that are potentially applicable to these diverse global populations, underscoring significant implications for global health. Objective: The Bodhya Eye Consortium is a collaboration among 8 high-volume nonprofit eyecare organizations from across North India. The consortium aims to harness real-world data consistently and with assured quality for collaborative research. This paper outlines the formation of the consortium as a proposed model for controlled collaborative research among the leading eyecare organizations of North India. Methods: We detail the creation and effective implementation of a consortium following a structured road map that included planning and assessment, establishing an exploratory task force, defining specialty areas, setting objectives and priorities, and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Central to this process was a comprehensive data audit aimed at standardizing data collection across all participating organizations. Results: The consortium currently comprises 9 organizations, each represented in the governance structure by the Governing Council. Scientific standards for published research are established and overseen by the Scientific Committee, while the Conflict Resolution Committee manages any unresolved disputes. The consortium's working groups, organized by various eyecare specialties, collaborate on research projects through virtual interactions. A foundational step in this process was the organizationwide data audit, which revealed that most organizations complied with accurate and standardized data collection practices. Organizations with deficiencies in data completeness developed action plans to address them. Subsequently, the consortium adopted data collection proformas, contributing to the publication of high-quality manuscripts characterized by low dropout rates. Conclusions: The collaborative research conducted by the Bodhya Eye Consortium---a group of high-volume eyecare organizations primarily from North India---offers a unique opportunity to contribute to scientific knowledge across various domains of eyecare. By leveraging the established heterogeneity of anthropological and genomic origins within the population, the findings can be generalizable, to some extent, to European, Middle Eastern, and European American populations. This access to potentially invaluable, generalizable data has significant global health implications and opens possibilities for broader collaboration. The model outlined in this descriptive paper can serve as a blueprint for other health care organizations looking to develop similar collaborations for research and knowledge sharing. ",
doi="10.2196/53370",
url="https://ojphi.jmir.org/2024/1/e53370",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348171"
}


@Article{info:doi/10.2196/55546,
author="Brunton, Lisa
and Cotterill, Sarah
and Wilson, Paul",
title="Evaluating the National Rollout of a Type 2 Diabetes Self-Management Intervention: Qualitative Interview Study With Local National Health Service Leads Responsible for Implementation",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="25",
volume="26",
pages="e55546",
keywords="type 2 diabetes",
keywords="structured education",
keywords="self-management",
keywords="digital interventions",
keywords="implementation",
keywords="qualitative methods",
keywords="evaluation",
abstract="Background: Approximately 4.5 million people live with type 2 diabetes mellitus (T2DM) in the United Kingdom. Evidence shows that structured education programs can improve glycemic control and reduce the risk of complications from T2DM, but they have low attendance rates. To widen access to T2DM structured education, National Health Service England commissioned a national rollout of Healthy Living, a digital self-management program. Objective: The objectives were to understand the barriers and enablers to adopting, implementing, and integrating Healthy Living into existing T2DM care pathways across England. Methods: We undertook a cross-sectional, qualitative telephone semistructured interview study to address the objectives. In total, 17 local National Health Service leads responsible for implementing Healthy Living across their locality were recruited. We conducted 16 one-time interviews across 16 case sites (1 of the interviews was conducted with 2 local leads from the same case site). Interview data were analyzed using thematic analysis. Results: Three overarching themes were generated: (1) implementation activities, (2) where Healthy Living fits within existing pathways, and (3) contextual factors affecting implementation. Of the 16 sites, 14 (88\%) were implementing Healthy Living; the barrier to not implementing it in 2 case sites was not wanting Healthy Living to compete with their current education provision for T2DM. We identified 6 categories of implementation activities across sites: communication strategies to raise awareness of Healthy Living, developing bespoke local resources to support general practices with referrals, providing financial reimbursement or incentives to general practices, promoting Healthy Living via public events, monitoring implementation across their footprint, and widening access across high-need groups. However, outside early engagement sites, most implementation activities were ``light touch,'' consisting mainly of one-way communications to raise awareness. Local leads were generally positive about Healthy Living as an additional part of their T2DM structured education programs, but some felt it was more suited to specific patient groups. Barriers to undertaking more prolonged, targeted implementation campaigns included implementation not being mandated, sites not receiving data on uptake across their footprint, and confusion in understanding where Healthy Living fit within existing care pathways. Conclusions: A passive process of disseminating information about Healthy Living to general practices rather than an active process of implementation occurred across most sites sampled. This study identified that there is a need for clearer communications regarding the type of patients that may benefit from the Healthy Living program, including when it should be offered and whether it should be offered instead of or in addition to other education programs. No sites other than early engagement sites received data to monitor uptake across their footprint. Understanding variability in uptake across practices may have enabled sites to plan targeted referral campaigns in practices that were not using the service. ",
doi="10.2196/55546",
url="https://www.jmir.org/2024/1/e55546"
}


@Article{info:doi/10.2196/58445,
author="Tabari, Parinaz
and Costagliola, Gennaro
and De Rosa, Mattia
and Boeker, Martin",
title="State-of-the-Art Fast Healthcare Interoperability Resources (FHIR)--Based Data Model and Structure Implementations: Systematic Scoping Review",
journal="JMIR Med Inform",
year="2024",
month="Sep",
day="24",
volume="12",
pages="e58445",
keywords="data model",
keywords="Fast Healthcare Interoperability Resources",
keywords="FHIR",
keywords="interoperability",
keywords="modeling",
keywords="PRISMA",
abstract="Background: Data models are crucial for clinical research as they enable researchers to fully use the vast amount of clinical data stored in medical systems. Standardized data and well-defined relationships between data points are necessary to guarantee semantic interoperability. Using the Fast Healthcare Interoperability Resources (FHIR) standard for clinical data representation would be a practical methodology to enhance and accelerate interoperability and data availability for research. Objective: This research aims to provide a comprehensive overview of the state-of-the-art and current landscape in FHIR-based data models and structures. In addition, we intend to identify and discuss the tools, resources, limitations, and other critical aspects mentioned in the selected research papers. Methods: To ensure the extraction of reliable results, we followed the instructions of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We analyzed the indexed articles in PubMed, Scopus, Web of Science, IEEE Xplore, the ACM Digital Library, and Google Scholar. After identifying, extracting, and assessing the quality and relevance of the articles, we synthesized the extracted data to identify common patterns, themes, and variations in the use of FHIR-based data models and structures across different studies. Results: On the basis of the reviewed articles, we could identify 2 main themes: dynamic (pipeline-based) and static data models. The articles were also categorized into health care use cases, including chronic diseases, COVID-19 and infectious diseases, cancer research, acute or intensive care, random and general medical notes, and other conditions. Furthermore, we summarized the important or common tools and approaches of the selected papers. These items included FHIR-based tools and frameworks, machine learning approaches, and data storage and security. The most common resource was ``Observation'' followed by ``Condition'' and ``Patient.'' The limitations and challenges of developing data models were categorized based on the issues of data integration, interoperability, standardization, performance, and scalability or generalizability. Conclusions: FHIR serves as a highly promising interoperability standard for developing real-world health care apps. The implementation of FHIR modeling for electronic health record data facilitates the integration, transmission, and analysis of data while also advancing translational research and phenotyping. Generally, FHIR-based exports of local data repositories improve data interoperability for systems and data warehouses across different settings. However, ongoing efforts to address existing limitations and challenges are essential for the successful implementation and integration of FHIR data models. ",
doi="10.2196/58445",
url="https://medinform.jmir.org/2024/1/e58445",
url="http://www.ncbi.nlm.nih.gov/pubmed/39316433"
}


@Article{info:doi/10.2196/59830,
author="Pugh, Jo Mary
and Haun, N. Jolie
and White, Jon P.
and Cochran, Gerald
and Mohanty, F. April
and McAndrew, M. Lisa
and Gordon, J. Adam
and Nelson, E. Richard
and Vanneman, E. Megan
and Naranjo, E. Diana
and Benzinger, C. Rachel
and Jones, L. Audrey
and Kean, Jacob
and Zickmund, L. Susan
and Fagerlin, Angela",
title="Developing Evidence to Support Policy: Protocol for the StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT)",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="19",
volume="13",
pages="e59830",
keywords="evidence-based policy-making",
keywords="policy evaluation",
keywords="knowledge translation",
keywords="veterans",
keywords="implementation science",
abstract="Background: All federal agencies are required to support appropriation requests with evidence and evaluation (US Public Law 115-435; the Evidence Act). The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is 1 of 6 centers that help the Department of Veterans Affairs (VA) meet this requirement. Objective: Working with the existing VA evaluation structure, SALIENT evaluations will contribute to (1) optimize policies and programs for veteran populations; (2) improve outcomes regarding health, equity, cost, and provider well-being; (3) advance the science of dissemination and knowledge translation; and (4) expand the implementation and dissemination science workforce. Methods: We leverage the Lean Sprint methodology (iterative, incremental, rule-governed approach to clearly defined, and time-boxed work) and 3 cores to develop our evaluation plans collaboratively with operational partners and key stakeholders including veterans, policy experts, and clinicians. The Operations Core will work with evaluation teams to develop timelines, facilitate work, monitor progress, and guide quality improvement within SALIENT. The Methods Core will work with evaluation teams to identify the most appropriate qualitative, quantitative, and mixed methods approaches to address each evaluation, ensure that the analyses are conducted appropriately, and troubleshoot when problems with data acquisition and analysis arise. The Knowledge Translation (KT) Core will target key partners and decision makers using a needs-based market segmentation approach to ensure that needs are incorporated in the dissemination of knowledge. The KT Core will create communications briefs, playbooks, and other materials targeted at these market segments to facilitate implementation of evidence-based practices and maximize the impact of evaluation results. Results: The SALIENT team has developed a center infrastructure to support high-priority evaluations, often to be responsive to shifting operational needs and priorities. Our team has engaged in our core missions and operations to rapidly evaluate a high-priority areas, develop a comprehensive Lean Sprint systems redesign approach to training, and accelerate rapid knowledge translation. Conclusions: With an array of interdisciplinary expertise, operational partnerships, and integrated resources, SALIENT has an established and evolving infrastructure to rapidly develop and implement high-impact evaluations. Projects are developed with sustained efficiency approaches that can pivot to new priorities as needed and effectively translate knowledge for key stakeholders and policy makers, while creating a learning health system infrastructure to foster the next generation of evaluation and implementation scientists. International Registered Report Identifier (IRRID): PRR1-10.2196/59830 ",
doi="10.2196/59830",
url="https://www.researchprotocols.org/2024/1/e59830"
}


@Article{info:doi/10.2196/57406,
author="Staehelin, Dario
and Dolata, Mateusz
and St{\"o}ckli, Livia
and Schwabe, Gerhard",
title="How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research",
journal="JMIR Med Inform",
year="2024",
month="Sep",
day="10",
volume="12",
pages="e57406",
keywords="patient-provider communication",
keywords="patient-generated data",
keywords="field study",
keywords="chronic care",
keywords="design science research",
keywords="patient-centered care",
keywords="integrated care",
keywords="patient-provider collaboration",
keywords="mobile phone",
abstract="Background: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers' workflow. Objective: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. Methods: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. Results: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. Conclusions: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care. ",
doi="10.2196/57406",
url="https://medinform.jmir.org/2024/1/e57406"
}


@Article{info:doi/10.2196/53939,
author="Lyles, Courtney
and Berrean, Beth
and Buenaventura, Ana
and Milter, Svetlana
and Hernandez, Daniel Dayana
and Sarkar, Urmimala
and Gutierrez, Christian
and Palmer, Nynikka
and Brown III, William",
title="Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="16",
volume="11",
pages="e53939",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="electronic health",
keywords="application",
keywords="digital health",
keywords="digital ecosystem",
keywords="informatics",
keywords="community-based",
keywords="community",
keywords="co-design",
keywords="human-centered design",
keywords="community health",
keywords="population health",
keywords="technology",
keywords="innovation",
keywords="operations",
keywords="social needs",
keywords="health resources",
keywords="qualitative analysis",
abstract="Background: Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective: We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods: Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results: Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled ``Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN),'' was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions: Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, and customization needed in these settings. ",
doi="10.2196/53939",
url="https://humanfactors.jmir.org/2024/1/e53939"
}


@Article{info:doi/10.2196/46407,
author="Cresswell, Kathrin
and de Keizer, Nicolette
and Magrabi, Farah
and Williams, Robin
and Rigby, Michael
and Prgomet, Mirela
and Kukhareva, Polina
and Wong, Shui-Yee Zoie
and Scott, Philip
and Craven, K. Catherine
and Georgiou, Andrew
and Medlock, Stephanie
and Brender McNair, Jytte
and Ammenwerth, Elske",
title="Evaluating Artificial Intelligence in Clinical Settings---Let Us Not Reinvent the Wheel",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e46407",
keywords="artificial intelligence",
keywords="evaluation",
keywords="theory",
keywords="patient safety",
keywords="optimisation",
keywords="health care",
keywords="optimization",
doi="10.2196/46407",
url="https://www.jmir.org/2024/1/e46407",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110494"
}


@Article{info:doi/10.2196/57717,
author="Shang, Di
and Williams, Cynthia
and Culiqi, Hera",
title="Telehealth Uptake Among Hispanic People During COVID-19: Retrospective Observational Study",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="24",
volume="12",
pages="e57717",
keywords="telehealth",
keywords="telemedicine",
keywords="ICT",
keywords="eHealth",
keywords="e-health",
keywords="Hispanic",
keywords="health equity",
keywords="health access",
keywords="Hispanics",
keywords="digital divide",
keywords="usage",
keywords="utilization",
keywords="equity",
keywords="inequity",
keywords="inequities",
keywords="access",
keywords="accessibility",
keywords="Spanish",
keywords="observational",
keywords="demographic",
keywords="demographics",
keywords="socioeconomic",
keywords="socioeconomics",
keywords="information and communication technology",
abstract="Background: The Hispanic community represents a sizeable community that experiences inequities in the US health care system. As the system has moved toward digital health platforms, evaluating the potential impact on Hispanic communities is critical. Objective: The study aimed to investigate demographic, socioeconomic, and behavioral factors contributing to low telehealth use in Hispanic communities. Methods: We used a retrospective observation study design to examine the study objectives. The COVID-19 Research Database Consortium provided the Analytics IQ PeopleCore consumer data and Office Alley claims data. The study period was from March 2020 to April 2021. Multiple logistic regression was used to determine the odds of using telehealth services. Results: We examined 3,478,287 unique Hispanic patients, 16.6\% (577,396) of whom used telehealth. Results suggested that patients aged between 18 and 44 years were more likely to use telehealth (odds ratio [OR] 1.07, 95\% CI 1.05-1.1; P<.001) than patients aged older than 65 years. Across all age groups, patients with high incomes were at least 20\% more likely to use telehealth than patients with lower incomes (P<.001); patients who had a primary care physician (P=.01), exhibited high medical usage (P<.001), or were interested in exercise (P=.03) were more likely to use telehealth; patients who had unhealthy behaviors such as smoking and alcohol consumption were less likely to use telehealth (P<.001). Male patients were less likely than female patients to use telehealth among patients aged 65 years and older (OR 0.94, 95\% CI 0.93-0.95; P<.001), while male patients aged between 18 and 44 years were more likely to use telehealth (OR 1.05, 95\% CI 1.03-1.07; P<.001). Among patients younger than 65 years, full-time employment was positively associated with telehealth use (P<.001). Patients aged between 18 and 44 years with high school or less education were 2\% less likely to use telehealth (OR 0.98, 95\% CI 0.97-0.99; P=.005). Results also revealed a positive association with using WebMD (WebMD LLC) among patients aged older than 44 years (P<.001), while there was a negative association with electronic prescriptions among those who were aged between 18 and 44 years (P=.009) and aged between 45 and 64 years (P=.004). Conclusions: This study demonstrates that telehealth use among Hispanic communities is dependent upon factors such as age, gender, education, socioeconomic status, current health care engagement, and health behaviors. To address these challenges, we advocate for interdisciplinary approaches that involve medical professionals, insurance providers, and community-based services actively engaging with Hispanic communities and promoting telehealth use. We propose the following recommendations: enhance access to health insurance, improve access to primary care providers, and allocate fiscal and educational resources to support telehealth use. As telehealth increasingly shapes health care delivery, it is vital for professionals to facilitate the use of all available avenues for accessing care. ",
doi="10.2196/57717",
url="https://medinform.jmir.org/2024/1/e57717"
}


@Article{info:doi/10.2196/55959,
author="Aisyah, Nur Dewi
and Setiawan, Heri Agus
and Lokopessy, Fawwaz Alfiano
and Faradiba, Nadia
and Setiaji, Setiaji
and Manikam, Logan
and Kozlakidis, Zisis",
title="The Information and Communication Technology Maturity Assessment at Primary Health Care Services Across 9 Provinces in Indonesia: Evaluation Study",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="18",
volume="12",
pages="e55959",
keywords="public health centers",
keywords="Puskesmas",
keywords="digital maturity",
keywords="infrastructure",
keywords="primary health care",
keywords="district health office",
keywords="primary care clinics",
keywords="Asia",
keywords="Asian",
keywords="Indonesia",
keywords="ICT",
keywords="information and communication technologies",
keywords="information and communication technology",
keywords="maturity",
keywords="adoption",
keywords="readiness",
keywords="implementation",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="cross sectional",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="primary care",
abstract="Background: Indonesia has rapidly embraced digital health, particularly during the COVID-19 pandemic, with over 15 million daily health application users. To advance its digital health vision, the government is prioritizing the development of health data and application systems into an integrated health care technology ecosystem. This initiative involves all levels of health care, from primary to tertiary, across all provinces. In particular, it aims to enhance primary health care services (as the main interface with the general population) and contribute to Indonesia's digital health transformation. Objective: This study assesses the information and communication technology (ICT) maturity in Indonesian health care services to advance digital health initiatives. ICT maturity assessment tools, specifically designed for middle-income countries, were used to evaluate digital health capabilities in 9 provinces across 5 Indonesian islands. Methods: A cross-sectional survey was conducted from February to March 2022, in 9 provinces across Indonesia, representing the country's diverse conditions on its major islands. Respondents included staff from public health centers (Puskesmas), primary care clinics (Klinik Pratama), and district health offices (Dinas Kesehatan Kabupaten/Kota). The survey used adapted ICT maturity assessment questionnaires, covering human resources, software and system, hardware, and infrastructure. It was administered electronically and involved 121 public health centers, 49 primary care clinics, and 67 IT staff from district health offices. Focus group discussions were held to delve deeper into the assessment results and gain more descriptive insights. Results: In this study, 237 participants represented 3 distinct categories: 121 public health centers, 67 district health offices, and 49 primary clinics. These instances were selected from a sample of 9 of the 34 provinces in Indonesia. Collected data from interviews and focus group discussions were transformed into scores on a scale of 1 to 5, with 1 indicating low ICT readiness and 5 indicating high ICT readiness. On average, the breakdown of ICT maturity scores was as follows: 2.71 for human resources' capability in ICT use and system management, 2.83 for software and information systems, 2.59 for hardware, and 2.84 for infrastructure, resulting in an overall average score of 2.74. According to the ICT maturity level pyramid, the ICT maturity of health care providers in Indonesia fell between the basic and good levels. The need to pursue best practices also emerged strongly. Further analysis of the ICT maturity scores, when examined by province, revealed regional variations. Conclusions: The maturity of ICT use is influenced by several critical components. Enhancing human resources, ensuring infrastructure, the availability of supportive hardware, and optimizing information systems are imperative to attain ICT maturity in health care services. In the context of ICT maturity assessment, significant score variations were observed across health care levels in the 9 provinces, underscoring the diversity in ICT readiness and the need for regionally customized follow-up actions. ",
doi="10.2196/55959",
url="https://medinform.jmir.org/2024/1/e55959"
}


@Article{info:doi/10.2196/56886,
author="Cummings, Camilla
and Raja, Pushpa
and Gabrielian, Sonya
and Doran, Neal",
title="Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data",
journal="JMIR Ment Health",
year="2024",
month="Jul",
day="9",
volume="11",
pages="e56886",
keywords="telemedicine",
keywords="quality of care",
keywords="serious mental illness",
keywords="telehealth",
keywords="adoption",
keywords="mental illness",
keywords="patients",
keywords="patient",
keywords="veterans",
keywords="veteran",
keywords="psychotherapy",
keywords="psychosocial",
keywords="mental healthcare",
keywords="suicide",
keywords="rehabilitation",
keywords="mental health care",
abstract="Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth's impacts on SMI care outcomes is mixed, necessitating further investigation. Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. Methods: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). Results: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=?4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=?4.49; P<.001; z=?3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=?3.74; P<.001), and continuity of care after a high-risk event (z=?2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=?4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized. Conclusions: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation---selected through a health equity lens---may improve quality of care among patients with SMI. ",
doi="10.2196/56886",
url="https://mental.jmir.org/2024/1/e56886"
}


@Article{info:doi/10.2196/52993,
author="DeLaRosby, Anna
and Mulcahy, Julie
and Norwood, Todd",
title="A Proposed Decision-Making Framework for the Translation of In-Person Clinical Care to Digital Care: Tutorial",
journal="JMIR Med Educ",
year="2024",
month="Jun",
day="26",
volume="10",
pages="e52993",
keywords="clinical decision-making",
keywords="digital health",
keywords="telehealth",
keywords="telerehab",
keywords="framework",
keywords="digital medicine",
keywords="cognitive process",
keywords="telemedicine",
keywords="clinical training",
doi="10.2196/52993",
url="https://mededu.jmir.org/2024/1/e52993"
}


@Article{info:doi/10.2196/55000,
author="Casella Jean-Baptiste, Meredith
and Vital Julmiste, Monide Thamar
and Ball, Ellen",
title="Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="14",
volume="8",
pages="e55000",
keywords="maternal health",
keywords="health informatics",
keywords="quality improvement",
keywords="Plan-Do-Study-Act",
keywords="PDSA",
keywords="maternal",
keywords="neonatal",
keywords="data collection",
keywords="prenatal",
keywords="outpatient",
keywords="electronic data",
keywords="nursing",
keywords="nursing staff",
keywords="nursing leadership",
abstract="Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the H{\^o}pital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18\% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18\% (58/325) to 85\% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at H{\^o}pital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18\% (58/325). Ten months of improvement strategies resulted in an average of 89\% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. ",
doi="10.2196/55000",
url="https://formative.jmir.org/2024/1/e55000",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875702"
}


@Article{info:doi/10.2196/53574,
author="Pienkowska, Anita
and Ravaut, Mathieu
and Mammadova, Maleyka
and Ang, Chin-Siang
and Wang, Hanyu
and Ong, Chwen Qi
and Bojic, Iva
and Qin, Mengqi Vicky
and Sumsuzzman, Md Dewan
and Ajuebor, Onyema
and Boniol, Mathieu
and Bustamante, Paola Juana
and Campbell, James
and Cometto, Giorgio
and Fitzpatrick, Siobhan
and Kane, Catherine
and Joty, Shafiq
and Car, Josip",
title="Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="13",
volume="8",
pages="e53574",
keywords="World Health Organization",
keywords="WHO",
keywords="public surveillance",
keywords="natural language processing",
keywords="NLP",
keywords="artificial intelligence",
keywords="AI",
keywords="COVID-19",
keywords="SARS-COV-2",
keywords="COVID-19 pandemic",
keywords="human-generated analysis",
keywords="decision-making",
keywords="strategic policy",
keywords="health workforce",
keywords="news article",
keywords="media content analysis",
keywords="news coverage",
keywords="health care worker",
keywords="mental health",
keywords="death risk",
keywords="intervention",
keywords="efficiency",
keywords="public health",
keywords="surveillance",
keywords="innovation",
keywords="innovative method",
abstract="Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19--related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic's onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence--assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. ",
doi="10.2196/53574",
url="https://formative.jmir.org/2024/1/e53574",
url="http://www.ncbi.nlm.nih.gov/pubmed/38869940"
}


@Article{info:doi/10.2196/54811,
author="Wu, Yuxuan
and Wu, Mingyue
and Wang, Changyu
and Lin, Jie
and Liu, Jialin
and Liu, Siru",
title="Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="12",
volume="12",
pages="e54811",
keywords="clinical decision support system",
keywords="electronic health record",
keywords="electronic medical record",
keywords="health information technology",
keywords="alert fatigue",
keywords="burnout",
keywords="health care professionals",
keywords="health care service",
keywords="EHR",
keywords="systematic review",
keywords="meta-analysis",
keywords="health information system",
keywords="clinician burnout",
keywords="health informatics",
abstract="Background: Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. Objective: This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. Methods: We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. Results: The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4\% (95\% CI 37.5\%-43.2\%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95\% CI 2.31-2.57). Conclusions: The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021281173 ",
doi="10.2196/54811",
url="https://medinform.jmir.org/2024/1/e54811",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865188"
}


@Article{info:doi/10.2196/54071,
author="Landis-Lewis, Zach
and Andrews, A. Chris
and Gross, A. Colin
and Friedman, P. Charles
and Shah, J. Nirav",
title="Exploring Anesthesia Provider Preferences for Precision Feedback: Preference Elicitation Study",
journal="JMIR Med Educ",
year="2024",
month="Jun",
day="11",
volume="10",
pages="e54071",
keywords="audit and feedback",
keywords="dashboard",
keywords="motivation",
keywords="visualization",
keywords="anesthesia care",
keywords="anesthesia",
keywords="feedback",
keywords="engagement",
keywords="effectiveness",
keywords="precision feedback",
keywords="experimental design",
keywords="design",
keywords="clinical practice",
keywords="motivational",
keywords="performance",
keywords="performance data",
abstract="Background: Health care professionals must learn continuously as a core part of their work. As the rate of knowledge production in biomedicine increases, better support for health care professionals' continuous learning is needed. In health systems, feedback is pervasive and is widely considered to be essential for learning that drives improvement. Clinical quality dashboards are one widely deployed approach to delivering feedback, but engagement with these systems is commonly low, reflecting a limited understanding of how to improve the effectiveness of feedback about health care. When coaches and facilitators deliver feedback for improving performance, they aim to be responsive to the recipient's motivations, information needs, and preferences. However, such functionality is largely missing from dashboards and feedback reports. Precision feedback is the delivery of high-value, motivating performance information that is prioritized based on its motivational potential for a specific recipient, including their needs and preferences. Anesthesia care offers a clinical domain with high-quality performance data and an abundance of evidence-based quality metrics. Objective: The objective of this study is to explore anesthesia provider preferences for precision feedback. Methods: We developed a test set of precision feedback messages with balanced characteristics across 4 performance scenarios. We created an experimental design to expose participants to contrasting message versions. We recruited anesthesia providers and elicited their preferences through analysis of the content of preferred messages. Participants additionally rated their perceived benefit of preferred messages to clinical practice on a 5-point Likert scale. Results: We elicited preferences and feedback message benefit ratings from 35 participants. Preferences were diverse across participants but largely consistent within participants. Participants' preferences were consistent for message temporality ($\alpha$=.85) and display format ($\alpha$=.80). Ratings of participants' perceived benefit to clinical practice of preferred messages were high (mean rating 4.27, SD 0.77). Conclusions: Health care professionals exhibited diverse yet internally consistent preferences for precision feedback across a set of performance scenarios, while also giving messages high ratings of perceived benefit. A ``one-size-fits-most approach'' to performance feedback delivery would not appear to satisfy these preferences. Precision feedback systems may hold potential to improve support for health care professionals' continuous learning by accommodating feedback preferences. ",
doi="10.2196/54071",
url="https://mededu.jmir.org/2024/1/e54071"
}


@Article{info:doi/10.2196/46954,
author="Paatela, Satu
and Kyyts{\"o}nen, Maiju
and Saranto, Kaija
and Kinnunen, Ulla-Mari
and Vehko, Tuulikki",
title="Experiences of Electronic Health Records' and Client Information Systems' Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="29",
volume="26",
pages="e46954",
keywords="practical nurse",
keywords="information and communication technology",
keywords="electronic health record",
keywords="client information system",
keywords="documentation",
keywords="mobile technology",
abstract="Background: The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today's era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients' homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities. Objective: This study aims to analyze practical nurses' experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device. Methods: A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings. Results: The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95\% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95\% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95\% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95\% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses' office (OR 2.33, 95\% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95\% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95\% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not. Conclusions: To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use. ",
doi="10.2196/46954",
url="https://www.jmir.org/2024/1/e46954",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809583"
}


