%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68344 %T Developing the Digital Health Communication Maturity Model: Systematic Review %A Kim,Grace Jeonghyun %A Namkoong,Kang %+ , Department of Communication, University of Maryland, College Park, Skinner Building, 4300 Chapel Ln, College Park, MD, 20782, United States, 1 2028920233, jkim0501@umd.edu %K digital health %K maturity model %K integrated model %K digital health communication %K health communication %K systematic review %K model development %K health care innovation %K digital transformation %K organizational readiness %K evaluation metrics %K health care technology %K digital strategy %D 2025 %7 14.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital health has become integral to public health care, advancing how services are accessed, delivered, and managed. Health organizations increasingly assess their digital health maturity to leverage these innovations fully. However, existing digital health maturity models (DHMMs) primarily focus on technology and infrastructure, often neglecting critical communication components. Objective: This systematic review addresses gaps in DHMMs by identifying deficiencies in user communication elements and proposing the digital health communication maturity model (DHCMM). The DHCMM integrates critical health communication dimensions such as satisfaction, engagement, personalization, and customization to provide a comprehensive evaluation framework. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to conduct a systematic review of studies selected from 3 databases: EBSCO, PubMed, and ProQuest. Studies were screened and included based on their focus on digital health maturity and communication elements, with the final selection limited to English-language research addressing DHMMs. Results: Of the 1138 initially identified studies, 31 (2.72%) met the inclusion criteria. Current DHMMs heavily emphasize infrastructure while overlooking user engagement and communication; for instance, only 35% (11/31) of the reviewed models incorporated user satisfaction, and less than one-fifth (6/31, 19%) addressed personalization or customization. The DHCMM addresses these gaps with 7 maturity levels, ranging from initial to engaged, and emphasizes user-centered metrics and governance. Quantitative analysis showed substantial variations in communication metrics, with satisfaction metrics incorporated at an average rate of 22% (7/31) across the reviewed models. Conclusions: The DHCMM shifts the focus of digital health maturity assessments by emphasizing communication and user engagement. This model provides health care organizations with a structured framework to enhance digital health initiatives, leading to better patient outcomes and system-wide efficiencies. The model delivers actionable insights for organizations aiming to achieve advanced digital maturity by addressing underrepresented dimensions. Future research should implement and refine the DHCMM across diverse health care contexts to enhance its effectiveness. The adoption of this model could result in more equitable, user-centered health care systems that integrate technological advancements with human-centered care. %M 40228239 %R 10.2196/68344 %U https://www.jmir.org/2025/1/e68344 %U https://doi.org/10.2196/68344 %U http://www.ncbi.nlm.nih.gov/pubmed/40228239 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58377 %T Factors Determining Acceptance of Internet of Things in Medical Education: Mixed Methods Study %A Alhumaid,Khadija %A Ayoubi,Kevin %A Khalifa,Maha %A Salloum,Said %K collaborative learning %K student %K college %K university %K education %K Internet of Things %K IoT %K technology acceptance model %K technology optimism %K TAM %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K adoption %K survey %K questionnaire %K ANN %K deep learning %K structural equation modeling %K neural network %K intent %K use %K medical education %K artificial neural network %K technology innovation %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X Background: The global increase in the Internet of Things (IoT) adoption has sparked interest in its application within the educational sector, particularly in colleges and universities. Previous studies have often focused on individual attitudes toward IoT without considering a multiperspective approach and have overlooked the impact of IoT on the technology acceptance model outside the educational domain. Objective: This study aims to bridge the research gap by investigating the factors influencing IoT adoption in educational settings, thereby enhancing the understanding of collaborative learning through technology. It seeks to elucidate how IoT can facilitate learning processes and technology acceptance among college and university students in the United Arab Emirates. Methods: A questionnaire was distributed to students across various colleges and universities in the United Arab Emirates, garnering 463 participants. The data collected were analyzed using a hybrid approach that integrates structural equation modeling (SEM) and artificial neural network (ANN), along with importance-performance map analysis to evaluate the significance and performance of each factor affecting IoT adoption. Results: The study, involving 463 participants, identifies 2 primary levels at which factors influence the intention to adopt IoT technologies. Initial influences include technology optimism (TOP), innovation, and learning motivation, crucial for application engagement. Advanced influences stem from technology acceptance model constructs, particularly perceived ease of use (PE) and perceived usefulness (PU), which directly enhance adoption intentions. Detailed statistical analysis using partial least squares–SEM reveals significant relationships: TOP and innovativeness impact PE (β=.412, P=.04; β=.608, P=.002, respectively), and PU significantly influences TOP (β=.381, P=.04), innovativeness (β=.557, P=.003), and learning motivation (β=.752, P<.001). These results support our hypotheses (H1, H2, H3, H4, and H5). Further, the intention to use IoT is significantly affected by PE and usefulness (β=.619, P<.001; β=.598, P<.001, respectively). ANN modeling enhances these findings, showing superior predictive power (R2=89.7%) compared to partial least squares–SEM (R2=86.3%), indicating a more effective identification of nonlinear associations. Importance-performance map analysis corroborates these results, demonstrating the importance and performance of PU as most critical, followed by technology innovativeness and optimism, in shaping behavioral intentions to use IoT. Conclusions: This research contributes methodologically by leveraging deep ANN architecture to explore nonlinear relationships among factors influencing IoT adoption in education. The study underscores the importance of both intrinsic motivational factors and perceived technological attributes in fostering IoT adoption, offering insights for educational institutions considering IoT integration into their learning environments. %R 10.2196/58377 %U https://humanfactors.jmir.org/2025/1/e58377 %U https://doi.org/10.2196/58377 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57782 %T Impact of Electronic Transition and Prefilled Templates on Drug Prescription Compliance: Retrospective Study %A Lambert,Aurélien %A Hombourger,Benoit %A Salleron,Julia %A Chergui,Fadila %A Vallance,Catherine %A Nicolas,Nadège %A Moussouni,Marie %A Cherif,Lounisse %A Chenot,Emile %A Gavoille,Céline %A Massard,Vincent %+ , Institut de Cancérologie de Lorraine, 6 avenue de bourgogne, Vandoeuvre-lès-Nancy, 54500, France, 33 383598400, a.lambert@nancy.unicancer.fr %K drug prescription %K electronic prescription %K handwriting %K medical oncology %K ambulatory care %D 2025 %7 9.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The transition from traditional handwritten prescriptions to electronic prescribing systems represents a significant advancement, with the potential to enhance treatment efficacy, patient safety, and professional communication. Objective: This study aimed to examine the impact of this transition within a medical oncology service, assessing the compliance of electronic prescriptions with established good practice standards and exploring the associated risks. Methods: In this retrospective analysis, we compared handwritten prescriptions from the pre-electronic era (January to May 2018) with electronic prescriptions (January to May 2021) following the implementation of the electronic prescribing system PandaLab Pro (PandaLab SAS). The inclusion criteria focused on outpatient oncology treatments, with a clear set of exclusion parameters to ensure a focused study scope. We defined good compliance as the written mention of the evaluated terms. The compliance rates were then compared using a chi-square test. Results: Our findings, based on a sample size of 260 prescriptions (randomized among 30,526 archived prescriptions), indicate a substantial improvement in electronic prescriptions’ compliance with prescribers and patient details, treatment accuracy, and overall adherence to regulatory standards. Notably, electronic formats achieved a remarkable 80.8% accuracy rate in compliance with safety criteria compared with 8.5% for handwritten prescriptions (P<.001). The use of prefilled prescriptions significantly increased compliance from a safety perspective (56% vs 96.2%; P<.001) compared with electronic prescriptions from scratch. Conclusions: The analysis further underscores the advantages of prefilled electronic prescription templates, which significantly improved compliance rates compared with manually filled electronic and handwritten prescriptions. Furthermore, the study revealed a marked shift in prescribing behaviors, with electronic prescriptions tending to be more concise yet more numerous, suggesting an impact on medication management and patient adherence, which warrants further investigation. The study supports the transition to electronic prescribing systems in oncology, highlighting enhanced traceability, compliance with health authority standards, and patient safety. The implementation of prefilled templates supported by pharmacists has emerged as a pivotal factor in this improved process. While acknowledging certain limitations, such as the nonquantitative assessment of time savings and acceptability, this research advocates for the widespread adoption of electronic prescriptions and serves as a benchmark for future e-prescription initiatives in France. %M 40202779 %R 10.2196/57782 %U https://www.jmir.org/2025/1/e57782 %U https://doi.org/10.2196/57782 %U http://www.ncbi.nlm.nih.gov/pubmed/40202779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59807 %T Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study %A Thorup,Charlotte Brun %A Uitto,Mika %A Butler-Henderson,Kerryn %A Wamala-Andersson,Sarah %A Hoffrén-Mikkola,Merja %A Schack Thoft,Diana %A Korsbakke Emtekær Hæsum,Lisa %A Irrazabal,Gabriela %A Pruneda González,Laura %A Valkama,Katja %+ Research Centre of Health and Applied Technology, University College of Northern Denmark, Selma Lagerløfs Vej 2, Aalborg, Aalborg, 9220, Denmark, 45 20729950, cbt@ucn.dk %K digital health literacy %K digital literacy %K Horizon Europe %K EU %K health technology %K life expectancy %K health literacy %K chronic disease %K digitalization %K digital health service %K digital health intervention %K technology %K healthcare %D 2025 %7 8.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The global demographic shift towards longer life expectancy and complex health needs is increasing the number of people with chronic diseases, placing pressure on health and care systems. With the digitalization of healthcare, digital Health Literacy (dHL), or the use of digital skills in health, is gaining importance. It involves navigating digital health information, using digital tools effectively, and making informed health decisions. Measuring dHL can help identify gaps and develop strategies to improve dHL and health, ensuring citizens equal opportunity to participate in a digital healthcare system. The European project “The Improving Digital Empowerment for Active and Healthy Living (IDEAHL)” with the objective to empower European Union citizens to use digital instruments to take a more active role in managing their health and well-being creates the base for this overview Objective: This paper aims to conduct an overview of existing assessment tools for measuring dHL and recommend strategies for choosing relevant assessment tools. Methods: This study was carried out as a mixed method study initiated by a scoping review (10 scientific databases, 14 databases with grey literature and 14 predefined reports) in addition to three papers published after finalisations the literature search in IDEAHL, followed by a qualitative workshop study and a final analysis combining results. Results: The literature search resulted in 33 papers on dHL instruments, that was analyzed together with three recently published reviews and findings from a workshop with 13 champions (understood as professionals with expertise in HL and dHL) from five countries (Spain, Denmark, Sweden, Australia, and Germany) representing the health sector or health literacy research. Future tools should adapt to the latest trends and technologies, considering attitudes towards digital health and trust in its services. They should identify beneficiaries of digital health services, measure the impact of dHL interventions, and objectively evaluate functional skills. These tools should be evidence-based, validate instruments, interpret dHL results, and capture diverse experiences to reveal health behaviour changes. Conclusions: The eHealth Literacy Scale (eHEALS), despite being the most frequently utilized tool, has limitations in scope and adaptability. Future tools need to reflect digital trends, encompassing individual skills. However, it is important to note that the ‘adequacy’ of dHL is context-specific and relies on healthcare systems and the technology provided, particularly the user interface. The focus should be on health improvement, not just elevating dHL levels. A comprehensive approach to dHL assessments addressing diversity and relevance is crucial. Ethical considerations in dHL, including privacy and data security, are important due to potential feelings of shame among those with low literacy levels. %M 40198098 %R 10.2196/59807 %U https://www.jmir.org/2025/1/e59807 %U https://doi.org/10.2196/59807 %U http://www.ncbi.nlm.nih.gov/pubmed/40198098 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e66451 %T Construction and Application of an Information Closed-Loop Management System for Maternal and Neonatal Access and Exit Rooms: Non Randomized Controlled Trial %A Jia,Shafeng %A Zhu,Naifeng %A Liu,Jia %A Cheng,Niankai %A Jiang,Ling %A Yang,Jing %K mother-infant same-room management %K information-based identity verification %K closed-loop management system %K newborn safety management %D 2025 %7 7.4.2025 %9 %J JMIR Med Inform %G English %X 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. %R 10.2196/66451 %U https://medinform.jmir.org/2025/1/e66451 %U https://doi.org/10.2196/66451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62732 %T Investigating Clinicians’ Intentions and Influencing Factors for Using an Intelligence-Enabled Diagnostic Clinical Decision Support System in Health Care Systems: Cross-Sectional Survey %A Zheng,Rui %A Jiang,Xiao %A Shen,Li %A He,Tianrui %A Ji,Mengting %A Li,Xingyi %A Yu,Guangjun %+ , Shanghai Children's Hospital, No 355 Luding Road, Shanghai, 200062, China, 86 18917762998, gjyu@shchildren.com.cn %K artificial intelligence %K clinical decision support systems %K task-technology fit %K technology acceptance model %K perceived risk %K performance expectations %K intention to use %D 2025 %7 7.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: An intelligence-enabled clinical decision support system (CDSS) is a computerized system that integrates medical knowledge, patient data, and clinical guidelines to assist health care providers make clinical decisions. Research studies have shown that CDSS utilization rates have not met expectations. Clinicians’ intentions and their attitudes determine the use and promotion of CDSS in clinical practice. Objective: The aim of this study was to enhance the successful utilization of CDSS by analyzing the pivotal factors that influence clinicians’ intentions to adopt it and by putting forward targeted management recommendations. Methods: This study proposed a research model grounded in the task-technology fit model and the technology acceptance model, which was then tested through a cross-sectional survey. The measurement instrument comprised demographic characteristics, multi-item scales, and an open-ended query regarding areas where clinicians perceived the system required improvement. We leveraged structural equation modeling to assess the direct and indirect effects of “task-technology fit” and “perceived ease of use” on clinicians’ intentions to use the CDSS when mediated by “performance expectation” and “perceived risk.” We collated and analyzed the responses to the open-ended question. Results: We collected a total of 247 questionnaires. The model explained 65.8% of the variance in use intention. Performance expectations (β=0.228; P<.001) and perceived risk (β=–0.579; P<.001) were both significant predictors of use intention. Task-technology fit (β=–0.281; P<.001) and perceived ease of use (β=–0.377; P<.001) negatively affected perceived risk. Perceived risk (β=–0.308; P<.001) negatively affected performance expectations. Task-technology fit positively affected perceived ease of use (β=0.692; P<.001) and performance expectations (β=0.508; P<.001). Task characteristics (β=0.168; P<.001) and technology characteristics (β=0.749; P<.001) positively affected task-technology fit. Contrary to expectations, perceived ease of use (β=0.108; P=.07) did not have a significant impact on use intention. From the open-ended question, 3 main themes emerged regarding clinicians’ perceived deficiencies in CDSS: system security risks, personalized interaction, seamless integration. Conclusions: Perceived risk and performance expectations were direct determinants of clinicians’ adoption of CDSS, significantly influenced by task-technology fit and perceived ease of use. In the future, increasing transparency within CDSS and fostering trust between clinicians and technology should be prioritized. Furthermore, focusing on personalized interactions and ensuring seamless integration into clinical workflows are crucial steps moving forward. %M 40194276 %R 10.2196/62732 %U https://www.jmir.org/2025/1/e62732 %U https://doi.org/10.2196/62732 %U http://www.ncbi.nlm.nih.gov/pubmed/40194276 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e66466 %T Identifying Patient-Reported Outcome Measure Documentation in Veterans Health Administration Chiropractic Clinic Notes: Natural Language Processing Analysis %A Coleman,Brian C %A Corcoran,Kelsey L %A Brandt,Cynthia A %A Goulet,Joseph L %A Luther,Stephen L %A Lisi,Anthony J %K Veterans Health Administration %K natural language processing %K quality of health care %K chiropractic %K patient reported outcome measures %K NLP %K AI %K artificial intelligence %K veteran %K chiropractor %K integrated health cohort %K musculoskeletal diagnosis %K musculoskeletal %K quality of care %K care %K PROM %K neural network %K chiropractic care %D 2025 %7 2.4.2025 %9 %J JMIR Med Inform %G English %X Background: The use of patient-reported outcome measures (PROMs) is an expected component of high-quality, measurement-based chiropractic care. The largest health care system offering integrated chiropractic care is the Veterans Health Administration (VHA). Challenges limit monitoring PROM use as a care quality metric at a national scale in the VHA. Structured data are unavailable, with PROMs often embedded within clinic text notes as unstructured data requiring time-intensive, peer-conducted chart review for evaluation. Natural language processing (NLP) of clinic text notes is one promising solution to extracting care quality data from unstructured text. Objective: This study aims to test NLP approaches to identify PROMs documented in VHA chiropractic text notes. Methods: VHA chiropractic notes from October 1, 2017, to September 30, 2020, were obtained from the VHA Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort. A rule-based NLP model built using medspaCy and spaCy was evaluated on text matching and note categorization tasks. SpaCy was used to build bag-of-words, convoluted neural networks, and ensemble models for note categorization. Performance metrics for each model and task included precision, recall, and F-measure. Cross-validation was used to validate performance metric estimates for the statistical and machine-learning models. Results: Our sample included 377,213 visit notes from 56,628 patients. The rule-based model performance was good for soft-boundary text-matching (precision=81.1%, recall=96.7%, and F-measure=88.2%) and excellent for note categorization (precision=90.3%, recall=99.5%, and F-measure=94.7%). Cross-validation performance of the statistical and machine learning models for the note categorization task was very good overall, but lower than rule-based model performance. The overall prevalence of PROM documentation was low (17.0%). Conclusions: We evaluated multiple NLP methods across a series of tasks, with optimal performance achieved using a rule-based method. By leveraging NLP approaches, we can overcome the challenges posed by unstructured clinical text notes to track documented PROM use. Overall documented use of PROMs in chiropractic notes was low and highlights a potential for quality improvement. This work represents a methodological advancement in the identification and monitoring of documented use of PROMs to ensure consistent, high-quality chiropractic care for veterans. %R 10.2196/66466 %U https://medinform.jmir.org/2025/1/e66466 %U https://doi.org/10.2196/66466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70789 %T Adoption of Large Language Model AI Tools in Everyday Tasks: Multisite Cross-Sectional Qualitative Study of Chinese Hospital Administrators %A Chen,Jun %A Liu,Yu %A Liu,Peng %A Zhao,Yiming %A Zuo,Yan %A Duan,Hui %+ , School of Public Administration and Policy, Renmin University of China, #59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 1062511122, rucduanhui@ruc.edu.cn %K large language model %K artificial intelligence %K health care administration %K technology adoption %K hospital administrator %K qualitative study %K barriers to adoption %D 2025 %7 1.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Large language model (LLM) artificial intelligence (AI) tools have the potential to streamline health care administration by enhancing efficiency in document drafting, resource allocation, and communication tasks. Despite this potential, the adoption of such tools among hospital administrators remains understudied, particularly at the individual level. Objective: This study aims to explore factors influencing the adoption and use of LLM AI tools among hospital administrators in China, focusing on enablers, barriers, and practical applications in daily administrative tasks. Methods: A multicenter, cross-sectional, descriptive qualitative design was used. Data were collected through semistructured face-to-face interviews with 31 hospital administrators across 3 tertiary hospitals in Beijing, Shenzhen, and Chengdu from June 2024 to August 2024. The Colaizzi method was used for thematic analysis to identify patterns in participants’ experiences and perspectives. Results: Adoption of LLM AI tools was generally low, with significant site-specific variations. Participants with higher technological familiarity and positive early experiences reported more frequent use, while barriers such as mistrust in tool accuracy, limited prompting skills, and insufficient training hindered broader adoption. Tools were primarily used for document drafting, with limited exploration of advanced functionalities. Participants strongly emphasized the need for structured training programs and institutional support to enhance usability and confidence. Conclusions: Familiarity with technology, positive early experiences, and openness to innovation may facilitate adoption, while barriers such as limited knowledge, mistrust in tool accuracy, and insufficient prompting skills can hinder broader use. LLM AI tools are now primarily used for basic tasks such as document drafting, with limited application to more advanced functionalities due to a lack of training and confidence. Structured tutorials and institutional support are needed to enhance usability and integration. Targeted training programs, combined with organizational strategies to build trust and improve accessibility, could enhance adoption rates and broaden tool use. Future quantitative investigations should validate the adoption rate and influencing factors. %M 40116330 %R 10.2196/70789 %U https://www.jmir.org/2025/1/e70789 %U https://doi.org/10.2196/70789 %U http://www.ncbi.nlm.nih.gov/pubmed/40116330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62957 %T Clinicians’ Perceptions and Potential Applications of Robotics for Task Automation in Critical Care: Qualitative Study %A Song,Jiafeng %A Sridhar,Rishika Iytha %A Rogers,Darlene Marie %A Hiddleson,Cheryl %A Davis,Carolyn %A Holden,Tina Lynn %A Ramsey-Haynes,Shanna %A Reif,Lisa %A Swann,Julie %A Jabaley,Craig S %A Gullatte,Mary %A Kamaleswaran,Rishikesan %+ , Department of Biomedical Engineering, Duke University, 2301 Erwin Road, Durham, NC, 27710, United States, 1 7163523686, sjfsjf2010@gmail.com %K robotics %K intensive care units %K critical care %K health care technology %K qualitative study %D 2025 %7 28.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in integrating robotics within intensive care units (ICUs) has been propelled by technological advancements, workforce challenges, and heightened clinical demands, including during the COVID-19 pandemic. The integration of robotics in ICUs could potentially enhance patient care and operational efficiency amid existing challenges faced by health care professionals, including high workload and decision-making complexities. Objective: This qualitative study aimed to explore ICU clinicians’ perceptions of robotic technology and to identify the types of tasks that might benefit from robotic assistance. We focused on the degree of acceptance, perceived challenges, and potential applications for improving patient care in 5 Southeastern US hospitals between January and August 2023. Methods: A qualitative study through semistructured interviews and questionnaires was conducted with 15 ICU clinicians (7 nurses, 6 physicians, and 2 advanced practice providers) from 5 hospitals in the Southeast United States. Directed content analysis was used to categorize and interpret participants’ statements, with statistical tests used to examine any role-based differences in how they viewed robotic integration. Results: Among the 15 participants, 73% (11/15) were female, with an average of 6.4 (SD 6.3) years of ICU experience. We identified 78 distinct tasks potentially suitable for robotic assistance, of which 50 (64%) involved direct patient care (eg, repositioning patients and assisting with simple procedures), 19 (24%) concerned indirect patient care (eg, delivering supplies and cleaning), 6 (8%) addressed administrative tasks (eg, answering call lights), and 3 (4%) were classified as mixed direct and indirect (eg, sitting with a patient to keep them calm). Most participants supported the automation of routine, noncritical tasks (eg, responding to nurse calls and measuring glucose levels), viewing this strategy as a way to alleviate workload and enhance efficiency. Conversely, high-complexity tasks requiring nuanced clinical judgment (eg, ventilator settings) were deemed unsuitable for full automation. Statistical analysis revealed no significant difference in how nurses, physicians, and advanced practice providers perceived these tasks (P=.22). Conclusions: Our findings indicate a significant opportunity to use robotic systems to perform noncomplex tasks in ICUs, thereby potentially improving efficiency and reducing staff burden. Clinicians largely view robots as supportive tools rather than substitutes for human expertise. However, concerns persist regarding privacy, patient safety, and the loss of human touch, particularly for tasks requiring high-level clinical decision-making. Future research should involve broader, more diverse clinician samples and investigate the long-term impact of robotic assistance on patient outcomes while also incorporating patient perspectives to ensure ethical, patient-centered adoption of robotic technology. %M 40153785 %R 10.2196/62957 %U https://www.jmir.org/2025/1/e62957 %U https://doi.org/10.2196/62957 %U http://www.ncbi.nlm.nih.gov/pubmed/40153785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70404 %T Primary Care Practice Factors Associated With Telehealth Adoption in the United States: Cross-Sectional Survey Analysis %A Mackwood,Matthew %A Fisher,Elliott %A Schmidt,Rachel O %A O'Malley,A James %A Rodriguez,Hector P %A Shortell,Stephen %A Akré,Ellesse-Roselee %A Berube,Alena %A Schifferdecker,Karen E %+ Department of Community & Family Medicine, Geisel School of Medicine, Dartmouth College, One Medical Center Drive, Hanover, NH, 03756, United States, 1 6036504000, matthew.b.mackwood@hitchcock.org %K telehealth %K telemedicine %K remote consultation %K primary health care %K general practice %K internet access %K health policy %K health care economics and organizations %K access to primary care %K digital divide %K vulnerable populations %K medically underserved area %D 2025 %7 28.3.2025 %9 Research Letter %J J Med Internet Res %G English %X In this national study of primary care practice–level factors associated with telehealth adoption in 2022, we found that training and assisting patients with the use of telehealth, broadband expansion efforts, and a higher proportion of low-income patients were associated with higher practice-level telehealth use, suggesting both opportunities for telehealth expansion and potential populations with higher need for its use. %M 40152920 %R 10.2196/70404 %U https://www.jmir.org/2025/1/e70404 %U https://doi.org/10.2196/70404 %U http://www.ncbi.nlm.nih.gov/pubmed/40152920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65241 %T The Role of the Installed Base in Information Exchange Among General Practitioners in Germany: Mixed Methods Study %A Holetzek,Tim %A Häusler,Andreas %A Gödde,Kathrin %A Rapp,Michael %A Spallek,Jacob %A Holmberg,Christine %+ Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Hochstrasse 15, Brandenburg/Havel, 14770, Germany, 49 03381411282, tim.holetzek@mhb-fontane.de %K digitalization %K general practitioners %K Germany %K information and communication technologies %K information exchange %K primary health care %K digital transformation %K mixed methods study %K digital health %K health application %K qualitative interview %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2%, SD 24.64), fax (n=109, 43.9%, SD 25.40), or post (n=50, 20.2%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs’ communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs’ practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers’ perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation. %M 40127672 %R 10.2196/65241 %U https://www.jmir.org/2025/1/e65241 %U https://doi.org/10.2196/65241 %U http://www.ncbi.nlm.nih.gov/pubmed/40127672 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60582 %T Health Care Professionals’ Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study %A Rivas,Eric Vincent %A Lesley,Ulf %A Davoody,Nadia %+ Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, Stockholm, SE-171 77, Sweden, 46 852486486, nadia.davoody@ki.se %K eHealth %K mobile health %K mHealth %K advanced home care %K content analysis %K nurse %K staff-patient relationship %K aging population %K patient engagement %K personalized care %K patient experience %D 2025 %7 24.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals’ (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited. Objective: This study aims to explore HCPs’ perspectives on using eHealth tools in advanced home care and these tools’ impact on HCP-patient relationships. Methods: In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes. Results: The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction. Conclusions: The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting. %M 40127432 %R 10.2196/60582 %U https://humanfactors.jmir.org/2025/1/e60582 %U https://doi.org/10.2196/60582 %U http://www.ncbi.nlm.nih.gov/pubmed/40127432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56836 %T Enhancing the Innovation Ecosystem: Overcoming Challenges to Introducing Information-Driven Technologies in Health Care %A Reed,Julie %A Svedberg,Petra %A Nygren,Jens %+ , School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K artificial intelligence %K ecosystem %K health care %K implementation %K technology adoption %K improvement %K complex-systems %D 2025 %7 24.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X As health care demands rise and resources remain constrained, optimizing health care systems has become critical. Information-driven technologies, such as data analytics and artificial intelligence (AI), offer significant potential to inform and enhance health care delivery at various levels. However, a persistent gap exists between the promise of these technologies and their implementation in routine practice. In this paper, we propose that fragmentation of the innovation ecosystem is behind the failure of new information-driven technologies to be taken up into practice and that these goals can be achieved by increasing the cohesion of the ecosystem. Drawing on our experiences and published literature, we explore five challenges that underlie current ecosystem fragmentation: (1) technology developers often focus narrowly on perfecting the technical specifications of products without sufficiently considering the broader ecosystem in which these innovations will operate; (2) lessons from academic studies on technology implementation are underused, and existing knowledge is not being built upon; (3) the perspectives of healthcare professionals and organizations are frequently overlooked, resulting in misalignment between technology developments and health care needs; (4) ecosystem members lack incentives to collaborate, leading to strong individual efforts but collective ecosystem failure; and (5) investment in enhancing cohesion between ecosystem members is insufficient, with limited recognition of the time and effort required to build effective collaborations. To address these challenges, we propose a series of recommendations: adopting a wide-lens perspective on the ecosystem; developing a shared-value proposition; fostering ecosystem leadership; and promoting local ownership of ecosystem investigation and enhancement. We conclude by proposing practical steps for ecosystem members to self-assess, diagnose, and improve collaboration and knowledge sharing. The recommendations presented in this paper are intended to be broadly applicable across various types of innovation and improvement efforts in diverse ecosystems. %M 40127434 %R 10.2196/56836 %U https://www.jmir.org/2025/1/e56836 %U https://doi.org/10.2196/56836 %U http://www.ncbi.nlm.nih.gov/pubmed/40127434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64933 %T Factors Influencing Primary Care Physicians’ Intent to Refer Patients With Hypertension to a Digital Remote Blood Pressure Monitoring Program: Mixed Methods Study %A Wu,Jennifer J %A Graham,Ross %A Çelebi,Julie %A Fraser,Kevin %A Gin,Geneen T %A Dang,Laurel %A Hatamy,Esmatullah %A Walker,Amanda %A Barbato,Courtney %A Lunde,Ottar %A Coles,Lisa %A Agnihotri,Parag %A Morn,Cassandra %A Tai-Seale,Ming %+ Department of Family Medicine, University of California, San Diego, 200 West Arbor Drive, San Diego, CA, 92103 - 8201A, United States, 1 6194719260, j1wu@health.ucsd.edu %K digital health %K primary care %K electronic health records %K referral %K hypertension %K remote monitoring %K remote blood pressure %K digital technology %K mobile phone %K mixed method %K quantitative analysis %K linear regression %K clinical information %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Primary care physicians’ (PCP) referral rates to digital health programs are highly variable. This study explores whether knowledge of the digital remote blood pressure monitoring (RBPM) program and information on referral patterns influence PCPs’ intention to refer patients. Objective: This study aims to examine the relationship between PCPs’ knowledge of the digital RBPM program and information on their own prior referral rates versus their own with their peers’ referral rates and their likelihood to refer patients to the digital RBPM program. Methods: This is a mixed methods study integrating quantitative analysis of electronic health record data regarding the frequency of PCPs’ referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs’ knowledge of the program and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient. They were randomized to either receive their own referral rate or their own plus their peers’ referral rate. They were assessed on their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined participant characteristics and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31% (n=70) responded to the survey. From electronic health record data, the mean referral rate of patients per PCP was 11.80% (SD 13.30%). The mean self-reported knowledge of the digital health program was 6.47 (SD 1.81). The mean likelihood of referring an eligible patient (on a scale of 0 to 10, with 0 being not at all, and 10 being definitely) based on a vignette was 8.54 (SD 2.12). The own referral data group’s mean likelihood to refer was 8.91 (SD 1.28), whereas the own plus peer prior referral data group was 8.35 (SD 2.19). Regression analyses suggested the intention to refer the vignette patient was significantly associated with their knowledge (coefficient 0.46, 95% CI 0.20-0.73; P<.001), whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95% CI 0.46-0.78; P<.