@Article{info:doi/10.2196/54334,
author="Huang, Ching-Yuan
and Lee, Po-Chun
and Chen, Long-Hui",
title="Exploring Consumers' Negative Electronic Word-of-Mouth of 5 Military Hospitals in Taiwan Through SERVQUAL and Flower of Services: Web Scraping Analysis",
journal="JMIR Form Res",
year="2024",
month="May",
day="29",
volume="8",
pages="e54334",
keywords="electronic word-of-mouth",
keywords="eWOM",
keywords="service quality",
keywords="SERVQUAL scale",
keywords="Flower of Services",
keywords="health care service quality",
keywords="military hospitals",
abstract="Background: In recent years, with the widespread use of the internet, the influence of electronic word-of-mouth (eWOM) has been increasingly recognized, particularly the significance of negative eWOM, which has surpassed positive eWOM in importance. Such reviews play a pivotal role in research related to service industry management, particularly in intangible service sectors such as hospitals, where they have become a reference point for improving service quality. Objective: This study comprehensively collected negative eWOM from 5 military hospitals in Taiwan that were at or above the level of regional teaching hospitals. It aimed to investigate service quality issues before and after the pandemic. The findings provide important references for formulating strategies to improve service quality. Methods: In this study, we used web scraping techniques to gather 1259 valid negative eWOM, covering the period from the inception of the first review to December 31, 2022. These reviews were categorized using content analysis based on the modified Parasuraman, Zeithaml, and Berry service quality (PZB SERVQUAL) scale and Flower of Services. Statistical data analysis was conducted to investigate the performance of service quality. Results: The annual count of negative reviews for each hospital has exhibited a consistent upward trajectory over the years, with a more pronounced increase following the onset of the pandemic. In the analysis, among the 5 dimensions of PZB SERVQUAL framework, the ``Assurance'' dimension yielded the least favorable results, registering a negative review rate as high as 58.3\%. Closely trailing, the ``Responsiveness'' dimension recorded a negative review rate of 34.2\%. When evaluating the service process, the subitem ``In Service: Diagnosis/Examination/Medical/Hospitalization'' exhibited the least satisfactory performance, with a negative review rate of 46.2\%. This was followed by the subitem ``In Service: Pre-diagnosis Waiting,'' which had a negative review rate of 20.2\%. To evaluate the average scores of negative reviews before and during the onset of the COVID-19 pandemic, independent sample t tests (2-tailed) were used. The analysis revealed statistically significant differences (P<.001). Furthermore, an ANOVA was conducted to investigate whether the length of the negative reviews impacted their ratings, which also showed significant differences (P=.01). Conclusions: Before and during the pandemic, there were significant differences in evaluating hospital services, and a higher word count in negative reviews indicated greater dissatisfaction with the service. Therefore, it is recommended that hospitals establish more comprehensive service quality management mechanisms, carefully respond to negative reviews, and categorize significant service deficiencies as critical events to prevent a decrease in overall service quality. Furthermore, during the service process, customers are particularly concerned about the attitude and responsiveness of health care personnel in the treatment process. Therefore, hospitals should enhance training and management in this area. ",
doi="10.2196/54334",
url="https://formative.jmir.org/2024/1/e54334",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809602"
}


@Article{info:doi/10.2196/45593,
author="Bienzeisler, Jonas
and Becker, Guido
and Erdmann, Bernadett
and Kombeiz, Alexander
and Majeed, W. Raphael
and R{\"o}hrig, Rainer
and Greiner, Felix
and Otto, Ronny
and Otto-Sobotka, Fabian
and ",
title="The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="14",
volume="26",
pages="e45593",
keywords="EHR",
keywords="emergency medicine",
keywords="AKTIN, process management",
keywords="crowding",
keywords="triage system",
keywords="electronic health record",
keywords="health care",
keywords="treatment",
keywords="emergency department",
abstract="Background: The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. Objective: This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. Methods: We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. Results: The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Conclusions: Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster. ",
doi="10.2196/45593",
url="https://www.jmir.org/2024/1/e45593",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743464"
}


@Article{info:doi/10.2196/46414,
author="Szczepura, Ala
and Khan, Jahan Amir
and Wild, Deidre
and Nelson, Sara
and Woodhouse, Sonja
and Collinson, Mark",
title="Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers' Well-Being: Retrospective Population-Based Database Study With Embedded User Survey",
journal="JMIR Aging",
year="2024",
month="May",
day="13",
volume="7",
pages="e46414",
keywords="digital adoption",
keywords="COVID-19",
keywords="informal caregivers",
keywords="carer support organization",
keywords="organization performance",
keywords="integrated care systems",
keywords="care systems",
keywords="health policy",
keywords="aging in place",
keywords="digital divide",
abstract="Background: The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be {\textsterling}111 billion (US\$ 152.7 billion) in England. Objective: This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers' support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery. Methods: This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses. Results: The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89\% (943/1929) to 86.68\% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8\%) and caregiver assessments (20.9\%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers' well-being assessments, support needs checks, and peer support groups. Conclusions: Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers' access to, and engagement with, such services. ",
doi="10.2196/46414",
url="https://aging.jmir.org/2024/1/e46414",
url="http://www.ncbi.nlm.nih.gov/pubmed/38739915"
}


@Article{info:doi/10.2196/55064,
author="Arsenault-Lapierre, Genevieve
and Lemay-Compagnat, Alexandra
and Guillette, Maxime
and Couturier, Yves
and Massamba, Victoria
and Dufour, Isabelle
and Maubert, Eric
and Fournier, Christine
and Denis, Julie
and Morin, Caroline
and Vedel, Isabelle",
title="Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations",
journal="JMIR Form Res",
year="2024",
month="May",
day="8",
volume="8",
pages="e55064",
keywords="dashboard",
keywords="learning health system",
keywords="health policy",
keywords="dementia care",
keywords="health care regionalization",
keywords="dementia",
keywords="Alzheimer disease",
keywords="qualitative",
keywords="collaborative",
keywords="focus group",
keywords="primary care",
keywords="implementation",
keywords="attitude",
keywords="opinion",
keywords="perception",
keywords="perspective",
keywords="service",
keywords="health care management",
abstract="Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled ``university/peripheral''; organizations for which only part of the territory is in rural areas, labeled ``mixed''; and organizations in remote or isolated areas, labeled ``remote/isolated'') and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. ",
doi="10.2196/55064",
url="https://formative.jmir.org/2024/1/e55064",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717803"
}


@Article{info:doi/10.2196/50588,
author="Katumba, Godfrey
and Mwanja, Herman
and Mayito, Jonathan
and Mbolanyi, Betty
and Isaasi, Fred
and Kibombo, Daniel
and Namumbya, Judith
and Musoke, David
and Kabazzi, Jonathan
and Sekamatte, Musa
and Idrakua, Lillian
and Walwema, Richard
and Lamorde, Mohammed
and Kakooza, Francis
and Etimu, Simon",
title="Establishing Antimicrobial Resistance Surveillance in the Water and Environment Sector in a Resource-Limited Setting: Methodical Qualitative and Quantitative Description of Uganda's Experience From 2021 to 2023",
journal="JMIRx Bio",
year="2024",
month="May",
day="7",
volume="2",
pages="e50588",
keywords="antimicrobial resistance",
keywords="surveillance system",
keywords="water and environment sector",
abstract="Background: Antimicrobial irrational use and poor disposal in the human and animal sectors promote antimicrobial resistance (AMR) in the environment as these antimicrobials and their active ingredients, coupled with resistant microbes, are released into the environment. While AMR containment programs in the human and animal sectors are well established in Uganda, those in the water and environment sector still need to be established and strengthened. Therefore, the Ministry of Water and Environment set out to establish an AMR surveillance program to bolster the One Health efforts for the containment of AMR under the National Action Plan 2018-2023. Objective: This study aims to describe Uganda's experience in establishing AMR surveillance in the water and environment sector. Methods: A methodical qualitative and quantitative description of the steps undertaken between August 2021 and March 2023 to establish an AMR surveillance system in the water and environment sector is provided. The Uganda Ministry of Water and Environment used a stepwise approach. Governance structures were streamlined, and sector-specific AMR surveillance guiding documents were developed, pretested, and rolled out. The National Water Quality Reference Laboratory infrastructure and microbiology capacity were enhanced to aid AMR detection and surveillance using conventional culture-based methods. A passive and targeted active surveillance hybrid was used to generate AMR data. Passive surveillance used remnants of water samples collected routinely for water quality monitoring while targeted active surveys were done at selected sites around the Kampala and Wakiso districts. Excel and Stata 15 statistical software were used for data analysis. Results: A sector-specific technical working group of 10 members and focal persons is in place, providing strategic direction and linkage to the national AMR surveillance program. The National Water Quality Reference Laboratory is now at biosafety level 2 and conducting microbiology testing using conventional culture-based techniques. Up to 460 water samples were processed and 602 bacterial isolates were recovered, of which 399 (66.3\%) and 203 (33.7\%) were priority pathogens and nonpriority pathogens, respectively. Of the 399 priority pathogens, 156 (39.1\%), 140 (35.1\%), 96 (24.1\%), and 7 (1.8\%) were Escherichia coli, Klebsiella species, Enterococcus species, and Salmonella species, respectively. E coli showed resistance to ampicillin (79\%), ciprofloxacin (29\%), and ceftriaxone (29\%). Similarly, Klebsiella species showed resistance to ampicillin (100\%), ciprofloxacin (17\%), and ceftriaxone (18\%). Enterococcus species showed resistance to ciprofloxacin (52\%), vancomycin (45\%), and erythromycin (56\%). Up to 254 (63.7\%) of the priority pathogens recovered exhibited multiple and extensive resistance to the different antibiotics set. Conclusions: Initial efforts to establish and implement AMR surveillance in the water and environment sector have succeeded in streamlining governance and laboratory systems to generate AMR data using conventional culture-based methods. ",
doi="10.2196/50588",
url="https://bio.jmirx.org/2024/1/e50588"
}


@Article{info:doi/10.2196/55499,
author="Asgari, Elham
and Kaur, Japsimar
and Nuredini, Gani
and Balloch, Jasmine
and Taylor, M. Andrew
and Sebire, Neil
and Robinson, Robert
and Peters, Catherine
and Sridharan, Shankar
and Pimenta, Dominic",
title="Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review",
journal="JMIR Med Inform",
year="2024",
month="Apr",
day="12",
volume="12",
pages="e55499",
keywords="electronic health record",
keywords="cognitive load",
keywords="burnout",
keywords="technology",
keywords="clinician",
doi="10.2196/55499",
url="https://medinform.jmir.org/2024/1/e55499",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607672"
}


@Article{info:doi/10.2196/50968,
author="O'Brien, Niki
and Fernandez Crespo, Roberto
and O'Driscoll, Fiona
and Prendergast, Mabel
and Chana, Deeph
and Darzi, Ara
and Ghafur, Saira",
title="Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="11",
volume="8",
pages="e50968",
keywords="acceptability",
keywords="cross sectional",
keywords="cybersecurity",
keywords="digital health",
keywords="digital transformation",
keywords="education",
keywords="feasibility",
keywords="framework",
keywords="frameworks",
keywords="global health",
keywords="health systems",
keywords="implementation",
keywords="organization",
keywords="organizational",
keywords="organizations",
keywords="patient safety",
keywords="SWOT",
keywords="TAM",
keywords="usability",
abstract="Background: Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care--specific resources to help organizations at different levels of maturity develop their cybersecurity practices. Objective: This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. Methods: A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95\% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. Results: A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. Conclusions: The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed. ",
doi="10.2196/50968",
url="https://formative.jmir.org/2024/1/e50968",
url="http://www.ncbi.nlm.nih.gov/pubmed/38603777"
}


@Article{info:doi/10.2196/54278,
author="Taye, Kefiyalew Biniam
and Gezie, Derseh Lemma
and Atnafu, Asmamaw
and Mengiste, Anagaw Shegaw
and Kaasb{\o}ll, Jens
and Gullslett, Knudsen Monika
and Tilahun, Binyam",
title="Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study",
journal="JMIR Med Inform",
year="2024",
month="Apr",
day="5",
volume="12",
pages="e54278",
keywords="individual medical records",
keywords="data quality",
keywords="completeness",
keywords="consistency",
keywords="nonfinancial incentives",
keywords="institutional birth",
keywords="health care quality",
keywords="quasi-experimental design",
keywords="Ethiopia",
abstract="Background: Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers' commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia. Objective: This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia. Methods: We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women's medical records. The study was conducted in the ``Wegera'' and ``Tach-armacheho'' districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women's birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women's birth records. The average treatment effect on the treated (ATET), with 95\% CIs, was computed using a difference-in-differences model. Results: In the intervention district, data completeness in women's personal records was nearly 4 times higher (ATET 3.8, 95\% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95\% CI 4.18-19; P=.03) than in the comparator district. Conclusions: This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up. ",
doi="10.2196/54278",
url="https://medinform.jmir.org/2024/1/e54278",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578684"
}


@Article{info:doi/10.2196/47133,
author="Strumann, Christoph
and Pfau, Lisa
and Wahle, Laila
and Schreiber, Raphael
and Steinh{\"a}user, Jost",
title="Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="26",
volume="26",
pages="e47133",
keywords="digitalization",
keywords="intersectoral",
keywords="discharge management",
keywords="readmission",
keywords="mixed methods design",
abstract="Background: Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. Objective: This study aims to evaluate the implementation of a digitalized discharge management system, the project ``Optimizing instersectoral discharge management'' (SEKMA, derived from the German Sektor{\"u}bergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. Methods: A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. Results: Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: ``optimization potential,'' ``barriers,'' and ``enablers.'' On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37\%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). Conclusions: This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system. ",
doi="10.2196/47133",
url="https://www.jmir.org/2024/1/e47133",
url="http://www.ncbi.nlm.nih.gov/pubmed/38530343"
}


@Article{info:doi/10.2196/53400,
author="Seo, Hyeram
and Ahn, Imjin
and Gwon, Hansle
and Kang, Heejun
and Kim, Yunha
and Choi, Heejung
and Kim, Minkyoung
and Han, Jiye
and Kee, Gaeun
and Park, Seohyun
and Ko, Soyoung
and Jung, HyoJe
and Kim, Byeolhee
and Oh, Jungsik
and Jun, Joon Tae
and Kim, Young-Hak",
title="Forecasting Hospital Room and Ward Occupancy Using Static and Dynamic Information Concurrently: Retrospective Single-Center Cohort Study",
journal="JMIR Med Inform",
year="2024",
month="Mar",
day="21",
volume="12",
pages="e53400",
keywords="hospital bed occupancy",
keywords="electronic medical records",
keywords="time series forecasting",
keywords="short-term memory",
keywords="combining static and dynamic variables",
abstract="Background: Predicting the bed occupancy rate (BOR) is essential for efficient hospital resource management, long-term budget planning, and patient care planning. Although macro-level BOR prediction for the entire hospital is crucial, predicting occupancy at a detailed level, such as specific wards and rooms, is more practical and useful for hospital scheduling. Objective: The aim of this study was to develop a web-based support tool that allows hospital administrators to grasp the BOR for each ward and room according to different time periods. Methods: We trained time-series models based on long short-term memory (LSTM) using individual bed data aggregated hourly each day to predict the BOR for each ward and room in the hospital. Ward training involved 2 models with 7- and 30-day time windows, and room training involved models with 3- and 7-day time windows for shorter-term planning. To further improve prediction performance, we added 2 models trained by concatenating dynamic data with static data representing room-specific details. Results: We confirmed the results of a total of 12 models using bidirectional long short-term memory (Bi-LSTM) and LSTM, and the model based on Bi-LSTM showed better performance. The ward-level prediction model had a mean absolute error (MAE) of 0.067, mean square error (MSE) of 0.009, root mean square error (RMSE) of 0.094, and R2 score of 0.544. Among the room-level prediction models, the model that combined static data exhibited superior performance, with a MAE of 0.129, MSE of 0.050, RMSE of 0.227, and R2 score of 0.600. Model results can be displayed on an electronic dashboard for easy access via the web. Conclusions: We have proposed predictive BOR models for individual wards and rooms that demonstrate high performance. The results can be visualized through a web-based dashboard, aiding hospital administrators in bed operation planning. This contributes to resource optimization and the reduction of hospital resource use. ",
doi="10.2196/53400",
url="https://medinform.jmir.org/2024/1/e53400",
url="http://www.ncbi.nlm.nih.gov/pubmed/38513229"
}


@Article{info:doi/10.2196/47667,
author="Jeong, Yejin
and Crowell, Trevor
and Devon-Sand, Anna
and Sakata, Theadora
and Sattler, Amelia
and Shah, Shreya
and Tsai, Timothy
and Lin, Steven",
title="Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="23",
volume="26",
pages="e47667",
keywords="barrier",
keywords="COVID-19",
keywords="digital health",
keywords="implementation",
keywords="internet-based care",
keywords="pandemic",
keywords="primary care",
keywords="resilience",
keywords="resilient system",
keywords="telehealth",
keywords="telemedicine",
doi="10.2196/47667",
url="https://www.jmir.org/2024/1/e47667",
url="http://www.ncbi.nlm.nih.gov/pubmed/38393776"
}


@Article{info:doi/10.2196/52524,
author="Modi, Shikha
and Feldman, S. Sue
and Berner, S. Eta
and Schooley, Benjamin
and Johnston, Allen",
title="Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study",
journal="JMIR Med Inform",
year="2024",
month="Jan",
day="24",
volume="12",
pages="e52524",
keywords="acceptance",
keywords="admission",
keywords="adoption",
keywords="clinical outcome",
keywords="cost",
keywords="economic",
keywords="EHR adoption",
keywords="EHR",
keywords="electronic health record",
keywords="finance",
keywords="financial outcome",
keywords="financial",
keywords="health outcome",
keywords="health record",
keywords="hospital",
keywords="hospitalization",
keywords="length of stay",
keywords="margin",
keywords="moderation analysis",
keywords="multivariate",
keywords="operating margin",
keywords="operating",
keywords="operation",
keywords="operational",
keywords="profit",
keywords="project management",
keywords="readmission rate",
keywords="readmission",
keywords="total margin",
keywords="value analysis",
keywords="value engineering",
keywords="value management",
abstract="Background: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. Objective: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. Methods: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. Results: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38\%. Hospitals with higher readmission payment adjustment factors have lower penalties. Conclusions: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins. ",
doi="10.2196/52524",
url="https://medinform.jmir.org/2024/1/e52524",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265848"
}


@Article{info:doi/10.2196/46146,
author="Dukhanin, Vadim
and Wolff, L. Jennifer
and Salmi, Liz
and Harcourt, Kendall
and Wachenheim, Deborah
and Byock, Ira
and Gonzales, J. Matthew
and Niehus, Doug
and Parshley, Marianne
and Reay, Caroline
and Epstein, Sara
and Mohile, Supriya
and Farrell, W. Timothy
and Supiano, A. Mark
and Jajodia, Anushka
and DesRoches, M. Catherine
and ",
title="Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="22",
volume="25",
pages="e46146",
keywords="patient portal",
keywords="electronic health record",
keywords="care partners",
keywords="stakeholder engagement",
keywords="patient engagement",
keywords="human-centered design",
keywords="mobile phone",
keywords="design",
keywords="older adults",
keywords="digital platform",
keywords="awareness",
keywords="development",
keywords="engagement",
keywords="stakeholder",
keywords="education",
abstract="Background: The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends---``care partners''---to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. Objective: We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. Methods: In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. Results: Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan ``People remember less than half of what their doctors say,'' which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. Conclusions: Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners. ",
doi="10.2196/46146",
url="https://www.jmir.org/2023/1/e46146",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991827"
}


@Article{info:doi/10.2196/49605,
author="Guo, Lin Lin
and Guo, Ying Lin
and Li, Jiao
and Gu, Wen Yao
and Wang, Yang Jia
and Cui, Ying
and Qian, Qing
and Chen, Ting
and Jiang, Rui
and Zheng, Si",
title="Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="1",
volume="25",
pages="e49605",
keywords="pediatric emergency department",
keywords="characteristics",
keywords="admission preferences",
keywords="waiting time",
keywords="machine learning",
keywords="electronic medical record",
abstract="Background: The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China's health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. Objective: This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. Methods: This retrospective analysis involved patients who were admitted to the emergency department of Children's Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. Results: In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26\% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90\%) compared with female patients (78,877/183,024, 43.10\%). Fever (50,715/183,024, 27.71\%), respiratory infection (43,269/183,024, 23.64\%), celialgia (9560/183,024, 5.22\%), and emesis (6898/183,024, 3.77\%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76\% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73\% (8.951/50.481) and increased the R2 by approximately 29.33\% (0.154/0.525). The SHAP method analysis highlighted that the features ``wait.green'' and ``department'' had the most significant influence on waiting times. Conclusions: This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China. ",
doi="10.2196/49605",
url="https://www.jmir.org/2023/1/e49605",
url="http://www.ncbi.nlm.nih.gov/pubmed/37910168"
}


@Article{info:doi/10.2196/48256,
author="Bediang, Georges",
title="Implementing Clinical Information Systems in Sub-Saharan Africa: Report and Lessons Learned From the MatLook Project in Cameroon",
journal="JMIR Med Inform",
year="2023",
month="Oct",
day="18",
volume="11",
pages="e48256",
keywords="implementation report",
keywords="challenges",
keywords="success factors",
keywords="Sub-Saharan Africa",
keywords="Cameroon",
keywords="healthcare",
keywords="health care",
keywords="clinical information",
keywords="information management",
keywords="clinical information systems",
keywords="hospital information systems",
keywords="data governance",
abstract="Background: Yaound{\'e} Central Hospital (YCH), located in the capital of Cameroon, is one of the leading referral hospitals in Cameroon. The hospital has several departments, including the Department of Gynecology-Obstetrics (hereinafter referred to as ``the Maternity''). This clinical department has faced numerous problems with clinical information management, including the lack of high-quality and reliable clinical information, lack of access to this information, and poor use of this information. Objective: We aim to improve the management of clinical information generated at the Maternity at YCH and to describe the challenges, success factors, and lessons learned during its implementation and use. Methods: Based on an open-source hospital information system (HIS), this intervention implemented a clinical information system (CIS) at the Maternity at YCH and was carried out using the HERMES model---the first part aimed to cover outpatient consultations, billing, and cash management of the Maternity. Geneva University Hospitals supported this project, and several outcomes were measured at the end. The following outcomes were assessed: project management, technical and organizational aspects, leadership, change management, user training, and system use. Implementation (Results): The first part of the project was completed, and the CIS was deployed in the Maternity at YCH. The main technical activities were adapting the open-source HIS to manage outpatient consultations and develop integrated billing and cash management software. In addition to technical aspects, we implemented several other activities. They consisted of the implementation of appropriate project governance or management, improvement of the organizational processes at the Maternity, promotion of the local digital health leadership and performance of change management, and implementation of the training and support of users. Despite barriers encountered during the project, the 6-month evaluation showed that the CIS was effectively used during the first 6 months. Conclusions: Implementation of the HIS or CIS is feasible in a resource-limited setting such as Cameroon. The CIS was implemented based on good practices at the Maternity at YCH. This project had successes but also many challenges. Beyond project management and technical and financial aspects, the other main problems of implementing health information systems or HISs in Africa lie in digital health leadership, governance, and change management. This digital health leadership, governance, and change management should prioritize data as a tool for improving productivity and managing health institutions, and promote a data culture among health professionals to support a change in mindset and the acquisition of information management skills. Moreover, in countries with a highly centralized political system like ours, a high-level strategic and political anchor for such projects is often necessary to guarantee their success. ",
doi="10.2196/48256",
url="https://medinform.jmir.org/2023/1/e48256",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851502"
}


@Article{info:doi/10.2196/50306,
author="Cavalcante de Oliveira, Paula Ana
and Lopes Galante, Mariana
and Senna Maia, Leila
and Craveiro, Isabel
and Pereira da Silva, Alessandra
and Fronteira, Ines
and Chan{\c{c}}a, Raphael
and Ferrinho, Paulo
and Dal Poz, Mario",
title="Policies and Management Interventions to Enhance Health and Care Workforce Capacity for Addressing the COVID-19 Pandemic: Protocol for a Living Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="5",
volume="12",
pages="e50306",
keywords="COVID-19",
keywords="health and care workforce policy",
keywords="health and care workforce capacity",
keywords="management interventions",
keywords="SARS-CoV-2",
keywords="pandemic",
abstract="Background: Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers' safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. Objective: The objective of this protocol review is to identify countries' range of experiences with policies and management interventions that can improve health and care workers' capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. Methods: We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization's COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. Results: The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. Conclusions: This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence. Trial Registration: PROSPERO CRD42022327041; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=327041 International Registered Report Identifier (IRRID): RR1-10.2196/50306 ",
doi="10.2196/50306",
url="https://www.researchprotocols.org/2023/1/e50306",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796568"
}


@Article{info:doi/10.2196/51303,
author="Kodama, Kana
and Konishi, Shozo
and Manabe, Shirou
and Okada, Katsuki
and Yamaguchi, Junji
and Wada, Shoya
and Sugimoto, Kento
and Itoh, Sakiko
and Takahashi, Daiyo
and Kawasaki, Ryo
and Matsumura, Yasushi
and Takeda, Toshihiro",
title="Impact of an Electronic Medical Record--Connected Questionnaire on Efficient Nursing Documentation: Usability and Efficacy Study",
journal="JMIR Nursing",
year="2023",
month="Sep",
day="25",
volume="6",
pages="e51303",
keywords="nursing system",
keywords="electronic questionnaire",
keywords="electronic medical record",
keywords="medical informatics",
keywords="EMR",
keywords="medical records",
keywords="EHR",
keywords="health record",
keywords="health records",
keywords="nursing",
keywords="documentation",
keywords="documenting",
keywords="usability",
keywords="self-reported",
keywords="patient data",
keywords="questionnaires",
keywords="data conversion",
keywords="nursing record",
keywords="nursing records",
keywords="data capture",
keywords="information system",
keywords="information systems",
abstract="Background: Documentation tasks comprise a large percentage of nurses' workloads. Nursing records were partially based on a report from the patient. However, it is not a verbatim transcription of the patient's complaints but a type of medical record. Therefore, to reduce the time spent on nursing documentation, it is necessary to assist in the appropriate conversion or citation of patient reports to professional records. However, few studies have been conducted on systems for capturing patient reports in electronic medical records. In addition, there have been no reports on whether such a system reduces the time spent on nursing documentation. Objective: This study aims to develop a patient self-reporting system that appropriately converts data to nursing records and evaluate its effect on reducing the documenting burden for nurses. Methods: An electronic medical record--connected questionnaire and a preadmission nursing questionnaire were administered. The questionnaire responses entered by the patients were quoted in the patient profile for inpatient assessment in the nursing system. To clarify its efficacy, this study examined whether the use of the electronic questionnaire system saved the nurses' time entering the patient profile admitted between August and December 2022. It also surveyed the usability of the electronic questionnaire between April and December 2022. Results: A total of 3111 (78\%) patients reported that they answered the electronic medical questionnaire by themselves. Of them, 2715 (88\%) felt it was easy to use and 2604 (85\%) were willing to use it again. The electronic questionnaire was used in 1326 of 2425 admission cases (use group). The input time for the patient profile was significantly shorter in the use group than in the no-use group (P<.001). Stratified analyses showed that in the internal medicine wards and in patients with dependent activities of daily living, nurses took 13\%-18\% (1.3 to 2 minutes) less time to enter patient profiles within the use group (both P<.001), even though there was no difference in the amount of information. By contrast, in the surgical wards and in the patients with independent activities of daily living, there was no difference in the time to entry (P=.50 and P=.20, respectively), but there was a greater amount of information in the use group. Conclusions: The study developed and implemented a system in which self-reported patient data were captured in the hospital information network and quoted in the nursing system. This system contributes to improving the efficiency of nurses' task recordings. ",
doi="10.2196/51303",
url="https://nursing.jmir.org/2023/1/e51303",
url="http://www.ncbi.nlm.nih.gov/pubmed/37634203"
}


@Article{info:doi/10.2196/40560,
author="Riihimies, Riikka
and Kosunen, Elise
and Koskela, H. Tuomas",
title="Segmenting Patients With Diabetes With the Navigator Service in Primary Care and a Description of the Self-Acting Patient Group: Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="8",
volume="25",
pages="e40560",
keywords="patient segmentation",
keywords="Navigator",
keywords="self-acting patient",
keywords="diabetes",
keywords="primary care",
keywords="self-management",
keywords="skills",
keywords="care",
keywords="nurse",
keywords="medication",
keywords="quality of life",
keywords="well-being",
keywords="digital",
keywords="patient",
abstract="Background: The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients' characteristics is lacking. Objective: The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses' appointments at a health center, the self-acting patient group's characteristics compared with other patient groups, and the concordance between the nurse's evaluation of the patient's group and the actual group assigned by Navigator (criterion validity). Methods: Patients with diabetes ?18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients' upcoming group results before the appointment. We describe the concordance (\%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients' diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients' responses to Navigator's question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients' distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups. Results: Most patients (259/304, 85.2\%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good. Conclusions: The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients' self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results. International Registered Report Identifier (IRRID): RR2-10.2196/20570 ",
doi="10.2196/40560",
url="https://www.jmir.org/2023/1/e40560",
url="http://www.ncbi.nlm.nih.gov/pubmed/37682585"
}