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95% CI –0.43 to 0.89; P=.48). Conclusions: Physicians’ intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, which was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program. %M 40126550 %R 10.2196/64933 %U https://www.jmir.org/2025/1/e64933 %U https://doi.org/10.2196/64933 %U http://www.ncbi.nlm.nih.gov/pubmed/40126550 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60019 %T Application of Internet Hospitals in the Disease Management of Patients With Ulcerative Colitis: Retrospective Study %A Yu,Tianzhi %A Li,Wanyu %A Liu,Yingchun %A Jin,Chunjie %A Wang,Zimin %A Cao,Hailong %+ Department of Gastroenterology, National Key Clinical Specialty, Tianjin Medical University General Hospital, 154 Anshan Road in Heping District, Tianjin, 300052, China, 86 +86 022 6036155, caohailong@tmu.edu.cn %K inflammatory bowel disease %K ulcerative colitis %K intelligent diagnosis and treatment service %K internet hospital %K chronic disease management %D 2025 %7 18.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Ulcerative colitis (UC) is a chronic disease characterized by frequent relapses, requiring long-term management and consuming substantial medical and social resources. Effective management of UC remains challenging due to the need for sustainable remission strategies, continuity of care, and access to medical services. Intelligent diagnosis refers to the use of artificial intelligence–driven algorithms to analyze patient-reported symptoms, generate diagnostic probabilities, and provide treatment recommendations through interactive tools. This approach could potentially function as a method for UC management. Objective: This study aimed to analyze the diagnosis and treatment data of UC from both physical hospitals and internet hospitals, highlighting the potential benefits of the intelligent diagnosis and treatment service model offered by internet hospitals. Methods: We collected data on the visits of patients with UC to the Department of Gastroenterology at Tianjin Medical University General Hospital. A total of 852 patients with UC were included between July 1, 2020, and June 31, 2023. Statistical methods, including chi-square tests for categorical variables, t tests for continuous variables, and rank-sum tests for visit numbers, were used to evaluate the medical preferences and expenses of patients with UC. Results: We found that internet hospitals and physical hospitals presented different medical service models due to the different distribution of medical needs and patient groups. Patients who chose internet hospitals focused on disease consultation and prescription medication (3295/3528, 93.40%). Patients’ medical preferences gradually shifted to web-based services provided by internet hospitals. Over time, 58.57% (270/461) of patients chose either web-based services or a combination of web-based and offline services for UC diagnosis and treatment. The number of visits in the combination of web-based and offline service modes was the highest (mean 13.83, SD 11.07), and younger patients were inclined to visit internet hospitals (49.66%>34.71%). In addition, compared with physical hospitals, there was no difference in testing fees and examination fees for patients with UC in internet hospitals, but medicine fees were lower. Conclusions: The intelligent diagnosis and treatment model provided by internet hospitals demonstrates the potential benefits in managing UC, including feasibility, accessibility, convenience, and economics. %M 40101745 %R 10.2196/60019 %U https://www.jmir.org/2025/1/e60019 %U https://doi.org/10.2196/60019 %U http://www.ncbi.nlm.nih.gov/pubmed/40101745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e50178 %T Examining Challenges to Co-Design Digital Health Interventions With End Users: Systematic Review %A Duffy,Anthony %A Boroumandzad,Nazanin %A Sherman,Alfredo Lopez %A Christie,Gregory %A Riadi,Indira %A Moreno,Sylvain %+ School of Interactive Arts & Technology, Simon Fraser University, 13450 102 Ave #250, Surrey, BC, V3T 0A3, Canada, 1 (778) 782 9742, sylvain_moreno@sfu.ca %K digital health %K end users %K user experience %K health behavior %K intervention %K co-design %K mobile health %K mHealth %K digital health citizen %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are changing the dynamic of health care by providing personalized, private, and instantaneous solutions to end users. However, the explosion of digital health has been fraught with challenges. The approach to co-design with end users varies across a diverse domain of stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital stakeholders (ie, user experience and retention) and health stakeholders (ie, safety and efficacy). Several methodologies and frameworks are being implemented to address this challenge to varying degrees of success. Objective: We aimed to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken to identify the key problem areas at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users. Methods: We conducted a systematic search of key databases for co-design studies involving end users in DHIs. Searches were divided into 3 relevant streams: health behavior, user experience, and digital methodologies and frameworks. The eligibility criteria were guided by the PerSPEcTiF framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In line with this framework, studies were included in this review that (1) address research on DHIs; (2) focus on interaction and co-design with end users; (3) explain results such that uptake, effectiveness, satisfaction, and health outcomes are discernible, positively or negatively; and (4) describe actionable procedures for better DHI design. The search was conducted in a diverse group of 6 bibliographical databases from January 2015 to May 2024: PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Institute of Electrical and Electronics Engineers Xplore, and Scopus. From the 13,961 studies initially screened for titles and abstracts, 489 (3.6%) were eligible for a full-text screening, of which 171 (1.2%) studies matched the inclusion criteria and were included in a qualitative synthesis. Results: Of the 171 studies analyzed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies. These studies identified several core themes when co-designing with end users: advancements, which included participatory co-design; challenges, which included participatory co-design, environment and context, testing, and cost and scale; and gaps, which included a pragmatic hybridized framework and industry implementability. Conclusions: This research supports a pragmatic shift toward using mixed methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of digital health co-designers with the pragmatism of Agile design methodology and the rigor of health care metrics. Trial Registration: PROSPERO CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238164 International Registered Report Identifier (IRRID): RR2-10.2196/28083 %M 40085834 %R 10.2196/50178 %U https://www.jmir.org/2025/1/e50178 %U https://doi.org/10.2196/50178 %U http://www.ncbi.nlm.nih.gov/pubmed/40085834 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63895 %T The Perceptions of Potential Prerequisites for Artificial Intelligence in Danish General Practice: Vignette-Based Interview Study Among General Practitioners %A Jørgensen,Natasha Lee %A Merrild,Camilla Hoffmann %A Jensen,Martin Bach %A Moeslund,Thomas B %A Kidholm,Kristian %A Thomsen,Janus Laust %K general practice %K general practitioners %K GPs %K artificial intelligence %K AI %K prerequisites %K interviews %K vignettes %K qualitative study %K thematic analysis %D 2025 %7 12.3.2025 %9 %J JMIR Med Inform %G English %X 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. %R 10.2196/63895 %U https://medinform.jmir.org/2025/1/e63895 %U https://doi.org/10.2196/63895 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e50294 %T Prescription Refill Adherence Before and After Patient Portal Registration in Among General Practice Patients in England Using the Clinical Practice Research Datalink: Longitudinal Observational Study %A Alturkistani,Abrar %A Beaney,Thomas %A Greenfield,Geva %A Costelloe,Ceire E %K patient portals %K personal health records %K general practice %K delivery of health care %K medication ordering %K health care %K medication adherence %K clinical practice research %K patient portal %K England %K longitudinal analysis %K patient health %K medication %K cardiovascular disease %K diabetes %K chronic kidney disease %D 2025 %7 11.3.2025 %9 %J JMIR Med Inform %G English %X Background: Patient portal use has been associated with improved patient health and improved adherence to medications, including statins. However, there is limited research on the association between patient portal registration and outcomes such as statin prescription refill adherence in the context of the National Health Service of England, where patient portals have been widely available since 2015. Objective: We aimed to explore statin prescription refill adherence among general practice patients in England. Methods: This study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee (ID: 21_000411). We used patient-level general practice data from the Clinical Practice Research Datalink in England. The data included patients with cardiovascular disease, diabetes, and chronic kidney disease, who were registered on the patient portal. The primary aim was to investigate whether statin prescription refill adherence, defined as ≥80% adherence based on the medication possession ratio, improved after patient portal registration. We used a multilevel logistic regression model to compare aggregate adherence 12 months before and 12 months after patient portal registration. Results: We included 44,141 patients in the study. The analysis revealed a 16% reduction in the odds of prescription refill adherence 12 months after patient portal registration (odds ratio [OR]: 0.84, 95% CI 0.81-0.86) compared to 12 months before registration in the fully adjusted model for patient- and practice-level variables. Conclusions: This study evaluated prescription refill adherence after patient portal registration. Registering to the portal does not fully explain the mechanisms underlying the relationship between patient portal use and health-related outcomes such as medication adherence. Although a small reduction in prescription refill adherence was observed, this reduction disappeared when the follow up time was reduced to 6 months. Given the limitations of the study, reduction in prescription refill adherence cannot be entirely attributable to patient portal registration. However, there may be potential confounding factors influencing this association which should be explored through future research. %R 10.2196/50294 %U https://medinform.jmir.org/2025/1/e50294 %U https://doi.org/10.2196/50294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63482 %T Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review %A Yew,Sheng Qian %A Trivedi,Daksha %A Adanan,Nurul Iman Hafizah %A Chew,Boon How %+ Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertforshire, AL10 9AB, United Kingdom, 44 01707286389, d.trivedi@herts.ac.uk %K digital health implementation %K facilitators %K barriers %K digital health classification framework %K lower- and middle-income countries %D 2025 %7 6.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons. Objective: To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs’ hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs. Methods: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework. Results: Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs’ hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported. Conclusions: In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients. %M 40053793 %R 10.2196/63482 %U https://www.jmir.org/2025/1/e63482 %U https://doi.org/10.2196/63482 %U http://www.ncbi.nlm.nih.gov/pubmed/40053793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57858 %T Assessing Digital Maturity of Hospitals: Viewpoint Comparing National Approaches in Five Countries %A Cresswell,Kathrin %A Jahn,Franziska %A Silsand,Line %A Woods,Leanna %A Postema,Tim %A Logan,Marion %A Malkic,Sevala %A Ammenwerth,Elske %+ Usher Institute, The University of Edinburgh, Usher Building, 5-7 Little France Road, Edinburgh BioQuarter-Gate 3, Edinburgh, EH16 4UX, United Kingdom, 44 (0)131 651 7869, Kathrin.Cresswell@ed.ac.uk %K digital maturity %K hospitals %K assessment %K decision making %K health systems %K infancy %K Australia %K Australian %K data collection %K data %K qualitative thematic analysis %K self-reporting %K practical feasibility %K long-term tracking %K local data %K monitoring %D 2025 %7 6.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Digital maturity assessments can inform strategic decision-making. However, national approaches to assessing the digital maturity of health systems are in their infancy, and there is limited insight into the context and processes associated with such assessments. This viewpoint article describes and compares national approaches to assessing the digital maturity of hospitals. We reviewed 5 national approaches to assessing the digital maturity of hospitals in Queensland (Australia), Germany, the Netherlands, Norway, and Scotland, exploring context, drivers, and approaches to measure digital maturity in each country. We observed a common focus on interoperability, and assessment findings were used to shape national digital health strategies. Indicators were broadly aligned, but 4 of 5 countries developed their own tailored indicator sets. Key topic areas across countries included interoperability, capabilities, leadership, governance, and infrastructure. Analysis of indicators was centralized, but data were shared with participating organizations. Only 1 setting conducted an academic evaluation. Major challenges of digital maturity assessment included the high cost and time required for data collection, questions about measurement accuracy, difficulties in consistent long-term tracking of indicators, and potential biases due to self-reporting. We also observed tensions between the practical feasibility of the process with the depth and breadth required by the complexity of the topic and tensions between national and local data needs. There are several key challenges in assessing digital maturity in hospitals nationally that influence the validity and reliability of output. These need to be explicitly acknowledged when making decisions informed by assessments and monitored over time. %M 40053724 %R 10.2196/57858 %U https://www.jmir.org/2025/1/e57858 %U https://doi.org/10.2196/57858 %U http://www.ncbi.nlm.nih.gov/pubmed/40053724 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e66464 %T Exploring Stakeholder Perspectives on the Barriers and Facilitators of Implementing Digital Technologies for Heart Disease Diagnosis: Qualitative Study %A Abdullayev,Kamilla %A Chico,Tim J A %A Canson,Jiana %A Mantelow,Matthew %A Buckley,Oli %A Condell,Joan %A Van Arkel,Richard J %A Diaz-Zuccarini,Vanessa %A Matcham,Faith %+ School of Psychology, University of Sussex, Pevensey 1, Falmer, BN1 9QH, United Kingdom, 44 01273 606755, f.matcham@sussex.ac.uk %K heart disease %K digital technologies %K stakeholder perspectives %K qualitative research %K digital technology %K health technology %K heart %K cardio %K cardiology %K cardiovascular %K qualitative %K focused group %K quality of care %K efficiency %K digital health %K mobile phone %K artificial intelligence %K AI %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: Digital technologies are increasingly being implemented in health care to improve the quality and efficiency of care for patients. However, the rapid adoption of health technologies over the last 5 years has failed to adequately consider patient and clinician needs, which results in ineffective implementation. There is also a lack of consideration for the differences between patient and clinician needs, resulting in overgeneralized approaches to the implementation and use of digital health technologies. Objective: This study aimed to explore barriers and facilitators of the implementation of digital technologies in the diagnosis of heart disease for both patients and clinicians, and to provide recommendations to increase the acceptability of novel health technologies. Methods: We recruited 32 participants from across the United Kingdom, including 23 (72%) individuals with lived experience of heart disease and 9 (28%) clinicians involved in diagnosing heart disease. Participants with experience of living with heart disease took part in semistructured focused groups, while clinicians contributed to one-to-one semistructured interviews. Inductive thematic analysis using a phenomenological approach was conducted to analyze the resulting qualitative data and to identify themes. Results were discussed with a cardiovascular patient advisory group to enhance the rigor of our interpretation of the data. Results: Emerging themes were separated into facilitators and barriers and categorized into resource-, technology-, and user-related themes. Resource-related barriers and facilitators related to concerns around increased clinician workload, the high cost of digital technologies, and systemic limitations within health care systems such as outdated equipment and limited support. Technology-related barriers and facilitators included themes related to reliability, accuracy, safety parameters, data security, ease of use, and personalization, all of which can impact engagement and trust with digital technologies. Finally, the most prominent themes were the user-related barriers and facilitators, which encompassed user attitudes, individual-level variation in preferences and capabilities, and impact on quality of health care experiences. This theme captured a wide variety of perspectives among the sample and revealed how patient and clinician attitudes and personal experiences substantially impact engagement with digital health technologies across the cardiovascular care pathway. Conclusions: Our findings highlight the importance of considering both patient and clinician needs and preferences when investigating the barriers and facilitators to effective implementation of digital health technologies. Facilitators to technology adoption include the need for cost-effective, accurate, reliable, and easy-to-use systems as well as adequate setup support and personalization to meet individual needs. Positive user attitudes, perceived improvement in care quality, and increased involvement in the care process also enhance engagement. While both clinicians and patients acknowledge the potential benefits of digital technologies, effective implementation hinges on addressing these barriers and leveraging facilitators to ensure that the technologies are perceived as useful, safe, and supportive of health care outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-072952 %M 40053721 %R 10.2196/66464 %U https://cardio.jmir.org/2025/1/e66464 %U https://doi.org/10.2196/66464 %U http://www.ncbi.nlm.nih.gov/pubmed/40053721 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58867 %T Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study %A Beerbaum,Julian %A Robens,Sibylle %A Fehring,Leonard %A Mortsiefer,Achim %A Meister,Sven %+ Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Pferdebachstr. 11, Witten, 58448, Germany, 49 230292678629, sven.meister@uni-wh.de %K technology acceptance %K UTAUT %K family doctor %K digital health %K eHealth %K video consultation %K electronic health records %K digital anamnesis %K online appointment scheduling %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients’ overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine. Objective: To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach. Methods: Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case. Results: Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; β=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; β=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; β=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; β=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; β=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; β=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; β=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; β=.053; P=.10). Conclusions: In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice. %M 40053731 %R 10.2196/58867 %U https://formative.jmir.org/2025/1/e58867 %U https://doi.org/10.2196/58867 %U http://www.ncbi.nlm.nih.gov/pubmed/40053731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65932 %T Enabling Telemedicine From the System-Level Perspective: Scoping Review %A Li,Xuezhu %A Huang,Lifeng %A Zhang,Hui %A Liang,Zhanming %+ School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, 510080, China, 86 13922252312, zhanghui3@mail.sysu.edu.cn %K telemedicine %K telehealth %K digital health %K success factors %K challenges %D 2025 %7 5.3.2025 %9 Review %J J Med Internet Res %G English %X 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. %M 40053725 %R 10.2196/65932 %U https://www.jmir.org/2025/1/e65932 %U https://doi.org/10.2196/65932 %U http://www.ncbi.nlm.nih.gov/pubmed/40053725 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e65549 %T Correlation Between Diagnosis-Related Group Weights and Nursing Time in the Cardiology Department: Cross-Sectional Study %A Lv,Chen %A Gong,Yi-Hong %A Wang,Xiu-Hua %A An,Jun %A Wang,Qian %A Han,Jing %A Chen,Xiao-Feng %K diagnosis-related groups %K nursing time %K workload %K human resources %K nursing %D 2025 %7 4.3.2025 %9 %J JMIR Med Inform %G English %X 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. %R 10.2196/65549 %U https://medinform.jmir.org/2025/1/e65549 %U https://doi.org/10.2196/65549 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68083 %T Empowering Health Care Actors to Contribute to the Implementation of Health Data Integration Platforms: Retrospective of the medEmotion Project %A Parciak,Marcel %A Pierlet,Noëlla %A Peeters,Liesbet M %+ Biomedical Research Institute, UHasselt - Hasselt University, Agoralaan, Diepenbeek, 3590, Belgium, 32 11269288, marcel.parciak@uhasselt.be %K data science %K health data integration %K health data platform %K real-world evidence %K health care %K health data %K data %K integration platforms %K collaborative %K platform %K Belgium %K Europe %K personas %K communication %K health care providers %K hospital-specific requirements %K digital health %D 2025 %7 4.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Health data integration platforms are vital to drive collaborative, interdisciplinary medical research projects. Developing such a platform requires input from different stakeholders. Managing these stakeholders and steering platform development is challenging, and misaligning the platform to the partners’ strategies might lead to a low acceptance of the final platform. We present the medEmotion project, a collaborative effort among 7 partners from health care, academia, and industry to develop a health data integration platform for the region of Limburg in Belgium. We focus on the development process and stakeholder engagement, aiming to give practical advice for similar future efforts based on our reflections on medEmotion. We introduce Personas to paraphrase different roles that stakeholders take and Demonstrators that summarize personas’ requirements with respect to the platform. Both the personas and the demonstrators serve 2 purposes. First, they are used to define technical requirements for the medEmotion platform. Second, they represent a communication vehicle that simplifies discussions among all stakeholders. Based on the personas and demonstrators, we present the medEmotion platform based on components from the Microsoft Azure cloud. The demonstrators are based on real-world use cases and showcase the utility of the platform. We reflect on the development process of medEmotion and distill takeaway messages that will be helpful for future projects. Investing in community building, stakeholder engagement, and education is vital to building an ecosystem for a health data integration platform. Instead of academic-led projects, the health care providers themselves ideally drive collaboration among health care providers. The providers are best positioned to address hospital-specific requirements, while academics take a neutral mediator role. This also includes the ideation phase, where it is vital to ensure the involvement of all stakeholders. Finally, balancing innovation with implementation is key to developing an innovative yet sustainable health data integration platform. %M 40053761 %R 10.2196/68083 %U https://www.jmir.org/2025/1/e68083 %U https://doi.org/10.2196/68083 %U http://www.ncbi.nlm.nih.gov/pubmed/40053761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66804 %T Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study %A Yan,Mengyao %A Sun,Wendi %A Tan,Cheng %A Wu,Yibo %A Liu,Yuanli %+ Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdan Sanjie, Dongcheng District, Beijing, 100730, China, 86 13522592907, liuyuanli_pumc@163.com %K older adults %K mobile health devices %K health management %K medical services %K mobile phone %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons’ desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher (β=.040; P=.007), being unemployed (β=.037; P=.02), having a high social status (β=.085; P<.001), possessing high health literacy (β=.089; P<.001), demonstrating high self-efficacy (β=.043; P=.02), not living with children (β=.0340; P=.02), having a household per capita monthly income of >Y4000 (US $550) (β=.048; P=.002), experiencing high perceived social support (β=.096; P<.001), reporting a high quality of life (β=.149; P<.001), having higher levels of family communication (β=–.071; P<.001), having an identity bubble (β=.085; P<.001), not having chronic diseases (β=.049; P=.001), and experiencing mild depression (β=–.035; P=.02) were associated with older adults’ willingness to use mHealth devices. The classification and regression tree decision tree model’s findings demonstrated that the primary determinants of older adults’ desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons’ propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. %M 40053781 %R 10.2196/66804 %U https://www.jmir.org/2025/1/e66804 %U https://doi.org/10.2196/66804 %U http://www.ncbi.nlm.nih.gov/pubmed/40053781 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63186 %T The Construction and Application of a Clinical Decision Support System for Cardiovascular Diseases: Multimodal Data-Driven Development and Validation Study %A Miao,Shumei %A Ji,Pei %A Zhu,Yongqian %A Meng,Haoyu %A Jing,Mang %A Sheng,Rongrong %A Zhang,Xiaoliang %A Ding,Hailong %A Guo,Jianjun %A Gao,Wen %A Yang,Guanyu %A Liu,Yun %K CVD %K CDSS %K multimodel data %K knowledge engine %K development %K cardiovascular disease %K clinical decision support system %D 2025 %7 3.3.2025 %9 %J JMIR Med Inform %G English %X Background: Due to the acceleration of the aging population and the prevalence of unhealthy lifestyles, the incidence of cardiovascular diseases (CVDs) in China continues to grow. However, due to the uneven distribution of medical resources across regions and significant disparities in diagnostic and treatment levels, the diagnosis and management of CVDs face considerable challenges. Objective: The purpose of this study is to build a cardiovascular diagnosis and treatment knowledge base by using new technology, form an auxiliary decision support system, and integrate it into the doctor’s workstation, to improve the assessment rate and treatment standardization rate. This study offers new ideas for the prevention and management of CVDs. Methods: This study designed a clinical decision support system (CDSS) with data, learning, knowledge, and application layers. It integrates multimodal data from hospital laboratory information systems, hospital information systems, electronic medical records, electrocardiography, nursing, and other systems to build a knowledge model. The unstructured data were segmented using natural language processing technology, and medical entity words and entity combination relationships were extracted using IDCNN (iterated dilated convolutional neural network) and TextCNN (text convolutional neural network). The CDSS refers to global CVD assessment indicators to design quality control strategies and an intelligent treatment plan recommendation engine map, establishing a big data analysis platform to achieve multidimensional, visualized data statistics for management decision support. Results: The CDSS system is embedded and interfaced with the physician workstation, triggering in real-time during the clinical diagnosis and treatment process. It establishes a 3-tier assessment control through pop-up windows and screen domination operations. Based on the intelligent diagnostic and treatment reminders of the CDSS, patients are given intervention treatments. The important risk assessment and diagnosis rate indicators significantly improved after the system came into use, and gradually increased within 2 years. The indicators of mandatory control, directly became 100% after the CDSS was online. The CDSS enhanced the standardization of clinical diagnosis and treatment. Conclusions: This study establishes a specialized knowledge base for CVDs, combined with clinical multimodal information, to intelligently assess and stratify cardiovascular patients. It automatically recommends intervention treatments based on assessments and clinical characterizations, proving to be an effective exploration of using a CDSS to build a disease-specific intelligent system. %R 10.2196/63186 %U https://medinform.jmir.org/2025/1/e63186 %U https://doi.org/10.2196/63186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62750 %T Digital Transformation in Patient Organizations: Interview and Focus Group Study %A Wallraf,Simon %A Köthemann,Sara %A Wiesemann,Claudia %A Wöhlke,Sabine %A Dierks,Marie-Luise %A Schmidt,Marion Andrea %A van Gils-Schmidt,Henk Jasper %A Lander,Jonas %+ Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Street 1, Hanover, 30625, Germany, 49 0511 532 4450, lander.jonas@mh-hannover.de %K patient organization %K patient support %K digitalization %K digital transformation %K health research %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient organizations (POs) are an integral part of the health care landscape, serving as advocates and support systems for patients and their families. As the digitalization of health care accelerates, POs are challenged to adapt their diverse roles to digital formats. However, the extent and form of POs’ digital adaptation and the challenges POs encounter in their digital transformation remain unexplored. Objective: This study aims to investigate the digital transformation processes within POs. We examined the types of digital activities and processes implemented, people involved in respective tasks, challenges encountered, and attitudes toward the digitalization of POs. Methods: The study was carried out by the multicenter interdisciplinary research network Pandora. We adopted a qualitative exploratory approach by conducting 37 semistructured interviews and 2 focus groups with representatives and members of POs in Germany. Results were obtained using a deductive-inductive approach based on a qualitative content analysis. Methods and results were reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results: POs primarily apply basic digital tools to engage in communication, health education, and information dissemination. Some also develop specific mobile apps and collect health data through patient registries. Volunteers cover a considerable part of the workload. Sometimes, POs collaborate with external partners, such as health professionals or other nonprofit organizations. Furthermore, many (13/46, 28%) interviewees referred to the importance of involving members in digitalization efforts to better meet their needs. However, they described the actual practices used to involve members in, for example, developing digital services as limited, passive, or implicit. When evaluating digital transformation processes, representatives and members of POs expressed generally positive attitudes and acknowledged their potential to improve the accessibility of support services, management efficiency, and outreach. Still, resource constraints; the complexity of digital initiatives; and accessibility issues for certain demographic groups, especially older persons, were frequently mentioned as challenges. Several (15/46, 33%) interviewees highlighted POs’ increasing responsibility to support their members’ digital competencies and digital health literacy. Conclusions: POs are actively involved in the digital transformation of health services. To navigate challenges and further shape and sustain digital activities and processes, POs may benefit from governance frameworks, that is, a clear plan outlining with whom, how, and with what objectives digital projects are being realized. Support from public, scientific, and policy institutions to enhance the process through training, mentorship, and fostering collaborative networks seems warranted. %M 39946181 %R 10.2196/62750 %U https://www.jmir.org/2025/1/e62750 %U https://doi.org/10.2196/62750 %U http://www.ncbi.nlm.nih.gov/pubmed/39946181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63610 %T Designing Patient-Centered Interventions for Emergency Care: Participatory Design Study %A Seo,Woosuk %A Jain,Shruti %A Le,Vivian %A Li,Jiaqi %A Zhang,Zhan %A Singh,Hardeep %A Pasupathy,Kalyan %A Mahajan,Prashant %A Park,Sun Young %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, United States, 1 2063109264, seow@umich.edu %K emergency department %K participatory design %K patient %K technology %K intervention %D 2025 %7 12.2.2025 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 39938082 %R 10.2196/63610 %U https://formative.jmir.org/2025/1/e63610 %U https://doi.org/10.2196/63610 %U http://www.ncbi.nlm.nih.gov/pubmed/39938082 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e57231 %T Enhancing Surgery Scheduling in Health Care Settings With Metaheuristic Optimization Models: Algorithm Validation Study %A Lopes,João %A Guimarães,Tiago %A Duarte,Júlio %A Santos,Manuel %K health care %K surgery scheduling problem %K metaheuristic model %K model optimization %K surgery scheduling %K artificial intelligence %D 2025 %7 11.2.2025 %9 %J JMIR Med Inform %G English %X 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 Universitário de Santo António (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. %R 10.2196/57231 %U https://medinform.jmir.org/2025/1/e57231 %U https://doi.org/10.2196/57231 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e46007 %T An Automated Clinical Laboratory Decision Support System for Test Utilization, Medical Necessity Verification, and Payment Processing %A Beqaj,Safedin %A Shrestha,Rojeet %A Hamill,Tim %+ Medical Database, Inc, 1 Post, Suite 200, Irvine, CA, 92618, United States, 1 8477693701, sajo@medicaldatabase.com %K clinical decision system %K CDSS %K laboratory decision system %K laboratory testing %K test utilization %K test ordering %K lab test %K laboratory %K testing %K payment %K decision-making %K user %K utilization %K processing %K decision %D 2025 %7 11.2.2025 %9 Viewpoint %J Interact J Med Res %G English %X Physicians could improve the efficiency of the health care system if a reliable resource were available to aid them in better understanding, selecting, and interpreting the diagnostic laboratory tests. It has been well established and widely recognized that (1) laboratory testing provides 70%-85% of the objective data that physicians use in the diagnosis and treatment of their patients; (2) orders for laboratory tests in the United States have increased, with an estimated volume of 4-5 billion tests per year; (3) there is a lack of user-friendly tools to guide physicians in their test selection and ordering; and (4) laboratory test overutilization and underutilization continue to represent a pervasive source of inefficiency in the health care system. These inappropriate test orders not only lead to slower or incorrect diagnoses for patients but also add a significant financial burden. In addition, many ordered tests are not reimbursed by Medicare because they are inappropriate for the medical condition or were ordered with the incorrect International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic code, not meeting the medical necessity. Therefore, current clinical laboratory test ordering procedures experience a quality gap. Often, providers do not have access to an appropriate tool that uses evidence-based guidelines or algorithms to ensure that tests are not duplicated, overused, or underused. This viewpoint lays out the potential use of an automated laboratory clinical decision support system that helps providers order the right test for the right disease and documents the right reason or medical necessity to pay for the testing. %M 39808833 %R 10.2196/46007 %U https://www.i-jmr.org/2025/1/e46007 %U https://doi.org/10.2196/46007 %U http://www.ncbi.nlm.nih.gov/pubmed/39808833 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64414 %T Physician Perspectives on the Potential Benefits and Risks of Applying Artificial Intelligence in Psychiatric Medicine: Qualitative Study %A Stroud,Austin M %A Curtis,Susan H %A Weir,Isabel B %A Stout,Jeremiah J %A Barry,Barbara A %A Bobo,William V %A Athreya,Arjun P %A Sharp,Richard R %+ Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 6502, sharp.richard@mayo.edu %K artificial intelligence %K machine learning %K digital health %K mental health %K psychiatry %K depression %K interviews %K family medicine %K physicians %K qualitative %K providers %K attitudes %K opinions %K perspectives %K ethics %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: As artificial intelligence (AI) tools are integrated more widely in psychiatric medicine, it is important to consider the impact these tools will have on clinical practice. Objective: This study aimed to characterize physician perspectives on the potential impact AI tools will have in psychiatric medicine. Methods: We interviewed 42 physicians (21 psychiatrists and 21 family medicine practitioners). These interviews used detailed clinical case scenarios involving the use of AI technologies in the evaluation, diagnosis, and treatment of psychiatric conditions. Interviews were transcribed and subsequently analyzed using qualitative analysis methods. Results: Physicians highlighted multiple potential benefits of AI tools, including potential support for optimizing pharmaceutical efficacy, reducing administrative burden, aiding shared decision-making, and increasing access to health services, and were optimistic about the long-term impact of these technologies. This optimism was tempered by concerns about potential near-term risks to both patients and themselves including misguiding clinical judgment, increasing clinical burden, introducing patient harms, and creating legal liability. Conclusions: Our results highlight the importance of considering specialist perspectives when deploying AI tools in psychiatric medicine. %M 39928397 %R 10.2196/64414 %U https://mental.jmir.org/2025/1/e64414 %U https://doi.org/10.2196/64414 %U http://www.ncbi.nlm.nih.gov/pubmed/39928397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53483 %T Status of Digital Health Technology Adoption in 5 Vietnamese Hospitals: Cross-Sectional Assessment %A Tran,Duc Minh %A Thanh Dung,Nguyen %A Minh Duc,Chau %A Ngoc Hon,Huynh %A Minh Khoi,Le %A Phuc Hau,Nguyen %A Thi Thu Huyen,Duong %A Thi Le Thu,Huynh %A Van Duc,Tran %A , %A Minh Yen,Lam %A Thwaites,C Louise %A Paton,Chris %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam, 84 2839237954, ductm@oucru.org %K electronic health record %K electronic medical record %K digital maturity %K clinical decision support %K digital infrastructure %K Vietnam %K health information technology %K digital health technology %K low- and middle-income country %D 2025 %7 6.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies (DHTs) have been recognized as a key solution to help countries, especially those in the low- and middle-income group, to achieve the Sustainable Development Goals (SDGs) and the World Health Organization’s (WHO) Triple Billion Targets. In hospital settings, DHTs need to be designed and implemented, considering the local context, to achieve usability and sustainability. As projects such as the Vietnam ICU Translational Applications Laboratory are seeking to integrate new digital technologies in the Vietnamese critical care settings, it is important to understand the current status of DHT adoption in Vietnamese hospitals. Objective: We aimed to explore the current digital maturity in 5 Vietnamese public hospitals to understand their readiness in implementing new DHTs. Methods: We assessed the adoption of some key DHTs and infrastructure in 5 top-tier public hospitals in Vietnam using a questionnaire adapted from the Vietnam Health Information Technology (HIT) Maturity Model. The questionnaire was answered by the heads of the hospitals’ IT departments, with follow-up for clarifications and verifications on some answers. Descriptive statistics demonstrated on radar plots and tile graphs were used to visualize the data collected. Results: Hospital information systems (HIS), laboratory information systems (LIS), and radiology information systems–picture archiving and communication systems (RIS-PACS) were implemented in all 5 hospitals, albeit at varied digital maturity levels. At least 50% of the criteria for LIS in the Vietnam HIT Maturity Model were satisfied by the hospitals in the assessment. However, this threshold was only met by 80% and 60% of the hospitals with regard to HIS and RIS-PACS, respectively. Two hospitals were not using any electronic medical record (EMR) system or fulfilling any extra digital capability, such as implementing clinical data repositories (CDRs) and clinical decision support systems (CDSS). No hospital reported sharing clinical data with other organizations using Health Level Seven (HL7) standards, such as Continuity of Care Document (CCD) and Clinical Document Architecture (CDA), although 2 (40%) reported their systems adopted these standards. Of the 5 hospitals, 4 (80%) reported their RIS-PACS adopted the Digital Imaging and Communications in Medicine (DICOM) standard. Conclusions: The 5 major Vietnamese public hospitals in this assessment have widely adopted information systems, such as HIS, LIS, and RIS-PACS, to support administrative and clinical tasks. Although the adoption of EMR systems is less common, their implementation revolves around data collection, management, and access to clinical data. Secondary use of clinical data for decision support through the implementation of CDRs and CDSS is limited, posing a potential barrier to the integration of external DHTs into the existing systems. However, the wide adoption of international standards, such as HL7 and DICOM, is a facilitator for the adoption of new DHTs in these hospitals. %M 39913927 %R 10.2196/53483 %U https://formative.jmir.org/2025/1/e53483 %U https://doi.org/10.2196/53483 %U http://www.ncbi.nlm.nih.gov/pubmed/39913927 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65546 %T Digital Health Technology Interventions for Improving Medication Safety: Systematic Review of Economic Evaluations %A Insani,Widya Norma %A Zakiyah,Neily %A Puspitasari,Irma Melyani %A Permana,Muhammad Yorga %A Parmikanti,Kankan %A Rusyaman,Endang %A Suwantika,Auliya Abdurrohim %+ Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21, Jatinangor, Sumedang, 45363, Indonesia, 62 7796200, widya.insani@unpad.ac.id %K digital health technology %K drug safety %K adverse drug events %K medication errors %K patient safety %D 2025 %7 5.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Medication-related harm, including adverse drug events (ADEs) and medication errors, represents a significant iatrogenic burden in clinical care. Digital health technology (DHT) interventions can significantly enhance medication safety outcomes. Although the clinical effectiveness of DHT for medication safety has been relatively well studied, much less is known about the cost-effectiveness of these interventions. Objective: This study aimed to systematically review the economic impact of DHT interventions on medication safety and examine methodological challenges to inform future research directions. Methods: A systematic search was conducted across 3 major electronic databases (ie, PubMed, Scopus, and EBSCOhost). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. Two independent investigators conducted a full-text review after screening preliminary titles and abstracts. We adopted recommendations from the Panel on Cost-Effectiveness in Health and Medicine for data extraction. A narrative analysis was conducted to synthesize clinical and economic outcomes. The quality of reporting for the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: We included 13 studies that assessed the cost-effectiveness (n=9, 69.2%), cost-benefit (n=3, 23.1%), and cost-utility (n=1, 7.7%) of DHT for medication safety. Of the included studies, more than half (n=7, 53.9%) evaluated a clinical decision support system (CDSS)/computerized provider order entry (CPOE), 4 (30.8%) examined automated medication-dispensing systems, and 2 (15.4%) focused on pharmacist-led outreach programs targeting health care professionals. In 12 (92.3% ) studies, DHT was either cost-effective or cost beneficial compared to standard care. On average, DHT interventions reduced ADEs by 37.12% (range 8.2%-66.5%) and medication errors by 54.38% (range 24%-83%). The key drivers of cost-effectiveness included reductions in outcomes, the proportion of errors resulting in ADEs, and implementation costs. Despite a significant upfront cost, DHT showed a return on investment within 3-4.25 years due to lower cost related with ADE treatment and improved workflow efficiency. In terms of reporting quality, the studies were classified as good (n=10, 76.9%) and moderate (n=3, 23.1%). Key methodological challenges included short follow-up periods, the absence of alert compliance tracking, the lack of ADE and error severity categorization, and omission of indirect costs. Conclusions: DHT interventions are economically viable to improve medication safety, with a substantial reduction in ADEs and medication errors. Future studies should prioritize incorporating alert compliance tracking, ADE and error severity classification, and evaluation of indirect costs, thereby increasing clinical benefits and economic viability. %M 39909404 %R 10.2196/65546 %U https://www.jmir.org/2025/1/e65546 %U https://doi.org/10.2196/65546 %U http://www.ncbi.nlm.nih.gov/pubmed/39909404 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63660 %T Long-Term Monitoring of Individuals With Chronic Obstructive Pulmonary Disease Using Digital Health Technology: Qualitative Study %A Chien,Shih-Ying %A Hu,Han-Chung %A Cho,Hsiu-Ying %+ Department of Industrial Design, Chang Gung University, No 259, Wen-Hwa 1st Road, Kweishan, Taoyuan, 333, Taiwan, 886 32118800 ext 5669, shihying@mail.cgu.edu.tw %K digital health %K chronic obstructive pulmonary disease %K digital health technology %K barriers and facilitators %K Taiwan %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health adoption in clinical practice has been widespread, yet there remains further potential for optimizing care specifically for chronic obstructive pulmonary disease (COPD). This study therefore conducted qualitative research involving 35 health care professionals from a range of hospitals in Taiwan. Objective: This study aims to investigate barriers and facilitators related to the implementation of digital health technology (DHT) in the long-term monitoring of individuals with COPD based on clinical experiences in Taiwan. The perspectives of Taiwanese health care professionals provided valuable insights into the challenges and opportunities associated with using DHT for the management and enhancement of respiratory rehabilitation and long-term monitoring of patients with COPD. Methods: Several key themes related to the development of DHT were identified. Barriers encompassed concerns pertaining to digital safety, insurance coverage, constraints related to medical resources, and the presence of a digital divide. Facilitators included the potential for cost reduction, personalized prescriptions, and instilling motivation in users. Results: To enhance the acceptance and use of DHT, embracing a user-centered approach that prioritizes the distinct needs of all parties involved is recommended. Moreover, optimizing and leveraging the effective use of DHT in managing the health of individuals with COPD promises to deliver care characterized by greater precision and efficiency. Conclusions: Overall, the benefits of using DHT for the long-term care of patients with COPD outweigh the disadvantages. After the COVID-19 pandemic, there has been an increased emphasis in Taiwan on the effectiveness of DHT in managing chronic diseases. Relevant studies including this paper have suggested that web-based exercise management systems could benefit patients with COPD in rehabilitation and tracking. Our findings provide meaningful directions for future research endeavors and practical implementation. By addressing identified barriers and capitalizing on facilitators, advancements can be made in the development and use of DHT, especially in overcoming challenges such as information security and operational methods. The implementation of the recommended strategies will likely lead to improved COPD care outcomes. %M 39908545 %R 10.2196/63660 %U https://www.jmir.org/2025/1/e63660 %U https://doi.org/10.2196/63660 %U http://www.ncbi.nlm.nih.gov/pubmed/39908545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65492 %T Measuring Digital Health Literacy in Older Adults: Development and Validation Study %A Kim,SungMin %A Park,Choonghee %A Park,Sunghyeon %A Kim,Dai-Jin %A Bae,Ye-Seul %A Kang,Jae-Heon %A Chun,Ji-Won %+ Department of Medical Informatics, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 3147 9727, jwchun@catholic.ac.kr %K digital health care %K older adults %K digital health literacy %K exploratory factor analysis %K confirmatory factor analysis %K mobile phone %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults’ digital health literacy levels. Objective: This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample. Methods: We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses. Results: A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity. Conclusions: This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels. %M 39908081 %R 10.2196/65492 %U https://www.jmir.org/2025/1/e65492 %U https://doi.org/10.2196/65492 %U http://www.ncbi.nlm.nih.gov/pubmed/39908081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51785 %T Why AI Monitoring Faces Resistance and What Healthcare Organizations Can Do About It: An Emotion-Based Perspective %A Werder,Karl %A Cao,Lan %A Park,Eun Hee %A Ramesh,Balasubramaniam %+ , Digital Business Innovation, IT University of Copenhagen, Rued Langgaards Vej 7, Copenhagen, 2300, Denmark, 45 72185386, karw@itu.dk %K artificial intelligence %K AI monitoring %K emotion %K resistance %K health care %D 2025 %7 31.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X Continuous monitoring of patients’ health facilitated by artificial intelligence (AI) has enhanced the quality of health care, that is, the ability to access effective care. However, AI monitoring often encounters resistance to adoption by decision makers. Healthcare organizations frequently assume that the resistance stems from patients’ rational evaluation of the technology’s costs and benefits. Recent research challenges this assumption and suggests that the resistance to AI monitoring is influenced by the emotional experiences of patients and their surrogate decision makers. We develop a framework from an emotional perspective, provide important implications for healthcare organizations, and offer recommendations to help reduce resistance to AI monitoring. %M 39889282 %R 10.2196/51785 %U https://www.jmir.org/2025/1/e51785 %U https://doi.org/10.2196/51785 %U http://www.ncbi.nlm.nih.gov/pubmed/39889282 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e64972 %T Machine Learning–Based Risk Factor Analysis and Prediction Model Construction for the Occurrence of Chronic Heart Failure: Health Ecologic Study %A Xu,Qian %A Cai,Xue %A Yu,Ruicong %A Zheng,Yueyue %A Chen,Guanjie %A Sun,Hui %A Gao,Tianyun %A Xu,Cuirong %A Sun,Jing %+ Department of Nursing, Zhongda Hospital Southeast University, No.87 Dingjiaqiao, Nanjing, 210009, China, 86 13912990156, xucuirong67@126.com %K machine learning, chronic heart failure, risk of occurrence %K prediction model, health ecology %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chronic heart failure (CHF) is a serious threat to human health, with high morbidity and mortality rates, imposing a heavy burden on the health care system and society. With the abundance of medical data and the rapid development of machine learning (ML) technologies, new opportunities are provided for in-depth investigation of the mechanisms of CHF and the construction of predictive models. The introduction of health ecology research methodology enables a comprehensive dissection of CHF risk factors from a wider range of environmental, social, and individual factors. This not only helps to identify high-risk groups at an early stage but also provides a scientific basis for the development of precise prevention and intervention strategies. Objective: This study aims to use ML to construct a predictive model of the risk of occurrence of CHF and analyze the risk of CHF from a health ecology perspective. Methods: This study sourced data from the Jackson Heart Study database. Stringent data preprocessing procedures were implemented, which included meticulous management of missing values and the standardization of data. Principal component analysis and random forest (RF) were used as feature selection techniques. Subsequently, several ML models, namely decision tree, RF, extreme gradient boosting, adaptive boosting (AdaBoost), support vector machine, naive Bayes model, multilayer perceptron, and bootstrap forest, were constructed, and their performance was evaluated. The effectiveness of the models was validated through internal validation using a 10-fold cross-validation approach on the training and validation sets. In addition, the performance metrics of each model, including accuracy, precision, sensitivity, F1-score, and area under the curve (AUC), were compared. After selecting the best model, we used hyperparameter optimization to construct a better model. Results: RF-selected features (21 in total) had an average root mean square error of 0.30, outperforming principal component analysis. Synthetic Minority Oversampling Technique and Edited Nearest Neighbors showed better accuracy in data balancing. The AdaBoost model was most effective with an AUC of 0.86, accuracy of 75.30%, precision of 0.86, sensitivity of 0.69, and F1-score of 0.76. Validation on the training and validation sets through 10-fold cross-validation gave an AUC of 0.97, an accuracy of 91.27%, a precision of 0.94, a sensitivity of 0.92, and an F1-score of 0.94. After random search processing, the accuracy and AUC of AdaBoost improved. Its accuracy was 77.68% and its AUC was 0.86. Conclusions: This study offered insights into CHF risk prediction. Future research should focus on prospective studies, diverse data, advanced techniques, longitudinal studies, and exploring factor interactions for better CHF prevention and management. %M 39889299 %R 10.2196/64972 %U https://medinform.jmir.org/2025/1/e64972 %U https://doi.org/10.2196/64972 %U http://www.ncbi.nlm.nih.gov/pubmed/39889299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62670 %T Electronic Health Record Data Collection Practices to Advance Standardization and Interoperability of Patient Preferences for Interpretation Services: Qualitative Study %A Heaney-Huls,Krysta %A Shams,Rida %A Nwefo,Ruth %A Kane,Rachel %A Gordon,Janna %A Laffan,Alison M %A Stare,Scott %A Dullabh,Prashila %+ , NORC at the University of Chicago, 55 E Monroe St 30th Floor, Chicago, IL, 60603, United States, 1 7734017110, heaney-huls-krysta@norc.org %K health information exchange %K interoperability %K electronic health records %K interpreter %K limited English proficiency %K communication barriers %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Poor health outcomes are well documented among patients with a non-English language preference (NELP). The use of interpreters can improve the quality of care for patients with NELP. Despite a growing and unmet need for interpretation services in the US health care system, rates of interpreter use in the care setting are consistently low. Standardized collection and exchange of patient interpretation needs can improve access to appropriate language assistance services. Objective: This study aims to examine current practices for collecting, documenting, and exchanging information on a patient’s self-reported preference for an interpreter in the electronic health record (EHR) and the implementation maturity and adoption level of available data standards. The paper identifies standards implementation; data collection workflows; use cases for collecting, documenting, and exchanging information on a patient’s self-reported preference for an interpreter; challenges to data collection and use; and opportunities to advance standardization of the interpreter needed data element to facilitate patient-centered care. Methods: We conducted a narrative review to describe the availability of terminology standards to facilitate health care organization documentation of a patient’s self-reported preference for an interpreter in the EHR. Key informant discussions with EHR developers, health systems, clinicians, a practice-based research organization, a national standards collaborative, a professional health care association, and Federal agency representatives filled in gaps from the narrative review. Results: The findings indicate that health care organizations value standardized collection and exchange of patient language assistance service needs and preferences. Informants identified three use cases for collecting, documenting, and exchanging information on a patient’s self-reported preference for an interpreter, which are (1) person-centered care, (2) transitions of care, and (3) health care administration. The discussions revealed that EHR developers provide a data field for documenting interpreter needed data, which are routinely collected across health care organizations through commonly used data collection workflows. However, this data element is not mapped to standard terminologies, such as Logical Observation Identifiers Names and Codes (LOINC) or Systematized Medical Nomenclature for Medicine–Clinical Terminology (SNOMED-CT), consequently limiting the opportunities to electronically share these data between health systems and community-based organizations. The narrative review and key informant discussions identified three potential challenges to using information on a patient’s self-reported preference for an interpreter for person-centered care and quality improvement, which are (1) lack of adoption of available data standards, (2) limited electronic exchange, and (3) patient mistrust. Conclusions: Collecting and documenting patient’s self-reported interpreter preferences can improve the quality of services provided, patient care experiences, and equitable health care delivery without invoking a significant burden on the health care system. Although there is routine collection and documentation of patient interpretation needs, the lack of standardization limits the exchange of this information among health care and community-based organizations. %M 39888652 %R 10.2196/62670 %U https://www.jmir.org/2025/1/e62670 %U https://doi.org/10.2196/62670 %U http://www.ncbi.nlm.nih.gov/pubmed/39888652 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60825 %T The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment %A Amhaz,Haneen %A Chen,Sally Xuanping %A Elchehimi,Amanee %A Han,Kylin Jialin %A Gil,Jade Morales %A Yao,Lu %A Vidler,Marianne %A Berry-Einarson,Kathryn %A Dewar,Kathryn %A Tuason,May %A Prestley,Nicole %A Doan,Quynh %A van Rooij,Tibor %A Costa,Tina %A Ogilvie,Gina %A Payne,Beth A %+ Women's Health Research Institute, H214-4500 Oak Street, Box 42, Vancouver, BC, V6H3N1, Canada, 1 604 875 3459, bpayne@cw.bc.ca %K digital health %K co-design %K digital strategy %K human-centered design %K eHealth %K cocreation %K codevelopment %K perinatal intervention %K quality of care %K digital tools %K pregnancy %K patient autonomy %K patient support %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. %M 39883935 %R 10.2196/60825 %U https://humanfactors.jmir.org/2025/1/e60825 %U https://doi.org/10.2196/60825 %U http://www.ncbi.nlm.nih.gov/pubmed/39883935 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54777 %T Factors Influencing Telemedicine Adoption Among Health Care Professionals: Qualitative Interview Study %A Schürmann,Fiona %A Westmattelmann,Daniel %A Schewe,Gerhard %+ Center for Management, University of Münster, Schlossplatz 3, Münster, 48149, Germany, 49 2518325010, d.west@uni-muenster.de %K trust referents %K multidimensional risk %K benefits %K transparency %K technology adoption %K telemedicine %K extended valence framework %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine is transforming health care by enabling remote diagnosis, consultation, and treatment. Despite rapid adoption during the COVID-19 pandemic, telemedicine uptake among health care professionals (HCPs) remains inconsistent due to perceived risks and lack of tailored policies. Existing studies focus on patient perspectives or general adoption factors, neglecting the complex interplay of contextual variables and trust constructs influencing HCPs’ telemedicine adoption. This gap highlights the need for a framework integrating risks, benefits, and trust in telemedicine adoption, while addressing health care’s unique dynamics. Objective: This study aimed to adapt and extend the extended valence framework (EVF) to telemedicine, deconstructing factors driving adoption from an HCP perspective. Specifically, it investigated the nuanced roles of perceived risks, benefits, and trust referents (eg, technology, treatment, technology provider, and patient) in shaping behavioral intentions, while integrating contextual factors. Methods: We used a qualitative research design involving semistructured interviews with 14 HCPs experienced in offering video consultations. The interview data were analyzed with deductive and inductive coding based on the EVF. Two coders conducted the coding process independently, achieving an intercoder reliability of 86.14%. The qualitative content analysis aimed to uncover the nuanced perspectives of HCPs, identifying key risk and benefit dimensions and trust referents relevant to telemedicine adoption. Results: The study reveals the complex considerations HCPs have when adopting telemedicine. Perceived risks were multidimensional, including performance risks such as treatment limitations (mentioned by 7/14, 50% of the participants) and reliance on technical proficiency of patients (5/14, 36%), privacy risks related to data security (10/14, 71%), and time and financial risks associated with training (7/14, 50%) and equipment costs (4/14, 29%). Perceived benefits encompassed convenience through reduced travel time (5/14, 36%), improved care quality due to higher accessibility (8/14, 57%), and operational efficiency (7/14, 50%). Trust referents played a pivotal role; trust in technology was linked to functionality (6/14, 43%) and reliability (5/14, 36%), while trust in treatment depended on effective collaboration (9/14, 64%). Transparency emerged as a critical antecedent of trust across different referents, comprising disclosure, clarity, and accuracy. In addition, the study highlighted the importance of context-specific variables such as symptom characteristics (10/14, 71%) and prior professional experience with telemedicine (11/14, 79%). Conclusions: This study expands the EVF for telemedicine, providing a framework integrating multidimensional risks, benefits, trust, and contextual factors. It advances theory by decomposing trust referents and transparency into actionable subdimensions and emphasizing context-specific variables. Practically, the findings guide stakeholders: policy makers should prioritize transparent regulations and data security, health care organizations should provide training and support for HCPs, and technology developers must design telemedicine solutions aligning with trust and usability needs. This understanding equips health care to address barriers, optimize adoption, and leverage telemedicine’s potential for sustainable clinical integration. %M 39869885 %R 10.2196/54777 %U https://formative.jmir.org/2025/1/e54777 %U https://doi.org/10.2196/54777 %U http://www.ncbi.nlm.nih.gov/pubmed/39869885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69798 %T Authors’ Reply: Japan's Telepsychiatry Dissemination: Current Status and Challenges %A Sugawara,Yuka %A Hirakawa,Yosuke %A Iwagami,Masao %A Kuroki,Haruo %A Mitani,Shuhei %A Inagaki,Ataru %A Ohashi,Hiroki %A Kubota,Mitsuru %A Koike,Soichi %A Wakimizu,Rie %A Nangaku,Masaomi %+ Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 3815 5411, mnangaku@m.u-tokyo.ac.jp %D 2025 %7 20.1.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39832363 %R 10.2196/69798 %U https://www.jmir.org/2025/1/e69798 %U https://doi.org/10.2196/69798 %U http://www.ncbi.nlm.nih.gov/pubmed/39832363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e22849 %T Japan's Telepsychiatry Dissemination: Current Status and Challenges %A Kinoshita,Shotaro %A Kishimoto,Taishiro %+ , Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, #7F Azabudai Hills Mori JP Tower 1-3-1, Azabudai, Minato-Ku, Tokyo, 106-0041, Japan, 81 3 5363 3829, tkishimoto@keio.jp %D 2025 %7 20.1.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39832367 %R 10.2196/22849 %U https://www.jmir.org/2025/1/e22849 %U https://doi.org/10.2196/22849 %U http://www.ncbi.nlm.nih.gov/pubmed/39832367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60512 %T Digital Age Transformation in Patient-Physician Communication: 25-Year Narrative Review (1999-2023) %A Song,Mingming %A Elson,Joel %A Bastola,Dhundy %+ University of Nebraska at Omaha, 1110 S 67th Street, Omaha, NE, 68182, United States, 1 4025544899, dkbastola@unomaha.edu %K health communication %K health IT %K patient empowerment %K shared decision-making %K patient-physician relationship %K trust %D 2025 %7 16.1.2025 %9 Review %J J Med Internet Res %G English %X Background: The evolution of patient-physician communication has changed since the emergence of the World Wide Web. Health information technology (health IT) has become an influential tool, providing patients with access to a breadth of health information electronically. While such information has greatly facilitated communication between patients and physicians, it has also led to information overload and the potential for spreading misinformation. This could potentially result in suboptimal health care outcomes for patients. In the digital age, effectively integrating health IT with patient empowerment, strong patient-physician relationships, and shared decision-making could be increasingly important for health communication and reduce these risks. Objective: This review aims to identify key factors in health communication and demonstrate how essential elements in the communication model, such as health IT, patient empowerment, and shared decision-making, can be utilized to optimize patient-physician communication and, ultimately, improve patient outcomes in the digital age. Methods: Databases including PubMed, Web of Science, Scopus, PsycINFO, and IEEE Xplore were searched using keywords related to patient empowerment, health IT, shared decision-making, patient-physician relationship, and health communication for studies published between 1999 and 2023. The data were constrained by a modified query using a multidatabase search strategy. The screening process was supported by the web-based software tool Rayyan. The review methodology involved carefully designed steps to provide a comprehensive summary of existing research. Topic modeling, trend analysis, and synthesis were applied to analyze and evaluate topics, trends, and gaps in health communication. Results: From a total of 389 selected studies, topic modeling analysis identified 3 primary topics: (1) Patient-Physician Relationship and Shared Decision-Making, (2) Patient Empowerment and Education Strategies, and (3) Health Care Systems and Health IT Implementations. Trend analysis further indicated their frequency and prominence in health communication from 1999 to 2023. Detailed examinations were conducted using secondary terms, including trust, health IT, patient-physician relationship, and patient empowerment, derived from the main topics. These terms clarified the collective impact on improving health communication dynamics. The synthesis of the role of health IT in health communication models underscores its critical role in shaping patient-centered health care frameworks. Conclusions: This review highlights the significant contributions of key topics that should be thoroughly investigated and integrated into health communication models in the digital age. While health IT plays an essential role in promoting shared decision-making and patient empowerment, challenges such as usability, privacy concerns, and digital literacy remain significant barriers. Future research should prioritize evaluating these key themes and addressing the challenges associated with health IT in health communication models. Additionally, exploring how emerging technologies, such as artificial intelligence, can support these goals may provide valuable insights for enhancing health communication. %M 39819592 %R 10.2196/60512 %U https://www.jmir.org/2025/1/e60512 %U https://doi.org/10.2196/60512 %U http://www.ncbi.nlm.nih.gov/pubmed/39819592 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59111 %T From Theory to Practice: Viewpoint on Economic Indicators for Trust in Digital Health %A Gille,Felix %A Maaß,Laura %A Ho,Benjamin %A Srivastava,Divya %+ University of Zurich, Digital Society Initiative, Rämistrasse 69, Zurich, 8001, Switzerland, 41 44635 7133, felix.gille@uzh.ch %K trust %K economics %K digital health %K digital health innovation %K artificial intelligence %K AI %K economic evaluation %K public trust %K health data %K medical apps %D 2025 %7 15.