@Article{info:doi/10.2196/45224,
author="O'Brien, Niki
and Li, Edmond
and Chaibva, N. Cynthia
and Gomez Bravo, Raquel
and Kovacevic, Lana
and Kwame Ayisi-Boateng, Nana
and Lounsbury, Olivia
and Nwabufo, F. Ngnedjou Francoise
and Senkyire, Kumi Ephraim
and Serafini, Alice
and Surafel Abay, Eleleta
and van de Vijver, Steven
and Wanjala, Mercy
and Wangari, Marie-Claire
and Moosa, Shabir
and Neves, Luisa Ana",
title="Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="7",
volume="25",
pages="e45224",
keywords="digital health",
keywords="digital health technology",
keywords="telemedicine",
keywords="remote care",
keywords="primary care",
keywords="primary health carel PHC",
keywords="COVID-19",
keywords="global health",
keywords="sub-Saharan Africa",
keywords="eHealth",
abstract="Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. ",
doi="10.2196/45224",
url="https://www.jmir.org/2023/1/e45224",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676721"
}


@Article{info:doi/10.2196/43692,
author="Boskma, Amber
and van der Braak, Kim
and Ansari, Neda
and Hooft, Lotty
and Wietasch, G{\"o}tz
and Franx, Arie
and van der Laan, Maarten",
title="Assessing the Well-Being at Work of Nurses and Doctors in Hospitals: Protocol for a Scoping Review of Monitoring Instruments",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="25",
volume="12",
pages="e43692",
keywords="well-being at work",
keywords="well-being",
keywords="well being",
keywords="health care professionals",
keywords="doctors",
keywords="nurses",
keywords="monitoring",
keywords="assessment",
keywords="measure",
keywords="scale",
keywords="instruments",
keywords="scoping literature review",
keywords="occupational health",
abstract="Background: Well-being at work can be defined as ``creating an environment to promote a state of contentment which allows an employee to flourish and achieve their full potential for the benefit of themselves and their organisation.'' In the health care context, well-being at work of nurses and doctors is important for good patient care. Moreover, it is strongly associated with individual- and organization-level consequences. Relevant literature presents models and concepts of physical, mental, and social well-being. This study uses the 6 elements of the job demands-resources (JD-R) model to interpret well-being at work (job demands, job resources, personal resources, leadership, well-being, and outcomes) as part of a Netherlands Federation of University Medical Hospitals program to find ways to improve and monitor health care professionals' well-being in Dutch hospitals. Many instruments exist to measure well-being at work in terms of population, setting, and other aspects. An overview of available and eligible instruments assessing and monitoring the well-being of nurses and doctors is currently missing. Objective: We will perform a scoping review aiming to provide an overview of validated instruments assessing and monitoring the well-being of nurses and doctors at work. Methods: We will perform a search of published literature in the following databases: Medline, Embase, and CINAHL. Studies will be eligible if they (1) assess well-being at work of nurses and doctors employed in hospitals; (2) describe an evaluation of an instrument or review an instrument; (3) measure well-being at work or aspects of well-being at work according to the elements of the JD-R model, and (4) were published in English from 2011 onwards. Title/abstract screening according to the eligibility criteria will be followed by full-text screening. Data extraction of included studies will be conducted by 3 reviewers independently. Reviewers will use standardized data extraction forms that include study characteristics, sample characteristics, measurement instrument details, and psychometric properties. The analysis will be descriptive. When synthesizing the data, a distinction will be made between comprehensive instruments and common instruments. Results: This scoping review identifies instruments that have been developed and validated for monitoring the well-being of nurses and doctors at work. Studies were searched between September and December 2021 and screened between December 2021 and May 2022. A total of 739 studies were included. Conclusions: Timely screening of well-being at work may be beneficial for individual health care workers, the organization, and patients. There is often a substantial gap and mismatch between employer perceptions of well-being and well-being interventions. It is important to develop and implement suitable interventions adapted to the needs of nurses and doctors and their health or other problems. Well-being screening should be timely to gain insight into these needs and problems. Moreover, to determine the effectiveness of well-being interventions, measurement is mandatory. The results will be critical for organizations to select a monitoring instrument that best fits the needs of employees and organizations. International Registered Report Identifier (IRRID): DERR1-10.2196/43692 ",
doi="10.2196/43692",
url="https://www.researchprotocols.org/2023/1/e43692",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624632"
}


@Article{info:doi/10.2196/49490,
author="Elkefi, Safa
and Asan, Onur",
title="Perceived Patient Workload and Its Impact on Outcomes During New Cancer Patient Visits: Analysis of a Convenience Sample",
journal="JMIR Hum Factors",
year="2023",
month="Aug",
day="18",
volume="10",
pages="e49490",
keywords="health care",
keywords="cancer patients' workload",
keywords="trust",
keywords="satisfaction",
keywords="health information technology",
abstract="Background: Studies exploring the workload in health care focus on the doctors' perspectives. The ecology of the health care environment is critical and different for doctors and patients. Objective: In this study, we explore the patient workload among newly diagnosed patients with cancer during their first visit and its impact on the patient's perceptions of the quality of care (their trust in their doctors, their satisfaction with the care visits, their perception of technology use). Methods: We collected data from the Hackensack Meridian Health, John Theurer Cancer Center between February 2021 and May 2022. The technology use considered during the visit is related to doctors' use of electronic health records. A total of 135 participants were included in the study. Most participants were 50-64 years old (n=91, 67.41\%). A majority (n=81, 60\%) of them were White, and only (n=16, 11.85\%) went to graduate schools. Results: The findings captured the significant effect of overall workload on trust in doctors and perception of health IT use within the visits. On the other hand, the overall workload did not impact patients' satisfaction during the visit. A total of 80\% (n=108) of patients experienced an overall high level of workload. Despite almost 55\% (n=75) of them experiencing a high mental load, 71.1\% (n=96) reported low levels of effort, 89\% (n=120) experienced low time pressure, 85.2\% (n=115) experienced low frustration levels, and 69.6\% (n=94) experienced low physical activity. The more overall workload patients felt, the less they trusted their doctors (odds ratio [OR] 0.059, 95\% CI 0.001-2.34; P=.007). Low trust was also associated with the demanding mental tasks in the visits (OR 0.055, 95\% CI 0.002-2.64; P<.001), the physical load (OR 0.194, 95\% CI 0.004-4.23; P<.001), the time load (OR 0.183, 95\% CI 0.02-2.35; P=.046) the effort needed to cope with the environment (OR 0.163, 95\% CI 0.05-1.69; P<.001), and the frustration levels (OR 0.323, 95\% CI 0.04-2.55; P=.03). The patients' perceptions of electronic health record use during the visit were negatively impacted by the overall workload experienced by the patients (OR 0.315, 95\% CI 0.08-6.35; P=.01) and the high frustration level experienced (OR 0.111, 95\% CI 0.015-3.75; P<.001). Conclusions: The study's findings established pathways for future research and have implications for cancer patients' workload. Better technology design and use can minimize perceived workload, which might contribute to the trust relationship between doctors and patients in this critical environment. Future human factors work needs to explore the workload and driving factors in longitudinal studies and assess whether these workloads might contribute to unintended patient outcomes and medical errors. ",
doi="10.2196/49490",
url="https://humanfactors.jmir.org/2023/1/e49490",
url="http://www.ncbi.nlm.nih.gov/pubmed/37594798"
}


@Article{info:doi/10.2196/46044,
author="Son, H. Elisa
and Nahm, Eun-Shim",
title="Adult Patients' Experiences of Using a Patient Portal With a Focus on Perceived Benefits and Difficulties, and Perceptions on Privacy and Security: Qualitative Descriptive Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="25",
volume="10",
pages="e46044",
keywords="patient portal",
keywords="patient engagement",
keywords="user review",
keywords="content analysis",
keywords="qualitative",
keywords="perception",
keywords="privacy",
keywords="security",
abstract="Background: Patient portals can facilitate patient engagement in care management. Driven by national efforts over the past decade, patient portals are being implemented by hospitals and clinics nationwide. Continuous evaluation of patient portals and reflection of feedback from end users across care settings are needed to make patient portals more user-centered after the implementation. Objective: The aim of this study was to investigate the lived experience of using a patient portal in adult patients recruited from a variety of care settings, focusing on their perceived benefits and difficulties of using the patient portal, and trust and concerns about privacy and security. Methods: This qualitative descriptive study was part of a cross-sectional digital survey research to examine the comprehensive experience of using a patient portal in adult patients recruited from 20 care settings from hospitals and clinics of a large integrated health care system in the mid-Atlantic area of the United States. Those who had used a patient portal offered by the health care system in the past 12 months were eligible to participate in the survey. Data collected from 734 patients were subjected to descriptive statistics and content analysis. Results: The majority of the participants were female and non-Hispanic White with a mean age of 53.1 (SD 15.34) years. Content analysis of 1589 qualitative comments identified 22 themes across 4 topics: beneficial aspects (6 themes) and difficulties (7 themes) in using the patient portal; trust (5 themes) and concerns (4 themes) about privacy and security of the patient portal. Most of the participants perceived the patient portal functions as beneficial for communicating with health care teams and monitoring health status and care activities. At the same time, about a quarter of them shared difficulties they experienced while using those functions, including not getting eMessage responses timely and difficulty finding information in the portal. Protected log-in process and trust in health care providers were the most mentioned reasons for trusting privacy and security of the patient portal. The most mentioned reason for concerns about privacy and security was the risk of data breaches such as hacking attacks and identity theft. Conclusions: This study provides an empirical understanding of the lived experience of using a patient portal in adult patient users across care settings with a focus on the beneficial aspects and difficulties in using the patient portal, and trust and concerns about privacy and security. Our study findings can serve as a valuable reference for health care institutions and software companies to implement more user-centered, secure, and private patient portals. Future studies may consider targeting other patient portal programs and patients with infrequent or nonuse of patient portals. ",
doi="10.2196/46044",
url="https://humanfactors.jmir.org/2023/1/e46044",
url="http://www.ncbi.nlm.nih.gov/pubmed/37490316"
}


@Article{info:doi/10.2196/42016,
author="Monahan, Corneille Ann
and Feldman, S. Sue",
title="The Utility of Predictive Modeling and a Systems Process Approach to Reduce Emergency Department Crowding: A Position Paper",
journal="Interact J Med Res",
year="2023",
month="Jul",
day="10",
volume="12",
pages="e42016",
keywords="emergency care, prehospital",
keywords="information systems",
keywords="crowding",
keywords="healthcare service",
keywords="healthcare system",
keywords="emergency department",
keywords="boarding",
keywords="exit block",
keywords="medical informatics, application",
keywords="health services research",
keywords="personalized medicine",
keywords="predictive medicine",
keywords="model, probabilistic",
keywords="polynomial model",
keywords="decision support technique",
keywords="systems approach",
keywords="predict",
keywords="evidence based health care",
keywords="hospital bed management",
keywords="management information systems",
keywords="position paper",
doi="10.2196/42016",
url="https://www.i-jmr.org/2023/1/e42016",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428536"
}


@Article{info:doi/10.2196/40327,
author="Naranjo-Saucedo, Belen Ana
and Escobar-Rodriguez, Antonio German
and Tabernero, Carmen
and Cuadrado, Esther
and Parra-Calderon, Luis Carlos
and Arenas, Alicia",
title="Mobile Health Requirements for the Occupational Health Assessment of Health Care Professionals: Delphi Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="31",
volume="7",
pages="e40327",
keywords="occupational health assessment",
keywords="psychosocial risks",
keywords="health care professionals",
keywords="mobile health",
keywords="mHealth",
keywords="Delphi method",
abstract="Background: In recent years, owing to the COVID-19 pandemic, awareness of the high level of stress among health care professionals has increased, and research in this area has intensified. Hospital staff members have historically been known to work in an environment involving high emotional demands, time pressure, and workload. Furthermore, the pandemic has increased the strain experienced by health care professionals owing to the high number of people they need to manage and, on many occasions, the limited available resources with which they must carry out their functions. These psychosocial risks are not always well dealt with by the organization or the professionals themselves. Therefore, it is necessary to have tools to assess these psychosocial risks and to optimize the management of this demand from health care professionals. Digital health, and more specifically, mobile health (mHealth), is presented as a health care modality that can contribute greatly to respond to these unmet needs. Objective: We aimed to analyze whether mHealth tools can provide value for the study and management of psychosocial risks in health care professionals, and assess the requirements of these tools. Methods: A Delphi study was carried out to determine the opinions of experts on the relevance of using mHealth tools to evaluate physiological indicators and psychosocial factors in order to assess occupational health, and specifically, stress and burnout, in health care professionals. The study included 58 experts with knowledge and experience in occupational risk prevention, psychosocial work, and health-related technology, as well as health professionals from private and public sectors. Results: Our data suggested that there is still controversy about the roles that organizations play in occupational risk prevention in general and psychosocial risks in particular. An adequate assessment of the stress levels and psychosocial factors can help improve employees' well-being. Moreover, making occupational health evaluations available to the team would positively affect employees by increasing their feelings of being taken into account by the organization. This assessment can be improved with mHealth tools that identify and quickly highlight the difficulties or problems that occur among staff and work teams. However, to achieve good adherence and participation in occupational health and safety evaluations, experts consider that it is essential to ensure the privacy of professionals and to develop feelings of being supported by their supervisors. Conclusions: For years, mHealth has been used mainly to propose intervention programs to improve occupational health. Our research highlights the usefulness of these tools for evaluating psychosocial risks in a preliminary and essential phase of approaches to improve the health and well-being of professionals in health care settings. The most urgent requirements these tools must meet are those aimed at protecting the confidentiality and privacy of measurements. ",
doi="10.2196/40327",
url="https://formative.jmir.org/2023/1/e40327",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256659"
}


@Article{info:doi/10.2196/46673,
author="Olesen, Linnet Mette
and Rossen, Sine
and J{\o}rgensen, Rikke
and Langballe Udbj{\o}rg, Line
and Hansson, Helena",
title="Usefulness of a Digitally Assisted Person-Centered Care Intervention: Qualitative Study of Patients' and Nurses' Experiences in a Long-term Perspective",
journal="JMIR Nursing",
year="2023",
month="May",
day="18",
volume="6",
pages="e46673",
keywords="digital technology",
keywords="digital nursing",
keywords="digitally assisted guided self-determination",
keywords="empowerment",
keywords="self-management",
keywords="person-centered care",
keywords="qualitative",
keywords="service design",
keywords="patient care",
keywords="nurse",
keywords="quality of life",
keywords="interview",
keywords="web-based questionnaire",
keywords="functionality",
keywords="support",
keywords="training",
keywords="implementation",
keywords="self-determination",
keywords="autonomy",
keywords="agency",
keywords="person centered",
keywords="patient centered",
keywords="client focus",
keywords="gynecology",
keywords="oncology",
keywords="health knowledge",
keywords="health care professional",
keywords="health care provider",
keywords="HCP",
keywords="mobile phone",
abstract="Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with the increasingly mature technology. The first theme was the different experiences and perspectives of nurses and patients concerning barriers to using DA-GSD and comprised 4 subthemes: conflicting perspectives on the ability of patients to engage with DA-GSD and how to provide it, conflicting perspectives on DA-GSD as a threat to the nurse-patient relationship, functionality of DA-GSD and available technical equipment, and data security. The other theme was what influenced the increased acceptability of DA-GSD among the nurses over time and comprised 3 subthemes: a re-evaluation of the nurse-patient relationship; improved functionality of DA-GSD; and supervision, experience, patient feedback, and a global pandemic. Conclusions: The nurses experienced more barriers to DA-GSD than the patients did. Acceptance of the intervention increased over time among the nurses in keeping with the intervention's improved functionality, additional guidance, and positive experiences, combined with patients finding it useful. Our findings emphasize the importance of supporting and training nurses if new technologies are to be implemented successfully. ",
doi="10.2196/46673",
url="https://nursing.jmir.org/2023/1/e46673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200076"
}


@Article{info:doi/10.2196/43518,
author="Strickland, Caroline
and Chi, Nancy
and Ditz, Laura
and Gomez, Luisa
and Wagner, Brittin
and Wang, Stanley
and Lizotte, J. Daniel",
title="Factors Influencing Admission Decisions in Skilled Nursing Facilities: Retrospective Quantitative Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="17",
volume="25",
pages="e43518",
keywords="decision-making",
keywords="skilled nursing facility",
keywords="patient admission",
keywords="decision",
keywords="nursing",
keywords="clinical",
keywords="database",
keywords="health informatics",
keywords="diagnosis",
keywords="modeling",
keywords="connection",
keywords="patient",
abstract="Background: Occupancy rates within skilled nursing facilities (SNFs) in the United States have reached a record low. Understanding drivers of occupancy, including admission decisions, is critical for assessing the recovery of the long-term care sector as a whole. We provide the first comprehensive analysis of financial, clinical, and operational factors that impact whether a patient referral to an SNF is accepted or denied, using a large health informatics database. Objective: Our key objectives were to describe the distribution of referrals sent to SNFs in terms of key referral- and facility-level features; analyze key financial, clinical, and operational variables and their relationship to admission decisions; and identify the key potential reasons behind referral decisions in the context of learning health systems. Methods: We extracted and cleaned referral data from 627 SNFs from January 2020 to March 2022, including information on SNF daily operations (occupancy and nursing hours), referral-level factors (insurance type and primary diagnosis), and facility-level factors (overall 5-star rating and urban versus rural status). We computed descriptive statistics and applied regression modeling to identify and describe the relationships between these factors and referral decisions, considering them individually and controlling for other factors to understand their impact on the decision-making process. Results: When analyzing daily operation values, no significant relationship between SNF occupancy or nursing hours and referral acceptance was observed (P>.05). By analyzing referral-level factors, we found that the primary diagnosis category and insurance type of the patient were significantly related to referral acceptance (P<.05). Referrals with primary diagnoses within the category ``Diseases of the Musculoskeletal System'' are least often denied whereas those with diagnoses within the ``Mental Illness'' category are most often denied (compared with other diagnosis categories). Furthermore, private insurance holders are least often denied whereas ``medicaid'' holders are most often denied (compared with other insurance types). When analyzing facility-level factors, we found that the overall 5-star rating and urban versus rural status of an SNF are significantly related to referral acceptance (P<.05). We found a positive but nonmonotonic relationship between the 5-star rating and referral acceptance rates, with the highest acceptance rates found among 5-star facilities. In addition, we found that SNFs in urban areas have lower acceptance rates than their rural counterparts. Conclusions: While many factors may influence a referral acceptance, care challenges associated with individual diagnoses and financial challenges associated with different remuneration types were found to be the strongest drivers. Understanding these drivers is essential in being more intentional in the process of accepting or denying referrals. We have interpreted our results using an adaptive leadership framework and suggested how SNFs can be more purposeful with their decisions while striving to achieve appropriate occupancy levels in ways that meet their goals and patients' needs. ",
doi="10.2196/43518",
url="https://www.jmir.org/2023/1/e43518",
url="http://www.ncbi.nlm.nih.gov/pubmed/37195755"
}


@Article{info:doi/10.2196/46694,
author="Perrin Franck, Caroline
and Babington-Ashaye, Awa
and Dietrich, Damien
and Bediang, Georges
and Veltsos, Philippe
and Gupta, Prasad Pramendra
and Juech, Claudia
and Kadam, Rigveda
and Collin, Maxime
and Setian, Lucy
and Serrano Pons, Jordi
and Kwankam, Yunkap S.
and Garrette, B{\'e}atrice
and Barbe, Solenne
and Bagayoko, Oumar Cheick
and Mehl, Garrett
and Lovis, Christian
and Geissbuhler, Antoine",
title="iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations",
journal="J Med Internet Res",
year="2023",
month="May",
day="10",
volume="25",
pages="e46694",
keywords="implementation science",
keywords="knowledge management",
keywords="reporting standards",
keywords="publishing standards",
keywords="guideline",
keywords="Digital Health Hub",
keywords="reporting guideline",
keywords="digital health implementation",
keywords="health outcome",
abstract="Background: Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. Objective: A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced ``I checked'') to improve the completeness of reporting on digital health implementations. Methods: A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. Results: The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. Conclusions: Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes. ",
doi="10.2196/46694",
url="https://www.jmir.org/2023/1/e46694",
url="http://www.ncbi.nlm.nih.gov/pubmed/37163336"
}


@Article{info:doi/10.2196/32962,
author="Olaye, M. Iredia
and Seixas, A. Azizi",
title="The Gap Between AI and Bedside: Participatory Workshop on the Barriers to the Integration, Translation, and Adoption of Digital Health Care and AI Startup Technology Into Clinical Practice",
journal="J Med Internet Res",
year="2023",
month="May",
day="2",
volume="25",
pages="e32962",
keywords="digital health",
keywords="startups",
keywords="venture capital",
keywords="artificial intelligence",
keywords="AI translation",
keywords="clinical practice",
keywords="early-stage",
keywords="funding",
keywords="bedside",
keywords="machine learning",
keywords="technology",
keywords="tech",
keywords="qualitative",
keywords="workshop",
keywords="entrepreneurs",
abstract="Background: Artificial intelligence (AI) and digital health technological innovations from startup companies used in clinical practice can yield better health outcomes, reduce health care costs, and improve patients' experience. However, the integration, translation, and adoption of these technologies into clinical practice are plagued with many challenges and are lagging. Furthermore, explanations of the impediments to clinical translation are largely unknown and have not been systematically studied from the perspective of AI and digital health care startup founders and executives. Objective: The aim of this paper is to describe the barriers to integrating early-stage technologies in clinical practice and health care systems from the perspectives of digital health and health care AI founders and executives. Methods: A stakeholder focus group workshop was conducted with a sample of 10 early-stage digital health and health care AI founders and executives. Digital health, health care AI, digital health--focused venture capitalists, and physician executives were represented. Using an inductive thematic analysis approach, transcripts were organized, queried, and analyzed for thematic convergence. Results: We identified the following four categories of barriers in the integration of early-stage digital health innovations into clinical practice and health care systems: (1) lack of knowledge of health system technology procurement protocols and best practices, (2) demanding regulatory and validation requirements, (3) challenges within the health system technology procurement process, and (4) disadvantages of early-stage digital health companies compared to large technology conglomerates. Recommendations from the study participants were also synthesized to create a road map to mitigate the barriers to integrating early-stage or novel digital health technologies in clinical practice. Conclusions: Early-stage digital health and health care AI entrepreneurs identified numerous barriers to integrating digital health solutions into clinical practice. Mitigation initiatives should create opportunities for early-stage digital health technology companies and health care providers to interact, develop relationships, and use evidence-based research and best practices during health care technology procurement and evaluation processes. ",
doi="10.2196/32962",
url="https://www.jmir.org/2023/1/e32962",
url="http://www.ncbi.nlm.nih.gov/pubmed/37129947"
}


@Article{info:doi/10.2196/43127,
author="Shah, Rathin Rohin
and Bailey, Peter Joseph",
title="Asymmetric Interoperability as a Strategy Among Provider Group Health Information Exchange: Directional Analysis",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="6",
volume="25",
pages="e43127",
keywords="health information exchange",
keywords="quality payment program",
keywords="electronic health records",
keywords="electronic referrals",
keywords="medical informatics",
keywords="technology adoption",
keywords="health information interoperability",
abstract="Background: High levels of seamless, bidirectional health information exchange continue to be broadly limited among provider groups despite the vast array of benefits that interoperability entails for patient care and the many persistent efforts across the health care ecosystem directed at advancing interoperability. As provider groups seek to act in their strategic best interests, they are often interoperable and exchange information in certain directions but not others, leading to the formation of asymmetries. Objective: We aimed to examine the correlation at the provider group level between the distinct directions of interoperability with regard to sending health information and receiving health information, to describe how this correlation varies across provider group types and provider group sizes, and to analyze the symmetries and asymmetries that arise in the exchange of patient health information across the health care ecosystem as a result. Methods: We used data from the Centers for Medicare \& Medicaid Services (CMS), which included interoperability performance information for 2033 provider groups within the Quality Payment Program Merit-based Incentive Payment System and maintained distinct performance measures for sending health information and receiving health information. In addition to compiling descriptive statistics, we also conducted a cluster analysis to identify differences among provider groups---particularly with respect to symmetric versus asymmetric interoperability. Results: We found that the examined directions of interoperability---sending health information and receiving health information---have relatively low bivariate correlation (0.4147) with a significant number of observations exhibiting asymmetric interoperability (42.5\%). Primary care providers are generally more likely to exchange information asymmetrically than specialty providers, being more inclined to receive health information than to send health information. Finally, we found that larger provider groups are significantly less likely to be bidirectionally interoperable than smaller groups, although both are asymmetrically interoperable at similar rates. Conclusions: The adoption of interoperability by provider groups is more nuanced than traditionally considered and should not be seen as a binary determination (ie, to be interoperable or not). Asymmetric interoperability---and its pervasive presence among provider groups---reiterates how the manner in which provider groups exchange patient health information is a strategic choice and may pose similar implications and potential harms as the practice of information blocking has in the past. Differences in the operational paradigms among provider groups of varying types and sizes may explain their varying extents of health information exchange for sending and receiving health information. There continues to remain substantial room for improvement on the path to achieving a fully interoperable health care ecosystem, and future policy efforts directed at advancing interoperability should consider the practice of being asymmetrically interoperable among provider groups. ",
doi="10.2196/43127",
url="https://www.jmir.org/2023/1/e43127",
url="http://www.ncbi.nlm.nih.gov/pubmed/37023418"
}


@Article{info:doi/10.2196/42615,
author="Syed, Rehan
and Eden, Rebekah
and Makasi, Tendai
and Chukwudi, Ignatius
and Mamudu, Azumah
and Kamalpour, Mostafa
and Kapugama Geeganage, Dakshi
and Sadeghianasl, Sareh
and Leemans, J. Sander J.
and Goel, Kanika
and Andrews, Robert
and Wynn, Thandar Moe
and ter Hofstede, Arthur
and Myers, Trina",
title="Digital Health Data Quality Issues: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="31",
volume="25",
pages="e42615",
keywords="data quality",
keywords="digital health",
keywords="electronic health record",
keywords="eHealth",
keywords="systematic reviews",
abstract="Background: The promise of digital health is principally dependent on the ability to electronically capture data that can be analyzed to improve decision-making. However, the ability to effectively harness data has proven elusive, largely because of the quality of the data captured. Despite the importance of data quality (DQ), an agreed-upon DQ taxonomy evades literature. When consolidated frameworks are developed, the dimensions are often fragmented, without consideration of the interrelationships among the dimensions or their resultant impact. Objective: The aim of this study was to develop a consolidated digital health DQ dimension and outcome (DQ-DO) framework to provide insights into 3 research questions: What are the dimensions of digital health DQ? How are the dimensions of digital health DQ related? and What are the impacts of digital health DQ? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a developmental systematic literature review was conducted of peer-reviewed literature focusing on digital health DQ in predominately hospital settings. A total of 227 relevant articles were retrieved and inductively analyzed to identify digital health DQ dimensions and outcomes. The inductive analysis was performed through open coding, constant comparison, and card sorting with subject matter experts to identify digital health DQ dimensions and digital health DQ outcomes. Subsequently, a computer-assisted analysis was performed and verified by DQ experts to identify the interrelationships among the DQ dimensions and relationships between DQ dimensions and outcomes. The analysis resulted in the development of the DQ-DO framework. Results: The digital health DQ-DO framework consists of 6 dimensions of DQ, namely accessibility, accuracy, completeness, consistency, contextual validity, and currency; interrelationships among the dimensions of digital health DQ, with consistency being the most influential dimension impacting all other digital health DQ dimensions; 5 digital health DQ outcomes, namely clinical, clinician, research-related, business process, and organizational outcomes; and relationships between the digital health DQ dimensions and DQ outcomes, with the consistency and accessibility dimensions impacting all DQ outcomes. Conclusions: The DQ-DO framework developed in this study demonstrates the complexity of digital health DQ and the necessity for reducing digital health DQ issues. The framework further provides health care executives with holistic insights into DQ issues and resultant outcomes, which can help them prioritize which DQ-related problems to tackle first. ",
doi="10.2196/42615",
url="https://www.jmir.org/2023/1/e42615",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000497"
}


@Article{info:doi/10.2196/45095,
author="Voorheis, Paula
and Bhuiya, R. Aunima
and Kuluski, Kerry
and Pham, Quynh
and Petch, Jeremy",
title="Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="15",
volume="25",
pages="e45095",
keywords="behavioral science",
keywords="behavior change",
keywords="health behavior",
keywords="digital health",
keywords="mobile health",
keywords="theories",
keywords="models",
keywords="frameworks",
abstract="Background: Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design. Objective: The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design? Methods: This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach. Results: Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice. Conclusions: When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice. ",
doi="10.2196/45095",
url="https://www.jmir.org/2023/1/e45095",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920442"
}


@Article{info:doi/10.2196/44172,
author="Horton, Anna
and Loban, Katya
and Nugus, Peter
and Fortin, Marie-Chantal
and Gunaratnam, Lakshman
and Knoll, Greg
and Mucsi, Istvan
and Chaudhury, Prosanto
and Landsberg, David
and Paquet, Michel
and Cantarovich, Marcelo
and Sandal, Shaifali",
title="Health System--Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="7",
volume="12",
pages="e44172",
keywords="transplantation",
keywords="living donor kidney transplantation",
keywords="health systems",
keywords="barriers",
keywords="resource based theory",
keywords="complex adaptive systems",
abstract="Background: Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT. Objective: Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces. Methods: This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question. Results: This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023. Conclusions: By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT. International Registered Report Identifier (IRRID): DERR1-10.2196/44172 ",
doi="10.2196/44172",
url="https://www.researchprotocols.org/2023/1/e44172",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881454"
}