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X User trust is pivotal for the adoption of digital health systems interventions (DHI). In response, numerous trust-building guidelines have recently emerged targeting DHIs such as artificial intelligence. The common aim of these guidelines aimed at private sector actors and government policy makers is to build trustworthy DHI. While these guidelines provide some indication of what trustworthiness is, the guidelines typically only define trust and trustworthiness in broad terms, they rarely offer guidance about economic considerations that would allow implementers to measure and balance trade-offs between costs and benefits. These considerations are important when deciding how best to allocate scarce resources (eg, financial capital, workforce, or time). The missing focus on economics undermines the potential usefulness of such guidelines. We propose the development of actionable trust-performance-indicators (including but not limited to surveys) to gather evidence on the cost-effectiveness of trust-building principles as a crucial step for successful implementation. Furthermore, we offer guidance on navigating the conceptual complexity surrounding trust and on how to sharpen the trust discourse. Successful implementation of economic considerations is critical to successfully build user trust in DHI. %M 39813672 %R 10.2196/59111 %U https://www.jmir.org/2025/1/e59111 %U https://doi.org/10.2196/59111 %U http://www.ncbi.nlm.nih.gov/pubmed/39813672 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e54152 %T Evaluation of an Interdisciplinary Educational Program to Foster Learning Health Systems: Education Evaluation %A Dushyanthen,Sathana %A Zamri,Nadia Izzati %A Chapman,Wendy %A Capurro,Daniel %A Lyons,Kayley %K continuing professional development %K learning health system %K flipped classroom %K digital health informatics %K data science %K health professions education %K interdisciplinary education %K foster %K foster learning %K health data %K design %K innovative %K innovative solution %K health care workforce %K Australia %K real time %K teaching model %D 2025 %7 14.1.2025 %9 %J JMIR Med Educ %G English %X Background: Learning health systems (LHS) have the potential to use health data in real time through rapid and continuous cycles of data interrogation, implementing insights to practice, feedback, and practice change. However, there is a lack of an appropriately skilled interprofessional informatics workforce that can leverage knowledge to design innovative solutions. Therefore, there is a need to develop tailored professional development training in digital health, to foster skilled interprofessional learning communities in the health care workforce in Australia. Objective: This study aimed to explore participants’ experiences and perspectives of participating in an interprofessional education program over 13 weeks. The evaluation also aimed to assess the benefits, barriers, and opportunities for improvements and identify future applications of the course materials. Methods: We developed a wholly online short course open to interdisciplinary professionals working in digital health in the health care sector. In a flipped classroom model, participants (n=400) undertook 2 hours of preclass learning online and then attended 2.5 hours of live synchronous learning in interactive weekly Zoom workshops for 13 weeks. Throughout the course, they collaborated in small, simulated learning communities (n=5 to 8), engaging in various activities and problem-solving exercises, contributing their unique perspectives and diverse expertise. The course covered a number of topics including background on LHS, establishing learning communities, the design thinking process, data preparation and machine learning analysis, process modeling, clinical decision support, remote patient monitoring, evaluation, implementation, and digital transformation. To evaluate the purpose of the program, we undertook a mixed methods evaluation consisting of pre- and postsurveys rating scales for usefulness, engagement, value, and applicability for various aspects of the course. Participants also completed identical measures of self-efficacy before and after (n=200), with scales mapped to specific skills and tasks that should have been achievable following each of the topics covered. Further, they undertook voluntary weekly surveys to provide feedback on which aspects to continue and recommendations for improvements, via free-text responses. Results: From the evaluation, it was evident that participants found the teaching model engaging, useful, valuable, and applicable to their work. In the self-efficacy component, we observed a significant increase (P<.001) in perceived confidence for all topics, when comparing pre- and postcourse ratings. Overall, it was evident that the program gave participants a framework to organize their knowledge and a common understanding and shared language to converse with other disciplines, changed the way they perceived their role and the possibilities of data and technologies, and provided a toolkit through the LHS framework that they could apply in their workplaces. Conclusions: We present a program to educate the health workforce on integrating the LHS model into standard practice. Interprofessional collaborative learning was a major component of the value of the program. This evaluation shed light on the multifaceted challenges and expectations of individuals embarking on a digital health program. Understanding the barriers and facilitators of the audience is crucial for creating an inclusive and supportive learning environment. Addressing these challenges will not only enhance participant engagement but also contribute to the overall success of the program and, by extension, the broader integration of digital health solutions into health care practice and, ultimately, patient outcomes. %R 10.2196/54152 %U https://mededu.jmir.org/2025/1/e54152 %U https://doi.org/10.2196/54152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e50852 %T AI Interventions to Alleviate Healthcare Shortages and Enhance Work Conditions in Critical Care: Qualitative Analysis %A Bienefeld,Nadine %A Keller,Emanuela %A Grote,Gudela %+ ETH Zurich, Weinbergstrasse 56/58, Zurich, 8093, Switzerland, 41 44 632 70 78, nbienefeld@ethz.ch %K artificial intelligence %K AI %K work design %K sociotechnical system %K work %K job %K occupational health %K sociotechnical %K new work %K future of work %K satisfaction %K health care professionals %K intensive care %K ICU %K stress mitigation %K worker %K employee %K stress %K health care professional %K overburdened %K burden %K burnout %K autonomy %K competence %K flexible %K task %K workplace %K hospital %D 2025 %7 13.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The escalating global scarcity of skilled health care professionals is a critical concern, further exacerbated by rising stress levels and clinician burnout rates. Artificial intelligence (AI) has surfaced as a potential resource to alleviate these challenges. Nevertheless, it is not taken for granted that AI will inevitably augment human performance, as ill-designed systems may inadvertently impose new burdens on health care workers, and implementation may be challenging. An in-depth understanding of how AI can effectively enhance rather than impair work conditions is therefore needed. Objective: This research investigates the efficacy of AI in alleviating stress and enriching work conditions, using intensive care units (ICUs) as a case study. Through a sociotechnical system lens, we delineate how AI systems, tasks, and responsibilities of ICU nurses and physicians can be co-designed to foster motivating, resilient, and health-promoting work. Methods: We use the sociotechnical system framework COMPASS (Complementary Analysis of Sociotechnical Systems) to assess 5 job characteristics: autonomy, skill diversity, flexibility, problem-solving opportunities, and task variety. The qualitative analysis is underpinned by extensive workplace observation in 6 ICUs (approximately 559 nurses and physicians), structured interviews with work unit leaders (n=12), and a comparative analysis of data science experts’ and clinicians’ evaluation of the optimal levels of human-AI teaming. Results: The results indicate that AI holds the potential to positively impact work conditions for ICU nurses and physicians in four key areas. First, autonomy is vital for stress reduction, motivation, and performance improvement. AI systems that ensure transparency, predictability, and human control can reinforce or amplify autonomy. Second, AI can encourage skill diversity and competence development, thus empowering clinicians to broaden their skills, increase the polyvalence of tasks across professional boundaries, and improve interprofessional cooperation. However, careful consideration is required to avoid the deskilling of experienced professionals. Third, AI automation can expand flexibility by relieving clinicians from administrative duties, thereby concentrating their efforts on patient care. Remote monitoring and improved scheduling can help integrate work with other life domains. Fourth, while AI may reduce problem-solving opportunities in certain areas, it can open new pathways, particularly for nurses. Finally, task identity and variety are essential job characteristics for intrinsic motivation and worker engagement but could be compromised depending on how AI tools are designed and implemented. Conclusions: This study demonstrates AI’s capacity to mitigate stress and improve work conditions for ICU nurses and physicians, thereby contributing to resolving health care staffing shortages. AI solutions that are thoughtfully designed in line with the principles for good work design can enhance intrinsic motivation, learning, and worker well-being, thus providing strategic value for hospital management, policy makers, and health care professionals alike. %M 39805110 %R 10.2196/50852 %U https://www.jmir.org/2025/1/e50852 %U https://doi.org/10.2196/50852 %U http://www.ncbi.nlm.nih.gov/pubmed/39805110 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59601 %T The CeHRes Roadmap 2.0: Update of a Holistic Framework for Development, Implementation, and Evaluation of eHealth Technologies %A Kip,Hanneke %A Beerlage-de Jong,Nienke %A van Gemert-Pijnen,Lisette J E W C %A Kelders,Saskia M %+ Section of Psychology, Health & Technology, Centre for eHealth and Wellbeing, University of Twente, Drienerlolaan 5, Enschede, 7522, Netherlands, 31 534896536, h.kip@utwente.nl %K eHealth development %K eHealth implementation %K CeHRes Roadmap %K participatory development %K human-centered design %K persuasive design %K eHealth framework %D 2025 %7 13.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X To ensure that an eHealth technology fits with its intended users, other stakeholders, and the context within which it will be used, thorough development, implementation, and evaluation processes are necessary. The CeHRes (Centre for eHealth and Wellbeing Research) Roadmap is a framework that can help shape these processes. While it has been successfully used in research and practice, new developments and insights have arisen since the Roadmap’s first publication in 2011, not only within the domain of eHealth but also within the different disciplines in which the Roadmap is grounded. Because of these new developments and insights, a revision of the Roadmap was imperative. This paper aims to present the updated pillars and phases of the CeHRes Roadmap 2.0. The Roadmap was updated based on four types of sources: (1) experiences with its application in research; (2) literature reviews on eHealth development, implementation, and evaluation; (3) discussions with eHealth researchers; and (4) new insights and updates from relevant frameworks and theories. The updated pillars state that eHealth development, implementation, and evaluation (1) are ongoing and intertwined processes; (2) have a holistic approach in which context, people, and technology are intertwined; (3) consist of continuous evaluation cycles; (4) require active stakeholder involvement from the start; and (5) are based on interdisciplinary collaboration. The CeHRes Roadmap 2.0 consists of 5 interrelated phases, of which the first is the contextual inquiry, in which an overview of the involved stakeholders, the current situation, and points of improvement is created. The findings from the contextual inquiry are specified in the value specification, in which the foundation for the to-be-developed eHealth technology is created by formulating values and requirements, preliminarily selecting behavior change techniques and persuasive features, and initiating a business model. In the Design phase, the requirements are translated into several lo-fi and hi-fi prototypes that are iteratively tested with end users and other stakeholders. A version of the technology is rolled out in the Operationalization phase, using the business model and an implementation plan. In the Summative Evaluation phase, the impact, uptake, and working mechanisms are evaluated using a multimethod approach. All phases are interrelated by continuous formative evaluation cycles that ensure coherence between outcomes of phases and alignment with stakeholder needs. While the CeHRes Roadmap 2.0 consists of the same phases as the first version, the objectives and pillars have been updated and adapted, reflecting the increased emphasis on behavior change, implementation, and evaluation as a process. There is a need for more empirical studies that apply and reflect on the CeHRes Roadmap 2.0 to provide points of improvement because just as with any eHealth technology, the Roadmap has to be constantly improved based on the input of its users. %M 39805104 %R 10.2196/59601 %U https://www.jmir.org/2025/1/e59601 %U https://doi.org/10.2196/59601 %U http://www.ncbi.nlm.nih.gov/pubmed/39805104 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59027 %T Mapping the Landscape of Digital Health Intervention Strategies: 25-Year Synthesis %A Liu,Shiyu %A Ma,Jingru %A Sun,Meichen %A Zhang,Chao %A Gao,Yujing %A Xu,Jinghong %+ , School of Journalism and Communication, Beijing Normal University, No 19, Xinjiekouwai St, Haidian District, Beijing, China, Beijing, 100875, China, 86 15810320711, 123abctg@163.com %K digital health interventions %K intervention strategies %K behavior change %K mHealth %K eHealth %K randomized controlled trial %D 2025 %7 13.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions have emerged as promising tools to promote health behavior change and improve health outcomes. However, a comprehensive synthesis of strategies contributing to these interventions is lacking. Objective: This study aims to (1) identify and categorize the strategies used in digital health interventions over the past 25 years; (2) explore the differences and changes in these strategies across time periods, countries, populations, delivery methods, and senders; and (3) serve as a valuable reference for future researchers and practitioners to improve the effectiveness of digital health interventions. Methods: This study followed a systematic review approach, complemented by close reading and text coding. A comprehensive search for published English academic papers from PubMed, Web of Science, and Scopus was conducted. The search employed a combination of digital health and intervention-related terms, along with database-specific subject headings and filters. The time span covered 25 years, from January 1, 1999, to March 10, 2024. Sample papers were selected based on study design, intervention details, and strategies. The strategies were identified and categorized based on the principles of Behavior Change Techniques and Behavior Strategies. Results: A total of 885 papers involving 954,847 participants met the eligibility criteria. We identified 173 unique strategies used in digital health interventions, categorized into 19 themes. The 3 most frequently used strategies in the sample papers were “guide” (n=492, 55.6%), “monitor” (n=490, 55.4%), and “communication” (n=392, 44.3%). The number of strategies employed in each paper ranged from 1 to 32. Most interventions targeted clients (n=844, 95.4%) and were carried out in hospitals (n=268, 30.3%). High-income countries demonstrated a substantially higher number and diversity of identified strategies than low- and middle-income countries, and the number of studies targeting the public (n=647, 73.1%) far exceeded those focusing on vulnerable groups (n=238, 26.9%). Conclusions: Digital health interventions and strategies have undergone considerable development over the past 25 years. They have evolved from simple approaches to sophisticated, personalized techniques and are trending toward multifaceted interventions, leveraging advanced technologies for real-time monitoring and feedback. Future studies should focus on rigorous evaluations, long-term effectiveness, and tailored approaches for diverse populations, and more attention should be given to vulnerable groups. %M 39804697 %R 10.2196/59027 %U https://www.jmir.org/2025/1/e59027 %U https://doi.org/10.2196/59027 %U http://www.ncbi.nlm.nih.gov/pubmed/39804697 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e55673 %T Identification of Use Cases, Target Groups, and Motivations Around Adopting Smart Speakers for Health Care and Social Care Settings: Scoping Review %A Merkel,Sebastian %A Schorr,Sabrina %+ Faculty of Social Science, Ruhr University Bochum, GD E1/ 155, Universitätsstraße 150, Bochum, 44801, Germany, 49 0234 32 25411, sebastian.merkel@ruhr-uni-bochum.de %K conversational agents %K smart speaker %K health care %K social care %K digitalization %K scoping review %K mobile phone %D 2025 %7 13.1.2025 %9 Review %J JMIR AI %G English %X Background: Conversational agents (CAs) are finding increasing application in health and social care, not least due to their growing use in the home. Recent developments in artificial intelligence, machine learning, and natural language processing have enabled a variety of new uses for CAs. One type of CA that has received increasing attention recently is smart speakers. Objective: The aim of our study was to identify the use cases, user groups, and settings of smart speakers in health and social care. We also wanted to identify the key motivations for developers and designers to use this particular type of technology. Methods: We conducted a scoping review to provide an overview of the literature on smart speakers in health and social care. The literature search was conducted between February 2023 and March 2023 and included 3 databases (PubMed, Scopus, and Sociological Abstracts), supplemented by Google Scholar. Several keywords were used, including technology (eg, voice assistant), product name (eg, Amazon Alexa), and setting (health care or social care). Publications were included if they met the predefined inclusion criteria: (1) published after 2015 and (2) used a smart speaker in a health care or social care setting. Publications were excluded if they met one of the following criteria: (1) did not report on the specific devices used, (2) did not focus specifically on smart speakers, (3) were systematic reviews and other forms of literature-based publications, and (4) were not published in English. Two reviewers collected, reviewed, abstracted, and analyzed the data using qualitative content analysis. Results: A total of 27 articles were included in the final review. These articles covered a wide range of use cases in different settings, such as private homes, hospitals, long-term care facilities, and outpatient services. The main target group was patients, especially older users, followed by doctors and other medical staff members. Conclusions: The results show that smart speakers have diverse applications in health and social care, addressing different contexts and audiences. Their affordability and easy-to-use interfaces make them attractive to various stakeholders. It seems likely that, due to technical advances in artificial intelligence and the market power of the companies behind the devices, there will be more use cases for smart speakers in the near future. %M 39804689 %R 10.2196/55673 %U https://ai.jmir.org/2025/1/e55673 %U https://doi.org/10.2196/55673 %U http://www.ncbi.nlm.nih.gov/pubmed/39804689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62768 %T The Willingness of Doctors to Adopt Artificial Intelligence–Driven Clinical Decision Support Systems at Different Hospitals in China: Fuzzy Set Qualitative Comparative Analysis of Survey Data %A Yu,Zhongguang %A Hu,Ning %A Zhao,Qiuyi %A Hu,Xiang %A Jia,Cunbo %A Zhang,Chunyu %A Liu,Bing %A Li,Yanping %+ Economics and Management School, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, China, 86 68753084, ypli@whu.edu.cn %K artificial intelligence %K clinical decision support systems %K willingness %K technology adoption %K fuzzy set qualitative comparative analysis %K fsQCA %K pathways %D 2025 %7 7.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence–driven clinical decision support systems (AI-CDSSs) are pivotal tools for doctors to improve diagnostic and treatment processes, as well as improve the efficiency and quality of health care services. However, not all doctors trust artificial intelligence (AI) technology, and many remain skeptical and unwilling to adopt these systems. Objective: This study aimed to explore in depth the factors influencing doctors’ willingness to adopt AI-CDSSs and assess the causal relationships among these factors to gain a better understanding for promoting the clinical application and widespread implementation of these systems. Methods: Based on the unified theory of acceptance and use of technology (UTAUT) and the technology-organization-environment (TOE) framework, we have proposed and designed a framework for doctors’ willingness to adopt AI-CDSSs. We conducted a nationwide questionnaire survey in China and performed fuzzy set qualitative comparative analysis to explore the willingness of doctors to adopt AI-CDSSs in different types of medical institutions and assess the factors influencing their willingness. Results: The survey was administered to doctors working in tertiary hospitals and primary/secondary hospitals across China. We received 450 valid responses out of 578 questionnaires distributed, indicating a robust response rate of 77.9%. Our analysis of the influencing factors and adoption pathways revealed that doctors in tertiary hospitals exhibited 6 distinct pathways for AI-CDSS adoption, which were centered on technology-driven pathways, individual-driven pathways, and technology-individual dual-driven pathways. Doctors in primary/secondary hospitals demonstrated 3 adoption pathways, which were centered on technology-individual and organization-individual dual-driven pathways. There were commonalities in the factors influencing adoption across different medical institutions, such as the positive perception of AI technology’s utility and individual readiness to try new technologies. There were also variations in the influence of facilitating conditions among doctors at different medical institutions, especially primary/secondary hospitals. Conclusions: From the perspective of the 6 pathways for doctors at tertiary hospitals and the 3 pathways for doctors at primary/secondary hospitals, performance expectancy and personal innovativeness were 2 indispensable and core conditions in the pathways to achieving favorable willingness to adopt AI-CDSSs. %M 39773696 %R 10.2196/62768 %U https://www.jmir.org/2025/1/e62768 %U https://doi.org/10.2196/62768 %U http://www.ncbi.nlm.nih.gov/pubmed/39773696 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52601 %T Digital Transformation of Rheumatology Care in Germany: Cross-Sectional National Survey %A May,Susann %A Darkow,Robert %A Knitza,Johannes %A Boy,Katharina %A Klemm,Philipp %A Heinze,Martin %A Vuillerme,Nicolas %A Petit,Pascal %A Steffens-Korbanka,Patricia %A Kladny,Heike %A Hornig,Johannes %A Aries,Peer %A Welcker,Martin %A Muehlensiepen,Felix %+ Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Germany, 49 1636055860, Felix.Muehlensiepen@mhb-fontane.de %K telemedicine %K digital health technologies %K rheumatology %K COVID-19 %K questionnaire %K telehealth %K eHealth %K digital health %K survey %K rheumatism %K Germany %K Europe %K national %K use %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K preference %K correlation %D 2025 %7 6.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, health care has undergone a rapid and unprecedented digital transformation. In many fields of specialty care, such as rheumatology, this shift is driven by the growing number of patients and limited resources, leading to increased use of digital health technologies (DHTs) to maintain high-quality clinical care. Previous studies examined user acceptance of individual DHTs in rheumatology, such as telemedicine, video consultations, and mHealth. However, it is essential to conduct cross-technology and continuous analyses of user acceptance and DHT use to maximize the benefits for all relevant stakeholders. Objective: This study aimed to explore the current acceptance, use, and preferences regarding DHTs among patients in rheumatology care in Germany. Methods: Rheumatology patients from 3 clinics in Germany were surveyed to understand their perspectives on DHTs. The survey included main themes, including acceptance, preferences, COVID-19’s impact, potential, and barriers related to DHTs. The data were analyzed using descriptive statistics and correlation analysis. Results: Out of 337 participants, 53% (179/337) reported using DHTs. Specific technologies included wearables (72/337, 21%), mHealth apps (71/337, 21%), digital therapeutics (32/337, 9%), electronic prescriptions (30/337, 9%), video consultations (15/337, 4%), and at-home blood self-sampling (3/337, 1%). Nearly two-thirds (220/337, 65%) found DHTs useful, and 69% (233/337) held a generally positive attitude toward DHTs. Attitudes shifted positively during the COVID-19 pandemic for 40% (135/337) of participants. Higher education was more prevalent among DHT users (114/179, 63.7%) compared with nonusers (42/151, 27.8%; P=.02). The main potential benefits identified were location-independent use (244/337, 72%) and time-independent use (216/337, 64%). Key barriers included insufficient user knowledge (165/337, 49%) and limited information on DHTs (134/337, 40%). Conclusions: Patient acceptance and use of DHTs in rheumatology is increasing in Germany. A prospective, standardized monitoring of digital transformation in rheumatology care is highly needed. %M 39761546 %R 10.2196/52601 %U https://www.jmir.org/2025/1/e52601 %U https://doi.org/10.2196/52601 %U http://www.ncbi.nlm.nih.gov/pubmed/39761546 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e54975 %T Effectiveness of Outpatient Chronic Pain Management for Middle-Aged Patients by Internet Hospitals: Retrospective Cohort Study %A Sang,Ling %A Zheng,Bixin %A Zeng,Xianzheng %A Liu,Huizhen %A Jiang,Qing %A Liu,Maotong %A Zhu,Chenyu %A Wang,Maoying %A Yi,Zengwei %A Song,Keyu %A Song,Li %K chronic pain management %K internet hospital %K physical hospital %K quality of life %K outpatient care %K telemedicine %K digital health %D 2024 %7 30.12.2024 %9 %J JMIR Med Inform %G English %X Background: Chronic pain is widespread and carries a heavy disease burden, and there is a lack of effective outpatient pain management. As an emerging internet medical platform in China, internet hospitals have been successfully applied for the management of chronic diseases. There are also a certain number of patients with chronic pain that use internet hospitals for pain management. However, no studies have investigated the effectiveness of pain management via internet hospitals. Objective: The aim of this retrospective cohort study was to explore the effectiveness of chronic pain management by internet hospitals and their advantages and disadvantages compared to traditional physical hospital visits. Methods: This was a retrospective cohort study. Demographic information such as the patient’s sex, age, and number of visits was obtained from the IT center. During the first and last patient visits, information on outcome variables such as the Brief Pain Inventory (BPI), medical satisfaction, medical costs, and adverse drug events was obtained through a telephone follow-up. All patients with chronic pain who had 3 or more visits (internet or offline) between September 2021, and February 2023, were included. The patients were divided into an internet hospital group and a physical hospital group, according to whether they had web-based or in-person consultations, respectively. To control for confounding variables, propensity score matching was used to match the two groups. Matching variables included age, sex, diagnosis, and number of clinic visits. Results: A total of 122 people in the internet hospital group and 739 people in the physical hospital group met the inclusion criteria. After propensity score matching, 77 patients in each of the two groups were included in the analysis. There was not a significant difference in the quality of life (QOL; QOL assessment was part of the BPI scale) between the internet hospital group and the physical hospital group (P=.80), but the QOL of both groups of patients improved after pain management (internet hospital group: P<.001; physical hospital group: P=.001). There were no significant differences in the pain relief rate (P=.25) or the incidence of adverse events (P=.60) between the two groups. The total cost (P<.001) and treatment-related cost (P<.001) of the physical hospital group were higher than those of the internet hospital group. In addition, the degree of satisfaction in the internet hospital group was greater than that in the physical hospital group (P=.01). Conclusions: Internet hospitals are an effective way of managing chronic pain. They can improve patients’ QOL and satisfaction, reduce treatment costs, and can be used as part of a multimodal strategy for chronic pain self-management. %R 10.2196/54975 %U https://medinform.jmir.org/2024/1/e54975 %U https://doi.org/10.2196/54975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63054 %T Factors Associated With Digital Capacity for Health Promotion Among Primary Care Workers: Cross-Sectional Survey Study %A Wang,Yining %A Ren,Hui %A Xiao,Shaotan %A Meng,Tian %A Sun,Shuyue %A Yu,Siyu %A Liu,Qing %A Wang,Fan %+ Fudan Development Institute, Fudan University, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K health promotion %K digital capacity %K primary care workers %K Digital Capabilities Framework %K online survey %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health education and promotion are recognized as effective strategies for fostering healthy ageing, reducing the disease burden, and addressing health inequalities, particularly when delivered through digital media. Primary care workers are often regarded as the key providers of these interventions. Despite the strong practical significance and substantial individual demand, the use of digital media for delivering health promotion practices was not widespread in China. One of the main challenges identified is the providers’ inadequate capacities. However, little is known about the digital capacity for health promotion among primary care workers. Objective: This study aimed to investigate the levels of digital capacity for health promotion and its associated factors among community health workers. Methods: A total of 1346 community health workers were recruited from across 47 communities in Shanghai, China, through cluster-stratified random sampling. The digital capacity for health promotion was measured using the revised version of the Digital Capabilities Framework. Web-based questionnaires were distributed to collect data from March 20 to March 29, 2024. Data were analyzed using descriptive statistics, independent t tests, one-way ANOVA, and linear hierarchical regression using Stata MP (version 17.0; StataCorp). Results: We included 1199 participants. Among them, 47.5% (570/1199) had high digital media use for more than 19.6 hours per week, whereas 31.8% (381/1199) demonstrated high digital media trust. The average level of digital capacity for health promotion was 16.71 (SD 2.94) out of 25 points. Demographics, digital media usage–related characteristics, perceived usefulness and usability, attitudes, and behaviors were significant predictors of the capacities, explaining 44.4% of the total variance. Master’s degree or above (β=.077; P=.013), perceived usability (β=.235; P<.001), attitudes toward digital media health promotion (β=.095; P=.002), and past digital media health promotion practices (β=.377; P<.001) had significantly positive associations with digital capacities for health promotion. However, senior (β=–.076; P=.008) or median (β=–.074; P=.01) titles had a significant negative association with capacity levels. Conclusions: A digitally capable workforce is required for primary health care systems to take full advantage of digital media health promotion. Therefore, solutions are necessary to achieve enhanced capacities among health professionals, including public health policy making, community empowerment, and individual practices. %M 39705686 %R 10.2196/63054 %U https://www.jmir.org/2024/1/e63054 %U https://doi.org/10.2196/63054 %U http://www.ncbi.nlm.nih.gov/pubmed/39705686 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e63710 %T Enhancing Standardized and Structured Recording by Elderly Care Physicians for Reusing Electronic Health Record Data: Interview Study %A Albers,Charlotte A W %A Wieland-Jorna,Yvonne %A de Bruijne,Martine C %A Smalbrugge,Martin %A Joling,Karlijn J %A de Boer,Marike E %+ Department of Medicine for Older People, Location Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 615867548, c.a.w.albers@amsterdamumc.nl %K electronic health records %K health information interoperability %K health information exchange %K reference standards %K long-term care %K nursing homes %K medical records %K attitude of health personnel %K qualitative research %K digital health %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Elderly care physicians (ECPs) in nursing homes document patients’ health, medical conditions, and the care provided in electronic health records (EHRs). However, much of these health data currently lack structure and standardization, limiting their potential for health information exchange across care providers and reuse for quality improvement, policy development, and scientific research. Enhancing this potential requires insight into the attitudes and behaviors of ECPs toward standardized and structured recording in EHRs. Objective: This study aims to answer why and how ECPs record their findings in EHRs and what factors influence them to record in a standardized and structured manner. The findings will be used to formulate recommendations aimed at enhancing standardized and structured data recording for the reuse of EHR data. Methods: Semistructured interviews were conducted with 13 ECPs working in Dutch nursing homes. We recruited participants through purposive sampling, aiming for diversity in age, gender, health care organization, and use of EHR systems. Interviews continued until we reached data saturation. Analysis was performed using inductive thematic analysis. Results: ECPs primarily use EHRs to document daily patient care, ensure continuity of care, and fulfill their obligation to record specific information for accountability purposes. The EHR serves as a record to justify their actions in the event of a complaint. In addition, some respondents also mentioned recording information for secondary purposes, such as research and quality improvement. Several factors were found to influence standardized and structured recording. At a personal level, it is crucial to experience the added value of standardized and structured recording. At the organizational level, clear internal guidelines and a focus on their implementation can have a substantial impact. At the level of the EHR system, user-friendliness, interoperability, and guidance were most frequently mentioned as being important. At a national level, the alignment of internal guidelines with overarching standards plays a pivotal role in encouraging standardized and structured recording. Conclusions: The results of our study are similar to the findings of previous research in hospital care and general practice. Therefore, long-term care can learn from solutions regarding standardized and structured recording in other health care sectors. The main motives for ECPs to record in EHRs are the daily patient care and ensuring continuity of care. Standardized and structured recording can be improved by aligning the recording method in EHRs with the primary care process. In addition, there are incentives for motivating ECPs to record in a standardized and structured way, mainly at the personal, organizational, EHR system, and national levels. %M 39671580 %R 10.2196/63710 %U https://medinform.jmir.org/2024/1/e63710 %U https://doi.org/10.2196/63710 %U http://www.ncbi.nlm.nih.gov/pubmed/39671580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60473 %T Success Factors of Growth-Stage Digital Health Companies: Systematic Literature Review %A Pfitzer,Estelle %A Bitomsky,Laura %A Nißen,Marcia %A Kausch,Christoph %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Institute for Implementation Science in Health Care, University of Zurich, Universitätstr. 84, Zurich, 8006, Switzerland, 41 71 224 72 44, tobias.kowatsch@uzh.ch %K digital health %K health information technology %K success factors %K systematic literature review %K growth-stage companies %K clinical softwares %K EHR %K electronic health records %K health companies %K funding %K digital therapeutics %K substance use disorder %K stakeholders %D 2024 %7 11.