@Article{info:doi/10.2196/40672,
author="Sotoodeh, Mani
and Zhang, Wenhui
and Simpson, L. Roy
and Hertzberg, Stover Vicki
and Ho, C. Joyce",
title="A Comprehensive and Improved Definition for Hospital-Acquired Pressure Injury Classification Based on Electronic Health Records: Comparative Study",
journal="JMIR Med Inform",
year="2023",
month="Feb",
day="23",
volume="11",
pages="e40672",
keywords="pressure ulcer",
keywords="decubitus ulcer",
keywords="electronic medical records",
keywords="bedsore",
keywords="nursing",
keywords="data mining",
keywords="electronic health record",
keywords="EHR",
keywords="nursing assessment",
keywords="pressure ulcer care",
keywords="pressure ulcer prevention",
keywords="EHR data",
keywords="EHR systems",
keywords="nursing quality",
abstract="Background: Patients develop pressure injuries (PIs) in the hospital owing to low mobility, exposure to localized pressure, circulatory conditions, and other predisposing factors. Over 2.5 million Americans develop PIs annually. The Center for Medicare and Medicaid considers hospital-acquired PIs (HAPIs) as the most frequent preventable event, and they are the second most common claim in lawsuits. With the growing use of electronic health records (EHRs) in hospitals, an opportunity exists to build machine learning models to identify and predict HAPI rather than relying on occasional manual assessments by human experts. However, accurate computational models rely on high-quality HAPI data labels. Unfortunately, the different data sources within EHRs can provide conflicting information on HAPI occurrence in the same patient. Furthermore, the existing definitions of HAPI disagree with each other, even within the same patient population. The inconsistent criteria make it impossible to benchmark machine learning methods to predict HAPI. Objective: The objective of this project was threefold. We aimed to identify discrepancies in HAPI sources within EHRs, to develop a comprehensive definition for HAPI classification using data from all EHR sources, and to illustrate the importance of an improved HAPI definition. Methods: We assessed the congruence among HAPI occurrences documented in clinical notes, diagnosis codes, procedure codes, and chart events from the Medical Information Mart for Intensive Care III database. We analyzed the criteria used for the 3 existing HAPI definitions and their adherence to the regulatory guidelines. We proposed the Emory HAPI (EHAPI), which is an improved and more comprehensive HAPI definition. We then evaluated the importance of the labels in training a HAPI classification model using tree-based and sequential neural network classifiers. Results: We illustrate the complexity of defining HAPI, with <13\% of hospital stays having at least 3 PI indications documented across 4 data sources. Although chart events were the most common indicator, it was the only PI documentation for >49\% of the stays. We demonstrate a lack of congruence across existing HAPI definitions and EHAPI, with only 219 stays having a consensus positive label. Our analysis highlights the importance of our improved HAPI definition, with classifiers trained using our labels outperforming others on a small manually labeled set from nurse annotators and a consensus set in which all definitions agreed on the label. Conclusions: Standardized HAPI definitions are important for accurately assessing HAPI nursing quality metric and determining HAPI incidence for preventive measures. We demonstrate the complexity of defining an occurrence of HAPI, given the conflicting and incomplete EHR data. Our EHAPI definition has favorable properties, making it a suitable candidate for HAPI classification tasks. ",
doi="10.2196/40672",
url="https://medinform.jmir.org/2023/1/e40672",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649481"
}


@Article{info:doi/10.2196/37923,
author="Riman, A. Kathryn
and Davis, S. Billie
and Seaman, B. Jennifer
and Kahn, M. Jeremy",
title="The Use of Electronic Health Record Metadata to Identify Nurse-Patient Assignments in the Intensive Care Unit: Algorithm Development and Validation",
journal="JMIR Med Inform",
year="2022",
month="Nov",
day="9",
volume="10",
number="11",
pages="e37923",
keywords="electronic health records",
keywords="algorithms",
keywords="intensive care unit",
keywords="documentation",
keywords="hospitals",
keywords="workforce",
keywords="nursing",
keywords="clinical informatics",
keywords="health informatics",
abstract="Background: Nursing care is a critical determinant of patient outcomes in the intensive care unit (ICU). Most studies of nursing care have focused on nursing characteristics aggregated across the ICU (eg, unit-wide nurse-to-patient ratios, education, and working environment). In contrast, relatively little work has focused on the influence of individual nurses and their characteristics on patient outcomes. Such research could provide granular information needed to create evidence-based nurse assignments, where a nurse's unique skills are matched to each patient's needs. To date, research in this area is hindered by an inability to link individual nurses to specific patients retrospectively and at scale. Objective: This study aimed to determine the feasibility of using nurse metadata from the electronic health record (EHR) to retrospectively determine nurse-patient assignments in the ICU. Methods: We used EHR data from 38 ICUs in 18 hospitals from 2018 to 2020. We abstracted data on the time and frequency of nurse charting of clinical assessments and medication administration; we then used those data to iteratively develop a deterministic algorithm to identify a single ICU nurse for each patient shift. We examined the accuracy and precision of the algorithm by performing manual chart review on a randomly selected subset of patient shifts. Results: The analytic data set contained 5,479,034 unique nurse-patient charting times; 748,771 patient shifts; 87,466 hospitalizations; 70,002 patients; and 8,134 individual nurses. The final algorithm identified a single nurse for 97.3\% (728,533/748,771) of patient shifts. In the remaining 2.7\% (20,238/748,771) of patient shifts, the algorithm either identified multiple nurses (4,755/748,771, 0.6\%), no nurse (14,689/748,771, 2\%), or the same nurse as the prior shift (794/748,771, 0.1\%). In 200 patient shifts selected for chart review, the algorithm had a 93\% accuracy (ie, correctly identifying the primary nurse or correctly identifying that there was no primary nurse) and a 94.4\% precision (ie, correctly identifying the primary nurse when a primary nurse was identified). Misclassification was most frequently due to patient transitions in care location, such as ICU transfers, discharges, and admissions. Conclusions: Metadata from the EHR can accurately identify individual nurse-patient assignments in the ICU. This information enables novel studies of ICU nurse staffing at the individual nurse-patient level, which may provide further insights into how nurse staffing can be leveraged to improve patient outcomes. ",
doi="10.2196/37923",
url="https://medinform.jmir.org/2022/11/e37923",
url="http://www.ncbi.nlm.nih.gov/pubmed/36350679"
}


@Article{info:doi/10.2196/37283,
author="Modi, Shikha
and Feldman, S. Sue",
title="The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review",
journal="JMIR Med Inform",
year="2022",
month="Sep",
day="27",
volume="10",
number="9",
pages="e37283",
keywords="electronic health records",
keywords="EHRs",
keywords="value",
keywords="financial outcomes",
keywords="clinical outcomes",
keywords="health informatics",
keywords="clinical informatics",
abstract="Background: Electronic health records (EHRs) are the electronic records of patient health information created during ?1 encounter in any health care setting. The Health Information Technology Act of 2009 has been a major driver of the adoption and implementation of EHRs in the United States. Given that the adoption of EHRs is a complex and expensive investment, a return on this investment is expected. Objective: This literature review aims to focus on how the value of EHRs as an intervention is defined in relation to the elaboration of value into 2 different value outcome categories, financial and clinical outcomes, and to understand how EHRs contribute to these 2 value outcome categories. Methods: This literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The initial search of key terms, EHRs, values, financial outcomes, and clinical outcomes in 3 different databases yielded 971 articles, of which, after removing 410 (42.2\%) duplicates, 561 (57.8\%) were incorporated in the title and abstract screening. During the title and abstract screening phase, articles were excluded from further review phases if they met any of the following criteria: not relevant to the outcomes of interest, not relevant to EHRs, nonempirical, and non--peer reviewed. After the application of the exclusion criteria, 80 studies remained for a full-text review. After evaluating the full text of the residual 80 studies, 26 (33\%) studies were excluded as they did not address the impact of EHR adoption on the outcomes of interest. Furthermore, 4 additional studies were discovered through manual reference searches and were added to the total, resulting in 58 studies for analysis. A qualitative analysis tool, ATLAS.ti. (version 8.2), was used to categorize and code the final 58 studies. Results: The findings from the literature review indicated a combination of positive and negative impacts of EHRs on financial and clinical outcomes. Of the 58 studies surveyed for this review of the literature, 5 (9\%) reported on the intersection of financial and clinical outcomes. To investigate this intersection further, the category ``Value--Intersection of Financial and Clinical Outcomes'' was generated. Approximately 80\% (4/5) of these studies specified a positive association between EHR adoption and financial and clinical outcomes. Conclusions: This review of the literature reports on the individual and collective value of EHRs from a financial and clinical outcomes perspective. The collective perspective examined the intersection of financial and clinical outcomes, suggesting a reversal of the current understanding of how IT investments could generate improvements in productivity, and prompted a new question to be asked about whether an increase in productivity could potentially lead to more IT investments. ",
doi="10.2196/37283",
url="https://medinform.jmir.org/2022/9/e37283",
url="http://www.ncbi.nlm.nih.gov/pubmed/36166286"
}


@Article{info:doi/10.2196/41051,
author="Krupp, Anna
and Steege, Linsey
and Lee, John
and Lopez, Dunn Karen
and King, Barbara",
title="Supporting Decision-Making About Patient Mobility in the Intensive Care Unit Nurse Work Environment: Work Domain Analysis",
journal="JMIR Nursing",
year="2022",
month="Sep",
day="27",
volume="5",
number="1",
pages="e41051",
keywords="clinical decision-making",
keywords="early ambulation",
keywords="intensive care unit",
keywords="nursing",
keywords="qualitative research",
keywords="cognitive work analysis",
abstract="Background: Patient mobility is an evidenced-based physical activity intervention initiated during intensive care unit (ICU) admission and continued throughout hospitalization to maintain functional status, yet mobility is a complex intervention and not consistently implemented. Cognitive work analysis (CWA) is a useful human factors framework for understanding complex systems and can inform future technology design to optimize outcomes. Objective: The aim of this study is to understand the complexity and constraints of the ICU work environment as it relates to nurses carrying out patient mobility interventions, using CWA. Methods: We conducted a work domain analysis and completed an abstraction hierarchy using the CWA framework. Data from documents, observation (32 hours), and interviews with nurses (N=20) from 2 hospitals were used to construct the abstraction hierarchy. Results: Nurses seek information from a variety of sources and integrate patient and unit information to inform decision-making. The completed abstraction hierarchy depicts multiple high-level priorities that nurses balance, specifically, providing quality, safe care to patients while helping to manage unit-level throughput needs. Connections between levels on the abstraction hierarchy describe how and why nurses seek patient and hospital unit information to inform mobility decision-making. The analysis identifies several opportunities for technology design to support nurse decision-making about patient mobility. Conclusions: Future interventions need to consider the complexity of the ICU environment and types of information nurses need to make decisions about patient mobility. Considerations for future system redesign include developing and testing clinical decision support tools that integrate critical patient and unit-level information to support nurses in making patient mobility decisions. ",
doi="10.2196/41051",
url="https://nursing.jmir.org/2022/1/e41051",
url="http://www.ncbi.nlm.nih.gov/pubmed/36166282"
}


@Article{info:doi/10.2196/29927,
author="Iglesias, Natalia
and Juarez, M. Jose
and Campos, Manuel",
title="Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="15",
volume="24",
number="9",
pages="e29927",
keywords="openEHR task planning",
keywords="business process model and notation",
keywords="BPMN",
keywords="clinical pathways",
keywords="catheter-related bloodstream infection",
keywords="CR-BSI",
keywords="clinical guidelines",
abstract="Background: Clinical pathways (CPs) are usually expressed by means of workflow formalisms, providing health care personnel with an easy-to-understand, high-level conceptual model of medical steps in specific patient conditions, thereby improving overall health care process quality in clinical practice. From a standardized perspective, the business process model and notation (BPMN), a widely spread general-purpose process formalism, has been used for conceptual modeling in clinical domains, mainly because of its easy-to-use graphical notation, facilitating the common understanding and communication of the parties involved in health care. However, BPMN is not particularly oriented toward the peculiarities of complex clinical processes such as infection diagnosis and treatment, in which time plays a critical role, which is why much of the BPMN clinical-oriented research has revolved around how to extend the standard to address these special needs. The shift from an agnostic, general-purpose BPMN notation to a natively clinical-oriented notation such as openEHR Task Planning (TP) could constitute a major step toward clinical process improvement, enhancing the representation of CPs for infection treatment and other complex scenarios. Objective: Our work aimed to analyze the suitability of a clinical-oriented formalism (TP) to successfully represent typical process patterns in infection treatment, identifying domain-specific improvements to the standard that could help enhance its modeling capabilities, thereby promoting the widespread adoption of CPs to improve medical practice and overall health care quality. Methods: Our methodology consisted of 4 major steps: identification of key features of infection CPs through literature review, clinical guideline analysis, and BPMN extensions; analysis of the presence of key features in TP; modeling of relevant process patterns of catheter-related bloodstream infection as a case study; and analysis and proposal of extensions in view of the results. Results: We were able to easily represent the same logic applied in the extended BPMN-based process models in our case study using out-of-the-box standard TP primitives. However, we identified possible improvements to the current version of TP to allow for simpler conceptual models of infection CPs and possibly of other complex clinical scenarios. Conclusions: Our study showed that the clinical-oriented TP specification is able to successfully represent the most complex catheter-related bloodstream infection process patterns depicted in our case study and identified possible extensions that can help increase its adequacy for modeling infection CPs and possibly other complex clinical conditions. ",
doi="10.2196/29927",
url="https://www.jmir.org/2022/9/e29927",
url="http://www.ncbi.nlm.nih.gov/pubmed/36107480"
}


@Article{info:doi/10.2196/37482,
author="Alexander, L. Gregory
and Liu, Jianfang
and Powell, R. Kimberly
and Stone, W. Patricia",
title="Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity",
journal="JMIR Aging",
year="2022",
month="Aug",
day="23",
volume="5",
number="3",
pages="e37482",
keywords="nursing homes",
keywords="health information technology",
keywords="policy",
keywords="nursing informatics",
keywords="electronic health record",
keywords="electronic data",
keywords="data sharing",
keywords="care providers",
keywords="resident",
keywords="care",
keywords="quality of care",
keywords="structural disparity",
keywords="clinical support",
keywords="administration",
abstract="Background: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods: NHs (n=6123, >20\%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7\%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes. ",
doi="10.2196/37482",
url="https://aging.jmir.org/2022/3/e37482",
url="http://www.ncbi.nlm.nih.gov/pubmed/35998030"
}


@Article{info:doi/10.2196/35612,
author="Haverinen, Jari
and Ker{\"a}nen, Niina
and Tuovinen, Timo
and Ruotanen, Ronja
and Reponen, Jarmo",
title="National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study",
journal="JMIR Med Inform",
year="2022",
month="Aug",
day="12",
volume="10",
number="8",
pages="e35612",
keywords="eHealth",
keywords="electronic health records",
keywords="picture archiving and communication systems",
keywords="health information exchange",
keywords="electronic prescribing",
keywords="referral and consultation",
keywords="videoconferencing",
keywords="clinical decision support systems",
keywords="health informatics",
keywords="clinical informatics",
abstract="Background: eHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities. Objective: The first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020. Methods: Data for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable. Results: All the specialized care organizations (21/21, 100\%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3\% (139/161) in 2011, 88.2\% (135/153) in 2014, 85.8\% (121/141) in 2017, and 95.6\% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations. Conclusions: eHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100\%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies. ",
doi="10.2196/35612",
url="https://medinform.jmir.org/2022/8/e35612",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969462"
}


@Article{info:doi/10.2196/34263,
author="Mbwogge, Mathew
and Astbury, Nicholas
and Nkumbe, Ebong Henry
and Bunce, Catey
and Bascaran, Covadonga",
title="Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention",
journal="JMIRx Med",
year="2022",
month="Aug",
day="9",
volume="3",
number="3",
pages="e34263",
keywords="waiting time",
keywords="waiting list",
keywords="patient satisfaction",
keywords="quality improvement",
keywords="clinical audit",
keywords="ophthalmology",
keywords="patient-centered care",
abstract="Background: Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. Objective: The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. Methods: This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51\% (25/49) preintervention participants and 49\% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. Results: In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95\% CI 0.99-1; P=.37; $\chi$23=0.4). The use of PDSA led to 15\% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32\% (8/25) to 33\% (8/24; z=0.1; P=.92). Conclusions: Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff. ",
doi="10.2196/34263",
url="https://med.jmirx.org/2022/3/e34263",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725529"
}


@Article{info:doi/10.2196/35798,
author="Powell, Adam
and Dolan, Paul",
title="Moving to Personalized Medicine Requires Personalized Health Plans",
journal="J Particip Med",
year="2022",
month="Aug",
day="4",
volume="14",
number="1",
pages="e35798",
keywords="quality-adjusted life years",
keywords="health insurance",
keywords="personalized outcomes",
keywords="patient preferences",
keywords="cost-effectiveness",
keywords="managed care",
doi="10.2196/35798",
url="https://jopm.jmir.org/2022/1/e35798",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925669"
}


@Article{info:doi/10.2196/39277,
author="Chima, Sophie
and Martinez-Gutierrez, Javiera
and Hunter, Barbara
and Manski-Nankervis, Jo-Anne
and Emery, Jon",
title="Optimization of a Quality Improvement Tool for Cancer Diagnosis in Primary Care: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="4",
volume="6",
number="8",
pages="e39277",
keywords="cancer",
keywords="primary health care",
keywords="diagnosis",
keywords="quality improvement",
keywords="clinical decision support tool",
keywords="general practice",
keywords="pilot",
keywords="feasibility",
keywords="Clinical Performance Feedback Intervention Theory",
abstract="Background: The most common route to a diagnosis of cancer is through primary care. Delays in diagnosing cancer occur when an opportunity to make a timely diagnosis is missed and is evidenced by patients visiting the general practitioner (GP) on multiple occasions before referral to a specialist. Tools that minimize prolonged diagnostic intervals and reduce missed opportunities to investigate patients for cancer are therefore a priority. Objective: This study aims to explore the usefulness and feasibility of a novel quality improvement (QI) tool in which algorithms flag abnormal test results that may be indicative of undiagnosed cancer. This study allows for the optimization of the cancer recommendations before testing the efficacy in a randomized controlled trial. Methods: GPs, practice nurses, practice managers, and consumers were recruited to participate in individual interviews or focus groups. Participants were purposively sampled as part of a pilot and feasibility study, in which primary care practices were receiving recommendations relating to the follow-up of abnormal test results for prostate-specific antigen, thrombocytosis, and iron-deficiency anemia. The Clinical Performance Feedback Intervention Theory (CP-FIT) was applied to the analysis using a thematic approach. Results: A total of 17 interviews and 3 focus groups (n=18) were completed. Participant themes were mapped to CP-FIT across the constructs of context, recipient, and feedback variables. The key facilitators to use were alignment with workflow, recognized need, the perceived importance of the clinical topic, and the GPs' perception that the recommendations were within their control. Barriers to use included competing priorities, usability and complexity of the recommendations, and knowledge of the clinical topic. There was consistency between consumer and practitioner perspectives, reporting language concerns associated with the word cancer, the need for more patient-facing resources, and time constraints of the consultation to address patients' worries. Conclusions: There was a recognized need for the QI tool to support the diagnosis of cancer in primary care, but barriers were identified that hindered the usability and actionability of the recommendations in practice. In response, the tool has been refined and is currently being evaluated as part of a randomized controlled trial. Successful and effective implementation of this QI tool could support the detection of patients at risk of undiagnosed cancer in primary care and assist in preventing unnecessary delays. ",
doi="10.2196/39277",
url="https://formative.jmir.org/2022/8/e39277",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925656"
}


@Article{info:doi/10.2196/37015,
author="Srikesavan, Cynthia
and Davey, Zoe
and Cipriani, Andrea
and Henshall, Catherine",
title="Resilience Enhancement Online Training for Nurses (REsOluTioN): Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="3",
volume="11",
number="8",
pages="e37015",
keywords="online training",
keywords="nurses",
keywords="resilience",
keywords="mental well-being",
keywords="pilot trial",
keywords="COVID-19",
keywords="nursing",
keywords="mental health",
keywords="health care staff",
keywords="psychological health",
keywords="online health",
keywords="resilience training",
keywords="health care setting",
abstract="Background: Globally, nurses are facing increased pressure to provide high-quality complex patient care within environments with scarce resources in terms of staffing, infrastructure, or financial reward. The strain and demand on the psychological health and well-being of nurses during COVID-19 has been substantial, with many experiencing burnout; as such, interventions to enhance resilience within the workplace are required. A face-to-face resilience enhancement training program for nurses that was effective in improving resilience levels was translated into a 4-week online training program, Resilience Enhancement Online Training for Nurses (REsOluTioN), to enable greater accessibility for nurses. Objective: This study aims to compare levels of resilience, psychological health, and well-being in nurses before and after the online resilience training compared to a wait list control group. It will also explore participants' engagement with the trial and their acceptability of the online training. Methods: This is a two-arm, parallel, randomized controlled trial with a 6-week follow-up period. Up to 100 registered nonagency nurses working at a National Health Service hospital trust in South England will be recruited. Four cohorts will run, and participants will be randomized into a wait list control group or to REsOluTioN. Pre- and postonline surveys will collect study outcome measure data. In the REsOluTioN arm, data will be collected on the perceived usefulness of the online training via an online survey. Institutional and health research authority approvals have been obtained. Results: REsOluTioN will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training will be interactive with input from mentors, health care leaders, and peers to promote engagement and enhanced communication, and will create a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them. This can increase self-knowledge and learning around workplace resilience coping strategies and provide a safe space to validate feelings through mentorship and peer support. Findings will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial is now finished and was conducted between August 2021 and May 2022. Conclusions: The REsOluTioN trial will enable preliminary data to be gathered to indicate the online training's effectiveness in enhancing nurses' resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): DERR1-10.2196/37015 ",
doi="10.2196/37015",
url="https://www.researchprotocols.org/2022/8/e37015",
url="http://www.ncbi.nlm.nih.gov/pubmed/35862692"
}


@Article{info:doi/10.2196/32168,
author="Yuan, Yingzhe
and Price, Megan
and Schmidt, F. David
and Ward, Merry
and Nebeker, Jonathan
and Pizer, Steven",
title="Integrated Health Record Viewers and Reduction in Duplicate Medical Imaging: Retrospective Observational Analysis",
journal="JMIR Med Inform",
year="2022",
month="May",
day="20",
volume="10",
number="5",
pages="e32168",
keywords="health informatics",
keywords="duplicate medical imaging",
keywords="health record viewer",
keywords="health care system",
keywords="health care",
keywords="health records",
keywords="electronic health records",
keywords="health information exchange",
abstract="Background: Health information exchange and multiplatform health record viewers support more informed medical decisions, improve quality of care, and reduce the risk of adverse outcomes due to fragmentation and discontinuity in care during transition of care. An example of a multiplatform health record viewer is the VA/DoD Joint Longitudinal Viewer (JLV), which supports the Department of Veterans Affairs (VA) and Department of Defense (DoD) health care providers with read-only access to patient medical records integrated from multiple sources. JLV is intended to support more informed medical decisions such as reducing duplicate medical imaging when previous image study results may meet current clinical needs. Objective: We estimated the impact of provider usage of JLV on duplicate imaging for service members transitioning from the DoD to the VA health care system. Methods: We conducted a retrospective cross-sectional study in fiscal year 2018 to examine the relationship between providers' use of JLV and the likelihood of ordering duplicate images. Our sample included recently separated service members who had a VA primary care visit in fiscal year 2018 within 90 days of a DoD imaging study. Patients who received at least one imaging study at VA within 90 days of a DoD imaging study of the same imaging mode and on the same body part are considered to have received potentially duplicate imaging studies. We use a logistic regression model with ``JLV provider'' (providers with 1 or more JLV audits in the prior 6 months) as the independent variable to estimate the relationship between JLV use and ordering of duplicate images. Control variables included provider image ordering rates in the prior 6 months, provider type, patient demographics (age, race, gender), and clinical characteristics (Elixhauser comorbidity score). Results: Providers known to utilize JLV in the prior 6 months order fewer duplicate images relative to providers not utilizing JLV for similar visits over time (odds ratio 0.44, 95\% CI 0.24-0.78; P=.005). This effect is robust across multiple specifications of linear and logistic regression models. The provider's practice pattern of ordering image studies and the patient's health status are powerful confounders. Conclusions: This study provides evidence that adoption of a longitudinal viewer of health records from multiple electronic health record systems is associated with a reduced likelihood of ordering duplicate images. Investments in health information exchange systems may be effective ways to improve the quality of care and reduce adverse outcomes for patients experiencing fragmentation and discontinuity of care. ",
doi="10.2196/32168",
url="https://medinform.jmir.org/2022/5/e32168",
url="http://www.ncbi.nlm.nih.gov/pubmed/35594070"
}


@Article{info:doi/10.2196/35929,
author="Singh, Hardeep
and Tang, Terence
and Steele Gray, Carolyn
and Kokorelias, Kristina
and Thombs, Rachel
and Plett, Donna
and Heffernan, Matthew
and Jarach, M. Carlotta
and Armas, Alana
and Law, Susan
and Cunningham, V. Heather
and Nie, Xin Jason
and Ellen, E. Moriah
and Thavorn, Kednapa
and Nelson, LA Michelle",
title="Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review",
journal="JMIR Aging",
year="2022",
month="May",
day="19",
volume="5",
number="2",
pages="e35929",
keywords="transitions",
keywords="health",
keywords="medical informatics",
keywords="aged",
keywords="mobile phone",
abstract="Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 ",
doi="10.2196/35929",
url="https://aging.jmir.org/2022/2/e35929",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587874"
}


@Article{info:doi/10.2196/36448,
author="Archer, Jessica
and Robinson, Luke
and Brown, Ted",
title="The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="13",
volume="11",
number="5",
pages="e36448",
keywords="allied health",
keywords="healthcare funding",
keywords="interprofessional collaboration",
keywords="integrated healthcare",
keywords="primary health",
keywords="primary care",
abstract="Background: Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding--related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic. Objective: The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels. Methods: A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures. Results: Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022. Conclusions: The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability. International Registered Report Identifier (IRRID): DERR1-10.2196/36448 ",
doi="10.2196/36448",
url="https://www.researchprotocols.org/2022/5/e36448",
url="http://www.ncbi.nlm.nih.gov/pubmed/35559853"
}


@Article{info:doi/10.2196/34787,
author="Attipoe, Selasi
and Hoffman, Jeffrey
and Rust, Steve
and Huang, Yungui
and Barnard, A. John
and Schweikhart, Sharon
and Hefner, L. Jennifer
and Walker, M. Daniel
and Linwood, Simon",
title="Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data",
journal="JMIR Med Inform",
year="2022",
month="May",
day="12",
volume="10",
number="5",
pages="e34787",
keywords="electronic health records",
keywords="access log analysis",
keywords="pediatrics",
keywords="primary care physicians",
keywords="work outside work",
keywords="work outside scheduled clinic hours",
abstract="Background: Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time. Objective: This study aimed to characterize EHR work outside scheduled clinic hours among primary care pediatricians using a retrospective descriptive task analysis of EHR access log data and actual physician clinic schedules to define work time. Methods: We conducted a retrospective, exploratory, descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large Midwestern pediatric health center to quantify and identify actions completed outside scheduled clinic hours. Mixed-effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR work during scheduled clinic hours on the use of EHRs outside scheduled clinic hours. Results: Primary care pediatricians (n=56) in this study generated 1,523,872 access log data points (across 1069 physician workdays) and spent an average of 4.4 (SD 2.0) hours and 0.8 (SD 0.8) hours per physician per workday engaged in EHRs during and outside scheduled clinic hours, respectively. Approximately three-quarters of the time working in EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed-effects regression revealed no associations of age, sex, or clinical full-time equivalent status with EHR use during or outside scheduled clinic hours. Conclusions: For every hour primary care pediatricians spent engaged with the EHR during scheduled clinic hours, they spent approximately 10 minutes interacting with the EHR outside scheduled clinic hours. Most of their time (during and outside scheduled clinic hours) was spent reviewing data, records, and other information in EHR. ",
doi="10.2196/34787",
url="https://medinform.jmir.org/2022/5/e34787",
url="http://www.ncbi.nlm.nih.gov/pubmed/35551055"
}