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Over the past decade, digital health technologies (DHTs) have grown rapidly, driven by innovations such as electronic health records and accelerated by the COVID-19 pandemic. Increased funding and regulatory support have further pushed the sector’s expansion. Despite early success, many DHT companies struggle to scale, with notable examples like Pear Therapeutics and Proteus Digital Health, which both declared bankruptcy after initial breakthroughs. These cases highlight the challenges of sustaining growth in a highly regulated health care environment. While there is research on success factors across industries, a gap remains in understanding the specific challenges faced by growth-stage DHT companies. Objective: This study aims to identify and discuss key factors that make growth-stage DHT companies successful. Specifically, we address three questions: (1) What are the success factors of growth-stage digital companies in general and (2) digital health companies in particular? (3) How do these success factors vary across DHTs? Methods: Following established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature review was conducted to answer the questions. A comprehensive literature search was conducted using management and medical literature databases: EBSCO, ProQuest, PubMed, Scopus, and Web of Science. The review spanned scientific articles published from 2000 to 2023, using a rigorous screening process and quality assessment using the Critical Appraisal Skills Programme (CASP) checklist. Results: From the 2972 studies initially screened, 36 were selected, revealing 52 success factors. We categorized them into internal factor categories (Product and Services, Operations, Business Models, and Team Composition) and external factor categories (Customers, Health Care System, Government and Regulators, Investors and Shareholders, Suppliers and Partners, and Competitors). Of the 52 factors, 19 were specific to DHT companies. The most frequently cited internal success factors included financial viability (n=18) and market demand and relevance of the product and service (n=13). External success factors emphasized the regulatory environment and policy framework (n=15). Key differences were observed between DHTs and broader digital companies in areas such as data security (P=.03), system interoperability (P=.01), and regulatory alignment (P=.02), with DHTs showing a higher frequency of these factors. In addition, success factors varied across different DHT categories. Health System Operational Software companies emphasized affordability and system integration, while Digital Therapeutics prioritized factors related to government regulations and regulatory approval. Conclusions: Essential characteristics contributing to the success of growth-stage digital health companies have been identified. This work, therefore, fills a knowledge gap and provides relevant stakeholders, including investors and entrepreneurs, with a valuable resource that can support informed decision-making in investment decisions and, in turn, enhance the success of fast-growing digital health companies. In addition, it provides the research community with a direction for future studies, enhancing the understanding, implementation, and growth of DHTs. International Registered Report Identifier (IRRID): RR2-10.1101/2024.05.06.24306674 %M 39661978 %R 10.2196/60473 %U https://www.jmir.org/2024/1/e60473 %U https://doi.org/10.2196/60473 %U http://www.ncbi.nlm.nih.gov/pubmed/39661978 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54636 %T Psychological Factors That Contribute to the Use of Video Consultations in Health Care: Systematic Review %A Haydon,Helen M %A Fowler,James A %A Taylor,Monica L %A Smith,Anthony C %A Caffery,Liam J %+ Centre for Online Health, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, Woolloongabba, 4102, Australia, 61 7 3176 4462, h.haydon@uq.edu.au %K telehealth %K video consultations %K psychological factors %K health professionals %K health services research %K psychological %K video %K systematic review %K review %K barriers %K engagement %K health services %K cognitive %K consultations %K psychological barrier %D 2024 %7 11.12.2024 %9 Review %J J Med Internet Res %G English %X Background: There are numerous benefits to delivering care via video consultations (VCs). Yet, the willingness of health care professionals (HCPs) to use video as a modality of care is one of the greatest barriers to its adoption. Decisions regarding whether to use video may be based on assumptions and concerns that are not necessarily borne of evidence. To effectively address psychological barriers to VC, it is essential to gain a better understanding of specific factors (eg, attitudes, beliefs, and emotions) that influence HCPs’ VC use. Objective: This study’s aim was to conduct a systematic literature review of psychological factors in HCPs that impair or promote VC use. Methods: Databases were searched in February 2023 for peer-reviewed primary research papers on VCs that discussed psychological factors of health professionals affecting the use of video to deliver health services. A psychological factor was defined as an intraindividual influence related to, or in reaction to, VC use—in this case, the individual being an HCP. Search terms included variations on “telehealth,” “clinician,” and psychological factors (eg, attitude and beliefs) in combination. Peer-reviewed papers of all methodological approaches were included if they were in an Australian setting and the full text was available in English. Studies where the main intervention was another digital health modality (eg, remote monitoring and telephone) were excluded. Studies were also excluded if they only reported on extrinsic factors (eg, environmental or economic). Information extracted included author, year, medical specialty, psychological component mentioned, explanation as to why the psychological factor was related to VC use, and exemplar quotes from the paper that correspond to a psychological component. Each extracted psychological factor was classified as a positive, negative, ambivalent, or neutral perspective on VC, and a thematic analysis then generated the factors and themes. Theories of behavior were considered and discussed to help frame the interaction between themes. Results: From 4592 studies, data were extracted from 90 peer-reviewed papers. Cognitive and emotional motivators and inhibitors, such as emotional responses, self-efficacy, attitudes, and perceived impact on the clinician as a professional, all interact to influence HCP engagement in VCs. These factors were complex and impacted upon one another. A cyclical relationship between these factors and intention to engage in VCs and actual use of VCs was found. These findings were used to form the psychological attributes of VC engagement (PAVE) model. Evidence suggests that HCPs fall within 4 key user categories based on the amount of cognitive and practical effort needed to deliver VCs. Conclusions: Although further research is needed to validate the current findings, this study provides opportunity for more targeted interventions that address psychological factors impeding effective use of VCs. %M 39661977 %R 10.2196/54636 %U https://www.jmir.org/2024/1/e54636 %U https://doi.org/10.2196/54636 %U http://www.ncbi.nlm.nih.gov/pubmed/39661977 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e59828 %T Development, Implementation, and Evaluation Methods for Dashboards in Health Care: Scoping Review %A Helminski,Danielle %A Sussman,Jeremy B %A Pfeiffer,Paul N %A Kokaly,Alex N %A Ranusch,Allison %A Renji,Anjana Deep %A Damschroder,Laura J %A Landis-Lewis,Zach %A Kurlander,Jacob E %K dashboard %K medical informatics %K quality improvement %K electronic health record %K scoping review %K monitoring %K health care system %K patient care %K clinical research %K emergency department %K inpatient %K clinical management %D 2024 %7 10.12.2024 %9 %J JMIR Med Inform %G English %X Background: Dashboards have become ubiquitous in health care settings, but to achieve their goals, they must be developed, implemented, and evaluated using methods that help ensure they meet the needs of end users and are suited to the barriers and facilitators of the local context. Objective: This scoping review aimed to explore published literature on health care dashboards to characterize the methods used to identify factors affecting uptake, strategies used to increase dashboard uptake, and evaluation methods, as well as dashboard characteristics and context. Methods: MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from inception through July 2020. Studies were included if they described the development or evaluation of a health care dashboard with publication from 2018‐2020. Clinical setting, purpose (categorized as clinical, administrative, or both), end user, design characteristics, methods used to identify factors affecting uptake, strategies to increase uptake, and evaluation methods were extracted. Results: From 116 publications, we extracted data for 118 dashboards. Inpatient (45/118, 38.1%) and outpatient (42/118, 35.6%) settings were most common. Most dashboards had ≥2 stated purposes (84/118, 71.2%); of these, 54 of 118 (45.8%) were administrative, 43 of 118 (36.4%) were clinical, and 20 of 118 (16.9%) had both purposes. Most dashboards included frontline clinical staff as end users (97/118, 82.2%). To identify factors affecting dashboard uptake, half involved end users in the design process (59/118, 50%); fewer described formative usability testing (26/118, 22%) or use of any theory or framework to guide development, implementation, or evaluation (24/118, 20.3%). The most common strategies used to increase uptake included education (60/118, 50.8%); audit and feedback (59/118, 50%); and advisory boards (54/118, 45.8%). Evaluations of dashboards (84/118, 71.2%) were mostly quantitative (60/118, 50.8%), with fewer using only qualitative methods (6/118, 5.1%) or a combination of quantitative and qualitative methods (18/118, 15.2%). Conclusions: Most dashboards forego steps during development to ensure they suit the needs of end users and the clinical context; qualitative evaluation—which can provide insight into ways to improve dashboard effectiveness—is uncommon. Education and audit and feedback are frequently used to increase uptake. These findings illustrate the need for promulgation of best practices in dashboard development and will be useful to dashboard planners. International Registered Report Identifier (IRRID): RR2-10.2196/34894 %R 10.2196/59828 %U https://medinform.jmir.org/2024/1/e59828 %U https://doi.org/10.2196/59828 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63355 %T The Implementation Outcomes and Population Impact of a Statewide IT Deployment for Family Caregivers: Mixed Methods Study %A Tonkikh,Orly %A Young,Heather M %A Bell,Janice F %A Famula,Jessica %A Whitney,Robin %A Mongoven,Jennifer %A Kelly,Kathleen %+ Betty Irene Moore School of Nursing, University of California Davis, 2570 48th Street, Sacramento, CA, 95817, United States, 1 9167342145, hmyoung@ucdavis.edu %K web-based assessment %K caregiver %K technology implementation %K Consolidated Framework for Implementation Research %K CFIR %K information technology %K IT %K family caregivers %K eHealth %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers. Objective: This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers. Methods: The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics. Results: We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being. Conclusions: This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact. %M 39657176 %R 10.2196/63355 %U https://aging.jmir.org/2024/1/e63355 %U https://doi.org/10.2196/63355 %U http://www.ncbi.nlm.nih.gov/pubmed/39657176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45763 %T Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study %A Huang,Xuan %A Wang,Ying %A Yang,Xixian %A Jiang,Ruo %A Liu,Yicheng %A Wang,Hui %+ Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China, 86 21 24058249, wangh2005@alumni.sjtu.edu.cn %K mobile health technology %K smartphones %K mobile phone %K internet hospital %K China %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China’s Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. %M 39631758 %R 10.2196/45763 %U https://formative.jmir.org/2024/1/e45763 %U https://doi.org/10.2196/45763 %U http://www.ncbi.nlm.nih.gov/pubmed/39631758 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53834 %T Patients’ and Clinicians’ Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study %A McCann,Lisa %A Lewis,Liane %A Oduntan,Olubukola %A Harris,Jenny %A Darley,Andrew %A Berg,Geir V %A Lubowitzki,Simone %A Cheevers,Katy %A Miller,Morven %A Armes,Jo %A Ream,Emma %A Fox,Patricia %A Furlong,Eileen Patricia %A Gaiger,Alexander %A Kotronoulas,Grigorios %A Patiraki,Elisabeth %A Katsaragakis,Stylianos %A McCrone,Paul %A Miaskowski,Christine %A Cardone,Antonella %A Orr,Dawn %A Flowerday,Adrian %A Skene,Simon %A Moore,Margaret %A De Souza,Nicosha %A Donnan,Peter %A Maguire,Roma %+ Digital Health and Wellness Group (DHaWG), Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 +441415483587, lisa.mccann@strath.ac.uk %K cancer %K clinician experiences %K digital interventions %K patient experiences %K remote monitoring %K qualitative methods %D 2024 %7 3.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention—Advanced Symptom Management System (ASyMS)—after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients’ and clinicians’ experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients’ experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients’ and clinicians’ experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients’ and clinicians’ experiences using ASyMS. One central orienting theme—ASyMS as a facilitator of change—was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is “normal” and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients’ and clinicians’ experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients’ and clinicians’ perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 %M 39626227 %R 10.2196/53834 %U https://www.jmir.org/2024/1/e53834 %U https://doi.org/10.2196/53834 %U http://www.ncbi.nlm.nih.gov/pubmed/39626227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58007 %T A Cross-Disciplinary Analysis of the Complexities of Scaling Up eHealth Innovation %A Allers,Sanne %A Carboni,Chiara %A Eijkenaar,Frank %A Wehrens,Rik %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester van Oudlaan 50, Rotterdam, 3062PA, Netherlands, 31 104081213, allers@eshpm.eur.nl %K innovation %K eHealth %K remote patient monitoring %K scale-up %K cross-disciplinary %K qualitative case study %K health care systems %K adaptation %K complexity %K health care %K framework %K ecological perspective %K barriers and facilitators %D 2024 %7 2.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X Innovative eHealth technologies are becoming increasingly common worldwide, with researchers and policy makers advocating their scale-up within and across health care systems. However, examples of successful scale-up remain extremely rare. Although this issue is widely acknowledged, there is still only a limited understanding of why scaling up eHealth technologies is so challenging. This article aims to contribute to a better understanding of the complexities innovators encounter when attempting to scale up eHealth technologies and their strategies for addressing these complexities. We draw on different theoretical perspectives as well as the findings of an interview-based case study of a prominent remote patient monitoring (RPM) innovation in the Netherlands. Specifically, we create a cross-disciplinary theoretical framework bringing together 3 perspectives on scale-up: a structural perspective (focusing on structural barriers and facilitators), an ecological perspective (focusing on local complexities), and a critical perspective (focusing on mutual adaptation between innovation and setting). We then mobilize these perspectives to analyze how various stakeholders (n=14) experienced efforts to scale up RPM technology. We provide 2 key insights: (1) the complexities and strategies associated with local eHealth scale-up are disconnected from those that actors encounter at a broader level scale-up, and this translates into a simultaneous need for stability and malleability, which catches stakeholders in an impasse, and (2) pre-existing circumstances and associated path dependencies shape the complexities of the local context and facilitate or constrain opportunities for the scale-up of eHealth innovation. The 3 theoretical perspectives used in this article, with their diverging assumptions about innovation scale-up, should be viewed as complementary and highlight different aspects of the complexities perceived as playing an important role. Using these perspectives, we conclude that the level at which scale-up is envisaged and the pre-existing local circumstances (2 factors whose importance is often neglected) contribute to an impasse in the scale-up of eHealth innovation at the broader level of scale. %M 39622044 %R 10.2196/58007 %U https://www.jmir.org/2024/1/e58007 %U https://doi.org/10.2196/58007 %U http://www.ncbi.nlm.nih.gov/pubmed/39622044 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e65281 %T Digital Solutions for Health Services and Systems Management: Narrative Review of Certified Software Features in the Brazilian Market %A Bellei,Ericles Andrei %A Domenighi,Pedro Rafael %A Freitas,Carla Maria Dal Sasso %A De Marchi,Ana Carolina Bertoletti %K health services administration %K health information management %K decision support systems %K digital health %K Brazil %K certified software %K features %K systems management %K health services %K interoperability %K digital solutions %D 2024 %7 29.11.2024 %9 %J JMIR Med Inform %G English %X The paper reviews digital solutions for health services management in Brazil, focusing on certified software features. It reveals the integration of various functionalities in operational, financial, and clinical needs simultaneously, which are critical for enhancing operational efficiency and patient care. This study highlights the integration of critical features like interoperability, compliance management, and data-driven decision support, although advancing innovation and integration remains essential for broader impact. %R 10.2196/65281 %U https://medinform.jmir.org/2024/1/e65281 %U https://doi.org/10.2196/65281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53986 %T A Taxonomy and Archetypes of AI-Based Health Care Services: Qualitative Study %A Blaß,Marlene %A Gimpel,Henner %A Karnebogen,Philip %+ FIM Research Center for Information Management, University of Hohenheim, Branch Business & Information Systems Engineering of the Fraunhofer FIT, Schloss Hohenheim 1, Stuttgart, 70599, Germany, 49 0711 459 24051, marlene.blass@fit.fraunhofer.de %K healthcare %K artificial intelligence %K AI %K taxonomy %K services %K cluster analysis %K archetypes %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To cope with the enormous burdens placed on health care systems around the world, from the strains and stresses caused by longer life expectancy to the large-scale emergency relief actions required by pandemics like COVID-19, many health care companies have been using artificial intelligence (AI) to adapt their services. Nevertheless, conceptual insights into how AI has been transforming the health care sector are still few and far between. This study aims to provide an overarching structure with which to classify the various real-world phenomena. A clear and comprehensive taxonomy will provide consensus on AI-based health care service offerings and sharpen the view of their adoption in the health care sector. Objective: The goal of this study is to identify the design characteristics of AI-based health care services. Methods: We propose a multilayered taxonomy created in accordance with an established method of taxonomy development. In doing so, we applied 268 AI-based health care services, conducted a structured literature review, and then evaluated the resulting taxonomy. Finally, we performed a cluster analysis to identify the archetypes of AI-based health care services. Results: We identified 4 critical perspectives: agents, data, AI, and health impact. Furthermore, a cluster analysis yielded 13 archetypes that demonstrate our taxonomy’s applicability. Conclusions: This contribution to conceptual knowledge of AI-based health care services enables researchers as well as practitioners to analyze such services and improve their theory-led design. %M 39602787 %R 10.2196/53986 %U https://www.jmir.org/2024/1/e53986 %U https://doi.org/10.2196/53986 %U http://www.ncbi.nlm.nih.gov/pubmed/39602787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56494 %T The Views and Experiences of Integrated Care System Commissioners About the Adoption and Implementation of Virtual Wards in England: Qualitative Exploration Study %A McGowan,Laura J %A Graham,Fiona %A Lecouturier,Jan %A Goffe,Louis %A Echevarria,Carlos %A Kelly,Michael P %A Sniehotta,Falko F %+ NIHR Policy Research Unit in Behavioural and Social Sciences, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4BN, United Kingdom, 44 191 2083463, laura.mcgowan@newcastle.ac.uk %K virtual wards %K remote monitoring %K whole systems %K qualitative %K implementation science %K integrated care system %K England %K digital technology %K acute care %K clinical practice %K semistructured interviews %K thematic analysis %K patient-centered care %K hospital-centric language %K eHealth %K health services %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees involved in the planning of, agreeing to, and monitoring of services within NHS England and have an important role in the adoption and implementation of VWs in clinical practice. Objective: This study aims to develop an understanding of the acceptability and feasibility of adopting and implementing VWs in England from integrated care system commissioners’ perspectives, including the identification of barriers and facilitators to implementation. Methods: Qualitative semistructured interviews were conducted with 20 commissioners employed by NHS England (NHSE) in various geographic regions of England. Thematic analysis was conducted, structured using the framework approach, and informed by the Consolidated Framework for Implementation Research. The COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines were followed. Results: Four overarching themes were identified reflecting the acceptability and feasibility of key adoption and implementation processes: (1) assessing the need for VWs, (2) coordinating a system approach, (3) agreeing to Program Outcomes: NHSE Versus Organizational Goals, and (4) planning and adapting services. Commissioners expressed the need for system-level change in care provision within the NHS, with VWs perceived as a promising model that could reform patient-centered care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also uncertainty over the extent to which VWs should be technology-enabled, and the specific ways technology may enhance condition-specific pathways. Differing interpretations of the NHSE instructions between different health care sectors and a lack of clarity in definitions, as well as use of hospital-centric language within national guidance, were considered hindrances to convening a system approach. Furthermore, narrow parameters of success measures in terms of goals and outcomes of VWs, unrealistic timescales for planning and delivery, lack of interoperability of technology and time-consuming procurement procedures, liability concerns, and patient suitability for technology-enabled home-based care were identified as barriers to implementation. Motivated and passionate clinical leads were considered key to successful implementation. Conclusions: VWs have the potential to reform patient-centered care in England and were considered a promising approach by commissioners in this study. However, there should be greater clarity over definitions and specifications for technology enablement and evidence provided about how technology can enhance patient care. The use of less hospital-centric language, a greater focus on patient-centered measures of success, and more time allowance to ensure the development of technology-enabled VW services that meet the needs of patients and staff could enhance adoption and implementation. %M 39602216 %R 10.2196/56494 %U https://www.jmir.org/2024/1/e56494 %U https://doi.org/10.2196/56494 %U http://www.ncbi.nlm.nih.gov/pubmed/39602216 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51056 %T Patient Preferences for Direct-to-Consumer Telemedicine Services: Replication and Extension of a Nationwide Survey %A Ivanova,Julia %A Wilczewski,Hattie %A Klocksieben,Farina %A Cummins,Mollie %A Soni,Hiral %A Ong,Triton %A Barrera,Janelle %A Harvey,Jillian %A O'Connell,Nathaniel %A McElligott,James %A Welch,Brandon %A Bunnell,Brian %K telemedicine %K survey %K patient preferences %K direct-to-consumer telemedicine %K patient-provider relationship %K inequity %K consumer %K patient experience %K willingness %K income %K association %K satisfaction %K mobile phone %D 2024 %7 27.11.2024 %9 %J JMIR Hum Factors %G English %X Background: A 2017 survey of patient perspectives showed overall willingness and comfort to use telemedicine, but low actual use. Given recent growth and widespread exposure of patients to telemedicine, patient preferences are likely to have changed. Objective: This study aimed to (1) identify demographic trends in patient preferences and experiences; (2) measure ease of use and satisfaction of telemedicine; and (3) measure changes in telemedicine use, willingness, and comfort since 2017. Methods: We replicated a 2017 study with a nationwide survey of US adults. The survey, an extended version of the previous study, measured patient health care access as well as knowledge, experiences, and preferences regarding telemedicine encounters. We recruited participants using SurveyMonkey Audience in July 2022. We used descriptive statistics and generalized estimating equations to measure change and identify trends. Results: We accrued 4577 complete responses. Patient experience with telemedicine was substantially higher in 2022 than in 2017, with 61.1% (vs 5.3%) of participants aware that their primary care provider offered telemedicine and 34.5% (vs 3.5%) reporting use of telemedicine with their primary care provider. This study also reported ease of use and satisfaction rates to be similar to in-person visits, while overall willingness and comfort in using telemedicine increased from 2017. Individuals at the poverty line were significantly less likely to report satisfaction with telemedicine visits. We found increased interpersonal distance in a patient and health care professional relationship significantly reduced patient ease of use, willingness, and comfort in using telemedicine. Conclusions: This study identified an association between income and patient satisfaction, conveying the importance of understanding telemedicine in relation to health care access and equity. Telemedicine ease of use and satisfaction were comparable to in-person visits. Individuals reported greater use and higher positive perceptions of telemedicine willingness and comfort since 2017. %R 10.2196/51056 %U https://humanfactors.jmir.org/2024/1/e51056 %U https://doi.org/10.2196/51056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62742 %T Assessing the Usability and Effectiveness of an AI-Powered Telehealth Platform: Mixed Methods Study on the Perspectives of Patients and Providers %A Jain,Ekta %A Gupta,Srishti %A Yadav,Vandana %A Kachnowski,Stan %+ Healthcare Innovation and Technology Lab, Lasker Hall, 3960 Broadway, Room 501, New York, NY, 10032, United States, 1 (212) 543 0100, vyadav@hitlab.org %K usability study %K telemedicine %K web platform %K patient-provider feedback %K artificial intelligence %K AI triage %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has revolutionized health care by significantly enhancing accessibility and convenience, yet barriers remain, such as providers’ challenges with technology use. With advancements in telemedicine technologies, understanding the viewpoints of patients and providers is crucial for an effective and acceptable telemedicine service. This study reports the findings on the usability and effectiveness of the HelixVM artificial intelligence powered platform, analyzing key aspetcs like asynchronous health care, access, time efficiency, productivity, data exchange, security, privacy, and quality of care from patient and provider perspectives. Objective: This study aims to assess the usability and effectiveness of the HelixVM marketplace platform. Methods: We recruited 102 patients and 12 providers in a mixed methods study design involving surveys and in-depth structured interviews with a subset of the providers. The survey questionnaires are a modified version of the Telehealth Usability Questionnaire. We analyzed patient data using descriptive statistics and exploratory factor analysis to identify latent demographic patterns. For provider data, we used a deductive thematic analysis approach to identify key themes from the interviews and interpreted overall sentiments of the providers as negative, neutral, or positive. We also calculated percentages of different provider responses from the survey and interviews, where applicable. Results: Overall, 86.3% (88/102) of the patients reported satisfaction with HelixVM, and 89.2% (91/102) indicated that they would use the services again. A total of 91.1% (93/102) of the patients agreed that HelixVM improves access to health care and is an acceptable way to receive health care, and 98% (100/102) agreed it saves time. Chi-square tests demonstrated statistical significance for all survey questions (P<.001). The results from factor analysis show a higher propensity of middle-aged women, who had a fast-track encounter type, who self-reported a medium level of technology savviness, and who are residing in the South region of the United States rating the platform more positively. With regard to the providers, the thematic analysis identified themes of asynchronous medicine in terms of the accessibility and quality of care, time and productivity, integration within the workflow, data exchange, and artificial intelligence triage. Certain challenges regarding incomplete data in patient charts and its impact on provider time were cited. Suggestions for improvements included options to ensure the completeness of patient charts and better screening to ensure that only asynchronous, qualified patients are able to reach the provider. Conclusions: Overall, our study findings indicate a positive experience for patients and providers. The use of fast-track prescription was considered favorable compared to traditional telemedicine. Some concerns on data completeness, gaps, and accuracy exist. Suggestions are provided for improvement. This study adds to the knowledge base of existing literature and provides a detailed analysis of the real-world implementation of a telemedicine market-place platform. %M 39418632 %R 10.2196/62742 %U https://formative.jmir.org/2024/1/e62742 %U https://doi.org/10.2196/62742 %U http://www.ncbi.nlm.nih.gov/pubmed/39418632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55897 %T Implementation of Machine Learning Applications in Health Care Organizations: Systematic Review of Empirical Studies %A Preti,Luigi M %A Ardito,Vittoria %A Compagni,Amelia %A Petracca,Francesco %A Cappellaro,Giulia %+ Department of Social and Political Sciences, Bocconi University, Via Sarfatti 25, Milan, 20136, Italy, 39 02 58365267, giulia.cappellaro@unibocconi.it %K artificial intelligence %K machine learning %K implementation %K health care organization %K barriers %K facilitators %D 2024 %7 25.11.2024 %9 Review %J J Med Internet Res %G English %X Background: There is a growing enthusiasm for machine learning (ML) among academics and health care practitioners. Despite the transformative potential of ML-based applications for patient care, their uptake and implementation in health care organizations are sporadic. Numerous challenges currently impede or delay the widespread implementation of ML in clinical practice, and limited knowledge is available regarding how these challenges have been addressed. Objective: This work aimed to (1) examine the characteristics of ML-based applications and the implementation process in clinical practice, using the Consolidated Framework for Implementation Research (CFIR) for theoretical guidance and (2) synthesize the strategies adopted by health care organizations to foster successful implementation of ML. Methods: A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted in PubMed, Scopus, and Web of Science over a 10-year period (2013-2023). The search strategy was built around 4 blocks of keywords (artificial intelligence, implementation, health care, and study type). Only empirical studies documenting the implementation of ML applications in clinical settings were considered. The implementation process was investigated using a thematic analysis and coding procedure. Results: Thirty-four studies were selected for data synthesis. Selected papers were relatively recent, with only 9% (3/34) of records published before 2019. ML-based applications were implemented mostly within hospitals (29/34, 85%). In terms of clinical workflow, ML-based applications supported mostly prognosis (20/34, 59%) and diagnosis (10/34, 29%). The implementation efforts were analyzed using CFIR domains. As for the inner setting domain, access to knowledge and information (12/34, 35%), information technology infrastructure (11/34, 32%), and organizational culture (9/34, 26%) were among the most observed dimensions influencing the success of implementation. As for the ML innovation itself, factors deemed relevant were its design (15/34, 44%), the relative advantage with respect to existing clinical practice (14/34, 41%), and perceived complexity (14/34, 41%). As for the other domains (ie, processes, roles, and outer setting), stakeholder engagement (12/34, 35%), reflecting and evaluating practices (11/34, 32%), and the presence of implementation leaders (9/34, 26%) were the main factors identified as important. Conclusions: This review sheds some light on the factors that are relevant and that should be accounted for in the implementation process of ML-based applications in health care. While the relevance of ML-specific dimensions, like trust, emerges clearly across several implementation domains, the evidence from this review highlighted that relevant implementation factors are not necessarily specific for ML but rather transversal for digital health technologies. More research is needed to further clarify the factors that are relevant to implementing ML-based applications at the organizational level and to support their uptake within health care organizations. Trial Registration: PROSPERO 403873; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403873 International Registered Report Identifier (IRRID): RR2-10.2196/47971 %M 39586084 %R 10.2196/55897 %U https://www.jmir.org/2024/1/e55897 %U https://doi.org/10.2196/55897 %U http://www.ncbi.nlm.nih.gov/pubmed/39586084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57612 %T Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia %A Yi,Siyan %A Yam,Esabelle Lo Yan %A Cheruvettolil,Kochukoshy %A Linos,Eleni %A Gupta,Anshika %A Palaniappan,Latha %A Rajeshuni,Nitya %A Vaska,Kiran Gopal %A Schulman,Kevin %A Eggleston,Karen N %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 6914, siyan@nus.edu.sg %K digital health innovations %K public health %K South and Southeast Asia %K health care challenges %K low- and middle-income countries %K LMICs %K global health %K health AI %K artificial intelligence %K public health responses %K global health contexts %K digital health %D 2024 %7 25.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital health innovations have emerged globally as a transformative force for addressing health system challenges, particularly in resource-constrained settings. The COVID-19 pandemic underscored the critical importance of these innovations for enhancing public health. In South and Southeast Asia, a region known for its cultural diversity and complex health care landscape, digital health innovations present a dynamic interplay of challenges and opportunities. We advocate for ongoing research built into system development and an evidence-based strategy focusing on designing and scaling national digital health infrastructures combined with a vibrant ecosystem or “marketplace” of local experiments generating shared experience about what works in which settings. As the global digital health revolution unfolds, the perspectives drawn from South and Southeast Asia—including the importance of local partnerships—may provide valuable insights for shaping future strategies and informing similar initiatives in low- and middle-income countries, contributing to effective digital health strategies across diverse global health contexts. %M 39586089 %R 10.2196/57612 %U https://www.jmir.org/2024/1/e57612 %U https://doi.org/10.2196/57612 %U http://www.ncbi.nlm.nih.gov/pubmed/39586089 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59837 %T Willingness to Be Contacted via a Patient Portal for Health Screening, Research Recruitment, and at-Home Self-Test Kits for Health Monitoring: Pilot Quantitative Survey %A Lockhart,Elizabeth %A Gootee,Jordan %A Copeland,Leah %A Turner,DeAnne %K patient portals %K patient engagement %K personal health records %K risk assessments %K health information %K information access %K open notes %K user perceptions %D 2024 %7 22.11.2024 %9 %J JMIR Form Res %G English %X Background: Patient portals are being increasingly used by health systems in the United States. Although some patients use portals for clinical use, patient perspectives on using portals for research-related activities, to complete health screenings, and to request at-home self-test kits are unclear. Objective: We aimed to understand patient perspectives on using electronic health portals for research; health-related screenings; and patient-initiated, home-based self-testing. Methods: Patients (N=105) from the Patient Engaged Research Center at a large, urban, midwestern health system completed a 23-item web-based survey on patient portal (MyChart) use and willingness to use the patient portal for research, risk assessments, and self-test kits. Frequencies and percentages were generated. Results: Almost all participants (102/105, 97.1%) had accessed MyChart at least once, with most (44/102, 43.1%) indicating they logged in at least once per month. Participants indicated logging into MyChart to check laboratory results or other health data (89/105, 84.8%), because they received a message to log in (85/105, 81%), and to message their health care professional (83/105, 79%). Fewer participants logged in to see what medications they had been prescribed (16/105, 15.2%) and to learn more about their health conditions (29/105, 27.6%). Most participants indicated logging into MyChart on a computer via a website (70/105, 66.7%) or on a smartphone via an app (54/105, 51.4%). When asked about how likely they would be to participate in different types of research if contacted via MyChart, most (90/105, 85.7%) said they would be likely to answer a survey, fill out a health assessment (87/105, 82.9%), or watch a video (86/105, 81.9%). Finally, participants would be willing to answer risk assessment questions on MyChart regarding sleep (74/101, 73.3%), stress (65/105, 61.9%), diabetes (60/105, 57.1%), anxiety (59/105, 56.2%), and depression (54/105, 51.4%) and would be interested in receiving an at-home self-test kit for COVID-19 (66/105, 62.9%), cholesterol (63/105, 60%), colon cancer (62/105, 59%), and allergies (56/105, 53.3%). There were no significant demographic differences for any results (all P values were >.05). Conclusions: Patient portals may be used for research recruitment; sending research-related information; and engaging patients to answer risk assessments, read about health information, and complete other clinical tasks. The lack of significant findings based on race and gender suggests that patient portals may be acceptable tools for recruiting research participants and conducting research. Allowing patients to request self-test kits and complete risk assessments in portals may help patients to take agency over their health care. Future research should examine if patient portal recruitment may help address persistent biases in clinical trial recruitment to increase enrollment of women and racial minority groups. %R 10.2196/59837 %U https://formative.jmir.org/2024/1/e59837 %U https://doi.org/10.2196/59837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59260 %T Hospital Length of Stay Prediction for Planned Admissions Using Observational Medical Outcomes Partnership Common Data Model: Retrospective Study %A Lee,Haeun %A Kim,Seok %A Moon,Hui-Woun %A Lee,Ho-Young %A Kim,Kwangsoo %A Jung,Se Young %A Yoo,Sooyoung %+ Department of Family Medicine, Seoul National University Bundang Hospital, 172, Dolma-ro bundang-gu, Seongnam-si, 13605, Republic of Korea, 82 0317878845, syjung@snubh.org %K length of stay %K machine learning %K Observational Medical Outcomes Partnership Common Data Model %K allocation of resources %K reproducibility of results %K hospital %K admission %K retrospective study %K prediction model %K electronic health record %K EHR %K South Korea %K logistic regression %K algorithm %K Shapley Additive Explanation %K health care %K clinical informatics %D 2024 %7 22.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate hospital length of stay (LoS) prediction enables efficient resource management. Conventional LoS prediction models with limited covariates and nonstandardized data have limited reproducibility when applied to the general population. Objective: In this study, we developed and validated a machine learning (ML)–based LoS prediction model for planned admissions using the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM). Methods: Retrospective patient-level prediction models used electronic health record (EHR) data converted to the OMOP CDM (version 5.3) from Seoul National University Bundang Hospital (SNUBH) in South Korea. The study included 137,437 hospital admission episodes between January 2016 and December 2020. Covariates from the patient, condition occurrence, medication, observation, measurement, procedure, and visit occurrence tables were included in the analysis. To perform feature selection, we applied Lasso regularization in the logistic regression. The primary outcome was an LoS of 7 days or longer, while the secondary outcome was an LoS of 3 days or longer. The prediction models were developed using 6 ML algorithms, with the training and test set split in a 7:3 ratio. The performance of each model was evaluated based on the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Shapley Additive Explanations (SHAP) analysis measured feature importance, while calibration plots assessed the reliability of the prediction models. External validation of the developed models occurred at an independent institution, the Seoul National University Hospital. Results: The final sample included 129,938 patient entry events in the planned admissions. The Extreme Gradient Boosting (XGB) model achieved the best performance in binary classification for predicting an LoS of 7 days or longer, with an AUROC of 0.891 (95% CI 0.887-0.894) and an AUPRC of 0.819 (95% CI 0.813-0.826) on the internal test set. The Light Gradient Boosting (LGB) model performed the best in the multiclassification for predicting an LoS of 3 days or more, with an AUROC of 0.901 (95% CI 0.898-0.904) and an AUPRC of 0.770 (95% CI 0.762-0.779). The most important features contributing to the models were the operation performed, frequency of previous outpatient visits, patient admission department, age, and day of admission. The RF model showed robust performance in the external validation set, achieving an AUROC of 0.804 (95% CI 0.802-0.807). Conclusions: The use of the OMOP CDM in predicting hospital LoS for planned admissions demonstrates promising predictive capabilities for stays of varying durations. It underscores the advantage of standardized data in achieving reproducible results. This approach should serve as a model for enhancing operational efficiency and patient care coordination across health care settings. %M 39576284 %R 10.2196/59260 %U https://www.jmir.org/2024/1/e59260 %U https://doi.org/10.2196/59260 %U http://www.ncbi.nlm.nih.gov/pubmed/39576284 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e52817 %T Factors Contributing to Successful Information System Implementation and Employee Well-Being in Health Care and Social Welfare Professionals: Comparative Cross-Sectional Study %A Nadav,Janna %A Kaihlanen,Anu-Marja %A Kujala,Sari %A Keskimäki,Ilmo %A Viitanen,Johanna %A Salovaara,Samuel %A Saukkonen,Petra %A Vänskä,Jukka %A Vehko,Tuulikki %A Heponiemi,Tarja %K implementation %K health information systems %K client information systems %K stress %K healthcare professionals %K social welfare professionals %K clinician well-being %K workplace stress %D 2024 %7 21.11.2024 %9 %J JMIR Med Inform %G English %X 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. %R 10.2196/52817 %U https://medinform.jmir.org/2024/1/e52817 %U https://doi.org/10.2196/52817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47311 %T Cybersecurity Interventions in Health Care Organizations in Low- and Middle-Income Countries: Scoping Review %A Hasegawa,Kaede %A O'Brien,Niki %A Prendergast,Mabel %A Ajah,Chris Agape %A Neves,Ana Luisa %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, 10th Floor, St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk %K computer security %K internet security %K network security %K digital health %K digital health technology %K cybersecurity %K health data %K global health %K security %K data science %K LMIC %K low income %K low resource %K scoping review %K review methodology %K implementation %K barrier %K facilitator %D 2024 %7 20.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review’s findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice. %M 39566062 %R 10.2196/47311 %U https://www.jmir.org/2024/1/e47311 %U https://doi.org/10.2196/47311 %U http://www.ncbi.nlm.nih.gov/pubmed/39566062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58933 %T A 25-Year Retrospective of Health IT Infrastructure Building: The Example of the Catalonia Region %A Piera-Jiménez,Jordi %A Carot-Sans,Gerard %A Ramiro-Pareta,Marina %A Nogueras,Maria Mercedes %A Folguera-Profitós,Júlia %A Ródenas,Pepi %A Jiménez-Rueda,Alba %A de Pando Navarro,Thais %A Mira Palacios,Josep Antoni %A Fajardo,Joan Carles %A Ustrell Campillo,Joan %A Vela,Emili %A Monterde,David %A Valero-Bover,Damià %A Bonet,Tara %A Tarrasó-Urios,Guillermo %A Cantenys-Sabà,Roser %A Fabregat-Fabregat,Pau %A Gómez Oliveros,Beatriz %A Berdún,Jesús %A Michelena,Xabier %A Cano,Isaac %A González-Colom,Rubèn %A Roca,Josep %A Solans,Oscar %A Pontes,Caridad %A Pérez-Sust,Pol %+ Catalan Health Service, Gran Via de les Corts Catalanes 587, Barcelona, 08007, Spain, 34 934643013, jpiera@catsalut.cat %K health ITs %K eHealth %K integrated care %K open platforms %K interoperability %K Catalonia %K digitalization %K health care structure %K health care delivery %K integrated pathway %K integrated treatment plan %K process management %D 2024 %7 18.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X Over the past decades, health care systems have significantly evolved due to aging populations, chronic diseases, and higher-quality care expectations. Concurrently with the added health care needs, information and communications technology advancements have transformed health care delivery. Technologies such as telemedicine, electronic health records, and mobile health apps promise enhanced accessibility, efficiency, and patient outcomes, leading to more personalized, data-driven care. However, organizational, political, and cultural barriers and the fragmented approach to health information management are challenging the integration of these technologies to effectively support health care delivery. This fragmentation collides with the need for integrated care pathways that focus on holistic health and wellness. Catalonia (northeast Spain), a region of 8 million people with universal health care coverage and a single public health insurer but highly heterogeneous health care service providers, has experienced outstanding digitalization and integration of health information over the past 25 years, when the first transition from paper to digital support occurred. This Viewpoint describes the implementation of health ITs at a system level, discusses the hits and misses encountered in this journey, and frames this regional implementation within the global context. We present the architectures and use trends of the health information platforms over time. This provides insightful information that can be used by other systems worldwide in the never-ending transformation of health care structure and services. %M 39556831 %R 10.2196/58933 %U https://www.jmir.org/2024/1/e58933 %U https://doi.org/10.2196/58933 %U http://www.ncbi.nlm.nih.gov/pubmed/39556831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50959 %T Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study %A Zhou,Zhiheng %A Jin,Danian %A He,Jinghua %A Zhou,Shengqing %A Wu,Jiang %A Wang,Shuangxi %A Zhang,Yang %A Feng,Tianyuan %+ Pingshan Hospital of Southern Medical University, No. 16 Renmin Road, Pingshan District, Shenzhen, 518118, China, 86 13828493963, zhihengz@163.com %K information platform %K active health %K chronic disease management %K effectiveness %K community %K digital health %K health literacy %K cardio-cerebrovascular disease %K China %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents’ self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the “i Active Health” applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents’ risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents’ health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients’ BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. %M 39556830 %R 10.2196/50959 %U https://www.jmir.org/2024/1/e50959 %U https://doi.org/10.2196/50959 %U http://www.ncbi.nlm.nih.gov/pubmed/39556830 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52301 %T The Added Value of Using Video in Out-of-Hours Primary Care Telephone Triage Among General Practitioners: Cross-Sectional Survey Study %A Nebsbjerg,Mette Amalie %A Bomholt,Katrine Bjørnshave %A Vestergaard,Claus Høstrup %A Christensen,Morten Bondo %A Huibers,Linda %K primary health care %K after-hours care %K referral and consultation %K general practitioners %K triage %K remote consultation %K telemedicine %D 2024 %7 15.11.2024 %9 %J JMIR Hum Factors %G English %X Background: Many countries have introduced video consultations in primary care both inside and outside of office hours. Despite some relational and technical limitations, general practitioners (GPs) have reported the benefits of video use in the daytime as it provides faster and more flexible access to health care. Studies have indicated that video may be specifically valuable in out-of-hours primary care (OOH-PC), but additional information on the added value of video use is needed. Objective: This study aimed to investigate triage GPs’ perspectives on video use in GP-led telephone triage in OOH-PC by exploring their reasons for choosing video use and its effect on triage outcome, the decision-making process, communication, and invested time. Methods: We conducted a cross-sectional questionnaire study among GPs performing telephone triage in the OOH-PC service in the Central Denmark Region from September 5, 2022, until December 21, 2022. The questionnaire was integrated into the electronic patient registration system as a pop-up window appearing after every third video contact. This setup automatically linked background data on the contact, patient, and GP to the questionnaire data. We used descriptive analyses to describe reasons for and effects of video use and GP evaluation, stratified by patient age. Results: A total of 2456 questionnaires were completed. The most frequent reasons for video use were to assess the severity (n=1951, 79.4%), to increase the probability of self-care (n=1279, 52.1%), and to achieve greater certainty in decision-making (n=810, 33%) (multiple answers were possible for reasons of video use). In 61.9% (n=1516) of contacts, the triage GPs anticipated that the contact would have resulted in a different triage outcome if video had not been used. Use of video resulted in a downgrading of severity level in 88.3% (n=1338) of cases. Triage GPs evaluated the use of video as positive in terms of their decision-making process (n=2358, 96%), communication (n=2214, 90.1%), and invested time (n=2391, 97.3%). Conclusions: Triage GPs assessed that the use of video in telephone triage did affect their triage outcome, mostly by downgrading the level of care needed. The participating triage GPs found video in OOH-PC to be of added value, particularly in communication and the decision-making process. %R 10.2196/52301 %U https://humanfactors.jmir.org/2024/1/e52301 %U https://doi.org/10.2196/52301 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52788 %T Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals %A Oudshoorn,Cathelijn %A Frielink,Noud %A Riper,Heleen %A Embregts,Petri %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, 5037 DB, Tilburg, Netherlands, 31 0134662969, c.e.m.oudshoorn@tilburguniversity.edu %K acceptance %K health care professionals %K intellectual disabilities %K eHealth %K disability %K psychological therapy %K support %K cross-sectional survey %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals’ acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants’ characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach α=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. %M 39531275 %R 10.2196/52788 %U https://formative.jmir.org/2024/1/e52788 %U https://doi.org/10.2196/52788 %U http://www.ncbi.nlm.nih.gov/pubmed/39531275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51412 %T Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study %A Liao,Wenmin %A He,Rong %A He,Zhonglian %A Shi,Nan %A Li,Dan %A Zhuang,Aihua %A Gan,Feng %A Sun,Ying %A Li,Chaofeng %+ State Key Laboratory of Oncology, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Dongfengdong road 651#, Guangzhou, 510060, China, 86 87343292, lichaofeng@sysucc.org.cn %K process reengineering %K blood sampling %K hospital administration %K medical informatics %K digital health %K patient experience %D 2024 %7 12.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. Objective: This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Methods: Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. Results: BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients’ waiting time by an average of 26.1 (SD 3.8; 95% CI –33.64 to –18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (β=1.13, 95% CI 0.91-1.36). Conclusions: BSSPR implementation for outpatients not only reduced waiting time and improved patients’ experience but also augmented the hospital’s capacity to provide medical services. This study’s findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services. %M 39531265 %R 10.2196/51412 %U https://www.jmir.org/2024/1/e51412 %U https://doi.org/10.2196/51412 %U http://www.ncbi.nlm.nih.gov/pubmed/39531265 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57609 %T Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study %A Liu,Yayuan %A Jin,Haofeng %A Yu,Zhuoyuan %A Tong,Yu %+ School of Management, Zhejiang University, Hangzhou, 310058, China, 86 57188206827, tong_yu@zju.edu.cn %K internet hospital %K online consultation %K telehealth %K outpatient visits %K outpatient expenses %K urban-rural healthcare disparity %D 2024 %7 11.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients’ offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients’ adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients’ adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and the associated expenses by 15.5% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients’ residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients’ adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients’ urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. %M 39527807 %R 10.2196/57609 %U https://www.jmir.org/2024/1/e57609 %U https://doi.org/10.2196/57609 %U http://www.ncbi.nlm.nih.gov/pubmed/39527807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55140 %T Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire %A Han,Tao %A Wei,Qinpeng %A Wang,Ruike %A Cai,Yijin %A Zhu,Hongyi %A Chen,Jiani %A Zhang,Zhiruo %A Li,Sisi %+ School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China, 86 02163846590 ext 776145, lisi8318@gmail.com %K service quality %K SERVQUAL %K Service Quality Questionnaire %K internet hospital %K e-hospital %K digital medical care %K health care professionals %K Chinese digital health care %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients’ use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients’ expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients’ overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients’ familiarity with and willingness to use these services. %M 39514849 %R 10.2196/55140 %U https://www.jmir.org/2024/1/e55140 %U https://doi.org/10.2196/55140 %U http://www.ncbi.nlm.nih.gov/pubmed/39514849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54018 %T In-Depth Examination of the Functionality and Performance of the Internet Hospital Information Platform: Development and Usability Study %A Zhang,Guang-Wei %A Li,Bin %A Gu,Zheng-Min %A Yang,Wei-Feng %A Wang,Yi-Ran %A Li,Hui-Jun %A Zheng,Han-Bing %A Yue,Ying-Xu %A Wang,Kui-Zhong %A Gong,Mengchun %A Gong,Da-Xin %+ Department of Smart Hospital, The First Hospital of China Medical University, 155 Nanjingbei Street, Shenyang, 110001, China, 86 02483283350, ydyyzhyy@163.com %K internet hospital %K smart hospital %K mobile applications %K operational data %K information system %K online service %K patient service %K management tool %K electronic prescriptions %K medical education %K integration %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals (IHs) have rapidly developed as a promising strategy to address supply-demand imbalances in China’s medical industry, with their capabilities directly dependent on information platform functionality. Furthermore, a novel theory of “Trinity” smart hospital has provided advanced guidelines on IH constructions. Objective: This study aimed to explore the construction experience, construction models, and development prospects based on operational data from IHs. Methods: Based on existing information systems and internet service functionalities, our hospital has built a “Smart Hospital Internet Information Platform (SHIIP)” for IH operations, actively to expand online services, digitalize traditional health care, and explore health care services modes throughout the entire process and lifecycle. This article encompasses the platform architecture design, technological applications, patient service content and processes, health care professional support features, administrative management tools, and associated operational data. Results: Our platform has presented a set of data, including 82,279,669 visits, 420,120 online medical consultations, 124,422 electronic prescriptions, 92,285 medication deliveries, 6,965,566 prediagnosis triages, 4,995,824 offline outpatient appointments, 2025 medical education articles with a total of 15,148,310 views, and so on. These data demonstrate the significant role of IH as an indispensable component of our physical hospital services, with deep integration between online and offline health care systems. Conclusions: The upward trends in various data metrics indicate that our IH has gained significant recognition and usage among both the public and healthcare workers, and may have promising development prospects. Additionally, the platform construction approach, which prioritizes comprehensive service digitization and the 'Trinity' of the public, healthcare workers, and managers, serves as an effective means of promoting the development of Internet Hospitals. Such insights may prove invaluable in guiding the development of IH and facilitating the continued evolution of the Internet healthcare sector. %M 39168813 %R 10.2196/54018 %U https://www.jmir.org/2024/1/e54018 %U https://doi.org/10.2196/54018 %U http://www.ncbi.nlm.nih.gov/pubmed/39168813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64674 %T System-Wide, Electronic Health Record–Based Medication Alerts for Appropriate Prescribing of Direct Oral Anticoagulants: Pilot Randomized Controlled Trial %A Smith,Shawna N %A Lanham,Michael S M %A Seagull,F Jacob %A Fabbri,Morris %A Dorsch,Michael P %A Jennings,Kathleen %A Barnes,Geoffrey %+ Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1425 E Ann St, Ann Arbor, MI, 48109, United States, 1 8882871082, gbarnes@umich.edu %K direct oral anticoagulants %K electronic health record %K medication safety %K prescribing errors %K pilot randomized controlled trial %K alert system optimization %K clinical decision support %K EHR %K randomized controlled trial %K RCT %K oral anticoagulants %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While direct oral anticoagulants (DOACs) have improved oral anticoagulation management, inappropriate prescribing remains prevalent and leads to adverse drug events. Antithrombotic stewardship programs seek to enhance DOAC prescribing but require scalable and sustainable strategies. Objective: We present a pilot, prescriber-level randomized controlled trial to assess the effectiveness of electronic health record (EHR)–based medication alerts in a large health system. Methods: The pilot assessed prescriber responses to alerts for initial DOAC prescription errors (apixaban and rivaroxaban). A user-centered, multistage design process informed alert development, emphasizing clear indication, appropriate dosing based on renal function, and drug-drug interactions. Alerts appeared whenever a DOAC was being prescribed in a way that did not follow package label instructions. Clinician responses measured acceptability, accuracy, feasibility, and utilization of the alerts. Results: The study ran from August 1, 2022, through April 30, 2023. Only 1 prescriber requested trial exclusion, demonstrating acceptability. The error rate for false alerts due to incomplete data was 6.6% (16/243). Two scenarios with alert design and/or execution errors occurred but were quickly identified and resolved, underlining the importance of a responsive quality assurance process in EHR-based interventions. Trial feasibility issues related to alert-data capture were identified and resolved. Trial feasibility was also assessed with balanced randomization of prescribers and the inclusion of various alerts across both medications. Assessing utilization, 34.2% (83/243) of the encounters (with 134 prescribers) led to a prescription change. Conclusions: The pilot implementation study demonstrated the acceptability, accuracy, feasibility, and estimates of the utilization of EHR-based medication alerts for DOAC prescriptions and successfully established just-in-time randomization of prescribing clinicians. This pilot study sets the stage for large-scale, randomized implementation evaluations of EHR-based alerts to improve medication safety. Trial Registration: ClinicalTrials.gov NCT05351749; https://clinicaltrials.gov/study/NCT05351749 %M 39514247 %R 10.2196/64674 %U https://formative.jmir.org/2024/1/e64674 %U https://doi.org/10.2196/64674 %U http://www.ncbi.nlm.nih.gov/pubmed/39514247 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64159 %T Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey %A Sugawara,Yuka %A Hirakawa,Yosuke %A Iwagami,Masao %A Kuroki,Haruo %A Mitani,Shuhei %A Inagaki,Ataru %A Ohashi,Hiroki %A Kubota,Mitsuru %A Koike,Soichi %A Wakimizu,Rie %A Nangaku,Masaomi %+ Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 3815 5411, mnangaku@m.u-tokyo.ac.jp %K telemedicine %K online medical care %K telehealth %K eHealth %K mobile phone %D 2024 %7 1.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown. Objective: This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care. Methods: In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan. Results: The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients’ need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected. Conclusions: Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption. %R 10.2196/64159 %U https://www.jmir.org/2024/1/e64159 %U https://doi.org/10.2196/64159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55766 %T Health Care Professionals’ Experience of Using AI: Systematic Review With Narrative Synthesis %A Ayorinde,Abimbola %A Mensah,Daniel Opoku %A Walsh,Julia %A Ghosh,Iman %A Ibrahim,Siti Aishah %A Hogg,Jeffry %A Peek,Niels %A Griffiths,Frances %+ Division of Health Sciences, Warwick Medical School, University of Warwick, Medical School Building, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 2476151098, a.ayorinde.1@warwick.ac.uk %K artificial intelligence %K clinical decision support systems %K CDSS %K decision-making %K quality assessment %K clinician experience %K health care professionals %K health care delivery %D 2024 %7 30.10.2024 %9 Review %J J Med Internet Res %G English %X Background: There has been a substantial increase in the development of artificial intelligence (AI) tools for clinical decision support. Historically, these were mostly knowledge-based systems, but recent advances include non–knowledge-based systems using some form of machine learning. The ability of health care professionals to trust technology and understand how it benefits patients or improves care delivery is known to be important for their adoption of that technology. For non–knowledge-based AI tools for clinical decision support, these issues are poorly understood. Objective: The aim of this study is to qualitatively synthesize evidence on the experiences of health care professionals in routinely using non–knowledge-based AI tools to support their clinical decision-making. Methods: In June 2023, we searched 4 electronic databases, MEDLINE, Embase, CINAHL, and Web of Science, with no language or date limit. We also contacted relevant experts and searched reference lists of the included studies. We included studies of any design that reported the experiences of health care professionals using non–knowledge-based systems for clinical decision support in their work settings. We completed double independent quality assessment for all included studies using the Mixed Methods Appraisal Tool. We used a theoretically informed thematic approach to synthesize the findings. Results: After screening 7552 titles and 182 full-text articles, we included 25 studies conducted in 9 different countries. Most of the included studies were qualitative (n=13), and the remaining were quantitative (n=9) and mixed methods (n=3). Overall, we identified 7 themes: health care professionals’ understanding of AI applications, level of trust and confidence in AI tools, judging the value added by AI, data availability and limitations of AI, time and competing priorities, concern about governance, and collaboration to facilitate the implementation and use of AI. The most frequently occurring are the first 3 themes. For example, many studies reported that health care professionals were concerned about not understanding the AI outputs or the rationale behind them. There were issues with confidence in the accuracy of the AI applications and their recommendations. Some health care professionals believed that AI provided added value and improved decision-making, and some reported that it only served as a confirmation of their clinical judgment, while others did not find it useful at all. Conclusions: Our review identified several important issues documented in various studies on health care professionals’ use of AI tools in real-world health care settings. Opinions of health care professionals regarding the added value of AI tools for supporting clinical decision-making varied widely, and many professionals had concerns about their understanding of and trust in this technology. The findings of this review emphasize the need for concerted efforts to optimize the integration of AI tools in real-world health care settings. Trial Registration: PROSPERO CRD42022336359; https://tinyurl.com/2yunvkmb %M 39476382 %R 10.2196/55766 %U https://www.jmir.org/2024/1/e55766 %U https://doi.org/10.2196/55766 %U http://www.ncbi.nlm.nih.gov/pubmed/39476382 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56898 %T Critical Success Factors and Acceptance of the Casemix System Implementation Within the Total Hospital Information System: Exploratory Factor Analysis of a Pilot Study %A Mustafa,Noor Khairiyah %A Ibrahim,Roszita %A Aizuddin,Azimatun Noor %A Aljunid,Syed Mohamed %A Awang,Zainudin %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 6th Floor, Pre-Clinical Block, Cheras, 56000, Malaysia, 60 391455887 ext 5888, roszita@ppukm.ukm.edu.my %K critical success factors %K exploratory factor analysis %K Casemix system %K acceptance %K Total Hospital Information System %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 α 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 α 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. %M 39470697 %R 10.2196/56898 %U https://formative.jmir.org/2024/1/e56898 %U https://doi.org/10.2196/56898 %U http://www.ncbi.nlm.nih.gov/pubmed/39470697 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57035 %T Targeted Development and Validation of Clinical Prediction Models in Secondary Care Settings: Opportunities and Challenges for Electronic Health Record Data %A van Maurik,I S %A Doodeman,H J %A Veeger-Nuijens,B W %A Möhringer,R P M %A Sudiono,D R %A Jongbloed,W %A van Soelen,E %K clinical prediction model %K electronic health record %K targeted validation %K EHR %K EMR %K prediction models %K validation %K CPM %K secondary care %K machine learning %K artificial intelligence %K AI %D 2024 %7 24.10.2024 %9 %J JMIR Med Inform %G English %X Before deploying a clinical prediction model (CPM) in clinical practice, its performance needs to be demonstrated in the population of intended use. This is also called “targeted validation.” Many CPMs developed in tertiary settings may be most useful in secondary care, where the patient case mix is broad and practitioners need to triage patients efficiently. However, since structured or rich datasets of sufficient quality from secondary to assess the performance of a CPM are scarce, a validation gap exists that hampers the implementation of CPMs in secondary care settings. In this viewpoint, we highlight the importance of targeted validation and the use of CPMs in secondary care settings and discuss the potential and challenges of using electronic health record (EHR) data to overcome the existing validation gap. The introduction of software applications for text mining of EHRs allows the generation of structured “big” datasets, but the imperfection of EHRs as a research database requires careful validation of data quality. When using EHR data for the development and validation of CPMs, in addition to widely accepted checklists, we propose considering three additional practical steps: (1) involve a local EHR expert (clinician or nurse) in the data extraction process, (2) perform validity checks on the generated datasets, and (3) provide metadata on how variables were constructed from EHRs. These steps help to generate EHR datasets that are statistically powerful, of sufficient quality and replicable, and enable targeted development and validation of CPMs in secondary care settings. This approach can fill a major gap in prediction modeling research and appropriately advance CPMs into clinical practice. %R 10.2196/57035 %U https://medinform.jmir.org/2024/1/e57035 %U https://doi.org/10.2196/57035 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e63456 %T Exploring Health Care Professionals’ Perspectives on the Use of a Medication and Care Support System and Recommendations for Designing a Similar Tool for Family Caregivers: Interview Study Among Health Care Professionals %A Ashimwe,Aimerence %A Davoody,Nadia %+ Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, S-17177, Sweden, 46 (0)8 524 864 86, nadia.davoody@ki.se %K eHealth %K telemedicine %K mobile health %K mHealth %K medication management %K home care %K family caregivers %K mobile phone %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the aging population on the rise, the demand for effective health care solutions to address adverse drug events is becoming increasingly urgent. Telemedicine has emerged as a promising solution for strengthening health care delivery in home care settings and mitigating drug errors. Due to the indispensable role of family caregivers in daily patient care, integrating digital health tools has the potential to streamline medication management processes and enhance the overall quality of patient care. Objective: This study aims to explore health care professionals’ perspectives on the use of a medication and care support system (MCSS) and collect recommendations for designing a similar tool for family caregivers. Methods: Fifteen interviews with health care professionals in a home care center were conducted. Thematic analysis was used, and 5 key themes highlighting the importance of using the MCSS tool to improve medication management in home care were identified. Results: All participants emphasized the necessity of direct communication between health care professionals and family caregivers and stated that family caregivers need comprehensive information about medication administration, patient conditions, and symptoms. Furthermore, the health care professionals recommended features and functions customized for family caregivers. Conclusions: This study underscored the importance of clear communication between health care professionals and family caregivers and the provision of comprehensive instructions to promote safe medication practices. By equipping family caregivers with essential information via a tool similar to the MCSS, a proactive approach to preventing errors and improving outcomes is advocated. %M 39442168 %R 10.2196/63456 %U https://medinform.jmir.org/2024/1/e63456 %U https://doi.org/10.2196/63456 %U http://www.ncbi.nlm.nih.gov/pubmed/39442168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54902 %T Accessibility, Cost, and Quality of an Online Regular Follow-Up Visit Service at an Internet Hospital in China: Mixed Methods Study %A Wang,Kun %A Zou,Wenxin %A Lai,Yingsi %A Hao,Chun %A Liu,Ning %A Ling,Xiang %A Liu,Xiaohan %A Liu,Ting %A Yang,Xin %A Zu,Chenxi %A Wu,Shaolong %+ School of Government, Sun Yat-sen University, No. 135 Xingang Xi Road, Guangzhou, 510000, China, 86 02087335706, wushlong@mail.sysu.edu.cn %K internet hospital %K medical service %K accessibility %K cost %K quality %K regular follow-up %D 2024 %7 21.