@Article{info:doi/10.2196/36579,
author="Krause-J{\"u}ttler, Grit
and Weitz, J{\"u}rgen
and Bork, Ulrich",
title="Interdisciplinary Collaborations in Digital Health Research: Mixed Methods Case Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="4",
volume="9",
number="2",
pages="e36579",
keywords="team science",
keywords="interdisciplinary",
keywords="research collaboration",
keywords="digital health",
keywords="team processes",
abstract="Background: Digital innovations in medicine are disruptive technologies that can change the way diagnostic procedures and treatments are delivered. Such innovations are typically designed in teams with different disciplinary backgrounds. This paper concentrates on 2 interdisciplinary research teams with 20 members from the medicine and engineering sciences working jointly on digital health solutions. Objective: The aim of this paper was to identify factors on the individual, team, and organizational levels that influence the implementation of interdisciplinary research projects elaborating on digital applications for medicine and, based on the results, to draw conclusions for the proactive design of the interdisciplinary research process to make these projects successful. Methods: To achieve this aim, 2 interdisciplinary research teams were observed, and a small case study (response rate: 15/20, 75\%) was conducted using a web-based questionnaire containing both closed and open self-report questions. The Spearman rank correlation coefficient was calculated to analyze the quantitative data. The answers to the open-ended questions were subjected to qualitative content analysis. Results: With regard to the interdisciplinary research projects investigated, the influencing factors of the three levels presented (individual, team, and organization) have proven to be relevant for interdisciplinary research cooperation. Conclusions: With regard to recommendations for the future design of interdisciplinary cooperation, management aspects are addressed, that is, the installation of a coordinator, systematic definition of goals, required resources, and necessary efforts on the part of the involved interdisciplinary research partners. As only small groups were investigated, further research in this field is necessary to derive more general recommendations for interdisciplinary research teams. Trial Registration: German Clinical Trials Register, DRKS00023909, https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00023909?; German Clinical Trials Register, DRKS00025077, https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00025077 ",
doi="10.2196/36579",
url="https://humanfactors.jmir.org/2022/2/e36579",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507400"
}


@Article{info:doi/10.2196/36346,
author="Gordon, Kayleigh
and Dainty, N. Katie
and Steele Gray, Carolyn
and DeLacy, Jane
and Shah, Amika
and Seto, Emily",
title="Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study",
journal="JMIR Nursing",
year="2022",
month="Apr",
day="28",
volume="5",
number="1",
pages="e36346",
keywords="telemonitoring",
keywords="TM",
keywords="nurse practitioner",
keywords="NP-led care",
keywords="models of care",
keywords="integrated care",
keywords="disease care model",
keywords="disease",
keywords="nurse",
keywords="nurse-led implementation",
keywords="complex chronic conditions",
keywords="CCC",
keywords="clinical team",
keywords="mobile phone",
abstract="Background: The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective: This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods: A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results: Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions: Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model. ",
doi="10.2196/36346",
url="https://nursing.jmir.org/2022/1/e36346",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482375"
}


@Article{info:doi/10.2196/33706,
author="Thiel, Bram
and Iao, Inez
and Smid, Joris
and de Wit, Emmy
and Koopman, Seppe
and Geerts, Bart
and Godfried, Marc
and Kalkman, Cor",
title="Adoption of a Postoperative Pain Self-Report Tool: Qualitative Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="26",
volume="9",
number="2",
pages="e33706",
keywords="innovation",
keywords="eHealth adoption model, mobile health",
keywords="pain",
keywords="self-report",
keywords="perioperative medicine",
keywords="postoperative pain",
keywords="surgery",
abstract="Background: With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage their postoperative pain. The results of a previously performed proof-of-concept study regarding the application were promising, and nurses as well as patients were optimistic regarding this innovative mobile application. Nevertheless, in reality, it appears that the usage and overall implementation of this application have stagnated since its introduction. Problems with innovation adoption are not novel; various studies have been conducted to explore the reasons for low implementation success of eHealth applications and indicated that adoption is influenced by multiple organizational factors. This study investigated the influence of these organizational factors on the adoption process, aiming to provide more insight in the dos and don'ts for implementing eHealth in the working processes of hospital care. Objective: This study aimed to provide insight in how to successfully implement a technological eHealth innovation in a general nonacademic hospital. Methods: A qualitative study was conducted to explore organizational factors affecting the innovation adoption process. Data were collected by conducting semistructured one-on-one interviews with 11 stakeholders. The data were analyzed using thematic analysis identifying overarching themes. Results: Absorptive capacity, referred to as an organization's dynamic capability pertaining to knowledge creation and utilization that enhances an organization's ability to gain and sustain a competitive advantage, was regarded as the most influential factor on the application's adoption. Accordingly, it appeared that innovation adoption is mainly determined by the capability and willingness to assimilate and transform new information into productive use and the ability to absorb a novel innovation. Absorptive capacity was found to be influenced by the innovation's benefit and the sense of ownership and responsibility. Organizational readiness and management support were also regarded as essential since absorptive capacity seemed to be mediated by these factors. The size of the hospital influenced eHealth adoption by the amount of resources available and by its organizational structure. Conclusions: In conclusion, absorptive capacity is essential for eHealth adoption, and it is mediated by management support and organizational readiness. It is recommended to increase the degree of willingness and ability to adopt an eHealth innovation by enhancing the relevance, engaging stakeholders, and assigning appropriate leaders to offer guidance. ",
doi="10.2196/33706",
url="https://humanfactors.jmir.org/2022/2/e33706",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471472"
}


@Article{info:doi/10.2196/28965,
author="Tilahun, Binyam
and Endehabtu, F. Berhanu
and Gashu, D. Kassahun
and Mekonnen, A. Zeleke
and Animut, Netsanet
and Belay, Hiwot
and Denboba, Wubshet
and Alemu, Hibret
and Mohammed, Mesoud
and Abate, Biruk",
title="Current and Future Needs for Human Resources for Ethiopia's National Health Information System: Survey and Forecasting Study",
journal="JMIR Med Educ",
year="2022",
month="Apr",
day="12",
volume="8",
number="2",
pages="e28965",
keywords="forecasting",
keywords="human resources",
keywords="health information system",
keywords="workforce",
keywords="Ethiopia",
keywords="health informatics",
keywords="healthcare professionals",
abstract="Background: Strengthening the national health information system is one of Ethiopia's priority transformation agendas. A well-trained and competent workforce is the essential ingredient to a strong health information system. However, this workforce has neither been quantified nor characterized well, and there is no roadmap of required human resources to enhance the national health information system. Objective: We aimed to determine the current state of the health information system workforce and to forecast the human resources needed for the health information system by 2030. Methods: We conducted a survey to estimate the current number of individuals employed in the health information system unit and the turnover rate. Document review and key-informant interviews were used to collect current human resources and available health information system position data from 110 institutions, including the Ministry of Health, federal agencies, regional health bureaus, zonal health departments, district health offices, and health facilities. The Delphi technique was used to forecast human resources required for the health information system in the next ten years: 3 rounds of workshops with experts from the Ministry of Health, universities, agencies, and regional health bureaus were held. In the first expert meeting, we set criteria, which was followed by expert suggestions and feedback. Results: As of April 2020, there were 10,344 health information system professionals working in the governmental health system. Nearly 95\% (20/21) of district health offices and 86.7\% (26/30) of health centers reported that the current number of health information system positions was inadequate. In the period from June 2015 to June 2019, health information technicians had high turnover (48/244, 19.7\%) at all levels of the health system. In the next ten years, we estimate that 50,656 health information system professionals will be needed to effectively implement the Ethiopia's national health information system. Conclusions: Current health information system--related staffing levels were found to be inadequate. To meet the estimated need of 50,656 multidisciplinary health information system professionals by 2030, the Ministry of Health and regional health bureaus, in collaboration with partners and academic institutions, need to work on retaining existing and training additional health information system professionals. ",
doi="10.2196/28965",
url="https://mededu.jmir.org/2022/2/e28965",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412469"
}


@Article{info:doi/10.2196/36200,
author="Kruse, Scott Clemens
and Mileski, Michael
and Dray, Gevin
and Johnson, Zakia
and Shaw, Cameron
and Shirodkar, Harsha",
title="Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="31",
volume="24",
number="3",
pages="e36200",
keywords="electronic health record",
keywords="physician burnout",
keywords="quality improvement",
keywords="psychiatry",
keywords="medical informatics",
keywords="COVID-19",
keywords="pandemic",
keywords="health informatic",
keywords="health care",
keywords="health care professional",
keywords="health care infrastructure",
keywords="health care system",
keywords="mental health",
keywords="cognitive fatigue",
abstract="Background: Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective: The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods: No human participants were involved in this review; however, 100\% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results: The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one's schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions: The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=201820 International Registered Report Identifier (IRRID): RR2-10.2196/15490 ",
doi="10.2196/36200",
url="https://www.jmir.org/2022/3/e36200",
url="http://www.ncbi.nlm.nih.gov/pubmed/35120019"
}


@Article{info:doi/10.2196/32994,
author="Duncan, Rhona
and Eden, Rebekah
and Woods, Leanna
and Wong, Ides
and Sullivan, Clair",
title="Synthesizing Dimensions of Digital Maturity in Hospitals: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="30",
volume="24",
number="3",
pages="e32994",
keywords="digital maturity",
keywords="digital capability",
keywords="eHealth",
keywords="digital hospitals",
keywords="capability model",
keywords="maturity model",
keywords="literature review",
keywords="electronic medical records",
abstract="Background: Digital health in hospital settings is viewed as a panacea for achieving the ``quadruple aim'' of health care, yet the outcomes have been largely inconclusive. To optimize digital health outcomes, a strategic approach is necessary, requiring digital maturity assessments. However, current approaches to assessing digital maturity have been largely insufficient, with uncertainty surrounding the dimensions to assess. Objective: The aim of this study was to identify the current dimensions used to assess the digital maturity of hospitals. Methods: A systematic literature review was conducted of peer-reviewed literature (published before December 2020) investigating maturity models used to assess the digital maturity of hospitals. A total of 29 relevant articles were retrieved, representing 27 distinct maturity models. The articles were inductively analyzed, and the maturity model dimensions were extracted and consolidated into a maturity model framework. Results: The consolidated maturity model framework consisted of 7 dimensions: strategy; information technology capability; interoperability; governance and management; patient-centered care; people, skills, and behavior; and data analytics. These 7 dimensions can be evaluated based on 24 respective indicators. Conclusions: The maturity model framework developed for this study can be used to assess digital maturity and identify areas for improvement. ",
doi="10.2196/32994",
url="https://www.jmir.org/2022/3/e32994",
url="http://www.ncbi.nlm.nih.gov/pubmed/35353050"
}


@Article{info:doi/10.2196/34090,
author="Liang, Su-Ying
and Stults, D. Cheryl
and Jones, G. Veena
and Huang, Qiwen
and Sutton, Jeremy
and Tennyson, Guy
and Chan, S. Albert",
title="Effects of Behavioral Economics--Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="30",
volume="9",
number="1",
pages="e34090",
keywords="access to care",
keywords="behavioral economics",
keywords="online",
keywords="web-based appointment scheduling",
keywords="health service",
keywords="behavior",
keywords="health care",
abstract="Background: Behavioral economics--based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient portals are a key tool for facilitating patient engagement in their health, and interventions deployed via patient portals have been effective in improving utilization of preventive health services. Objective: We examined the impacts of behavioral economics--based nudge health maintenance reminders on appointment scheduling through a patient portal and appointment completion for 2 preventive services: Medicare wellness visits and Pap smear. Methods: We conducted a retrospective observational study using electronic health record data from an integrated health care system in Northern California. Nudge health maintenance reminders with behavioral economics--based language were implemented for all sites in November 2017 for Medicare wellness visits and for selected sites in February 2018 for Pap smears. We analyzed 125,369 health maintenance reminders for Medicare wellness visits, and 585,358 health maintenance reminders for Pap smear sent between January 2017 and February 2020. The primary outcomes were rate of appointments scheduled through the patient portal and appointment completion rate. We compared the outcomes between those who received the new, behavioral economics--based health maintenance reminders (the nudge group) and those who received the original, standard health maintenance reminders (the control group).  We used segmented regression with interrupted time series to assess the immediate and gradual effect of the nudge for Medicare wellness visits, and we used logistic regression to assess the association of nudge health maintenance reminders, adjusting for the propensity to receive a nudge health maintenance reminder, for Pap smear. Results: The rates of appointments scheduled through the patient portal were higher for nudge health maintenance reminder recipients than those for control health maintenance reminder recipients (Medicare wellness visits---nudge: 12,537/96,839, 13.0\%; control: 2,769/28,530, 9.7\%, P<.001; Pap smear---nudge: 8,239/287,149, 2.9\%; control: 1,868/120,047, 1.6\%; P<.001). Rates of appointment completion were higher for nudge health maintenance reminders for Pap smear (nudge: 67,399/287,149, 23.5\% control: 20,393/120,047, 17.0\%; P<.001) but were comparable for Medicare wellness visits (nudge: 49,835/96,839, 51.5\% control: 14,781/28,530, 51.8\%; P=.30). There was a marginally gradual effect of nudge on number of appointments scheduled through the patient portal for the overall Medicare wellness visits sample (at a monthly rate of 0.26\%, P=.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46\%, P=.04). For Pap smear, nudge health maintenance reminders were positively associated with number of appointments scheduled through the patient portal (overall sample: propensity adjusted odds ratio [OR] 1.62; 95\% CI 1.50-1.74; among scheduled appointments: propensity adjusted OR 1.61, 95\% CI 1.47-1.76) and with appointment completion (propensity adjusted OR 1.07; 1.04-1.10). Conclusions: Nudges, a behavioral economics--based approach to providing health maintenance reminders, increased the number of appointments scheduled through the patient portal for Medicare wellness visits and Pap smear. Our study demonstrates that a simple approach---framing and modifying language in an electronic message---can have a significant and long-term impact on patient engagement and access to care. ",
doi="10.2196/34090",
url="https://humanfactors.jmir.org/2022/1/e34090",
url="http://www.ncbi.nlm.nih.gov/pubmed/35353051"
}


@Article{info:doi/10.2196/33128,
author="Velayati, Farnia
and Ayatollahi, Haleh
and Hemmat, Morteza
and Dehghan, Reza",
title="Telehealth Business Models and Their Components: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="29",
volume="24",
number="3",
pages="e33128",
keywords="telehealth",
keywords="telemedicine",
keywords="mobile health",
keywords="business model",
keywords="value",
keywords="commerce",
keywords="revenue",
keywords="market",
keywords="systematic review",
keywords="health care",
abstract="Background: Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services. Objective: The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry. Methods: This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively. Results: Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components. Conclusions: Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization. ",
doi="10.2196/33128",
url="https://www.jmir.org/2022/3/e33128",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348471"
}


@Article{info:doi/10.2196/28639,
author="Knop, Michael
and Weber, Sebastian
and Mueller, Marius
and Niehaves, Bjoern",
title="Human Factors and Technological Characteristics Influencing the Interaction of Medical Professionals With Artificial Intelligence--Enabled Clinical Decision Support Systems: Literature Review",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="24",
volume="9",
number="1",
pages="e28639",
keywords="artificial intelligence",
keywords="clinical decision support systems",
keywords="CDSS",
keywords="decision-making",
keywords="diagnostic decision support",
keywords="human--computer interaction",
keywords="human--AI collaboration",
keywords="machine learning",
keywords="patient outcomes",
keywords="deep learning",
keywords="trust",
keywords="literature review",
abstract="Background: The digitization and automation of diagnostics and treatments promise to alter the quality of health care and improve patient outcomes, whereas the undersupply of medical personnel, high workload on medical professionals, and medical case complexity increase. Clinical decision support systems (CDSSs) have been proven to help medical professionals in their everyday work through their ability to process vast amounts of patient information. However, comprehensive adoption is partially disrupted by specific technological and personal characteristics. With the rise of artificial intelligence (AI), CDSSs have become an adaptive technology with human-like capabilities and are able to learn and change their characteristics over time. However, research has not reflected on the characteristics and factors essential for effective collaboration between human actors and AI-enabled CDSSs. Objective: Our study aims to summarize the factors influencing effective collaboration between medical professionals and AI-enabled CDSSs. These factors are essential for medical professionals, management, and technology designers to reflect on the adoption, implementation, and development of an AI-enabled CDSS. Methods: We conducted a literature review including 3 different meta-databases, screening over 1000 articles and including 101 articles for full-text assessment. Of the 101 articles, 7 (6.9\%) met our inclusion criteria and were analyzed for our synthesis. Results: We identified the technological characteristics and human factors that appear to have an essential effect on the collaboration of medical professionals and AI-enabled CDSSs in accordance with our research objective, namely, training data quality, performance, explainability, adaptability, medical expertise, technological expertise, personality, cognitive biases, and trust. Comparing our results with those from research on non-AI CDSSs, some characteristics and factors retain their importance, whereas others gain or lose relevance owing to the uniqueness of human-AI interactions. However, only a few (1/7, 14\%) studies have mentioned the theoretical foundations and patient outcomes related to AI-enabled CDSSs. Conclusions: Our study provides a comprehensive overview of the relevant characteristics and factors that influence the interaction and collaboration between medical professionals and AI-enabled CDSSs. Rather limited theoretical foundations currently hinder the possibility of creating adequate concepts and models to explain and predict the interrelations between these characteristics and factors. For an appropriate evaluation of the human-AI collaboration, patient outcomes and the role of patients in the decision-making process should be considered. ",
doi="10.2196/28639",
url="https://humanfactors.jmir.org/2022/1/e28639",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323118"
}


@Article{info:doi/10.2196/33046,
author="Blijleven, Vincent
and Hoxha, Florian
and Jaspers, Monique",
title="Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="15",
volume="24",
number="3",
pages="e33046",
keywords="electronic health records",
keywords="electronic medical records",
keywords="framework",
keywords="patient safety",
keywords="unintended consequences",
keywords="usability",
keywords="workarounds",
keywords="workflow",
abstract="Background: Electronic health record (EHR) system users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, the quality of care, and the efficiency of care. Objective: This review aims to aid in identifying, analyzing, and resolving EHR workarounds; the Sociotechnical EHR Workaround Analysis (SEWA) framework was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment. Methods: A scoping literature review was performed on studies related to EHR workarounds published between 2010 and 2021 in the MEDLINE, Embase, CINAHL, Cochrane, or IEEE databases. A total of 737 studies were retrieved, of which 62 (8.4\%) were included in the final analysis. Using an analytic framework, the included studies were investigated to uncover the rationales that EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impacts of workarounds. Results: The SEWA framework was theoretically validated and extended based on the scoping review. Extensive support for the pre-existing rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple pre-existing rationales for workarounds were refined to describe each rationale more accurately. Conclusions: SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and, as such, provides a theoretically validated and more complete synthesis of EHR workaround rationales, attributes, possible scopes, and types of impact. The revised SEWA framework can aid researchers and practitioners in a wider range of health care settings to identify, analyze, and resolve workarounds. This will improve user-centered EHR design and redesign, ultimately leading to improved patient safety, quality of care, and efficiency of care. ",
doi="10.2196/33046",
url="https://www.jmir.org/2022/3/e33046",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289752"
}


@Article{info:doi/10.2196/35584,
author="Matava, Clyde
and So, Jeannette
and Williams, RJ
and Kelley, Simon
and ",
title="A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19--Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends---Extra Lists (ORRACLE-Xtra) Implementation Study",
journal="JMIR Perioper Med",
year="2022",
month="Mar",
day="15",
volume="5",
number="1",
pages="e35584",
keywords="waiting lists",
keywords="quality improvement",
keywords="patient satisfaction",
keywords="COVID-19",
keywords="ambulatory surgery",
keywords="pandemics",
keywords="Canada",
abstract="Background: The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends---Extra Lists (ORRACLE-Xtra). Objective: Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5\% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5\%), with 38.1\% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8\% (110/121), with 79\% (64/81) of staff reporting satisfaction with working weekends. Conclusions: Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. ",
doi="10.2196/35584",
url="https://periop.jmir.org/2022/1/e35584",
url="http://www.ncbi.nlm.nih.gov/pubmed/34887242"
}


@Article{info:doi/10.2196/24582,
author="Schlieter, Hannes
and Marsch, A. Lisa
and Whitehouse, Diane
and Otto, Lena
and Londral, Rita Ana
and Teepe, Wilhelm Gisbert
and Benedict, Martin
and Ollier, Joseph
and Ulmer, Tom
and Gasser, Nathalie
and Ultsch, Sabine
and Wollschlaeger, Bastian
and Kowatsch, Tobias",
title="Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="11",
volume="24",
number="3",
pages="e24582",
keywords="digital health",
keywords="health care delivery",
keywords="health interventions",
keywords="digital health services",
keywords="enablers",
keywords="barriers",
doi="10.2196/24582",
url="https://www.jmir.org/2022/3/e24582",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275065"
}


@Article{info:doi/10.2196/34152,
author="Haraldsson, Patrik
and Ros, Axel
and Jonker, Dirk
and Areskoug Josefsson, Kristina",
title="Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="10",
volume="11",
number="3",
pages="e34152",
keywords="occupational health interventions",
keywords="implementation",
keywords="mixed methods",
keywords="COVID-19 pandemic",
keywords="COVID-19",
keywords="pandemic",
keywords="occupational health",
keywords="health interventions",
keywords="health care",
keywords="support services",
keywords="employee health",
abstract="Background: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees. Objective: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting. Methods: A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed. Results: The mixed methods evaluation of the quality improvement project received funding from Futurum--Academy for Health and Care, J{\"o}nk{\"o}ping County Council and Region J{\"o}nk{\"o}ping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021. Conclusions: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole. International Registered Report Identifier (IRRID): DERR1-10.2196/34152 ",
doi="10.2196/34152",
url="https://www.researchprotocols.org/2022/3/e34152",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234649"
}


@Article{info:doi/10.2196/34920,
author="Svedberg, Petra
and Reed, Julie
and Nilsen, Per
and Barlow, James
and Macrae, Carl
and Nygren, Jens",
title="Toward Successful Implementation of Artificial Intelligence in Health Care Practice: Protocol for a Research Program",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="9",
volume="11",
number="3",
pages="e34920",
keywords="process evaluation",
keywords="complex intervention",
keywords="implementation",
keywords="knowledge exchange",
keywords="health policy",
keywords="organizational change",
keywords="capacity building",
keywords="qualitative methods",
keywords="framework analysis",
abstract="Background: The uptake of artificial intelligence (AI) in health care is at an early stage. Recent studies have shown a lack of AI-specific implementation theories, models, or frameworks that could provide guidance for how to translate the potential of AI into daily health care practices. This protocol provides an outline for the first 5 years of a research program seeking to address this knowledge-practice gap through collaboration and co-design between researchers, health care professionals, patients, and industry stakeholders. Objective: The first part of the program focuses on two specific objectives. The first objective is to develop a theoretically informed framework for AI implementation in health care that can be applied to facilitate such implementation in routine health care practice. The second objective is to carry out empirical AI implementation studies, guided by the framework for AI implementation, and to generate learning for enhanced knowledge and operational insights to guide further refinement of the framework. The second part of the program addresses a third objective, which is to apply the developed framework in clinical practice in order to develop regional capacity to provide the practical resources, competencies, and organizational structure required for AI implementation; however, this objective is beyond the scope of this protocol. Methods: This research program will use a logic model to structure the development of a methodological framework for planning and evaluating implementation of AI systems in health care and to support capacity building for its use in practice. The logic model is divided into time-separated stages, with a focus on theory-driven and coproduced framework development. The activities are based on both knowledge development, using existing theory and literature reviews, and method development by means of co-design and empirical investigations. The activities will involve researchers, health care professionals, and other stakeholders to create a multi-perspective understanding. Results: The project started on July 1, 2021, with the Stage 1 activities, including model overview, literature reviews, stakeholder mapping, and impact cases; we will then proceed with Stage 2 activities. Stage 1 and 2 activities will continue until June 30, 2026. Conclusions: There is a need to advance theory and empirical evidence on the implementation requirements of AI systems in health care, as well as an opportunity to bring together insights from research on the development, introduction, and evaluation of AI systems and existing knowledge from implementation research literature. Therefore, with this research program, we intend to build an understanding, using both theoretical and empirical approaches, of how the implementation of AI systems should be approached in order to increase the likelihood of successful and widespread application in clinical practice. International Registered Report Identifier (IRRID): PRR1-10.2196/34920 ",
doi="10.2196/34920",
url="https://www.researchprotocols.org/2022/3/e34920",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262500"
}


@Article{info:doi/10.2196/32800,
author="Tajirian, Tania
and Jankowicz, Damian
and Lo, Brian
and Sequeira, Lydia
and Strudwick, Gillian
and Almilaji, Khaled
and Stergiopoulos, Vicky",
title="Tackling the Burden of Electronic Health Record Use Among Physicians in a Mental Health Setting: Physician Engagement Strategy",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="8",
volume="24",
number="3",
pages="e32800",
keywords="burnout",
keywords="organizational strategy",
keywords="electronic health record use",
keywords="clinical informatics",
keywords="medical informatics",
doi="10.2196/32800",
url="https://www.jmir.org/2022/3/e32800",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258473"
}


@Article{info:doi/10.2196/37419,
author="Stausberg, J{\"u}rgen
and Uslu, Aykut",
title="Authors' Reply to: Interpretation Bias Toward the Positive Impacts of Digital Interventions in Health Care. Comment on ``Value of the Electronic Medical Record for Hospital Care: Update From the Literature''",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="4",
volume="24",
number="3",
pages="e37419",
keywords="cost analysis",
keywords="costs and cost analyses",
keywords="economic advantage",
keywords="electronic medical records",
keywords="electronic records",
keywords="health care",
keywords="hospitals",
keywords="computerized medical records systems",
keywords="quality of health care",
keywords="secondary data",
doi="10.2196/37419",
url="https://www.jmir.org/2022/3/e37419",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254272"
}


@Article{info:doi/10.2196/37208,
author="Shakibaei Bonakdeh, Erfan",
title="Interpretation Bias Toward the Positive Impacts of Digital Interventions in Health Care. Comment on ``Value of the Electronic Medical Record for Hospital Care: Update From the Literature''",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="4",
volume="24",
number="3",
pages="e37208",
keywords="cost analysis",
keywords="costs and cost analyses",
keywords="economic advantage",
keywords="electronic medical records",
keywords="electronic records",
keywords="health care",
keywords="hospitals",
keywords="computerized medical records system",
keywords="quality of health care",
keywords="secondary data",
doi="10.2196/37208",
url="https://www.jmir.org/2022/3/e37208",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254276"
}


@Article{info:doi/10.2196/32373,
author="Alhajri, Noora
and Simsekler, Emre Mecit Can
and Alfalasi, Buthaina
and Alhashmi, Mohamed
and Memon, Hamda
and Housser, Emma
and Abdi, Mustafa Abdulhamid
and Balalaa, Nahed
and Al Ali, Maryam
and Almaashari, Raghda
and Al Memari, Shammah
and Al Hosani, Farida
and Al Zaabi, Yousif
and Almazrouei, Shereena
and Alhashemi, Hamed",
title="Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: Cross-sectional Study",
journal="JMIR Med Inform",
year="2022",
month="Feb",
day="15",
volume="10",
number="2",
pages="e32373",
keywords="COVID-19",
keywords="patient satisfaction",
keywords="technology acceptance",
keywords="hospital",
keywords="community clinic",
keywords="video consultation",
keywords="audio consultation",
keywords="outpatient department",
keywords="OPD",
keywords="policy making",
keywords="UAE",
abstract="Background: Telemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients' perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic. Objective: We aimed to explore the differences in patients' perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine. Methods: In this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients' perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services. Results: A total of 515 patients participated in this survey. Patients' satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8\%; community clinics: 114/172, 66.3\%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95\% CI 1.04-6.33; P=.04) and patients' support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95\% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95\% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95\% CI 1.15-21.19; P=.03), addressed patients' needs (OR 2.63, 95\% CI 1.13-6.11; P=.03), and eased expression of patients' medical concerns during the COVID-19 pandemic (OR 2.19, 95\% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95\% CI 1.09-4.14; P=.03), as compared to any other age group in this study. Conclusions: These findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery. ",
doi="10.2196/32373",
url="https://medinform.jmir.org/2022/2/e32373",
url="http://www.ncbi.nlm.nih.gov/pubmed/34978281"
}