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine provides remote health care services to overcome constraints of time and space in accessing medical care. Similarly, internet hospitals in China support and provide remote health care services. Due to the COVID-19 pandemic, there has been a proliferation of internet hospitals. Many new services, including online consultations and regular online follow-up visit services, can now be accessed via internet hospitals in China. However, the accessibility, cost, and quality advantages of regular online follow-up visit services remain unclear. Objective: This study aimed to evaluate the accessibility, costs, and quality of an online regular follow-up visit service provided by an internet hospital in China. By analyzing the accessibility, costs, and quality of this service from the supply and demand sides, we can summarize the practical and theoretical experiences. Methods: A mixed methods study was conducted using clinical records from 18,473 patients receiving 39,239 online regular follow-up visit services at an internet hospital in 2021, as well as interviews with 7 physicians, 2 head nurses, and 3 administrative staff members. The quantitative analysis examined patient demographics, diagnoses, prescriptions, geographic distribution, physician characteristics, accessibility (travel time and costs), and service hours. The qualitative analysis elucidated physician perspectives on ensuring the quality of online health care. Results: Patients were predominantly middle-aged men with chronic diseases like viral hepatitis who were located near the hospital. The vast majority were from Guangdong province where the hospital is based, especially concentrated in Guangzhou city. The online regular follow-up visit service reduced travel time by 1 hour to 9 hours and costs by ¥6 to ¥991 (US $0.86-$141.32) depending on proximity, with greater savings for patients farther from the hospital. Consultation times were roughly equivalent between online and in-person visits. Physicians provided most online services during lunch breaks (12 PM to 2 PM) or after work hours (7 PM to 11 PM), indicating increased workload. The top departments providing online regular follow-up visit services were Infectious Diseases, Rheumatology, and Dermatology. The most commonly prescribed medications aligned with the prevalent chronic diagnoses. To ensure quality, physicians conducted initial in-person consultations to fully evaluate patients before allowing online regular follow-up visits, during which they communicated with patients to assess conditions and determine if in-person care was warranted. They also periodically reminded patients to come in person for more comprehensive evaluations. However, they acknowledged online visits cannot fully replace face-to-face care. Conclusions: Telemedicine services such as online regular follow-up visit services provided by internet hospitals must strictly adhere to fundamental medical principles of diagnosis, prescription, and treatment. For patients with chronic diseases, online regular follow-up visit services improve accessibility and reduce cost but cannot fully replace in-person evaluations. Physicians leverage various strategies to ensure the quality of online care. %M 39432365 %R 10.2196/54902 %U https://www.jmir.org/2024/1/e54902 %U https://doi.org/10.2196/54902 %U http://www.ncbi.nlm.nih.gov/pubmed/39432365 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60306 %T Enhancing Clinicians’ Use of Electronic Patient-Reported Outcome Measures in Outpatient Care: Mixed Methods Study %A van Engen,Veerle %A Bonfrer,Igna %A Ahaus,Kees %A Den Hollander-Ardon,Monique %A Peters,Ingrid %A Buljac-Samardzic,Martina %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 010 408 8555, vanengen@eshpm.eur.nl %K patient-reported outcome measure %K value-based health care %K implementation %K clinician %K behavior %K barrier %K facilitator %K strategies %K professionalization %K mixed methods %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing use of patient-reported outcome measures (PROMs) for collecting self-reported data among hospital outpatients, clinicians’ use of these data remains suboptimal. Insight into this issue and strategies to enhance the use of PROMs are critical but limited. Objective: This study aimed to examine clinicians’ use of PROM data for value-based outpatient consultations and identify efforts to enhance their use of PROMs in a Dutch university hospital. First, we aimed to investigate clinicians’ use of outpatients’ PROM data in 2023, focusing on adoption, implementation, and maintenance. Second, we aimed to develop insights into the organizational-level strategies implemented to enhance clinicians’ use of PROM data from 2020 to 2023. This included understanding the underlying rationales for these strategies and identifying strategies that appeared to be missing to address barriers or leverage facilitators. Third, we aimed to explore the key factors driving and constraining clinicians’ use of PROMs in 2023. Methods: We integrated data from 4 sources: 1-year performance data on clinicians’ use of PROMs (n=70 subdepartments), internal hospital documents from a central support team (n=56), a survey among clinicians (n=47), and interviews with individuals contributing to the organizational-level implementation of PROMs (n=20). The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to analyze clinicians’ adoption, implementation, and maintenance of PROMs. Strategies were analyzed using the Expert Recommendations for Implementing Change taxonomy, and results were structured around the constructs of capability, opportunity, and motivation. Results: On average, around 2023, clinicians accessed PROM data for approximately 3 of 20 (14%) patients during their outpatient consultation, despite numerous strategies to improve this practice. We identified issues in adoption, implementation, and maintenance. The hospital’s strategies, shaped organically and pragmatically, were related to 27 (37%) out of 73 Expert Recommendations for Implementing Change strategies. These strategies focused on enhancing clinicians’ capability, opportunity, and motivation. We found shortcomings in the quality of execution and completeness of strategies in relation to addressing all barriers and leveraging facilitators. We identified variations in the factors influencing the use of PROMs among frequent PROM users, occasional users, and nonusers. Challenges to effective facilitation were apparent, with certain desired strategies being unfeasible or impeded. Conclusions: Enhancing clinicians’ use of PROMs has remained challenging despite various strategies aimed at improving their capability, opportunity, and motivation. The use of PROMs may require more substantial changes than initially expected, necessitating a shift in clinicians’ professional attitudes and practices. Hospitals can facilitate rather than manage clinicians’ genuine use of PROMs. They must prioritize efforts to engage clinicians with PROMs for value-based outpatient care. Specific attention to their professionalization may be warranted. Tailored strategies, designed to address within-group differences in clinicians’ needs and motivation, hold promise for future efforts. %M 39422999 %R 10.2196/60306 %U https://www.jmir.org/2024/1/e60306 %U https://doi.org/10.2196/60306 %U http://www.ncbi.nlm.nih.gov/pubmed/39422999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60081 %T Primary Care Informatics: Vitalizing the Bedrock of Health Care %A You,Jacqueline Guan-Ting %A Leung,Tiffany I %A Pandita,Deepti %A Sakumoto,Matthew %+ Department of Medicine, University of California San Francisco, 533 Parnassus Avenue, U127, San Francisco, CA, 94143, United States, 1 4154761000, matthew.sakumoto@ucsf.edu %K health care delivery %K primary care %K primary health care %K primary prevention %K quality of health care %K holistic care %K holistic medicine %K people-centric care %K person-centric care %K medical informatics applications %K primary care informatics %K medical informatics %K health informatics %K information science %K data science %D 2024 %7 15.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X Primary care informatics (PCI) professionals address workflow and technology solutions in a wide spectrum of health, ranging from optimizing the experience of the individual patient in the clinic room to supporting the health of populations and augmenting the work of frontline primary care clinical teams. PCI overlaps uniquely with 2 disciplines with an impact on societal health—primary care and health informatics. Primary care is a gateway to health care access and aims to synthesize and coordinate numerous, complex elements of patients’ health and medical care in a holistic manner. However, over the past 25 years, primary care has become a specialty in crisis: in a post–COVID-19 world, workforce shortages, clinician burnout, and continuing challenges in health care access all contribute to difficulties in sustaining primary care. Informatics professionals are poised to change this trajectory. In this viewpoint, we aim to inform readers of the discipline of PCI and its importance in the design, support, and maintenance of essential primary care services. Although this work focuses on primary care in the United States, which includes general internal medicine, family medicine, and pediatrics (and depending on definition, includes specialties such as obstetrics and gynecology), many of the principles outlined can also be applied to comparable health care services and settings in other countries. We highlight (1) common global challenges in primary care, (2) recent trends in the evolution of PCI (personalized medicine, population health, social drivers of health, and team-based care), and (3) opportunities to move forward PCI with current and emerging technologies using the 4Cs of primary care framework. In summary, PCI offers important contributions to health care and the informatics field, and there are many opportunities for informatics professionals to enhance the primary care experience for patients, families, and their care teams. %M 39405512 %R 10.2196/60081 %U https://www.jmir.org/2024/1/e60081 %U https://doi.org/10.2196/60081 %U http://www.ncbi.nlm.nih.gov/pubmed/39405512 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53705 %T Exploring Physicians’ Perceptions of Digital Health’s Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study %A Sze,Kai Ping %A Fong,Qi Wei %A De Roza,Jacqueline Giovanna %A Lee,Eng Sing %A Tan,Shu Yun %+ National Healthcare Group Polyclinics, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore, 65 63553000, kai_ping_sze@nhgp.com.sg %K patient-physician relationship %K patient communication %K trust %K primary care medicine %K digital health %K primary care %K longitudinal care %K policy %K implementation %D 2024 %7 15.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39405515 %R 10.2196/53705 %U https://www.jmir.org/2024/1/e53705 %U https://doi.org/10.2196/53705 %U http://www.ncbi.nlm.nih.gov/pubmed/39405515 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e56263 %T Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study %A Suzumoto,Jun %A Mori,Yukiko %A Kuroda,Tomohiro %K health information exchange %K audit log %K Japan %K HIE %K audit %K logs %K usage %K medical informatics %K rate %K hospitals %K electronic health record %D 2024 %7 9.10.2024 %9 %J JMIR Med Inform %G English %X 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. %R 10.2196/56263 %U https://medinform.jmir.org/2024/1/e56263 %U https://doi.org/10.2196/56263 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48580 %T Patient Safety Incident Reporting and Learning Guidelines Implemented by Health Care Professionals in Specialized Care Units: Scoping Review %A Gqaleni,Tusiwe Mabel %A Mkhize,Sipho Wellington %A Chironda,Geldine %+ School of Nursing and Public Health, University of KwaZulu-Natal, 238 Mazisi Kunene Road, College of Health Sciences, Durban, 4041, South Africa, 27 031260400 ext 1559, gqalenit@ukzn.ac.za %K patient safety incidents %K adverse events %K harm %K near misses %K reporting guidelines %K implementation guidelines %K implementation practices %K intervention strategies %K critical care units %K intensive care units %K patient safety %K specialized care unit %K guidelines %K clinical practice %K healthcare professional %K ICU %D 2024 %7 4.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Implementing Patient Safety Incident Reporting and Learning (PSIRL) guidelines is critical in guiding clinical practice and improving clinical outcomes in specialized care units (SCUs). There is limited research on the evidence of the implemented PSIRL guidelines in SCUs at the global level. Objective: This review aims to map the evidence of PSIRL guidelines implemented by health care professionals in specialized care units globally. Methods: A scoping review methodology, according to Joanna Briggs Institute, was adopted. The eligibility criteria were guided by the Population, Concept, and Context (PCC) framework, with the Population including health care professionals, the Concept including PSIRL guidelines, and the Context including specialized units globally. Papers written in English were searched from relevant databases and search engines. The PRISMA-ScR (Preferred Reporting Items for Scoping Reviews and Meta-Analyses extension for Scoping Reviews) checklist for used. Results: The 13 selected studies were published from 2003 to 2023. Most articles are from the Netherlands and Switzerland (n=3), followed by South Africa (n=2). The nature of implemented PSIRL guidelines was computer-based (n=11) and paper-based incident reporting (n=2). The reporting system was intended for all the health care professionals within the specialized units, focusing on patients, staff members, and families. The outcomes of implemented incident reporting guidelines were positive, as evidenced by improved reporting of incidents, including medication errors (n=8) and decreased rate of incidents and errors (n=4). Furthermore, 1 study showed no change (n=1) in implementing the incident reporting guidelines. Conclusions: The implementation of reporting of patient safety incidents (PSIs) in specialized units started to be reported around 2002; however, the frequency of yearly publications remains very low. Although some specialized units are still using multifaceted interventions and paper reporting systems in reporting PSIs, the implementation of electronic and computer-based reporting systems is gaining momentum. The effective implementation of an electronic-based reporting system should extend into other units beyond critical care units, as it increases the reporting of PSIs, reducing time to make an informed reporting of PSIs and immediate accessibility to information when needed for analysis. The evidence on the implementation of PSI reporting guidelines in SCUs comes from 5 different continents (Asia, Africa, Australia, Europe, and North America). However, the number identified for certain countries within each continent is very minimal. %M 39365987 %R 10.2196/48580 %U https://www.jmir.org/2024/1/e48580 %U https://doi.org/10.2196/48580 %U http://www.ncbi.nlm.nih.gov/pubmed/39365987 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49691 %T Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis %A Tarver,Willi L %A Savoy,April %A Patel,Himalaya %A Weiner,Michael %A Holden,Richard J %+ School of Industrial Engineering, Purdue University, 799 W. Michigan St. ET 201, Indianapolis, IN, 46202, United States, 1 3172782194, asavoy@purdue.edu %K health information technology %K mobile devices %K nursing and nursing systems %K outpatient care %K SEIPS 2.0 %K work-system analysis %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39348682 %R 10.2196/49691 %U https://humanfactors.jmir.org/2024/1/e49691 %U https://doi.org/10.2196/49691 %U http://www.ncbi.nlm.nih.gov/pubmed/39348682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62790 %T Evolutionary Trends in the Adoption, Adaptation, and Abandonment of Mobile Health Technologies: Viewpoint Based on 25 Years of Research %A Portz,Jennifer %A Moore,Susan %A Bull,Sheana %+ Division of General Internal Medicine, School of Medicine, University of Colorado, Mailstop B119, Aurora, CO, 80045, United States, 1 303 724 8856, jennifer.portz@CUAnschutz.edu %K technology adoption %K mobile health %K SMS text messaging %K mobile apps %K wearables %K social media %D 2024 %7 27.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Over the past quarter-century, mobile health (mHealth) technologies have experienced significant changes in adoption rates, adaptation strategies, and instances of abandonment. Understanding the underlying factors driving these trends is essential for optimizing the design, implementation, and sustainability of interventions using these technologies. The evolution of mHealth adoption has followed a progressive trajectory, starting with cautious exploration and later accelerating due to technological advancements, increased smartphone penetration, and growing acceptance of digital health solutions by both health care providers and patients. However, alongside widespread adoption, challenges related to usability, interoperability, privacy concerns, and socioeconomic disparities have emerged, necessitating ongoing adaptation efforts. While many mHealth initiatives have successfully adapted to address these challenges, technology abandonment remains common, often due to unsustainable business models, inadequate user engagement, and insufficient evidence of effectiveness. This paper utilizes the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework to examine the interplay between the academic and industry sectors in patterns of adoption, adaptation, and abandonment, using 3 major mHealth innovations as examples: health-related SMS text messaging, mobile apps and wearables, and social media for health communication. Health SMS text messaging has demonstrated significant potential as a tool for health promotion, disease management, and patient engagement. The proliferation of mobile apps and devices has facilitated a shift from in-person and in-clinic practices to mobile- and wearable-centric solutions, encompassing everything from simple activity trackers to advanced health monitoring devices. Social media, initially characterized by basic text-based interactions in chat rooms and online forums, underwent a paradigm shift with the emergence of platforms such as MySpace and Facebook. This transition ushered in an era of mass communication through social media. The rise of microblogging and visually focused platforms such as Twitter(now X), Instagram, Snapchat, and TikTok, along with the integration of live streaming and augmented reality features, exemplifies the ongoing innovation within the social media landscape. Over the past 25 years, there have been remarkable strides in the adoption and adaptation of mHealth technologies, driven by technological innovation and a growing recognition of their potential to revolutionize health care delivery. Each mobile technology uniquely enhances public health and health care by catering to different user needs. SMS text messaging offers wide accessibility and proven effectiveness, while mobile apps and wearables provide comprehensive functionalities for more in-depth health management. Social media platforms amplify these efforts with their vast reach and community-building potential, making it essential to select the right tool for specific health interventions to maximize impact and engagement. Nevertheless, continued efforts are needed to address persistent challenges and mitigate instances of abandonment, ensuring that mHealth interventions reach their full potential in improving health outcomes and advancing equitable access to care. %M 39331463 %R 10.2196/62790 %U https://www.jmir.org/2024/1/e62790 %U https://doi.org/10.2196/62790 %U http://www.ncbi.nlm.nih.gov/pubmed/39331463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49387 %T Health Professionals’ Views on the Use of Conversational Agents for Health Care: Qualitative Descriptive Study %A MacNeill,A Luke %A MacNeill,Lillian %A Luke,Alison %A Doucet,Shelley %+ Centre for Research in Integrated Care, University of New Brunswick, 355 Campus Ring Road, Saint John, NB, E2L 4L5, Canada, 1 506 648 5777, luke.macneill@unb.ca %K conversational agents %K chatbots %K health care %K health professionals %K health personnel %K qualitative %K interview %D 2024 %7 25.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, there has been an increase in the use of conversational agents for health promotion and service delivery. To date, health professionals’ views on the use of this technology have received limited attention in the literature. Objective: The purpose of this study was to gain a better understanding of how health professionals view the use of conversational agents for health care. Methods: Physicians, nurses, and regulated mental health professionals were recruited using various web-based methods. Participants were interviewed individually using the Zoom (Zoom Video Communications, Inc) videoconferencing platform. Interview questions focused on the potential benefits and risks of using conversational agents for health care, as well as the best way to integrate conversational agents into the health care system. Interviews were transcribed verbatim and uploaded to NVivo (version 12; QSR International, Inc) for thematic analysis. Results: A total of 24 health professionals participated in the study (19 women, 5 men; mean age 42.75, SD 10.71 years). Participants said that the use of conversational agents for health care could have certain benefits, such as greater access to care for patients or clients and workload support for health professionals. They also discussed potential drawbacks, such as an added burden on health professionals (eg, program familiarization) and the limited capabilities of these programs. Participants said that conversational agents could be used for routine or basic tasks, such as screening and assessment, providing information and education, and supporting individuals between appointments. They also said that health professionals should have some oversight in terms of the development and implementation of these programs. Conclusions: The results of this study provide insight into health professionals’ views on the use of conversational agents for health care, particularly in terms of the benefits and drawbacks of these programs and how they should be integrated into the health care system. These collective findings offer useful information and guidance to stakeholders who have an interest in the development and implementation of this technology. %M 39320936 %R 10.2196/49387 %U https://www.jmir.org/2024/1/e49387 %U https://doi.org/10.2196/49387 %U http://www.ncbi.nlm.nih.gov/pubmed/39320936 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59939 %T Equity in Digital Mental Health Interventions in the United States: Where to Next? %A Robinson,Athena %A Flom,Megan %A Forman-Hoffman,Valerie L %A Histon,Trina %A Levy,Monique %A Darcy,Alison %A Ajayi,Toluwalase %A Mohr,David C %A Wicks,Paul %A Greene,Carolyn %A Montgomery,Robert M %+ Woebot Health, 535 Mission St Fl 14, San Francisco, CA, 94105, United States, 1 707 563 1759, scicomms@woebothealth.com %K Digital Mental Health Interventions %K mental health %K health equity %K access to health care %K health plan implementations %D 2024 %7 24.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Health care technologies have the ability to bridge or hinder equitable care. Advocates of digital mental health interventions (DMHIs) report that such technologies are poised to reduce the documented gross health care inequities that have plagued generations of people seeking care in the United States. This is due to a multitude of factors such as their potential to revolutionize access; mitigate logistical barriers to in-person mental health care; and leverage patient inputs to formulate tailored, responsive, and personalized experiences. Although we agree with the potential of DMHIs to advance health equity, we articulate several steps essential to mobilize and sustain meaningful forward progression in this endeavor, reflecting on decades of research and learnings drawn from multiple fields of expertise and real-world experience. First, DMHI manufacturers must build diversity, equity, inclusion, and belonging (DEIB) processes into the full spectrum of product evolution itself (eg, product design, evidence generation) as well as into the fabric of internal company practices (eg, talent recruitment, communication principles, and advisory boards). Second, awareness of the DEIB efforts—or lack thereof—in DMHI research trials is needed to refine and optimize future study design for inclusivity as well as proactively address potential barriers to doing so. Trials should incorporate thoughtful, inclusive, and creative approaches to recruitment, enrollment, and measurement of social determinants of health and self-identity, as well as a prioritization of planned and exploratory analyses examining outcomes across various groups of people. Third, mental health care advocacy, research funding policies, and local and federal legislation can advance these pursuits, with directives from the US Preventive Services Taskforce, National Institutes of Health, and Food and Drug Administration applied as poignant examples. For products with artificial intelligence/machine learning, maintaining a “human in the loop” as well as prespecified and adaptive analytic frameworks to monitor and remediate potential algorithmic bias can reduce the risk of increasing inequity. Last, but certainly not least, is a call for partnership and transparency within and across ecosystems (academic, industry, payer, provider, regulatory agencies, and value-based care organizations) to reliably build health equity into real-world DMHI product deployments and evidence-generation strategies. All these considerations should also extend into the context of an equity-informed commercial strategy for DMHI manufacturers and health care organizations alike. The potential to advance health equity in innovation with DMHI is apparent. We advocate the field’s thoughtful and evergreen advancement in inclusivity, thereby redefining the mental health care experience for this generation and those to come. %M 39316436 %R 10.2196/59939 %U https://www.jmir.org/2024/1/e59939 %U https://doi.org/10.2196/59939 %U http://www.ncbi.nlm.nih.gov/pubmed/39316436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58198 %T We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party? %A Fitzpatrick,Skye %A Crenshaw,Alexander O %A Donkin,Victoria %A Collins,Alexis %A Xiang,Angela %A Earle,Elizabeth A %A Goenka,Kamya %A Varma,Sonya %A Bushe,Julianne %A McFadden,Tara %A Librado,Andrea %A Monson,Candice %+ York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 4167362100 ext 66214, skyefitz@yorku.ca %K online interventions %K self-help %K digital interventions %K mental health %K psychotherapy %K intervention desirability %D 2024 %7 19.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public’s assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness. %M 39298760 %R 10.2196/58198 %U https://www.jmir.org/2024/1/e58198 %U https://doi.org/10.2196/58198 %U http://www.ncbi.nlm.nih.gov/pubmed/39298760 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e54116 %T Usage, Attitudes, Facilitators, and Barriers Toward Digital Health Technologies in Musculoskeletal Care: Survey Among Primary Care Physiotherapists in Norway %A Martinsen,Lars %A Østerås,Nina %A Moseng,Tuva %A Tveter,Anne Therese %+ Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0370, Norway, 47 22451500, lars.martinsen@diakonsyk.no %K physiotherapy %K physiotherapist %K physiotherapists %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K ehealth %K telemedicine %K tele-medicine %K family medicine %K primary care %K primary health care %K musculoskeletal %K musculoskeletal care %K muscle %K skeleton %K musculoskeletal disorders %K MSD %K MSDs %K internet survey %K internet surveys %K online survey %K online surveys %K web-based survey %K web-based surveys %K survey %K surveys %K mobile phone %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Work burden increases for physiotherapists in the primary health care sector as the prevalence of musculoskeletal disorders (MSDs) increases. Digital health technologies (DHTs) are proposed as a viable solution to secure the sustainability of the health care system and have shown promising results in a range of conditions. However, little is known about use of DHTs among physiotherapists in the primary health care sector in Norway. Objective: This study aimed to investigate the use of and attitudes toward DHTs among physiotherapists treating patients with MSDs in primary care, and potential facilitators or barriers for adopting DHTs in clinical practice. Methods: An author-developed web-based questionnaire was distributed to physiotherapists in all Norwegian municipalities in March 2023. The questionnaire included items regarding use of technologies, attitudes, suitability, and factors influencing adoption of DHT. Suitability and agreement on statements were scored on an 11-point numeric rating scale (0=very unsuitable or strongly disagree, 10=very suitable or strongly agree). Differences across employment sites and users versus nonusers of DHT were analyzed using the χ2 test, Fisher exact test, Student t test, and Mann-Whitney U test. Results: Approximately 5000 physiotherapists were invited to participate, of which 6.8% (338) completed the questionnaire. A total of 46.2% (156/338) offered DHTs in their practice, of which 53.2% (83/156) used it on a weekly basis, mostly telephone consultations (105/156, 67.3%). A higher proportion of physiotherapists in private practice offered DHT compared with those employed by municipalities (95/170, 55.9% vs 61/168, 36.3%; P<.001). A majority (272/335, 81.2%) were positive about recommending DHTs to their patients. Suitability of DHTs in physiotherapy was rated an average of 6 (SD 2.1). Apps for smartphones or tablets were rated most suitable (mean rating 6.8, SD 2.4). The most frequently reported advantages were flexibility in how physiotherapy is offered (278/338, 82.3%) and reduced travel time for the patient (235/338, 70%). The highest rated disadvantages were limited scope for physical examination (252/338, 74.6%) and difficulty in building rapport with the patient (227/338, 67.2%). The main facilitators and barriers included a functioning (median rating 10, IQR 8-10) or lack of functioning (median rating 9, IQR 8-10) internet connection, respectively. Lack of training in DHTs was prominent regarding evaluation, diagnosing, and treatment (median rating 0, IQR 0-2), with minor, but significant, differences between nonusers and users (median rating 0, IQR 0-1 vs median rating 1, IQR 0-4); P<.001). Conclusions: Physiotherapists in Norwegian primary care treating patients with MSDs are positive about using DHTs, and almost 50% (156/338) have adopted them in clinical practice. Concerns are related to lack of a physical examination and technical aspects. Training in the use of DHTs should be addressed in implementation processes. %M 39283661 %R 10.2196/54116 %U https://rehab.jmir.org/2024/1/e54116 %U https://doi.org/10.2196/54116 %U http://www.ncbi.nlm.nih.gov/pubmed/39283661 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57406 %T How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research %A Staehelin,Dario %A Dolata,Mateusz %A Stöckli,Livia %A Schwabe,Gerhard %+ Department of Informatics, University of Zurich, Binzmühlestrasse 14, Zurich, 8050, Switzerland, 41 763103137, dario.staehelin@ost.ch %K patient-provider communication %K patient-generated data %K field study %K chronic care %K design science research %K patient-centered care %K integrated care %K patient-provider collaboration %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 39255481 %R 10.2196/57406 %U https://medinform.jmir.org/2024/1/e57406 %U https://doi.org/10.2196/57406 %U http://www.ncbi.nlm.nih.gov/pubmed/39255481 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46901 %T User Experiences of Transitioning From a Homegrown Electronic Health Record to a Vendor-Based Product in the Department of Veterans Affairs: Qualitative Findings From a Mixed Methods Evaluation %A Anderson,Ekaterina %A Moldestad,Megan %A Brunner,Julian %A Ball,Sherry %A Helfrich,Christian %A Orlander,Jay %A Rinne,Seppo %A Sayre,George %+ Center for Health Optimization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 7816874936, Ekaterina.Anderson@va.gov %K electronic health records %K United States Department of Veterans Affairs %K Veterans Affairs %K organizational change %K delivery of health care %K integrated %K medical informatics %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Department of Veterans Affairs (VA), the largest nationally integrated health system in the United States, is transitioning from its homegrown electronic health record (EHR) to a new vendor-based EHR, Oracle Cerner. Experiences of the first VA site to transition have been widely discussed in the media, but in-depth accounts based on rigorous research are lacking. Objective: We sought to explore employee perspectives on the rationale for, and value of, transitioning from a VA-tailored EHR to a vendor-based product. Methods: As part of a larger mixed methods, multisite, formative evaluation of VA clinician and staff experiences with the EHR transition, we conducted semistructured interviews at the Mann-Grandstaff VA Medical Center before, during, and after going live in October 2020. In total, we completed 122 interviews with 26 participants across multiple departments. Results: Before the new vendor-based EHR went live, participants initially expressed cautious optimism about the transition. However, in subsequent interviews following the go-live, participants increasingly critiqued the vendor’s understanding of VA’s needs, values, and workflows, as well as what they perceived as an inadequate fit between the functionalities of the new vendor-based EHR system and VA’s characteristic approach to care. As much as a year after going live, participants reiterated these concerns while also expressing a desire for substantive changes to the transition process, with some questioning the value of continuing with the transition. Conclusions: VA’s transition from a homegrown EHR to a vendor-based EHR system has presented substantial challenges, both practical and cultural in nature. Consequently, it is a valuable case study for understanding the sociotechnical dimension of EHR-to-EHR transitions. These findings have implications for both VA leadership and the broader community of policy makers, vendors, informaticists, and others involved in large-scale health information technology implementations. %M 39255006 %R 10.2196/46901 %U https://formative.jmir.org/2024/1/e46901 %U https://doi.org/10.2196/46901 %U http://www.ncbi.nlm.nih.gov/pubmed/39255006 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e58347 %T Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics %A Wunderlich,Maximilian Markus %A Frey,Nicolas %A Amende-Wolf,Sandro %A Hinrichs,Carl %A Balzer,Felix %A Poncette,Akira-Sebastian %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Invalidenstraße 90, Berlin, 10115 Berlin, Germany, 49 030 450 581 018, akira-sebastian.poncette@charite.de %K patient monitoring %K intensive care unit %K ICU %K alarm fatigue %K alarm management %K patient safety %K alarm system %K alarm system quality %K medical devices %K clinical alarms %K COVID-19 %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue. Objective: We aimed to compare alarm situations between provisional COVID-19 ICUs and non–COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff. Methods: Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non–COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel. Results: COVID-19 ICUs had significantly more alarms per bed per day than non–COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19–specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04). Conclusions: Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings. %M 39250783 %R 10.2196/58347 %U https://medinform.jmir.org/2024/1/e58347 %U https://doi.org/10.2196/58347 %U http://www.ncbi.nlm.nih.gov/pubmed/39250783 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e58478 %T Practical Applications of Large Language Models for Health Care Professionals and Scientists %A Reis,Florian %A Lenz,Christian %A Gossen,Manfred %A Volk,Hans-Dieter %A Drzeniek,Norman Michael %K artificial intelligence %K healthcare %K chatGPT %K large language model %K prompting %K LLM %K applications %K AI %K scientists %K physicians %K health care %D 2024 %7 5.9.2024 %9 %J JMIR Med Inform %G English %X With the popularization of large language models (LLMs), strategies for their effective and safe usage in health care and research have become increasingly