@Article{info:doi/10.2196/32695,
author="Bucalon, Bernard
and Shaw, Tim
and Brown, Kerri
and Kay, Judy",
title="State-of-the-art Dashboards on Clinical Indicator Data to Support Reflection on Practice: Scoping Review",
journal="JMIR Med Inform",
year="2022",
month="Feb",
day="14",
volume="10",
number="2",
pages="e32695",
keywords="practice analytics dashboards",
keywords="data visualization",
keywords="reflective practice",
keywords="professional learning",
keywords="mobile phone",
abstract="Background: There is an increasing interest in using routinely collected eHealth data to support reflective practice and long-term professional learning. Studies have evaluated the impact of dashboards on clinician decision-making, task completion time, user satisfaction, and adherence to clinical guidelines. Objective: This scoping review aims to summarize the literature on dashboards based on patient administrative, medical, and surgical data for clinicians to support reflective practice. Methods: A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in 5 electronic databases (MEDLINE, Embase, Scopus, ACM Digital Library, and Web of Science) to identify studies that met the inclusion criteria. Study selection and characterization were performed by 2 independent reviewers (BB and CP). One reviewer extracted the data that were analyzed descriptively to map the available evidence. Results: A total of 18 dashboards from 8 countries were assessed. Purposes for the dashboards were designed for performance improvement (10/18, 56\%), to support quality and safety initiatives (6/18, 33\%), and management and operations (4/18, 22\%). Data visualizations were primarily designed for team use (12/18, 67\%) rather than individual clinicians (4/18, 22\%). Evaluation methods varied among asking the clinicians directly (11/18, 61\%), observing user behavior through clinical indicators and use log data (14/18, 78\%), and usability testing (4/18, 22\%). The studies reported high scores on standard usability questionnaires, favorable surveys, and interview feedback. Improvements to underlying clinical indicators were observed in 78\% (7/9) of the studies, whereas 22\% (2/9) of the studies reported no significant changes in performance. Conclusions: This scoping review maps the current literature landscape on dashboards based on routinely collected clinical indicator data. Although there were common data visualization techniques and clinical indicators used across studies, there was diversity in the design of the dashboards and their evaluation. There was a lack of detail regarding the design processes documented for reproducibility. We identified a lack of interface features to support clinicians in making sense of and reflecting on their personal performance data. ",
doi="10.2196/32695",
url="https://medinform.jmir.org/2022/2/e32695",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156928"
}


@Article{info:doi/10.2196/29541,
author="Garcia, P. Angely
and De La Vega, F. Shelley
and Mercado, P. Susan",
title="Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="14",
volume="24",
number="2",
pages="e29541",
keywords="health information systems",
keywords="the Philippines",
keywords="aged",
keywords="hospitals",
keywords="community health centers",
keywords="database",
keywords="geriatric assessment",
keywords="elderly",
keywords="digital health",
keywords="medical records",
keywords="health policy",
abstract="Background: The rapid aging of the world's population requires systems that support health facilities' provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee--approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52\%) of the 27 hospitals and 4 (25\%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96\%) hospitals and all (16/16, 100\%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility--based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. ",
doi="10.2196/29541",
url="https://www.jmir.org/2022/2/e29541",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156927"
}


@Article{info:doi/10.2196/30512,
author="P{\'e}rez-Mart{\'i}, Montserrat
and Casad{\'o}-Mar{\'i}n, Lina
and Guill{\'e}n-Villar, Abraham",
title="Electronic Records With Tablets at the Point of Care in an Internal Medicine Unit: Before-After Time Motion Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="10",
volume="9",
number="1",
pages="e30512",
keywords="electronic health records",
keywords="nursing",
keywords="computer handheld",
keywords="equipment and supplies (devices tablets mobile phones, devices and technologies)",
keywords="workflow",
abstract="Background: There are many benefits of nursing professionals being able to consult electronic health records (EHRs) at the point of care. It promotes quality and patient security, communication, continuity of care, and time dedicated to records. Objective: The aim of this study was to evaluate whether making EHRs available at the point of care with tablets reduces nurses' time spent on records compared with the current system. The analysis included sociodemographic and qualitative variables, time spent per patient, and work shift. This time difference can be used for direct patient care. Methods: A before-after time motion study was carried out in the internal medicine unit. There was a total of 130 observations of 2 hours to 3 hours in duration of complete patient records that were carried out at the beginning of the nurses' work shifts. We calculated the time dedicated to measuring vital signs, patient evaluation, and EHR recording. The main variable was time spent per patient. Results: The average time spent per patient (total time/patients admitted) was lower with the tablet group (mean 4.22, SD 0.14 minutes) than with the control group (mean 4.66, SD 0.12 minutes); there were statistically significant differences (W=3.20, P=.001) and a low effect (d=.44) between groups. The tablet group saved an average of 0.44 (SD 0.13) minutes per patient. Similar results were obtained for the afternoon shift, which saved an average of 0.60 (SD 0.15) minutes per patient (t34=3.82, P=.01) and high effect (d=.77). However, although there was a mean difference of 0.26 (SD 0.22) minutes per patient for the night shift, this was not statistically significant (t29=1.16, P=.25). The ``nonparticipating'' average age was higher (49.57, SD 2.92 years) compared with the ``afternoon shift participants'' and ``night shift participants'' (P=.007). ``Nonparticipants'' of the night shift had a worse perception of the project. Conclusions: This investigation determined that, with EHRs at the point of care, the time spent for registration by the nursing staff decreases, because of reduced movements and avoiding data transcription. It eliminates unnecessary work that does not add value, and therefore, care is improved. So, we think EHRs at the point of care should be the future or natural method for nursing to undertake. However, variables that could have a negative effect include age, night shift, and nurses' perceptions. Therefore, it is proposed that training in the different work platforms and the participation of nurses are fundamental axes that any institution should consider before their implementation. ",
doi="10.2196/30512",
url="https://humanfactors.jmir.org/2022/1/e30512",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142624"
}


@Article{info:doi/10.2196/32392,
author="Tran, Minh Duc
and Thwaites, Louise C.
and Van Nuil, Ilo Jennifer
and McKnight, Jacob
and Luu, Phuoc An
and Paton, Chris
and ",
title="Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="9",
volume="24",
number="2",
pages="e32392",
keywords="digital health",
keywords="eHealth",
keywords="policy",
keywords="Vietnam",
keywords="hospital care",
keywords="data",
keywords="health",
keywords="electronic medical records",
keywords="standards",
keywords="compulsory",
keywords="patient ID",
keywords="administrative information",
keywords="health insurance ID",
keywords="mobile phone",
abstract="Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence--based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government's requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Th? Vi?n Ph{\'a}p Lu?t, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians' performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system's capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting. ",
doi="10.2196/32392",
url="https://www.jmir.org/2022/2/e32392",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138264"
}


@Article{info:doi/10.2196/20702,
author="Naeem, Iffat
and Quan, Hude
and Singh, Shaminder
and Chowdhury, Nashit
and Chowdhury, Mohammad
and Saini, Vineet
and TC, Turin",
title="Factors Associated With Willingness to Share Health Information: Rapid Review",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="9",
volume="9",
number="1",
pages="e20702",
keywords="health information",
keywords="information sharing",
keywords="health data",
keywords="EMR",
keywords="PHR",
keywords="mobile phone",
abstract="Background: To expand research and strategies to prevent disease, comprehensive and real-time data are essential. Health data are increasingly available from platforms such as pharmaceuticals, genomics, health care imaging, medical procedures, wearable devices, and internet activity. Further, health data are integrated with an individual's sociodemographic information, medical conditions, genetics, treatments, and health care. Ultimately, health information generation and flow are controlled by the patient or participant; however, there is a lack of understanding about the factors that influence willingness to share health information. A synthesis of the current literature on the multifactorial nature of health information sharing preferences is required to understand health information exchange. Objective: The objectives of this review are to identify peer-reviewed literature that reported factors associated with health information sharing and to organize factors into cohesive themes and present a narrative synthesis of factors related to willingness to share health information. Methods: This review uses a rapid review methodology to gather literature regarding willingness to share health information within the context of eHealth, which includes electronic health records, personal health records, mobile health information, general health information, or information on social determinants of health. MEDLINE and Google Scholar were searched using keywords such as electronic health records AND data sharing OR sharing preference OR willingness to share. The search was limited to any population that excluded health care workers or practitioners, and the participants aged ?18 years within the US or Canadian context. The data abstraction process using thematic analysis where any factors associated with sharing health information were highlighted and coded inductively within each article. On the basis of shared meaning, the coded factors were collated into major themes. Results: A total of 26 research articles met our inclusion criteria and were included in the qualitative analysis. The inductive thematic coding process revealed multiple major themes related to sharing health information. Conclusions: This review emphasized the importance of data generators' viewpoints and the complex systems of factors that shape their decision to share health information. The themes explored in this study emphasize the importance of trust at multiple levels to develop effective information exchange partnerships. In the case of improving precision health care, addressing the factors presented here that influence willingness to share information can improve sharing capacity for individuals and allow researchers to reorient their methods to address hesitation in sharing health information. ",
doi="10.2196/20702",
url="https://humanfactors.jmir.org/2022/1/e20702",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138263"
}


@Article{info:doi/10.2196/32714,
author="Khan, Ullah Waqas
and Shachak, Aviv
and Seto, Emily",
title="Understanding Decision-Making in the Adoption of Digital Health Technology: The Role of Behavioral Economics' Prospect Theory",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="7",
volume="24",
number="2",
pages="e32714",
keywords="decision-making",
keywords="digital health technology adoption",
keywords="prospect theory",
doi="10.2196/32714",
url="https://www.jmir.org/2022/2/e32714",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129459"
}


@Article{info:doi/10.2196/31167,
author="Terlouw, Gijs
and Kuipers, Derek
and Veldmeijer, Lars
and van 't Veer, Job
and Prins, Jelle
and Pierie, Jean-Pierre",
title="Boundary Objects as Dialogical Learning Accelerators for Social Change in Design for Health: Systematic Review",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="3",
volume="9",
number="1",
pages="e31167",
keywords="boundary objects",
keywords="health",
keywords="innovation",
keywords="design",
keywords="systematic review",
abstract="Background: Boundary objects can add value for innovative design and implementation research in health care through their organizational focus and the dynamic structure between ill-structured and tailored use. However, when innovation is approached as a boundary object, more attention will need to be paid to the preimplementation phase. Research and design thinking pay attention to the preimplementation stage but do not have a social or organizational focus per se. The integration of boundary objects in design methodologies can provide a more social and organizational focus in innovative design projects by mapping out the mechanisms that occur at boundaries during design. Four dialogical learning mechanisms that can be triggered at boundaries have been described in the literature: identification, coordination, reflection, and transformation. These mechanisms seem suitable for integration in innovative design research on health. Objective: Focusing on innovation in health, this study aims to find out whether the different learning mechanisms can be linked to studies on health innovation that mention boundary objects as a concept and assess whether the related mechanisms provide insight into the stage of the design and implementation or change process. Methods: The following 6 databases were searched for relevant abstracts: PubMed, Scopus, Education Resources Information Center, PsycINFO, Information Science and Technology Abstracts, and Embase. These databases cover a wide range of published studies in the field of health. Results: Our initial search yielded 3102 records; after removing the duplicates, 2186 (70.47\%) records were screened on the title and abstract, and 25 (0.81\%) papers were included; of the 13 papers where we identified 1 mechanism, 5 (38\%) described an innovation or innovative project, and of the 12 papers where we identified more mechanisms, 9 (75\%) described the development or implementation of an innovation. The reflective mechanism was not identified solely but was present in papers describing a more successful development or implementation project of innovation. In these papers, the predetermined goals were achieved, and the process of integration was relatively smoother. Conclusions: The concept of boundary objects has found its way into health care. Although the idea of a boundary object was introduced to describe how specific artifacts can fulfill a bridging function between different sociocultural sites and thus have a social focus, the focus in the included papers was often on the boundary object itself rather than the social effect. The reflection and transformation mechanisms were underrepresented in the included studies but based on the findings in this review, pursuing to trigger the reflective mechanism in design, development, and implementation projects can lead to a more fluid and smooth integration of innovation into practice. ",
doi="10.2196/31167",
url="https://humanfactors.jmir.org/2022/1/e31167",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113023"
}


@Article{info:doi/10.2196/28870,
author="Neher, Margit
and Nyg{\aa}rdh, Annette
and Brostr{\"o}m, Anders
and Lundgren, Johan
and Johansson, Peter",
title="Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="28",
volume="24",
number="1",
pages="e28870",
keywords="clients",
keywords="computer-assisted therapy",
keywords="consultation telehealth",
keywords="decision-makers",
keywords="implementation",
keywords="patients",
keywords="politicians",
keywords="qualitative methods",
keywords="remote",
keywords="mobile phone",
abstract="Background: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth. ",
doi="10.2196/28870",
url="https://www.jmir.org/2022/1/e28870",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089139"
}


@Article{info:doi/10.2196/28323,
author="Woodcock, W. Elizabeth",
title="Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e28323",
keywords="appointment",
keywords="scheduling",
keywords="outpatient",
keywords="ambulatory",
keywords="online",
keywords="self-serve",
keywords="e-book",
keywords="web-based",
keywords="automation",
keywords="patient satisfaction",
keywords="self-scheduling",
keywords="eHealth",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients' arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective: The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods: A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results: In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients' needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework's inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions: This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research. ",
doi="10.2196/28323",
url="https://www.jmir.org/2022/1/e28323",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014968"
}


@Article{info:doi/10.2196/17273,
author="Huang, Ming
and Fan, Jungwei
and Prigge, Julie
and Shah, D. Nilay
and Costello, A. Brian
and Yao, Lixia",
title="Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e17273",
keywords="patient portal",
keywords="secure message",
keywords="patient-clinician communication",
keywords="workload",
keywords="response time",
keywords="message round",
abstract="Background: Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care. Objective: The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester. Methods: We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity. Results: During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely ``physician---primary care,'' ``registered nurse---specialty,'' and ``physician---specialty,'' bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The ``nurse practitioner or physician assistant---primary care'' and ``physician---primary care'' categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0\% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4\% (22,121/408,526) of their daily messages. The clinicians replied to 72.2\% (1,272,069/1,761,739) patient messages within 1 day and 90.6\% (1,595,702/1,761,739) within 3 days. In 95.1\% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds. Conclusions: Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients' needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency. ",
doi="10.2196/17273",
url="https://www.jmir.org/2022/1/e17273",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014964"
}


@Article{info:doi/10.2196/33600,
author="Zhang, Zhongan
and Zheng, Xu
and An, Kai
and He, Yunfan
and Wang, Tong
and Zhou, Ruizhu
and Zheng, Qilin
and Nuo, Mingfu
and Liang, Jun
and Lei, Jianbo",
title="Current Status of the Health Information Technology Industry in China from the China Hospital Information Network Conference: Cross-sectional Study of Participating Companies",
journal="JMIR Med Inform",
year="2022",
month="Jan",
day="11",
volume="10",
number="1",
pages="e33600",
keywords="medical informatics",
keywords="China Hospital Information Network Conference",
keywords="industry analysis",
keywords="county medical community",
keywords="smart hospital",
keywords="cross-sectional study",
keywords="digital therapeutic",
keywords="information network",
keywords="health care",
keywords="hospital information",
keywords="medical information",
keywords="tertiary hospital",
abstract="Background: The China Hospital Information Network Conference (CHINC) is one of the most influential academic and technical exchange activities in medical informatics and medical informatization in China. It collects frontier ideas in medical information and has an important reference value for the analysis of China's medical information industry development. Objective: This study summarizes the current situation and future development of China's medical information industry and provides a future reference for China and abroad in the future by analyzing the characteristics of CHINC exhibitors in 2021. Methods: The list of enterprises and participating keywords were obtained from the official website of CHINC. Basic characteristics of the enterprises, industrial fields, applied technologies, company concepts, and other information were collected from the TianYanCha website and the VBDATA company library. Descriptive analysis was used to analyze the collected data, and we summarized the future development directions. Results: A total of 205 enterprises officially participated in the exhibition. Most of the enterprises were newly founded, of which 61.9\% (127/205) were founded in the past 10 years. The majority of these enterprises were from first-tier cities, and 79.02\% (162/205) were from Beijing, Zhejiang, Guangdong, Shanghai, and Jiangsu Provinces. The median registered capital is 16.67 million RMB (about US \$2.61 million), and there are 35 (72.2\%) enterprises with a registered capital of more than 100 million RMB (about US \$15.68 million), 17 (8.3\%) of which are already listed. A total of 126 enterprises were found in the VBDATA company library, of which 39 (30.9\%) are information technology vendors and 57 (45.2\%) are application technology vendors. In addition, 16 of the 57 (28\%) use artificial intelligence technology. Smart medicine and internet hospitals were the focus of the enterprises participating in this conference. Conclusions: China's tertiary hospital informatization has basically completed the construction of the primary stage. The average grade of hospital electronic medical records exceeds grade 3, and 78.13\% of the provinces have reached grade 3 or above. The characteristics are as follows: On the one hand, China's medical information industry is focusing on the construction of smart hospitals, including intelligent systems supporting doctors' scientific research, diagnosis-related group intelligent operation systems, and office automation systems supporting hospital management, single-disease clinical decision support systems assisting doctors' clinical care, and intelligent internet of things for logistics. On the other hand, the construction of a compact county medical community is becoming a new focus of enterprises under the guidance of practical needs and national policies to improve the quality of grassroots health services. In addition, whole-course management and digital therapy will also become a new hotspot in the future. ",
doi="10.2196/33600",
url="https://medinform.jmir.org/2022/1/e33600",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014959"
}


@Article{info:doi/10.2196/28762,
author="Garcia, Gracie
and Crenner, Christopher",
title="Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="7",
volume="9",
number="1",
pages="e28762",
keywords="electronic health records",
keywords="electronic medical records",
keywords="health information technology",
keywords="health information exchange",
keywords="health policy",
keywords="international",
keywords="emergency medicine",
keywords="medical informatics",
keywords="meaningful use",
keywords="burnout",
abstract="Background: The variability in physicians' attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective: This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods: We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results: Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care's dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions: Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research. ",
doi="10.2196/28762",
url="https://humanfactors.jmir.org/2022/1/e28762",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994702"
}


@Article{info:doi/10.2196/31246,
author="Cresswell, Kathrin
and Dom{\'i}nguez Hern{\'a}ndez, Andr{\'e}s
and Williams, Robin
and Sheikh, Aziz",
title="Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="6",
volume="9",
number="1",
pages="e31246",
keywords="cloud technology",
keywords="qualitative",
keywords="adoption",
keywords="implementation",
keywords="digital health",
keywords="data processing",
keywords="health care",
keywords="risk assessment",
keywords="user engagement",
abstract="Background: The use of cloud computing (involving storage and processing of data on the internet) in health care has increasingly been highlighted as having great potential in facilitating data-driven innovations. Although some provider organizations are reaping the benefits of using cloud providers to store and process their data, others are lagging behind. Objective: We aim to explore the existing challenges and barriers to the use of cloud computing in health care settings and investigate how perceived risks can be addressed. Methods: We conducted a qualitative case study of cloud computing in health care settings, interviewing a range of individuals with perspectives on supply, implementation, adoption, and integration of cloud technology. Data were collected through a series of in-depth semistructured interviews exploring current applications, implementation approaches, challenges encountered, and visions for the future. The interviews were transcribed and thematically analyzed using NVivo 12 (QSR International). We coded the data based on a sociotechnical coding framework developed in related work. Results: We interviewed 23 individuals between September 2020 and November 2020, including professionals working across major cloud providers, health care provider organizations, innovators, small and medium-sized software vendors, and academic institutions. The participants were united by a common vision of a cloud-enabled ecosystem of applications and by drivers surrounding data-driven innovation. The identified barriers to progress included the cost of data migration and skill gaps to implement cloud technologies within provider organizations, the cultural shift required to move to externally hosted services, a lack of user pull as many benefits were not visible to those providing frontline care, and a lack of interoperability standards and central regulations. Conclusions: Implementations need to be viewed as a digitally enabled transformation of services, driven by skill development, organizational change management, and user engagement, to facilitate the implementation and exploitation of cloud-based infrastructures and to maximize returns on investment. ",
doi="10.2196/31246",
url="https://humanfactors.jmir.org/2022/1/e31246",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989688"
}


@Article{info:doi/10.2196/29288,
author="Kang-Yi, D. Christina
and Page, Amy",
title="Purpose Formulation, Coalition Building, and Evidence Use in Public--Academic Partnerships: Web-Based Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="5",
volume="9",
number="1",
pages="e29288",
keywords="use of research evidence",
keywords="public care policy",
keywords="public--academic partnership",
keywords="partnership purpose formulation",
keywords="partnership coalition building",
keywords="youth mental health and well-being",
abstract="Background: Partnerships between academic institutions and public care agencies (public--academic partnerships [PAPs]) can promote effective policy making and care delivery. Public care agencies are often engaged in PAPs for evidence-informed policy making in health care. Previous research has reported essential partnership contextual factors and mechanisms that promote evidence-based policy making and practice in health care. However, the studies have not yet informed whether public care agency leaders' and academic researchers' perceptions of partnership purpose formulation and coalition building evolve through the PAP life cycle and whether public care agency leaders' use of research evidence differs through life cycle stages. Objective: This exploratory study aims to focus on PAPs designed to improve youth mental health and well-being outcomes. This study also aims to identify public care agency leaders' and academic researchers' perceptions of PAP purpose formulation (structure, goals, primary function, and agenda-setting process) and coalition building (mutual benefits, trust, convener's role, member role clarity, and conflict management) by PAP life cycle stage and examine whether public care agency leaders' use of research evidence differs according to the perception of PAP purpose formulation and coalition building through the PAP life cycle. Methods: A web-based survey of PAP experience was conducted by recruiting academic researchers (n=40) and public care agency leaders (n=26) who were engaged in PAPs for the past 10 years. Public care agency leaders additionally participated in the survey of the Structured Interview for Evidence Use scale (n=48). Results: Most public care agency leaders and academic researchers in PAPs formed, matured, and sustained perceived their PAP as having purpose formulation context well aligned with their organizational purpose formulation context, pursuing mutual benefits, having leadership representation and role clarity, having a higher level of trust, and knowing how to handle conflicts. Most PAPs across all life cycle stages crystallized another issue to focus, but not all PAPs with issue crystallization had purpose reformulation. Public care agency leaders who trusted academic researchers in their PAP had greater use of research evidence. Public care agency leaders in PAPs that had gone through new issue crystallization also showed greater use of research evidence compared with those that had not. Conclusions: To promote public care agency leaders' use of research evidence, focusing on developing trusting partnerships and continuously crystallizing PAP issues are important. International Registered Report Identifier (IRRID): RR2-10.2196/14382 ",
doi="10.2196/29288",
url="https://humanfactors.jmir.org/2022/1/e29288",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989678"
}


@Article{info:doi/10.2196/27392,
author="Zhong, Yang
and Tao, Wenjuan
and Yang, Yanlin
and Wu, Hao
and Li, Weimin
and Wen, Jin",
title="Comparison of User-Oriented Information Services on the Websites of Large Hospitals in China and the United States: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="29",
volume="23",
number="12",
pages="e27392",
keywords="hospital websites",
keywords="internet",
keywords="information services",
keywords="marketing mix",
keywords="7Ps",
keywords="health care information services",
keywords="hospital management",
keywords="hospitals",
keywords="patient services",
keywords="eHealth",
abstract="Background: Many people use the internet to access health care information to support health care decisions, and hospital websites can be the first point of contact to provide health care information services for consumers. However, little is known about the current information services provided by the websites of large Chinese hospitals. Objective: The aim of this study is to evaluate and compare the information services of the websites of large hospitals in China and the United States. We hope that our findings will benefit hospital managers worldwide in providing service information on the web. Methods: This study adopted a cross-sectional analytical approach to evaluate the websites of large hospitals in China and the United States in 2020. A total of 300 large hospitals were randomly selected, of which half were in China and half were in the United States. Based on the 7Ps marketing mix, we identified 39 items that represent typical hospital website information services, covering the following seven dimensions: product, price, place, propagation, people, process, and physical evidence. Results: Most of the items (34/39, 87\%) related to information services offered by hospital websites were less covered in China than in the United States; however, 5 items (appointments by a third-party platform, mobile payment, hospital value, hospital environment display, and physicians' profiles) had higher coverage in China. The average scores for hospital websites in China and the United States were 13.25 (SD 2.99) points and 23.16 (SD 2.76) points, respectively. Generally, high scores were given to the south areas of China and north areas of the United States. Conclusions: Hospital websites in China lagged behind those in the United States with regard to information services offered. We recommend that hospital managers in China place more emphasis on the people, product, and propagation dimensions of the 7Ps marketing mix in the construction of information services on hospital websites. Through the comparison of the websites of large hospitals in China and the United States, our study findings can provide suggestions for forming standard hospital website construction guidelines worldwide. ",
doi="10.2196/27392",
url="https://www.jmir.org/2021/12/e27392",
url="http://www.ncbi.nlm.nih.gov/pubmed/34964717"
}


@Article{info:doi/10.2196/26763,
author="Wang, Hsiao-Han
and Lin, Yu-Hsuan",
title="Assessing Physicians' Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="24",
volume="23",
number="12",
pages="e26763",
keywords="smartphone",
keywords="mobile app",
keywords="work hours",
keywords="recall bias",
keywords="time perception",
keywords="physicians",
keywords="labor policy",
abstract="Background: Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians' well-being. Objective: The aim of this study was to estimate physicians' recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians' work hours. Methods: We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the ``Staff Hours'' app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results: App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by --8.97 (SD 8.60) hours and --6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=--0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=--0.119, P=.48). The percentage of hours not recalled (38.6\%) was significantly higher for the penultimate week (38.6\%) than for the first week (16.0\%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions: Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias. ",
doi="10.2196/26763",
url="https://www.jmir.org/2021/12/e26763",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951600"
}


@Article{info:doi/10.2196/27096,
author="Heponiemi, Tarja
and Gluschkoff, Kia
and Vehko, Tuulikki
and Kaihlanen, Anu-Marja
and Saranto, Kaija
and Nissinen, Sari
and Nadav, Janna
and Kujala, Sari",
title="Electronic Health Record Implementations and Insufficient Training Endanger Nurses' Well-being: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e27096",
keywords="electronic health records",
keywords="implementation",
keywords="information systems",
keywords="training",
keywords="stress",
keywords="cognitive failures",
keywords="time pressure",
keywords="registered nurses",
abstract="Background: High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after implementations of HIS. In particular, poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive workload. Moreover, the need to learn new systems may require considerable effort from nurses. Thus, EHR implementations may have an effect on the well-being of nurses. Objective: This study aimed to examine the associations of EHR-to-EHR implementations and the sufficiency of related training with perceived stress related to information systems (SRIS), time pressure, and cognitive failures among registered nurses. Moreover, we examined the moderating effect of the employment sector (hospital, primary care, social services, and others) on these associations. Methods: This study was a cross-sectional survey study of 3610 registered Finnish nurses in 2020. EHR implementation was measured by assessing whether the work unit of each respondent had implemented or will implement a new EHR (1) within the last 6 months, (2) within the last 12 months, (3) in the next 12 months, and (4) at no point within the last 12 months or in the forthcoming 12 months. The associations were examined using analyses of covariance adjusted for age, gender, and employment sector. Results: The highest levels of SRIS (adjusted mean 4.07, SE 0.05) and time pressure (adjusted mean 4.55, SE 0.06) were observed among those who had experienced an EHR implementation within the last 6 months. The lowest levels of SRIS (adjusted mean 3.26, SE 0.04), time pressure (adjusted mean 4.41, SE 0.05), and cognitive failures (adjusted mean 1.84, SE 0.02) were observed among those who did not experience any completed or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS (F1=153.40, P<.001), time pressure (F1=80.95, P<.001), and cognitive failures (F1=34.96, P<.001) than those who had received insufficient training. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals. Conclusions: EHR implementations and insufficient training related to these implementations may endanger the well-being of nurses and even lead to errors. Thus, it is extremely important for organizations to offer comprehensive training before, during, and after implementations. Moreover, easy-to-use systems that allow transition periods, a re-engineering approach, and user involvement may be beneficial to nurses in the implementation process. Training and other improvements would be especially important in hospitals. ",
doi="10.2196/27096",
url="https://www.jmir.org/2021/12/e27096",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941546"
}


@Article{info:doi/10.2196/26323,
author="Uslu, Aykut
and Stausberg, J{\"u}rgen",
title="Value of the Electronic Medical Record for Hospital Care: Update From the Literature",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e26323",
keywords="cost analysis",
keywords="costs and cost analyses",
keywords="economic advantage",
keywords="electronic medical records",
keywords="electronic records",
keywords="health care",
keywords="hospitals",
keywords="medical records systems computerized",
keywords="quality of health care",
keywords="secondary data",
abstract="Background: Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negative effects on the outcome of health care systems. Objective: The aim of this review is to summarize empirical studies about the value of electronic medical records (EMRs) for hospital care published between 2010 and spring 2019. Methods: The authors adopted their method from a series of literature reviews. The literature search was performed on MEDLINE with ``Medical Record System, Computerized'' as the essential keyword. The selection process comprised 2 phases looking for a consent of both authors. Starting with 1345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies' quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications' conclusions concerning the medical record's impact on quality and efficiency of health care. Results: The majority of the studies stemmed from the United States (19/23, 83\%). Mostly, the studies used publicly available data (``secondary data studies''; 17/23, 74\%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78\%), 16 the effect on the efficiency of health care (70\%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56\%); 14/18 studies showed an increase of health care quality (78\%); the remaining 4 studies missed explicit information about the proposed positive effect. Conclusions: This review revealed a clear evidence about the value of EMRs. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records to guide their implementation and operation. ",
doi="10.2196/26323",
url="https://www.jmir.org/2021/12/e26323",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941544"
}


@Article{info:doi/10.2196/34170,
author="Schwarz, Julian
and B{\"a}rk{\aa}s, Annika
and Blease, Charlotte
and Collins, Lorna
and H{\"a}gglund, Maria
and Markham, Sarah
and Hochwarter, Stefan",
title="Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="14",
volume="8",
number="12",
pages="e34170",
keywords="electronic health record",
keywords="open notes",
keywords="user involvement",
keywords="patient advocacy",
keywords="patient portal",
keywords="patient rights",
keywords="collaborative health care",
keywords="participation",
keywords="coproduction",
keywords="system transformation",
keywords="health care reform",
abstract="Background: Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)---often referred to as open notes---have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective: This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders' perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods: A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results: Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members' mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions: PAEHRs in MHC may strengthen user involvement, patients' autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention. ",
doi="10.2196/34170",
url="https://mental.jmir.org/2021/12/e34170",
url="http://www.ncbi.nlm.nih.gov/pubmed/34904956"
}


@Article{info:doi/10.2196/28896,
author="Keith, J. Mark
and Dean, L. Douglas
and Gaskin, James
and Anderson, Greg",
title="Team Building Through Team Video Games: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Dec",
day="14",
volume="9",
number="4",
pages="e28896",
keywords="team video gaming",
keywords="team building",
keywords="flow",
keywords="team cohesion",
keywords="video games",
keywords="gamification",
keywords="team",
keywords="teamwork",
keywords="cohesion",
keywords="theory",
keywords="framework",
keywords="performance",
abstract="Background: Organizations of all types require the use of teams. Poor team member engagement costs billions of US dollars annually. Objective: This study aimed to explain how team building can be accomplished with team video gaming based on a team cohesion model enhanced by team flow theory. Methods: In this controlled experiment, teams were randomly assigned to a team video gaming treatment or a control treatment. Team productivity was measured during both pretreatment and posttreatment team tasks. After the pretest, teams who were involved in the team video gaming treatment competed against other teams by playing the Halo or Rock Band video game for 45 minutes. After the pretest, teams in the control treatment worked alone for 45 minutes. Then, all teams completed the posttest team activity. This same experimental protocol was conducted on 2 different team tasks. Results: For both tasks, teams in the team video gaming treatment increased their productivity significantly more (F1=8.760, P=.004) on the posttest task than teams in the control treatment. Our flow-based theoretical model explained team performance improvement more than twice as well (R2=40.6\%) than prior related research (R2=18.5\%). Conclusions: The focused immersion caused by team video gaming increased team performance while the enjoyment component of flow decreased team performance on the posttest. Both flow and team cohesion contributed to team performance, with flow contributing more than cohesion. Team video gaming did not increase team cohesion, so team video gaming effects are independent of cohesion. Team video gaming is a valid practical method for developing and improving newly formed teams. ",
doi="10.2196/28896",
url="https://games.jmir.org/2021/4/e28896",
url="http://www.ncbi.nlm.nih.gov/pubmed/34904954"
}


@Article{info:doi/10.2196/27072,
author="North, Frederick
and Nelson, M. Elissa
and Buss, J. Rebecca
and Majerus, J. Rebecca
and Thompson, C. Matthew
and Crum, A. Brian",
title="The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison",
journal="JMIR Med Inform",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e27072",
keywords="electronic health record",
keywords="schedule",
keywords="patient appointment",
keywords="preventive health service",
keywords="office visit",
keywords="outpatient care",
keywords="mammogram",
keywords="software tool",
keywords="computer software application",
keywords="mobile applications",
keywords="self-schedule",
keywords="app",
keywords="EHR",
keywords="screening",
keywords="diagnostic",
keywords="cancer",
abstract="Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective: The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods: We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results: For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3\% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4\% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3\% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7\% (536/9433) no-shows compared to 4.6\% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95\% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95\% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or ``clean up'' self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5\% (7553/8079) of their finalized appointments; only 74.5\% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5\% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5\% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95\% CI 4.48-5.37; P<.001). Conclusions: Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends. ",
doi="10.2196/27072",
url="https://medinform.jmir.org/2021/12/e27072",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878997"
}


@Article{info:doi/10.2196/31668,
author="Nadav, Janna
and Kaihlanen, Anu-Marja
and Kujala, Sari
and Laukka, Elina
and Hilama, Pirjo
and Koivisto, Juha
and Keskim{\"a}ki, Ilmo
and Heponiemi, Tarja",
title="How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="1",
volume="23",
number="12",
pages="e31668",
keywords="digital services",
keywords="implementation",
keywords="health and social care professionals",
keywords="integration",
keywords="normalization process theory",
keywords="interview",
keywords="social work",
keywords="health care",
keywords="focus groups",
abstract="Background: Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals' routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. Objective: The aim of this study is to examine health and social care professionals' experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals' routine work. Methods: A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. Results: Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals' routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources.  The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals' work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered.  Moreover, (14) the service should support professionals' work tasks. Conclusions: We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services. ",
doi="10.2196/31668",
url="https://www.jmir.org/2021/12/e31668",
url="http://www.ncbi.nlm.nih.gov/pubmed/34855610"
}


@Article{info:doi/10.2196/32180,
author="Chen, Rai-Fu
and Hsiao, Ju-Ling",
title="Health Professionals' Perspectives on Electronic Medical Record Infusion and Individual Performance: Model Development and Questionnaire Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="30",
volume="9",
number="11",
pages="e32180",
keywords="health care professional",
keywords="electronic medical records",
keywords="IS infusion",
keywords="individual performance",
keywords="EHR",
keywords="electronic health record",
keywords="performance",
keywords="perspective",
keywords="information system",
keywords="integration",
keywords="decision-making",
keywords="health information exchange",
keywords="questionnaire",
abstract="Background: Electronic medical records (EMRs) are integrated information sources generated by health care professionals (HCPs) from various health care information systems. EMRs play crucial roles in improving the quality of care and medical decision-making and in facilitating cross-hospital health information exchange. Although many hospitals have invested considerable resources and efforts to develop EMRs for several years, the factors affecting the long-term success of EMRs, particularly in the EMR infusion stage, remain unclear. Objective: The aim of this study was to investigate the effects of technology, user, and task characteristics on EMR infusion to determine the factors that largely affect EMR infusion. In addition, we examined the effect of EMR infusion on individual HCP performance. Methods: A questionnaire survey was used to collect data from HCPs with >6 months experience in using EMRs in a Taiwanese teaching hospital. A total of 316 questionnaires were distributed and 211 complete copies were returned, yielding a valid response rate of 66.8\%. The collected data were further analyzed using WarpPLS 5.0. Results: EMR infusion (R2=0.771) was mainly affected by user habits ($\beta$=.411), portability ($\beta$=.217), personal innovativeness ($\beta$=.198), technostress ($\beta$=.169), and time criticality ($\beta$=.168), and individual performance (R2=0.541) was affected by EMR infusion ($\beta$=.735). This finding indicated that user (habit, personal innovativeness, and technostress), technology (portability), and task (mobility and time criticality) characteristics have major effects on EMR infusion. Furthermore, the results indicated that EMR infusion positively affects individual performance. Conclusions: The factors identified in this study can extend information systems infusion theory and provide useful insights for the further improvement of EMR development in hospitals and by the government, specifically in its infusion stage. In addition, the developed instrument can be used as an assessment tool to identify the key factors for EMR infusion, and to evaluate the extent of EMR infusion and the individual performance of hospitals that have implemented EMR systems. Moreover, the results can help governments to understand the urgent needs of hospitals in implementing EMR systems, provide sufficient resources and support to improve the incentives of EMR development, and develop adequate EMR policies for the meaningful use of electronic health records among hospitals and clinics. ",
doi="10.2196/32180",
url="https://medinform.jmir.org/2021/11/e32180",
url="http://www.ncbi.nlm.nih.gov/pubmed/34851297"
}


@Article{info:doi/10.2196/30485,
author="Par{\'e}, Guy
and Raymond, Louis
and Castonguay, Alexandre
and Grenier Ouimet, Antoine
and Trudel, Marie-Claude",
title="Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="16",
volume="9",
number="11",
pages="e30485",
keywords="medical appointment scheduling system",
keywords="electronic booking",
keywords="e-booking",
keywords="primary care",
keywords="accessibility of care",
keywords="availability of care",
keywords="advance access",
keywords="electronic medical record",
abstract="Background: The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. Objective: This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? Methods: A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. Results: A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly ``automated appointment confirmation and reminders'' and ``online appointment confirmation, modification, or cancellation by the patient.'' More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic's electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. Conclusions: The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions. ",
doi="10.2196/30485",
url="https://medinform.jmir.org/2021/11/e30485",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783670"
}


@Article{info:doi/10.2196/27568,
author="Keniston, Angela
and McBeth, Lauren
and Pell, Jonathan
and Bowden, Kasey
and Metzger, Anna
and Nordhagen, Jamie
and Anthony, Amanda
and Rice, John
and Burden, Marisha",
title="The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="8",
volume="8",
number="4",
pages="e27568",
keywords="discharge planning",
keywords="health information technology",
keywords="quasi-experimental design",
keywords="multidisciplinary",
keywords="teamwork",
abstract="Background: In the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication. Objective: The aim of this study is to evaluate the effectiveness of a discharge communication tool. Methods: This was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider. Results: During the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85\% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94\% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88\% of providers, and 34/34, 100\% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7\% (P=.06). Conclusions: The Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations. ",
doi="10.2196/27568",
url="https://humanfactors.jmir.org/2021/4/e27568",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747702"
}


@Article{info:doi/10.2196/27671,
author="van Poelgeest, Rube
and Schrijvers, Augustinus
and Boonstra, Albert
and Roes, Kit",
title="Medical Specialists' Perspectives on the Influence of Electronic Medical Record Use on the Quality of Hospital Care: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2021",
month="Oct",
day="27",
volume="8",
number="4",
pages="e27671",
keywords="electronic medical record (emr)",
keywords="hospitals",
keywords="quality",
keywords="health care",
keywords="medical specialist",
abstract="Background: Numerous publications show that electronic medical records (EMRs) may make an important contribution to increasing the quality of care. There are indications that particularly the medical specialist plays an important role in the use of EMRs in hospitals. Objective: The aim of this study was to examine how, and by which aspects, the relationship between EMR use and the quality of care in hospitals is influenced according to medical specialists. Methods: To answer this question, a qualitative study was conducted in the period of August-October 2018. Semistructured interviews of around 90 min were conducted with 11 medical specialists from 11 different Dutch hospitals. For analysis of the answers, we used a previously published taxonomy of factors that can influence the use of EMRs. Results: The professional experience of the participating medical specialists varied between 5 and 27 years. Using the previously published taxonomy, these medical specialists considered technical barriers the most significant for EMR use. The suboptimal change processes surrounding implementation were also perceived as a major barrier. A final major problem is related to the categories ``social'' (their relationships with the patients and fellow care providers), ``psychological'' (based on their personal issues, knowledge, and perceptions), and ``time'' (the time required to select, implement, and learn how to use EMR systems and subsequently enter data into the system). However, the medical specialists also identified potential technical facilitators, particularly in the assured availability of information to all health care professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve the quality of care but consider these possibilities currently lacking. Conclusions: The 11 medical specialists shared positive experiences with EMR use when comparing it to formerly used paper records. The fact that involved health care professionals can access patient data at any time they need is considered important. However, in practice, potential quality improvement lags as long as decision support cannot be applied because of the lack of a fully coded patient record. ",
doi="10.2196/27671",
url="https://humanfactors.jmir.org/2021/4/e27671",
url="http://www.ncbi.nlm.nih.gov/pubmed/34704955"
}


@Article{info:doi/10.2196/26700,
author="Gehri, Beatrice
and Bachnick, Stefanie
and Schwendimann, Ren{\'e}
and Simon, Michael",
title="Matching Registered Nurse Services With Changing Care Demands in Psychiatric Hospitals: Protocol for a Multicenter Observational Study (MatchRN Psychiatry Study)",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="17",
volume="10",
number="8",
pages="e26700",
keywords="quality of care",
keywords="psychiatric hospitals",
keywords="nurses",
keywords="patient routine data",
keywords="work environment",
keywords="Switzerland",
abstract="Background: The quality of care is often poorly assessed in mental health settings, and accurate evaluation requires the monitoring and comparison of not only the outcomes but also the structures and processes. The resulting data allow hospital administrators to compare their patient outcome data against those reported nationally. As Swiss psychiatric hospitals are planned and coordinated at the cantonal level, they vary considerably. In addition, nursing care structures and processes, such as nurse staffing, are only reported and aggregated at the national level, whereas nurse outcomes, such as job satisfaction or intention to leave, have yet to be assessed in Swiss psychiatric hospitals. Because they lack these key figures, psychiatric hospitals' quality of care cannot be reasonably described. Objective: This study's purpose is to describe health care quality by exploring hospital structures such as nurse staffing and the work environment; processes such as the rationing of care; nurse outcomes, including job satisfaction and work-life balance; and patients' symptom burden. Methods: MatchRN Psychiatry is a multicenter observational study of Swiss psychiatric hospitals. The sample for this study included approximately 1300 nurses from 113 units of 13 psychiatric hospitals in Switzerland's German-speaking region. In addition, routine patient assessment data from each participating hospital were included. The nurse survey consisted of 164 items covering three dimensions---work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses' education levels. Routine patient data included items such as main diagnosis, the number and duration of freedom-restrictive measures, and symptom burden at admission and discharge. Data were collected between September 2019 and June 2021. The data will be analyzed descriptively by using multilevel regression linear mixed models and generalized linear mixed models to explore associations between variables of interest. Results: The response rate from the nurse survey was 71.49\% (1209/1691). All data are currently being checked for consistency and plausibility. The MatchRN Psychiatry study is funded by the participating psychiatric hospitals and the Swiss Psychiatric Nursing Leaders Association (Vereinigung Pflegekader Psychiatrie Schweiz). Conclusions: For the first time, the MatchRN Psychiatry study will systematically evaluate the quality of care in psychiatric hospitals in Switzerland in terms of organizational structures, processes, and patient and nurse outcomes. The participating psychiatric hospitals will benefit from findings that are relevant to the future planning of nurse staffing. The findings of this study will contribute to improvement strategies for nurses' work environments and patient experiences in Swiss psychiatric hospitals. International Registered Report Identifier (IRRID): DERR1-10.2196/26700 ",
doi="10.2196/26700",
url="https://www.researchprotocols.org/2021/8/e26700",
url="http://www.ncbi.nlm.nih.gov/pubmed/34402796"
}


@Article{info:doi/10.2196/27180,
author="Tossaint-Schoenmakers, Rosian
and Versluis, Anke
and Chavannes, Niels
and Talboom-Kamp, Esther
and Kasteleyn, Marise",
title="The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome",
journal="J Med Internet Res",
year="2021",
month="May",
day="10",
volume="23",
number="5",
pages="e27180",
keywords="eHealth",
keywords="digital health",
keywords="blended care",
keywords="quality",
keywords="integration",
keywords="health care organization",
keywords="structure",
keywords="process",
keywords="outcome",
abstract="Background: Health care organizations are increasingly working with eHealth. However, the integration of eHealth into regular health care is challenging. It requires organizations to change the way they work and their structure and care processes to be adapted to ensure that eHealth supports the attainment of the desired outcomes. Objective: The aims of this study are to investigate whether there are identifiable indicators in the structure, process, and outcome categories that are related to the successful integration of eHealth in regular health care, as well as to investigate which indicators of structure and process are related to outcome indicators. Methods: A systematic literature review was conducted using the Donabedian Structure-Process-Outcome (SPO) framework to identify indicators that are related to the integration of eHealth into health care organizations. Data extraction sheets were designed to provide an overview of the study characteristics, eHealth characteristics, and indicators. The extracted indicators were organized into themes and subthemes of the structure, process, and outcome categories. Results: Eleven studies were included, covering a variety of study designs, diseases, and eHealth tools. All studies identified structure, process, and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in the structure, process, and outcome categories was 175, 84, and 88, respectively. The themes with the most-noted indicators and their mutual interaction were inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions), and technology (38 indicators, 12 interactions)---all within the structure category; health care actions (38 indicators, 15 interactions) within the process category; and efficiency (30 indicators, 15 interactions) within the outcome category. In-depth examination identified four most-reported indicators, namely ``deployment of human resources'' (n=11), in the inner setting theme within the structure category; ``ease of use'' (n=16) and ``technical issue'' (n=10), both in the technology theme within the structure category; and ``health logistics'' (n=26), in the efficiency theme within the outcome category. Conclusions: Three principles are important for the successful integration of eHealth into health care. First, the role of the care receiver needs to be incorporated into the organizational structure and daily care process. Second, the technology must be well attuned to the organizational structure and daily care process. Third, the deployment of human resources to the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organization, daily process, or the end results. ",
doi="10.2196/27180",
url="https://www.jmir.org/2021/5/e27180",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970123"
}


@Article{info:doi/10.2196/28216,
author="Jiang, Ying
and Koh, Ling Karen Wei
and Ramachandran, Joann Hadassah
and Tay, Kian Yee
and Wu, Xi Vivien
and Shorey, Shefaly
and Wang, Wenru",
title="Patients' Experiences of a Nurse-Led, Home-Based Heart Failure Self-management Program: Findings From a Qualitative Process Evaluation",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="27",
volume="23",
number="4",
pages="e28216",
keywords="self-care",
keywords="psychosocial educational",
keywords="nurse-led",
keywords="mHealth",
keywords="self-management",
keywords="heart failure",
keywords="process evaluation",
keywords="nursing",
keywords="mobile phone",
abstract="Background: Heart failure (HF) is a major public health problem that places a significant disease burden on society. Self-care is important in the management of HF because it averts disease progression and reduces the number of hospitalizations. Effective nursing interventions promote HF self-care. Objective: This study aims to explore participants' perspectives on a nurse-led, home-based heart failure self-management program (HOM-HEMP) in a randomized controlled trial conducted in Singapore to gain insight into the effectiveness of the study intervention. Methods: A descriptive, qualitative approach was used. English- or Chinese-speaking participants from the intervention arms were recruited through a purposive sampling method from January 2019 to July 2019. Individual, face-to-face, semistructured interviews were conducted with 11 participants. All interviews were audio recorded and transcribed verbatim, with the participant identifiers omitted to ensure confidentiality. The thematic analysis approach was used to identify, analyze, and report patterns (themes) within the data. Results: A total of six themes emerged from the process evaluation interviews and were categorized according to the Donabedian structure-process-outcome framework as intervention structure, intervention process, and intervention outcome. These six themes were manageability of the intervention, areas for improvement, benefits of visiting, personal accountability in self-care, empowered with knowledge and skills in self-care after the intervention, and increased self-efficacy in cardiac care. Conclusions: The findings of the process evaluation provided additional information on participants' perceptions and experiences with the HOM-HEMP intervention. Although a home visit may be perceived as resource intensive, it remains to be the preferred way of engagement for most patients. Nurses play an important role in promoting HF self-care. The process of interaction with the patient can be an important process for empowering self-care behavior changes. ",
doi="10.2196/28216",
url="https://www.jmir.org/2021/4/e28216",
url="http://www.ncbi.nlm.nih.gov/pubmed/33904823"
}


@Article{info:doi/10.2196/21109,
author="Dimitrovski, Tomi
and Bath, A. Peter
and Ketikidis, Panayiotis
and Lazuras, Lambros",
title="Factors Affecting General Practitioners' Readiness to Accept and Use an Electronic Health Record System in the Republic of North Macedonia: A National Survey of General Practitioners",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="5",
volume="9",
number="4",
pages="e21109",
keywords="general practitioner",
keywords="eHealth",
keywords="technology acceptance",
keywords="electronic health record",
abstract="Background: Electronic health records (EHRs) represent an important aspect of digital health care, and to promote their use further, we need to better understand the drivers of their acceptance among health care professionals. EHRs are not simple computer applications; they should be considered as a highly integrated set of systems. Technology acceptance theories can be used to better understand users' intentions to use EHRs. It is recommended to assess factors that determine the future acceptance of a system before it is implemented. Objective: This study uses a modified version of the Unified Theory of Acceptance and Use of Technology with the aim of examining the factors associated with intentions to use an EHR application among general practitioners (GPs) in the Republic of North Macedonia, a country that has been underrepresented in extant literature. More specifically, this study aims to assess the role of technology acceptance predictors such as performance expectancy, effort expectancy, social influence, facilitating conditions, job relevance, descriptive norms, and satisfaction with existing eHealth systems already implemented in the country. Methods: A web-based invitation was sent to 1174 GPs, of whom 458 completed the questionnaire (response rate=40.2\%). The research instrument assessed performance expectancy, effort expectancy, facilitating conditions, and social influence in relation to the GPs' intentions to use future EHR systems. Job relevance, descriptive norms, satisfaction with currently used eHealth systems in the country, and computer/internet use were also measured. Results: Hierarchical linear regression analysis showed that effort expectancy, descriptive norms, social influence, facilitating conditions, and job relevance were significantly associated with intentions to use the future EHR system, but performance expectance was not. Multiple mediation modeling analyses further showed that social influence (z=2.64; P<.001), facilitating conditions (z=4.54; P<.001), descriptive norms (z=4.91; P<.001), and effort expectancy (z=5.81; P=.008) mediated the association between job relevance and intentions. Finally, moderated regression analysis showed that the association between social influence and usage intention was significantly moderated (P=.02) by experience (Bexperience{\texttimes}social influence=.005; 95\% CI 0.001 to 0.010; $\beta$=.080). In addition, the association between social influence and intentions was significantly moderated (P=.02) by age (Bage{\texttimes}social influence=.005; 95\% CI 0.001 to 0.010; $\beta$=.077). Conclusions: Expectations of less effort in using EHRs and perceptions on supportive infrastructures for enabling EHR use were significantly associated with the greater acceptance of EHRs among GPs. Social norms were also associated with intentions, even more so among older GPs and those with less work experience. The theoretical and practical implications of these findings are also discussed. ",
doi="10.2196/21109",
url="https://medinform.jmir.org/2021/4/e21109",
url="http://www.ncbi.nlm.nih.gov/pubmed/33818399"
}


@Article{info:doi/10.2196/23450,
author="North, Frederick
and Nelson, M. Elissa
and Majerus, J. Rebecca
and Buss, J. Rebecca
and Thompson, C. Matthew
and Crum, A. Brian",
title="Impact of Web-Based Self-Scheduling on Finalization of Well-Child Appointments in a Primary Care Setting: Retrospective Comparison Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="18",
volume="9",
number="3",
pages="e23450",
keywords="electronic health record",
keywords="schedules",
keywords="patient appointment",
keywords="preventive health service",
keywords="office visit",
keywords="outpatient care",
keywords="software tool",
keywords="computer software application",
keywords="mobile applications",
keywords="child health",
keywords="pediatric",
keywords="preventive care",
keywords="self",
abstract="Background: Web-booking of flights, hotels, and sports events has become commonplace in the travel and entertainment industry, but self-scheduling of health care appointments on the web is not yet widely used. An electronic health record that integrates appointment scheduling and patient web-based access to medical records creates an opportunity for patient self-scheduling. The Mayo Clinic developed and implemented a feature in its Patient Online Services (POS) web and mobile platform that allows software-managed self-scheduling of well-child visits. Objective: This study aims to examine the use of a new self-scheduling appointment feature within POS in both web and mobile formats and determine the use characteristics, outcomes, and efficiency of self-scheduling compared with staff scheduling. Methods: Within a primary care setting, we collected 13 months of all appointment activity for the well-child visit for children aged 2-12 years. As these specific appointment types are for minors, self-scheduling is performed by parents or other proxies. We compared the appointment actions of scheduling and cancelling for both self-scheduled and staff-scheduled appointments. The frequency in which patients were using self-scheduling outside of normal business hours was quantified, and we compared no-show outcomes of finalized appointments. Results: Of the 1099 patients who performed any self-scheduling actions, 73.1\% (803/1099) exclusively used self-scheduling and self-cancelling software. For those with access to self-scheduling (patients registered with the Mayo Clinic POS), 4.92\% (1201/24,417) of all well-child appointment-scheduling actions were self-scheduled. Staff scheduling required more than a single appointment step (eg, schedule, cancel, reschedule) in 28.32\% (3729/13,168) compared with only 6.93\% (53/765) of self-scheduled appointments (P<.001). Self-scheduling appointment actions took place outside of regular business hours 29.5\% (354/1201) of the time. No-shows accounted for 3.07\% (28/912) of the self-scheduled finalized appointments compared with 4.12\% (693/16,828) of staff-scheduled appointments, which is a nonsignificant difference (P=.12). Staff-scheduled finalized appointments (that allowed for scheduling appointments for more than 12 weeks in the future) revealed a potential demand of 11.15\% (1876/16,828) for appointments with longer lead times. Conclusions: Self-scheduling can generate a significant number of finalized appointments, decreasing the need for staff scheduler time. We found that 29.5\% (354/1201) of the self-scheduling activity took place outside of the usual staff scheduler hours, adding convenience value to the scheduling process. For exclusive self-schedulers, 93.1\% (712/765) finalized the appointment in a single step. The no-show rates were not adversely affected by the self-scheduling. ",
doi="10.2196/23450",
url="https://medinform.jmir.org/2021/3/e23450",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734095"
}


@Article{info:doi/10.2196/23306,
author="Esdar, Moritz
and H{\"u}bner, Ursula
and Thye, Johannes
and Babitsch, Birgit
and Liebe, Jan-David",
title="The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="15",
volume="9",
number="3",
pages="e23306",
keywords="organizational innovation",
keywords="health information management",
keywords="organizational culture",
keywords="diffusion of innovation",
keywords="hospital information systems",
keywords="organizational change management",
abstract="Background: Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations' innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. Objective: The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. Methods: We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. Results: The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R{\texttwosuperior}=0.56), which in turn explains the perceived HIT quality (R{\texttwosuperior}=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model's statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. Conclusions: The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT. ",
doi="10.2196/23306",
url="https://medinform.jmir.org/2021/3/e23306",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720029"
}


@Article{info:doi/10.2196/22974,
author="Ausserhofer, Dietmar
and Favez, Lauriane
and Simon, Michael
and Z{\'u}{\~n}iga, Franziska",
title="Electronic Health Record Use in Swiss Nursing Homes and Its Association With Implicit Rationing of Nursing Care Documentation: Multicenter Cross-sectional Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="2",
volume="9",
number="3",
pages="e22974",
keywords="electronic health records",
keywords="nursing homes",
keywords="nursing care",
keywords="health care rationing",
keywords="rationing of nursing care",
keywords="unfinished care",
keywords="documentation",
keywords="patient care planning",
keywords="mobile phone",
abstract="Background: Nursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing. Objective: This study aims to describe nurses' perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system's association with implicit rationing of nursing care documentation. Methods: This was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system's usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. Results: Overall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42\% (1362/1962; guarantees safe care and treatment) to 78.32\% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61\%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system's usefulness ($\beta$=?.12; 95\% CI ?0.17 to ?0.06) and sufficient numbers of computers ($\beta$=?.09; 95\% CI ?0.12 to ?0.06) were consistently associated with lower implicit rationing of nursing care documentation. Conclusions: Both the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes. ",
doi="10.2196/22974",
url="https://medinform.jmir.org/2021/3/e22974",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650983"
}


@Article{info:doi/10.2196/25495,
author="Laukka, Elina
and P{\"o}lkki, Tarja
and Heponiemi, Tarja
and Kaihlanen, Anu-Marja
and Kanste, Outi",
title="Leadership in Digital Health Services: Protocol for a Concept Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="4",
volume="10",
number="2",
pages="e25495",
keywords="health care",
keywords="leadership",
keywords="health services",
keywords="concept analysis",
keywords="telehealth",
abstract="Background: Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective: The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods: The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results: An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions: A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. International Registered Report Identifier (IRRID): PRR1-10.2196/25495 ",
doi="10.2196/25495",
url="http://www.researchprotocols.org/2021/2/e25495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538702"
}


@Article{info:doi/10.2196/17040,
author="Bautista, Robert John
and Lin, C. Trisha T.
and Theng, Yin-Leng",
title="Influence of Organizational Issues on Nurse Administrators' Support to Staff Nurses' Use of Smartphones for Work Purposes in the Philippines: Focus Group Study",
journal="JMIR Nursing",
year="2020",
month="Jan",
day="10",
volume="3",
number="1",
pages="e17040",
keywords="BYOD",
keywords="IT consumerization",
keywords="nurse administrators",
keywords="organizational support",
keywords="Philippines",
keywords="smartphone",
abstract="Background: Studies show that nurses use their own smartphones for work purposes, and there are several organizational issues related to this. However, it is unclear what these organizational issues are in the Philippines and the influence they have on nurse administrators' (ie, superiors) support to staff nurses' (ie, subordinates) use of smartphones for work purposes. Objective: Drawing from the Organizational Support Theory (OST), this study aimed to identify organizational issues that influence nurse administrators' support to staff nurses' use of smartphones for work purposes. Methods: Between June and July 2017, 9 focus groups with 43 nurse administrators (ie, head nurses, nurse supervisors, and nurse managers) were conducted in 9 tertiary-level general hospitals in Metro Manila, the Philippines. Drawing from OST, issues were classified as those that encouraged or inhibited nurse administrators to support nurses' use of smartphones for work purposes. Results: Nurse administrators were encouraged to support nurses' use of smartphones for work purposes when (1) personal smartphones are superior to workplace technologies, (2) personal smartphones resolve unit phone problems, and (3) policy is unrealistic to implement. Conversely, issues that inhibited nurse administrators to support nurses' use of smartphones for work purposes include (1) smartphone use for nonwork purposes and (2) misinterpretation by patients. Conclusions: Nurse administrators in the Philippines faced several organizational issues that encouraged or inhibited support to staff nurses' use of smartphones for work purposes. Following OST, the extent of their support can influence staff nurses' perceived organizational support on the use of smartphones for work purposes, Overall, the findings highlight the role and implication of organizational support in the context of smartphone consumerization in hospital settings, especially in developing countries. ",
doi="10.2196/17040",
url="https://nursing.jmir.org/2020/1/e17040",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345781"
}


@Article{info:doi/10.2196/16377,
author="Lee, J. Edmund W.
and Viswanath, Kasisomayajula",
title="Big Data in Context: Addressing the Twin Perils of Data Absenteeism and Chauvinism in the Context of Health Disparities Research",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="7",
volume="22",
number="1",
pages="e16377",
keywords="big data",
keywords="artificial intelligence",
keywords="health informatics",
keywords="wearable electronic devices",
keywords="mobile health",
keywords="social media",
keywords="electronic health records",
keywords="digital divide",
keywords="health disparities",
doi="10.2196/16377",
url="https://www.jmir.org/2020/1/e16377",
url="http://www.ncbi.nlm.nih.gov/pubmed/31909724"
}


@Article{info:doi/10.2196/16093,
author="Greenhalgh, Trisha
and Wherton, Joseph
and Shaw, Sara
and Papoutsi, Chrysanthi
and Vijayaraghavan, Shanti
and Stones, Rob",
title="Infrastructure Revisited: An Ethnographic Case Study of how Health Information Infrastructure Shapes and Constrains Technological Innovation",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="19",
volume="21",
number="12",
pages="e16093",
keywords="information infrastructure",
keywords="structuration theory",
keywords="video consultations",
keywords="neo-institutional theory",
keywords="organizational ethnography",
keywords="hidden work",
keywords="actor-network theory",
abstract="Background: Star defined infrastructure as something other things ``run on''; it consists mainly of ``boring things.'' Building on her classic 1999 paper, and acknowledging contemporary developments in technologies, services, and systems, we developed a new theorization of health information infrastructure with five defining characteristics: (1) a material scaffolding, backgrounded when working and foregrounded upon breakdown; (2) embedded, relational, and emergent; (3) collectively learned, known, and practiced (through technologically-supported cooperative work and organizational routines); (4) patchworked (incrementally built and fixed) and path-dependent (influenced by technical and socio-cultural legacies); and (5) institutionally supported and sustained (eg, embodying standards negotiated and overseen by regulatory and professional bodies). Objective: Our theoretical objective was, in a health care context, to explore what information infrastructure is and how it shapes, supports, and constrains technological innovation. Our empirical objective was to examine the challenges of implementing and scaling up video consultation services. Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to ``boring things'': the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate incrementally, taking account of technological and socio-cultural legacies; (5) consider standards but also where these standards come from and what priorities and interests they represent; and (6) seek to create leeway for these standards to be adapted to different local conditions. ",
doi="10.2196/16093",
url="http://www.jmir.org/2019/12/e16093/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31855184"
}


@Article{info:doi/10.2196/14279,
author="Mather, Carey
and Cummings, Elizabeth
and Gale, Fred",
title="Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study",
journal="JMIR Nursing",
year="2019",
month="Aug",
day="09",
volume="2",
number="1",
pages="e14279",
keywords="digital",
keywords="health policy",
keywords="digital professionalism",
keywords="nursing education",
abstract="Background: The 2017 Australian Digital Health Agency (ADHA) Strategy is based on the underlying assumption that digital technology in health care environments is ubiquitous. The ADHA Strategy views health professionals, especially nurses, as grappling with the complexity of installing and using digital technologies to facilitate personalized and sustainable person-centered care. Yet, ironically, the 2018 debate over how to enroll Australians into the national electronic health record system and its alteration from an opt-in to an opt-out model heightened public and professional concern over what constituted a ``safe, seamless and secure'' health information system. What can be termed a digital technology paradox has emerged where, although it is widely acknowledged that there are benefits from deploying and using digital technology in the workplace, the perception of risk renders it unavailable or inaccessible at point of care. The inability of nurses to legitimately access and use mobile technology is impeding the diffusion of digital technology in Australian health care environments and undermining the 2017 ADHA Strategy. Objective: This study explored the nature and scope of usability of mobile technology at point of care, in order to understand how current governance structures impacted on access and use of digital technology from an organizational perspective. Methods: Individual semistructured interviews were conducted with 6 representatives from professional nursing organizations. A total of 10 interview questions focused on factors that impacted the use of mobile technology for learning at point of care. Seven national organizations and 52 members from the Coalition of National Nursing and Midwifery Organisations were invited to participate. Interviews were recorded and transcribed verbatim. Data analysis was systematic and organized, consisting of trial coding; member checking was undertaken to ensure rigor. A codebook was developed to provide a framework for analysis to identify the themes latent in the transcribed data. Nurses as stakeholders emerged as a key theme. Results: Out of 6 participants, 4 female (67\%) and 2 male (33\%) senior members of the nursing profession were interviewed. Each interview lasted between 17 and 54 minutes, which reflected the knowledge of participants regarding the topic of interest and their availability. Two subthemes, coded as ways of thinking and ways of acting, emerged from the open codes. Participants provided examples of the factors that impacted the capacity of nurses to adopt digital technology from an emic perspective. There were contributing factors that related to actions, including work-arounds, attentiveness, and experiences. Nurses also indicated that there were attitudes and influences that impacted thinking regarding access and use of mobile technology at point of care. Conclusions: Nurses are inadequately prepared for the digital future that has now arrived in health care environments. Nurses do not perceive that they are leaders in decision making regarding digital technology adoption, nor are they able to facilitate digital literacy or model digital professionalism. ",
doi="10.2196/14279",
url="https://nursing.jmir.org/2019/1/e14279/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345771"
}


@Article{info:doi/10.2196/medinform.9510,
author="Dusseljee-Peute, W. Linda
and Van der Togt, Remko
and Jansen, Bas
and Jaspers, W. Monique",
title="The Value of Radio Frequency Identification in Quality Management of the Blood Transfusion Chain in an Academic Hospital Setting",
journal="JMIR Med Inform",
year="2019",
month="Aug",
day="05",
volume="7",
number="3",
pages="e9510",
keywords="radio waves",
keywords="automatic data processing",
keywords="blood transfusion",
keywords="geographic information systems",
keywords="temperature",
keywords="technology",
keywords="guideline adherence",
abstract="Background: A complex process like the blood transfusion chain could benefit from modern technologies such as radio frequency identification (RFID). RFID could, for example, play an important role in generating logistic and temperature data of blood products, which are important in assessing the quality of the logistic process of blood transfusions and the product itself. Objective: This study aimed to evaluate whether location, time stamp, and temperature data generated in real time by an active RFID system containing temperature sensors attached to red blood cell (RBC) products can be used to assess the compliance of the management of RBCs to 4 intrahospital European and Dutch guidelines prescribing logistic and temperature constraints in an academic hospital setting. Methods: An RFID infrastructure supported the tracking and tracing of 243 tagged RBCs in a clinical setting inside the hospital at the blood transfusion laboratory, the operating room complex, and the intensive care unit within the Academic Medical Center, a large academic hospital in Amsterdam, the Netherlands. The compliance of the management of 182 out of the 243 tagged RBCs could be assessed on their adherence to the following guidelines on intrahospital storage, transport, and distribution: (1) RBCs must be preserved within an environment with a temperature between 2{\textdegree}C and 6{\textdegree}C; (2) RBCs have to be transfused within 1 hour after they have left a validated cooling system; (3) RBCs that have reached a temperature above 10{\textdegree}C must not be restored or must be transfused within 24 hours or else be destroyed; (4) unused RBCs are to be returned to the BTL within 24 hours after they left the transfusion laboratory. Results: In total, 4 blood products (4/182 compliant; 2.2\%) complied to all applicable guidelines. Moreover, 15 blood products (15/182 not compliant to 1 out of several guidelines; 8.2\%) were not compliant to one of the guidelines of either 2 or 3 relevant guidelines. Finally, 148 blood products (148/182 not compliant to 2 guidelines; 81.3\%) were not compliant to 2 out of the 3 relevant guidelines. Conclusions: The results point out the possibilities of using RFID technology to assess the quality of the blood transfusion chain itself inside a hospital setting in reference to intrahospital guidelines concerning the storage, transport, and distribution conditions of RBCs. This study shows the potentials of RFID in identifying potential bottlenecks in hospital organizations' processes by use of objective data, which are to be tackled in process redesign efforts. The effect of these efforts can subsequently be evaluated by the use of RFID again. As such, RFID can play a significant role in optimization of the quality of the blood transfusion chain. ",
doi="10.2196/medinform.9510",
url="https://medinform.jmir.org/2019/3/e9510/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31381503"
}


@Article{info:doi/10.2196/14797,
author="Danak, U. Shivang
and Guetterman, C. Timothy
and Plegue, A. Melissa
and Holmstrom, L. Heather
and Kadri, Reema
and Duthler, Alexander
and Yoo, Anne
and Buis, R. Lorraine",
title="Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study",
journal="JMIR Med Inform",
year="2019",
month="Jul",
day="11",
volume="7",
number="3",
pages="e14797",
keywords="electronic health records",
keywords="documentation",
keywords="medical informatics",
abstract="Background: With the increasing adoption of electronic health record (EHR) systems, documentation-related burdens have been increasing for health care providers. Recent estimates indicate that primary care providers spend about one-half of their workdays interacting with the EHR, of which about half is focused on clerical tasks. To reduce documentation burdens associated with the EHR, health care systems and physician practices are increasingly implementing medical scribes to assist providers with real-time documentation. Scribes are typically unlicensed paraprofessionals who assist health care providers bydocumenting notes electronically under the direction of a licensed practitioner or physician in real time. Despite the promise of scribes, few studies have investigated their effect on clinical encounters, particularly with regard to patient-provider communication. Objective: The purpose of this quasi-experimental pilot study was to understand how scribes affect patient-physician communication in primary care clinical encounters. Methods: We employed a convergent mixed methods design and included a sample of three physician-scribe pairs and 34 patients. Patients' clinical encounters were randomly assigned to a scribe or nonscribe group. We conducted patient surveys focused on perceptions of patient-provider communication and satisfaction with encounters, video recorded clinical encounters, and conducted physician interviews about their experiences with scribes. Results: Overall, the survey results revealed that patients across both arms reported very high satisfaction of communication with their physician, their physician's use of the EHR, and their care, with very little variability. Video recording analysis supported patient survey data by demonstrating high measures of communication among physicians in both scribed and nonscribed encounters. Furthermore, video recordings revealed that the presence of scribes had very little effect on the clinical encounter. Conclusions: From the patient's perspective, scribes are an acceptable addition to clinical encounters. Although they do not have much impact on patients' perceptions of satisfaction and their impact on the clinical encounter itself was minimal, their potential to reduce documentation-related burden on physicians is valuable. Physicians noted important issues related to scribes, including important considerations for implementing scribe programs, the role of scribes in patient interactions, how physicians work with scribes, characteristics of good scribes, and the role of scribes in physician workflow. ",
doi="10.2196/14797",
url="http://medinform.jmir.org/2019/3/e14797/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31298218"
}


@Article{info:doi/10.2196/10059,
author="Jalali, S. Mohammad
and Kaiser, P. Jessica",
title="Cybersecurity in Hospitals: A Systematic, Organizational Perspective",
journal="J Med Internet Res",
year="2018",
month="May",
day="28",
volume="20",
number="5",
pages="e10059",
keywords="cybersecurity",
keywords="hospitals",
keywords="organizational models",
keywords="computer simulation",
abstract="Background: Cybersecurity incidents are a growing threat to the health care industry in general and hospitals in particular. The health care industry has lagged behind other industries in protecting its main stakeholder (ie, patients), and now hospitals must invest considerable capital and effort in protecting their systems. However, this is easier said than done because hospitals are extraordinarily technology-saturated, complex organizations with high end point complexity, internal politics, and regulatory pressures. Objective: The purpose of this study was to develop a systematic and organizational perspective for studying (1) the dynamics of cybersecurity capability development at hospitals and (2) how these internal organizational dynamics interact to form a system of hospital cybersecurity in the United States. Methods: We conducted interviews with hospital chief information officers, chief information security officers, and health care cybersecurity experts; analyzed the interview data; and developed a system dynamics model that unravels the mechanisms by which hospitals build cybersecurity capabilities. We then use simulation analysis to examine how changes to variables within the model affect the likelihood of cyberattacks across both individual hospitals and a system of hospitals. Results: We discuss several key mechanisms that hospitals use to reduce the likelihood of cybercriminal activity. The variable that most influences the risk of cyberattack in a hospital is end point complexity, followed by internal stakeholder alignment. Although resource availability is important in fueling efforts to close cybersecurity capability gaps, low levels of resources could be compensated for by setting a high target level of cybersecurity. Conclusions: To enhance cybersecurity capabilities at hospitals, the main focus of chief information officers and chief information security officers should be on reducing end point complexity and improving internal stakeholder alignment. These strategies can solve cybersecurity problems more effectively than blindly pursuing more resources. On a macro level, the cyber vulnerability of a country's hospital infrastructure is affected by the vulnerabilities of all individual hospitals. In this large system, reducing variation in resource availability makes the whole system less vulnerable---a few hospitals with low resources for cybersecurity threaten the entire infrastructure of health care. In other words, hospitals need to move forward together to make the industry less attractive to cybercriminals. Moreover, although compliance is essential, it does not equal security. Hospitals should set their target level of cybersecurity beyond the requirements of current regulations and policies. As of today, policies mostly address data privacy, not data security. Thus, policy makers need to introduce policies that not only raise the target level of cybersecurity capabilities but also reduce the variability in resource availability across the entire health care system. ",
doi="10.2196/10059",
url="http://www.jmir.org/2018/5/e10059/"
}


@Article{info:doi/10.2196/jmir.8977,
author="Chen, Chien-I Sonia",
title="Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study",
journal="J Med Internet Res",
year="2018",
month="Jan",
day="04",
volume="20",
number="1",
pages="e3",
keywords="health care",
keywords="innovation",
keywords="eHealth",
keywords="technology",
keywords="smart health",
keywords="Taiwanese health care",
abstract="Background: Technology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work. Objective: The objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges. Methods: A qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion. Results: First, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader's vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care. Conclusions: This study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients. ",
doi="10.2196/jmir.8977",
url="http://www.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29301736"
}


@Article{info:doi/10.2196/medinform.8026,
author="Arcury, A. Thomas
and Quandt, A. Sara
and Sandberg, C. Joanne
and Miller Jr, P. David
and Latulipe, Celine
and Leng, Xiaoyan
and Talton, W. Jenifer
and Melius, P. Kathryn
and Smith, Alden
and Bertoni, G. Alain",
title="Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study",
journal="JMIR Med Inform",
year="2017",
month="Nov",
day="14",
volume="5",
number="4",
pages="e47",
keywords="electronic health records",
keywords="electronic personal health information management",
keywords="health disparities",
keywords="aging",
keywords="rural health",
abstract="Background: Patient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization. Objective: The primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability. Methods: Patients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization. Results: A total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5\%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization. Conclusions: Leverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities. ",
doi="10.2196/medinform.8026",
url="http://medinform.jmir.org/2017/4/e47/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29138129"
}


@Article{info:doi/10.2196/medinform.7892,
author="Long, Sandra
and Monsen, A. Karen
and Pieczkiewicz, David
and Wolfson, Julian
and Khairat, Saif",
title="Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis",
journal="JMIR Med Inform",
year="2017",
month="Oct",
day="12",
volume="5",
number="4",
pages="e39",
keywords="consumer health information",
keywords="user effort",
keywords="patient acceptance of health care",
keywords="health expenditures",
keywords="health services accessibility",
abstract="Background: For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. Objective: The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. Methods: A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Results: Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer's household, number of visits to providers outside the consumer's insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. Conclusions: This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care. ",
doi="10.2196/medinform.7892",
url="http://medinform.jmir.org/2017/4/e39/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29025697"
}


@Article{info:doi/10.2196/medinform.6512,
author="Riahi, Sanaz
and Fischler, Ilan
and Stuckey, I. Melanie
and Klassen, E. Philip
and Chen, John",
title="The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study",
journal="JMIR Med Inform",
year="2017",
month="Jan",
day="05",
volume="5",
number="1",
pages="e1",
keywords="electronic health records",
keywords="health information management",
keywords="medical informatics",
keywords="mental health",
keywords="organizational innovation",
keywords="psychiatry",
keywords="quality improvement",
abstract="Background: Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective: The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods: The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results: Medication and patient scan rates have been greater than 95\% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7\%, which resulted in cost savings of more than Can \$1.4 million (US \$1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions: EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. ",
doi="10.2196/medinform.6512",
url="http://medinform.jmir.org/2017/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28057607"
}


@Article{info:doi/10.2196/medinform.6372,
author="Colorafi, Karen
and Bailey, Bryan",
title="It's Time for Innovation in the Health Insurance Portability and Accountability Act (HIPAA)",
journal="JMIR Med Inform",
year="2016",
month="Nov",
day="02",
volume="4",
number="4",
pages="e34",
keywords="innovation",
keywords="HIPAA",
keywords="electronic health record demonstration",
doi="10.2196/medinform.6372",
url="http://medinform.jmir.org/2016/4/e34/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27806923"
}


@Article{info:doi/10.2196/medinform.5984,
author="Choi, Iee
and Kim, Kyu Jin
and Kim, Jun Sun
and Cho, Chul Soo
and Kim, Nyeo Il",
title="Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors",
journal="JMIR Med Inform",
year="2016",
month="Aug",
day="04",
volume="4",
number="3",
pages="e26",
keywords="social media",
keywords="personal satisfaction",
keywords="information systems",
keywords="patient transfer",
abstract="Background: The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. Objective: In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. Methods: Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. Results: The number of patients transferred was reported to increase by 65\% (26/40) obstetricians and 40\% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72\% (29/40) obstetricians and 59\% (34/57) pediatricians. Satisfaction was indicated by 83\% (33/40) obstetricians and 89\% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). Conclusions: The users were highly satisfied and different users indicated different factors of satisfaction. This finding implies that users' requirements should be accommodated in future developments of patient transfer information systems. ",
doi="10.2196/medinform.5984",
url="http://medinform.jmir.org/2016/3/e26/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27492978"
}


@Article{info:doi/10.2196/mhealth.5464,
author="Duhm, Julian
and Fleischmann, Robert
and Schmidt, Sein
and Hupperts, Hagen
and Brandt, A. Stephan",
title="Mobile Electronic Medical Records Promote Workflow: Physicians' Perspective From a Survey",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jun",
day="06",
volume="4",
number="2",
pages="e70",
keywords="tablet PC",
keywords="electronic health record",
keywords="usability",
keywords="health services",
keywords="inpatient care",
abstract="Background: As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians' perceptions of this tool within an inpatient setting. Objective: This study examined physicians' perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR. Methods: We developed a 57-item survey questionnaire designed to examine users' perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians' patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95\% confidence intervals and multivariate analysis of variance to identify predictors of tablet use. Results: Physicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians' satisfaction with the devices and their motivation regarding their further use. Tracking data yielded that only a few of the available functions were used frequently. Conclusions: Although tablet PCs were consistently perceived as beneficial, several factors contributed to the fact that their full potential was not fully exploited. Training in functionality and providing a reliable infrastructure might foster successful tablet implementation. ",
doi="10.2196/mhealth.5464",
url="http://mhealth.jmir.org/2016/2/e70/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27268720"
}


@Article{info:doi/10.2196/humanfactors.4996,
author="Kurahashi, M. Allison
and Weinstein, B. Peter
and Jamieson, Trevor
and Stinson, N. Jennifer
and Cafazzo, A. Joseph
and Lokuge, Bhadra
and Morita, P. Plinio
and Cohen, Eyal
and Rapoport, Adam
and Bezjak, Andrea
and Husain, Amna",
title="In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System",
journal="JMIR Human Factors",
year="2016",
month="Mar",
day="24",
volume="3",
number="1",
pages="e12",
keywords="collaborative care",
keywords="patient-centered care",
keywords="patient engagement",
keywords="chronic disease",
keywords="communication",
keywords="Internet communication tools",
keywords="Internet communication technologies",
abstract="Background: We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space. Objective: The objectives of this paper are to present the iterative design of the separate views for health care providers (HCPs) within each patient's secure space and examine patients', caregivers', and HCPs' perspectives on this separate view for HCP-only communication. Methods: The overall research program includes cycles of ethnography, prototyping, usability testing, and pilot testing. This paper describes the usability testing phase that directly informed development. A descriptive qualitative approach was used to analyze participant perspectives that emerged during usability testing. Results: During usability testing, we sampled 89 participants from three user groups: 23 patients, 19 caregivers, and 47 HCPs. Almost all perspectives from the three user groups supported the need for an HCP-only communication view. In an earlier prototype, the visual presentation caused confusion among HCPs when reading and composing messages about whether a message was visible to the patient. Usability testing guided us to design a more deliberate distinction between posting in the Patient and Team view and the Health Care Provider Only view at the time of composing a message, which once posted is distinguished by an icon. Conclusions: The team made a decision to incorporate an HCP-only communication view based on findings during earlier phases of work. During usability testing we tested the separate communication views, and all groups supported this partition. We spent considerable effort designing the partition; however, preliminary findings from the next phase of evaluation, pilot testing, show that the Patient and Team communication is predominantly being used. This demonstrates the importance of a subsequent phase of the clinical trial of Loop to validate the concept and design. ",
doi="10.2196/humanfactors.4996",
url="http://humanfactors.jmir.org/2016/1/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025912"
}


@Article{info:doi/10.2196/medinform.4457,
author="Slight, Patricia Sarah
and Berner, S. Eta
and Galanter, William
and Huff, Stanley
and Lambert, L. Bruce
and Lannon, Carole
and Lehmann, U. Christoph
and McCourt, J. Brian
and McNamara, Michael
and Menachemi, Nir
and Payne, H. Thomas
and Spooner, Andrew S.
and Schiff, D. Gordon
and Wang, Y. Tracy
and Akincigil, Ayse
and Crystal, Stephen
and Fortmann, P. Stephen
and Vandermeer, L. Meredith
and Bates, W. David",
title="Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities",
journal="JMIR Med Inform",
year="2015",
month="Sep",
day="18",
volume="3",
number="3",
pages="e30",
keywords="medical informatics",
keywords="health policy",
keywords="electronic health records",
keywords="meaningful use",
abstract="Background: With the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for ``meaningful use'' (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems. Objective: The Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. Methods: We gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group. Results: Stakeholders' knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs. Conclusions: Although MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children. ",
doi="10.2196/medinform.4457",
url="http://medinform.jmir.org/2015/3/e30/"
}


@Article{info:doi/10.2196/jmir.3965,
author="Ford II, H. James
and Alagoz, Esra
and Dinauer, Susan
and Johnson, A. Kimberly
and Pe-Romashko, Klaren
and Gustafson, H. David",
title="Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders",
journal="J Med Internet Res",
year="2015",
month="Aug",
day="18",
volume="17",
number="8",
pages="e201",
keywords="mHealth",
keywords="substance abuse disorder",
keywords="sustainability",
keywords="funding",
keywords="engagement",
keywords="staff",
keywords="client",
keywords="implementation",
abstract="Background: Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective: Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods: Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results: Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions: Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes. ",
doi="10.2196/jmir.3965",
url="http://www.jmir.org/2015/8/e201/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26286257"
}


@Article{info:doi/10.2196/medinform.3106,
author="Kruse, Scott Clemens
and DeShazo, Jonathan
and Kim, Forest
and Fulton, Lawrence",
title="Factors Associated With Adoption of Health Information Technology: A Conceptual Model Based on a Systematic Review",
journal="JMIR Med Inform",
year="2014",
month="May",
day="23",
volume="2",
number="1",
pages="e9",
keywords="electronic health record (EHR)",
keywords="electronic medical record (EMR)",
keywords="health information technology (HIT)",
keywords="medical information systems",
keywords="computerized provider order entry (CPOE)",
keywords="adoption",
abstract="Background: The Health Information Technology for Economic and Clinical Health Act (HITECH) allocated \$19.2 billion to incentivize adoption of the electronic health record (EHR). Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Center for Medicare and Medicaid Services (CMS). Organizational theories attempt to explain factors that influence organizational change, and many theories address changes in organizational strategy. However, due to the complexities of the health care industry, existing organizational theories fall short of demonstrating association with significant health care IT implementations. There is no organizational theory for health care that identifies, groups, and analyzes both internal and external factors of influence for large health care IT implementations like adoption of the EHR. Objective: The purpose of this systematic review is to identify a full-spectrum of both internal organizational and external environmental factors associated with the adoption of health information technology (HIT), specifically the EHR. The result is a conceptual model that is commensurate with the complexity of with the health care sector. Methods: We performed a systematic literature search in PubMed (restricted to English), EBSCO Host, and Google Scholar for both empirical studies and theory-based writing from 1993-2013 that demonstrated association between influential factors and three modes of HIT: EHR, electronic medical record (EMR), and computerized provider order entry (CPOE).  We also looked at published books on organizational theories. We made notes and noted trends on adoption factors. These factors were grouped as adoption factors associated with various versions of EHR adoption. Results: The resulting conceptual model summarizes the diversity of independent variables (IVs) and dependent variables (DVs) used in articles, editorials, books, as well as quantitative and qualitative studies (n=83). As of 2009, only 16.30\% (815/4999) of nonfederal, acute-care hospitals had adopted a fully interoperable EHR. From the 83 articles reviewed in this study, 16/83 (19\%) identified internal organizational factors and 9/83 (11\%) identified external environmental factors associated with adoption of the EHR, EMR, or CPOE.  The conceptual model for EHR adoption associates each variable with the work that identified it. Conclusions: Commonalities exist in the literature for internal organizational and external environmental factors associated with the adoption of the EHR and/or CPOE. The conceptual model for EHR adoption associates internal and external factors, specific to the health care industry, associated with adoption of the EHR. It becomes apparent that these factors have some level of association, but the association is not consistently calculated individually or in combination. To better understand effective adoption strategies, empirical studies should be performed from this conceptual model to quantify the positive or negative effect of each factor. ",
doi="10.2196/medinform.3106",
url="http://medinform.jmir.org/2014/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25599673"
}


@Article{info:doi/10.2196/medinform.2510,
author="Unertl, M. Kim
and Johnson, B. Kevin
and Gadd, S. Cynthia
and Lorenzi, M. Nancy",
title="Bridging Organizational Divides in Health Care: An Ecological View of Health Information Exchange",
journal="JMIR Med Inform",
year="2013",
month="Oct",
day="29",
volume="1",
number="1",
pages="e3",
keywords="health information systems",
keywords="qualitative research",
keywords="ethnography",
keywords="community networks",
keywords="information sharing",
keywords="organizational models",
keywords="information ecology",
abstract="Background: The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term successful implementation. Objective: Our study investigated the impacts of HIE technology on organizations, health care providers, and patients through a new, context-aware perspective, the Regional Health Information Ecology. Methods: We conducted more than 180 hours of direct observation, informal interviews during observation, and 9 formal semi-structured interviews. Data collection focused on workflow and information flow among health care team members and patients and on health care provider use of HIE technology. Results: We structured the data analysis around five primary information ecology components: system, locality, diversity, keystone species, and coevolution. Our study identified three main roles, or keystone species, involved in HIE: information consumers, information exchange facilitators, and information repositories. The HIE technology impacted patient care by allowing providers direct access to health information, reducing time to obtain health information, and increasing provider awareness of patient interactions with the health care system. Developing the infrastructure needed to support HIE technology also improved connections among information technology support groups at different health care organizations. Despite the potential of this type of technology to improve continuity of patient care, HIE technology adoption by health care providers was limited. Conclusions: To successfully build a HIE network, organizations had to shift perspectives from an ownership view of health data to a continuity of care perspective. To successfully integrate external health information into clinical work practices, health care providers had to move toward understanding potential contributions of external health information. Our study provides a foundation for future context-aware development and implementation of HIE technology. Integrating concepts from the Regional Health Information Ecology into design and implementation may lead to wider diffusion and adoption of HIE technology into clinical work. ",
doi="10.2196/medinform.2510",
url="http://www.jmir.org/2013/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25600166"
}