pertinent. Despite the growing interest and eagerness among health care professionals and scientists to exploit the potential of LLMs, initial attempts may yield suboptimal results due to a lack of user experience, thus complicating the integration of artificial intelligence (AI) tools into workplace routine. Focusing on scientists and health care professionals with limited LLM experience, this viewpoint article highlights and discusses 6 easy-to-implement use cases of practical relevance. These encompass customizing translations, refining text and extracting information, generating comprehensive overviews and specialized insights, compiling ideas into cohesive narratives, crafting personalized educational materials, and facilitating intellectual sparring. Additionally, we discuss general prompting strategies and precautions for the implementation of AI tools in biomedicine. Despite various hurdles and challenges, the integration of LLMs into daily routines of physicians and researchers promises heightened workplace productivity and efficiency. %R 10.2196/58478 %U https://medinform.jmir.org/2024/1/e58478 %U https://doi.org/10.2196/58478 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54638 %T Constructing a Hospital Department Development–Level Assessment Model: Machine Learning and Expert Consultation Approach in Complex Hospital Data Environments %A Liu,Jingkun %A Tai,Jiaojiao %A Han,Junying %A Zhang,Meng %A Li,Yang %A Yang,Hongjuan %A Yan,Ziqiang %+ Big Data Analysis Center, Honghui Hospital, Xi'an Jiaotong University, No. 555, Youyi Road, Beilin District, Xi'an, 710054, China, 86 15389268019, heluxue68@hotmail.com %K machine algorithms %K hospital management %K model construction %K support vector machine %K clustering %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Every hospital manager aims to build harmonious, mutually beneficial, and steady-state departments. Therefore, it is important to explore a hospital department development assessment model based on objective hospital data. Objective: This study aims to use a novel machine learning algorithm to identify key evaluation indexes for hospital departments, offering insights for strategic planning and resource allocation in hospital management. Methods: Data related to the development of a hospital department over the past 3 years were extracted from various hospital information systems. The resulting data set was mined using neural machine algorithms to assess the possible role of hospital departments in the development of a hospital. A questionnaire was used to consult senior experts familiar with the hospital to assess the actual work in each hospital department and the impact of each department’s development on overall hospital discipline. We used the results from this questionnaire to verify the accuracy of the departmental risk scores calculated by the machine learning algorithm. Results: Deep machine learning was performed and modeled on the hospital system training data set. The model successfully leveraged the hospital’s training data set to learn, predict, and evaluate the working and development of hospital departments. A comparison of the questionnaire results with the risk ranking set from the departments machine learning algorithm using the cosine similarity algorithm and Pearson correlation analysis showed a good match. This indicates that the department development assessment model and risk score based on the objective data of hospital systems are relatively accurate and objective. Conclusions: This study demonstrated that our machine learning algorithm provides an accurate and objective assessment model for hospital department development. The strong alignment of the model's risk assessments with expert opinions, validated through statistical analysis, highlights its reliability and potential to guide strategic hospital management decisions. %M 39230941 %R 10.2196/54638 %U https://formative.jmir.org/2024/1/e54638 %U https://doi.org/10.2196/54638 %U http://www.ncbi.nlm.nih.gov/pubmed/39230941 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59168 %T Understanding Older Adults’ Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study %A Knotnerus,Hanna R %A Ngo,Hà T N %A Maarsingh,Otto R %A van Vugt,Vincent A %K digital health care %K digital health platform %K general practice %K qualitative research %K older adults %K primary care %K mobile phone %D 2024 %7 30.8.2024 %9 %J JMIR Aging %G English %X Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners’ (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients’ choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people’s experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients’ experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. %R 10.2196/59168 %U https://aging.jmir.org/2024/1/e59168 %U https://doi.org/10.2196/59168 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e58456 %T Impact of an Electronic Health Record–Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial %A Pradhan,Apoorva %A Wright,Eric A %A Hayduk,Vanessa A %A Berhane,Juliana %A Sponenberg,Mallory %A Webster,Leeann %A Anderson,Hannah %A Park,Siyeon %A Graham,Jove %A Friedenberg,Scott %K headache management %K migraine management %K electronic health record–based alerts %K primary care %K clinician decision support tools %K electronic health record %K EHR %D 2024 %7 29.8.2024 %9 %J JMIR Med Inform %G English %X Background: Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%‐30% of referrals from primary care to neurology. In primary care, electronic health record–based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care. Objective: This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients’ overall headache management. Methods: We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021 to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocks based on region and patient-to–health care provider ratios and then 1:1 randomized within each block into either the control or intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic health record. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, from baseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resource use. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. Results: We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test 6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21). We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009). The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate –1.89, 95% CI –5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32% (303/2677) of alerts were acted upon. Conclusions: The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alerts by health care providers prompts future alterations of the alert and exploration of alternative approaches. Trial Registration: ClinicalTrials.gov NCT05067725; https://clinicaltrials.gov/study/NCT05067725 %R 10.2196/58456 %U https://medinform.jmir.org/2024/1/e58456 %U https://doi.org/10.2196/58456 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e48633 %T Barriers to and Facilitators of Artificial Intelligence Adoption in Health Care: Scoping Review %A Hassan,Masooma %A Kushniruk,Andre %A Borycki,Elizabeth %+ Department of Health Information Science, University of Victoria, HSD Building, A202, Victoria, BC, V8W 2Y2, Canada, 1 6472876274, masooma.d.hassan@gmail.com %K artificial intelligence %K governance %K health information systems %K artificial intelligence adoption %K system implementation %K health care organizations %K health services %K mobile phone %D 2024 %7 29.8.2024 %9 Review %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI) use cases in health care are on the rise, with the potential to improve operational efficiency and care outcomes. However, the translation of AI into practical, everyday use has been limited, as its effectiveness relies on successful implementation and adoption by clinicians, patients, and other health care stakeholders. Objective: As adoption is a key factor in the successful proliferation of an innovation, this scoping review aimed at presenting an overview of the barriers to and facilitators of AI adoption in health care. Methods: A scoping review was conducted using the guidance provided by the Joanna Briggs Institute and the framework proposed by Arksey and O’Malley. MEDLINE, IEEE Xplore, and ScienceDirect databases were searched to identify publications in English that reported on the barriers to or facilitators of AI adoption in health care. This review focused on articles published between January 2011 and December 2023. The review did not have any limitations regarding the health care setting (hospital or community) or the population (patients, clinicians, physicians, or health care administrators). A thematic analysis was conducted on the selected articles to map factors associated with the barriers to and facilitators of AI adoption in health care. Results: A total of 2514 articles were identified in the initial search. After title and abstract reviews, 50 (1.99%) articles were included in the final analysis. These articles were reviewed for the barriers to and facilitators of AI adoption in health care. Most articles were empirical studies, literature reviews, reports, and thought articles. Approximately 18 categories of barriers and facilitators were identified. These were organized sequentially to provide considerations for AI development, implementation, and the overall structure needed to facilitate adoption. Conclusions: The literature review revealed that trust is a significant catalyst of adoption, and it was found to be impacted by several barriers identified in this review. A governance structure can be a key facilitator, among others, in ensuring all the elements identified as barriers are addressed appropriately. The findings demonstrate that the implementation of AI in health care is still, in many ways, dependent on the establishment of regulatory and legal frameworks. Further research into a combination of governance and implementation frameworks, models, or theories to enhance trust that would specifically enable adoption is needed to provide the necessary guidance to those translating AI research into practice. Future research could also be expanded to include attempts at understanding patients’ perspectives on complex, high-risk AI use cases and how the use of AI applications affects clinical practice and patient care, including sociotechnical considerations, as more algorithms are implemented in actual clinical environments. %M 39207831 %R 10.2196/48633 %U https://humanfactors.jmir.org/2024/1/e48633 %U https://doi.org/10.2196/48633 %U http://www.ncbi.nlm.nih.gov/pubmed/39207831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55717 %T Impacts of Clinical Decision Support Systems on the Relationship, Communication, and Shared Decision-Making Between Health Care Professionals and Patients: Multistakeholder Interview Study %A Funer,Florian %A Schneider,Diana %A Heyen,Nils B %A Aichinger,Heike %A Klausen,Andrea Diana %A Tinnemeyer,Sara %A Liedtke,Wenke %A Salloch,Sabine %A Bratan,Tanja %+ Competence Center Emerging Technologies, Fraunhofer Institute for Systems and Innovation Research ISI, Breslauer Straße 48, Karlsruhe, 76139, Germany, 49 0721 6809 58, diana.schneider@isi.fraunhofer.de %K clinical decision support system %K CDSS %K health care professionals %K patients %K relationships %K communication %K shared decision-making %K Germany %D 2024 %7 23.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. Little is known so far about the impact of such systems on the health care professional–patient relationship, and there is a lack of agreement about whether and how patients should be informed about the use of CDSSs. Objective: This study aims to explore, in an empirically informed manner, the potential implications for the health care professional–patient relationship and to underline the importance of this relationship when using CDSSs for both patients and future professionals. Methods: Using a methodological triangulation, 15 medical students and 12 trainee nurses were interviewed in semistructured interviews and 18 patients were involved in focus groups between April 2021 and April 2022. All participants came from Germany. Three examples of CDSSs covering different areas of health care (ie, surgery, nephrology, and intensive home care) were used as stimuli in the study to identify similarities and differences regarding the use of CDSSs in different fields of application. The interview and focus group transcripts were analyzed using a structured qualitative content analysis. Results: From the interviews and focus groups analyzed, three topics were identified that interdependently address the interactions between patients and health care professionals: (1) CDSSs and their impact on the roles of and requirements for health care professionals, (2) CDSSs and their impact on the relationship between health care professionals and patients (including communication requirements for shared decision-making), and (3) stakeholders’ expectations for patient education and information about CDSSs and their use. Conclusions: The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional–patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship. Therefore, the anticipated effects on the relationship between health care professionals and patients could be specifically addressed in patient information about the use of CDSSs. %M 39178023 %R 10.2196/55717 %U https://www.jmir.org/2024/1/e55717 %U https://doi.org/10.2196/55717 %U http://www.ncbi.nlm.nih.gov/pubmed/39178023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50217 %T Factors Influencing the Implementation of Digital Advance Care Planning: Qualitative Interview Study %A Bradshaw,Andy %A Birtwistle,Jacqueline %A Evans,Catherine J %A Sleeman,Katherine E %A Richards,Suzanne %A Foy,Robbie %A Millares Martin,Pablo %A Carder,Paul %A Allsop,Matthew J %A Twiddy,Maureen %+ Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9LU, United Kingdom, 44 1133434185, m.j.allsop@leeds.ac.uk %K palliative care %K electronic palliative care coordination systems %K electronic health record systems %K advance care planning %K end of life care %K technology %K Normalization Process Theory %K NPT %K qualitative %D 2024 %7 16.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Palliative care aims to improve the quality of life for people with life-limiting illnesses. Advance care planning conversations that establish a patient’s wishes and preferences for care are part of a person-centered approach. Internationally, electronic health record systems are digital interventions used to record and share patients’ advance care plans across health care services and settings. They aim to provide tools that support electronic information sharing and care coordination. Within the United Kingdom, Electronic Palliative Care Coordination Systems (EPaCCS) are an example of this. Despite over a decade of policy promoting EPaCCS nationally, there has been limited implementation and consistently low levels of use by health professionals. Objective: The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England. Methods: A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels. Results: Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access. Conclusions: EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally. %M 39151167 %R 10.2196/50217 %U https://www.jmir.org/2024/1/e50217 %U https://doi.org/10.2196/50217 %U http://www.ncbi.nlm.nih.gov/pubmed/39151167 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e53427 %T Pediatric Sedation Assessment and Management System (PSAMS) for Pediatric Sedation in China: Development and Implementation Report %A Zhu,Ziyu %A Liu,Lan %A Du,Min %A Ye,Mao %A Xu,Ximing %A Xu,Ying %K electronic data capture %K information systems %K pediatric sedation %K sedation management %K workflow optimization %D 2024 %7 7.8.2024 %9 %J JMIR Med Inform %G English %X Background: Recently, the growing demand for pediatric sedation services outside the operating room has imposed a heavy burden on pediatric centers in China. There is an urgent need to develop a novel system for improved sedation services. Objective: This study aimed to develop and implement a computerized system, the Pediatric Sedation Assessment and Management System (PSAMS), to streamline pediatric sedation services at a major children’s hospital in Southwest China. Methods: PSAMS was designed to reflect the actual workflow of pediatric sedation. It consists of 3 main components: server-hosted software; client applications on tablets and computers; and specialized devices like gun-type scanners, desktop label printers, and pulse oximeters. With the participation of a multidisciplinary team, PSAMS was developed and refined during its application in the sedation process. This study analyzed data from the first 2 years after the system’s deployment. Implementation (Results): From January 2020 to December 2021, a total of 127,325 sedations were performed on 85,281 patients using the PSAMS database. Besides basic variables imported from Hospital Information Systems (HIS), the PSAMS database currently contains 33 additional variables that capture comprehensive information from presedation assessment to postprocedural recovery. The recorded data from PSAMS indicates a one-time sedation success rate of 97.1% (50,752/52,282) in 2020 and 97.5% (73,184/75,043) in 2021. The observed adverse events rate was 3.5% (95% CI 3.4%‐3.7%) in 2020 and 2.8% (95% CI 2.7%-2.9%) in 2021. Conclusions: PSAMS streamlined the entire sedation workflow, reduced the burden of data collection, and laid a foundation for future cooperation of multiple pediatric health care centers. %R 10.2196/53427 %U https://medinform.jmir.org/2024/1/e53427 %U https://doi.org/10.2196/53427 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56528 %T Exploring How Patients Are Supported to Use Online Services in Primary Care in England Through “Digital Facilitation”: Survey Study %A Winder,Rachel %A Campbell,John L %A Akter,Nurunnahar %A Aminu,Abodunrin Q %A Lambert,Jeffrey %A Cockcroft,Emma %A Thomas,Chloe %A Clark,Christopher E %A Bryce,Carol %A Sussex,Jon %A Atherton,Helen %A Marriott,Christine %A Abel,Gary %+ University of Exeter Medical School, University of Exeter, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, United Kingdom, 44 44 1392 722821, john.campbell@exeter.ac.uk %K primary care %K online services %K access to online health care services %K general practice %K survey %K digital support %K inequalities %K remote consultation %K health services research %K digital technology %D 2024 %7 7.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health service policy in many jurisdictions is driving greater investment into digital primary care services. While some patients and practices may benefit, there are concerns that not all are able or wish to access primary care services online. “Digital facilitation” is the “range of processes, procedures, and personnel seeking to support patients in their uptake and use of online services” and may address such concerns. Objective: As part of a multimethod research program, we undertook surveys of practice staff and patients to gain insight into the support being offered by practices and explore patients’ experiences of this support. Methods: General practices from 4 regions of England were sent a questionnaire exploring the modes of digital facilitation offered, the personnel involved in its delivery, and views on the motivations and drivers for providing support. Moreover, 12,822 patients registered with 62 general practices (predominantly those providing practice survey responses) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services. Results: Almost one-third of practices (156/500, 31.2%) responded to the practice survey, with most reporting using passive modes of digital facilitation (eg, display, leaflets, and SMS text messages) and few using active modes (eg, offering tablets or computers or using practice champions). However, 90.9% (130/143) reported providing ad hoc support. Practices agreed that it was the responsibility of both the practice (105/144, 72.9%) and the wider National Health Service (118/143, 82.5%) to support patients in using online services and that providing such support benefited the practice (126/144, 87.5%) and their patients (132/144, 91.7%). Nearly a quarter of the patients (3051/12,822, 23.8%) responded to the patient survey, with few (522/3051, 17.11% or less) reporting awareness of any modes of digital facilitation apart from text messages and emails (1205/3051, 39.5%) and only 13.36% (392/2935) reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of 4 outcomes: being aware of, or of using, digital facilitation efforts, or being told about or being helped to use online services (all P<.05), particularly with regard to being helped to use online services (adjusted odds ratio for patients aged 85 years versus those aged 55-64 years: 0.08, 95% CI 0.02-0.36). However, ethnic minority participants or those for whom their first language was not English had positive associations with these outcomes. Conclusions: General practices recognize that patients would benefit from support to access online services. However, the support provided is often passive or ad hoc, and patients were seldom aware of digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support for all patients, particularly to provide targeted support for older patients. %M 39110960 %R 10.2196/56528 %U https://www.jmir.org/2024/1/e56528 %U https://doi.org/10.2196/56528 %U http://www.ncbi.nlm.nih.gov/pubmed/39110960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56316 %T Digital Maturity as a Predictor of Quality and Safety Outcomes in US Hospitals: Cross-Sectional Observational Study %A Snowdon,Anne %A Hussein,Abdulkadir %A Danforth,Melissa %A Wright,Alexandra %A Oakes,Reid %+ Department of Mathematics & Statistics, University of Windsor, Windsor, ON, Canada, 1 4164001956, alexandra.wright@uwindsor.ca %K digital health %K readiness %K cross sectional %K observational %K regression %K digital maturity %K association %K associations %K correlation %K correlations %K quality and safety %K hospital performance %K workforce %K health outcomes %K safety %K service %K services %K healthcare system %K healthcare systems %K hospital %K hospitals %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that an advanced digitally enabled workforce is associated with strong safety leadership and culture and better patient health and safety outcomes. Objective: This study aimed to examine the relationship between digital maturity and quality and safety outcomes in US hospitals. Methods: The data sources were hospital safety letter grades as well as quality and safety scores on a continuous scale published by The Leapfrog Group. We used the digital maturity level (measured using the Electronic Medical Record Assessment Model [EMRAM]) of 1026 US hospitals. This was a cross-sectional, observational study. Logistic, linear, and Tweedie regression analyses were used to explore the relationships among The Leapfrog Group's Hospital Safety Grades, individual Leapfrog safety scores, and digital maturity levels classified as advanced or fully developed digital maturity (EMRAM levels 6 and 7) or underdeveloped maturity (EMRAM level 0). Digital maturity was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership as confounding variables. Hospitals were divided into the following 2 groups to compare safety and quality outcomes: hospitals that were digitally advanced and hospitals with underdeveloped digital maturity. Data from The Leapfrog Group's Hospital Safety Grades report published in spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospital beds were obtained from the CMS database. Results: The results revealed that the odds of achieving a higher Leapfrog Group Hospital Safety Grade was statistically significantly higher, by 3.25 times, for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7; odds ratio 3.25, 95% CI 2.33-4.55). Conclusions: Hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes. The study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity compared with hospitals with underdeveloped digital maturity. %M 39106100 %R 10.2196/56316 %U https://www.jmir.org/2024/1/e56316 %U https://doi.org/10.2196/56316 %U http://www.ncbi.nlm.nih.gov/pubmed/39106100 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e50375 %T Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways %A Yilma,Tesfahun Melese %A Taddese,Asefa %A Mamuye,Adane %A Endehabtu,Berhanu Fikadie %A Alemayehu,Yibeltal %A Senay,Asaye %A Daka,Dawit %A Abraham,Loko %A Tadesse,Rabeal %A Melkamu,Gemechis %A Wendrad,Naod %A Kaba,Oli %A Mohammed,Mesoud %A Denboba,Wubshet %A Birhan,Dawit %A Biru,Amanuel %A Tilahun,Binyam %+ Department of Health Informatics, Center for Digital Health and Implementation Science, University of Gondar, Chechela Street, College of Medicine and Health Sciences, University of Gondar, Gondar, 196, Ethiopia, 251 918779820, tesfahun.melese@uog.edu.et %K health information system %K digital health system %K District Health Information System version 2 %K DHIS2 %K maturity assessment %K Stages of Continuous Improvement %K Ethiopia %D 2024 %7 26.7.2024 %9 Implementation Report %J JMIR Med Inform %G English %X Background: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. Objective: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. Methods: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. Results: The national DHIS2 implementation’s maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. Conclusions: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed. %M 39059005 %R 10.2196/50375 %U https://medinform.jmir.org/2024/1/e50375 %U https://doi.org/10.2196/50375 %U http://www.ncbi.nlm.nih.gov/pubmed/39059005 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e55959 %T The Information and Communication Technology Maturity Assessment at Primary Health Care Services Across 9 Provinces in Indonesia: Evaluation Study %A Aisyah,Dewi Nur %A Setiawan,Agus Heri %A Lokopessy,Alfiano Fawwaz %A Faradiba,Nadia %A Setiaji,Setiaji %A Manikam,Logan %A Kozlakidis,Zisis %K public health centers %K Puskesmas %K digital maturity %K infrastructure %K primary health care %K district health office %K primary care clinics %K Asia %K Asian %K Indonesia %K ICT %K information and communication technologies %K information and communication technology %K maturity %K adoption %K readiness %K implementation %K eHealth %K telehealth %K telemedicine %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K primary care %D 2024 %7 18.7.2024 %9 %J JMIR Med Inform %G English %X 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. %R 10.2196/55959 %U https://medinform.jmir.org/2024/1/e55959 %U https://doi.org/10.2196/55959 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e56879 %T Development and Implementation of a Safety Incident Report System for Health Care Discipline Students During Clinical Internships: Observational Study %A Gil-Hernández,Eva %A Carrillo,Irene %A Guilabert,Mercedes %A Bohomol,Elena %A Serpa,Piedad C %A Ribeiro Neves,Vanessa %A Maluenda Martínez,Maria %A Martin-Delgado,Jimmy %A Pérez-Esteve,Clara %A Fernández,César %A Mira,José Joaquín %+ Universidad Miguel Hernández, Avenida Universidad s/n, Elche, 03202, Spain, 34 966658984, jose.mira@umh.es %K reporting systems %K education %K medical %K nursing %K undergraduate %K patient safety %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Patient safety is a fundamental aspect of health care practice across global health systems. Safe practices, which include incident reporting systems, have proven valuable in preventing the recurrence of safety incidents. However, the accessibility of this tool for health care discipline students is not consistent, limiting their acquisition of competencies. In addition, there is no tools to familiarize students with analyzing safety incidents. Gamification has emerged as an effective strategy in health care education. Objective: This study aims to develop an incident reporting system tailored to the specific needs of health care discipline students, named Safety Incident Report System for Students. Secondary objectives included studying the performance of different groups of students in the use of the platform and training them on the correct procedures for reporting. Methods: This was an observational study carried out in 3 phases. Phase 1 consisted of the development of the web-based platform and the incident registration form. For this purpose, systems already developed and in use in Spain were taken as a basis. During phase 2, a total of 223 students in medicine and nursing with clinical internships from universities in Argentina, Brazil, Colombia, Ecuador, and Spain received an introductory seminar and were given access to the platform. Phase 3 ran in parallel and involved evaluation and feedback of the reports received as well as the opportunity to submit the students’ opinion on the process. Descriptive statistics were obtained to gain information about the incidents, and mean comparisons by groups were performed to analyze the scores obtained. Results: The final form was divided into 9 sections and consisted of 48 questions that allowed for introducing data about the incident, its causes, and proposals for an improvement plan. The platform included a personal dashboard displaying submitted reports, average scores, progression, and score rankings. A total of 105 students participated, submitting 147 reports. Incidents were mainly reported in the hospital setting, with complications of care (87/346, 25.1%) and effects of medication or medical products (82/346, 23.7%) being predominant. The most repeated causes were related confusion, oversight, or distractions (49/147, 33.3%) and absence of process verification (44/147, 29.9%). Statistically significant differences were observed between the mean final scores received by country (P<.001) and sex (P=.006) but not by studies (P=.47). Overall, participants rated the experience of using the Safety Incident Report System for Students positively. Conclusions: This study presents an initial adaptation of reporting systems to suit the needs of students, introducing a guided and inspiring framework that has garnered positive acceptance among students. Through this endeavor, a pathway toward a safety culture within the faculty is established. A long-term follow-up would be desirable to check the real benefits of using the tool during education. Trial Registration: Trial Registration: ClinicalTrials.gov NCT05350345; https://clinicaltrials.gov/study/NCT05350345 %M 39024005 %R 10.2196/56879 %U https://mededu.jmir.org/2024/1/e56879 %U https://doi.org/10.2196/56879 %U http://www.ncbi.nlm.nih.gov/pubmed/39024005 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49570 %T The Potential of Evidence-Based Clinical Intake Tools to Discover or Ground Prevalence of Symptoms Using Real-Life Digital Health Encounters: Retrospective Cohort Study %A Avnat,Eden %A Samin,Michael %A Ben Joya,Daniel %A Schneider,Eyal %A Yanko,Elia %A Eshel,Dafna %A Ovadia,Shahar %A Lev,Yossi %A Souroujon,Daniel %+ Kahun Medical Ltd, 4 Ariel Sharon St, Givatayim, 515909117, Israel, 972 545299622, eden@kahun.com %K clinical intake tool %K evidence-based medicine %K big data %K digital health %K symptoms %K prevalence %D 2024 %7 16.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence-based clinical intake tools (EBCITs) are structured assessment tools used to gather information about patients and help health care providers make informed decisions. The growing demand for personalized medicine, along with the big data revolution, has rendered EBCITs a promising solution. EBCITs have the potential to provide comprehensive and individualized assessments of symptoms, enabling accurate diagnosis, while contributing to the grounding of medical care. Objective: This work aims to examine whether EBCITs cover data concerning disorders and symptoms to a similar extent as physicians, and thus can reliably address medical conditions in clinical settings. We also explore the potential of EBCITs to discover and ground the real prevalence of symptoms in different disorders thereby expanding medical knowledge and further supporting medical diagnoses made by physicians. Methods: Between August 1, 2022, and January 15, 2023, patients who used the services of a digital health care (DH) provider in the United States were first assessed by the Kahun EBCIT. Kahun platform gathered and analyzed the information from the sessions. This study estimated the prevalence of patients’ symptoms in medical disorders using 2 data sets. The first data set analyzed symptom prevalence, as determined by Kahun’s knowledge engine. The second data set analyzed symptom prevalence, relying solely on data from the DH patients gathered by Kahun. The variance difference between these 2 prevalence data sets helped us assess Kahun’s ability to incorporate new data while integrating existing knowledge. To analyze the comprehensiveness of Kahun’s knowledge engine, we compared how well it covers weighted data for the symptoms and disorders found in the 2019 National Ambulatory Medical Care Survey (NMCAS). To assess Kahun’s diagnosis accuracy, physicians independently diagnosed 250 of Kahun-DH’s sessions. Their diagnoses were compared with Kahun’s diagnoses. Results: In this study, 2550 patients used Kahun to complete a full assessment. Kahun proposed 108,523 suggestions related to symptoms during the intake process. At the end of the intake process, 6496 conditions were presented to the caregiver. Kahun covered 94% (526,157,569/562,150,572) of the weighted symptoms and 91% (1,582,637,476/173,4783,244) of the weighted disorders in the 2019 NMCAS. In 90% (224/250) of the sessions, both physicians and Kahun suggested at least one identical disorder, with a 72% (367/507) total accuracy rate. Kahun’s engine yielded 519 prevalences while the Kahun-DH cohort yielded 599; 156 prevalences were unique to the latter and 443 prevalences were shared by both data sets. Conclusions: ECBITs, such as Kahun, encompass extensive amounts of knowledge and could serve as a reliable database for inferring medical insights and diagnoses. Using this credible database, the potential prevalence of symptoms in different disorders was discovered or grounded. This highlights the ability of ECBITs to refine the understanding of relationships between disorders and symptoms, which further supports physicians in medical diagnosis. %M 39012659 %R 10.2196/49570 %U https://www.jmir.org/2024/1/e49570 %U https://doi.org/10.2196/49570 %U http://www.ncbi.nlm.nih.gov/pubmed/39012659 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56095 %T The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study %A Wosny,Marie %A Strasser,Livia Maria %A Hastings,Janna %+ School of Medicine, University of St Gallen, St.Jakob-Strasse 21, St.Gallen, 9000, Switzerland, 41 712243249, mariejohanna.wosny@unisg.ch %K health care %K health care technology %K health care information technology %K hospital information technology %K clinical information systems %K health care professionals %K experience %K frustration %K clinician burnout %K technology implementation %K paradoxes %K digital tool %K digital tools %K hospital %K hospitals %K qualitative interview study %K interview %K interviews %K Switzerland %K thematic analysis %D 2024 %7 15.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians’ well-being. Objective: The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. Methods: Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. Results: Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs’ experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. Conclusions: Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges. %M 39008341 %R 10.2196/56095 %U https://www.jmir.org/2024/1/e56095 %U https://doi.org/10.2196/56095 %U http://www.ncbi.nlm.nih.gov/pubmed/39008341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62775 %T Author’s Reply: Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective %A Aldridge,Grace %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, 3168, Australia, 61 39905 072, grace.aldridge@monash.edu %K parenting interventions %K technology %K sports sociology %K child mental health %K adolescent mental health %K adverse childhood experiences %K systematic review %K intervention %K digital technology, parenting %K parenting program %K engagement %K support %D 2024 %7 3.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38959063 %R 10.2196/62775 %U https://www.jmir.org/2024/1/e62775 %U https://doi.org/10.2196/62775 %U http://www.ncbi.nlm.nih.gov/pubmed/38959063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60513 %T Mental Health Problems Among Children and Adolescents From a Sports Sociology Perspective %A Li,Yuan %A Zhai,Qun %A Peng,Weihang %+ Faculty of Health Sciences and Sports, Macao Polytechnic University, Comes Street, Macao, 999078, Macao, 853 68911106, zqun@mpu.edu.mo %K sociology of sport %K children %K adolescents %K mental health %K systematic review %K intervention %K digital technology, parenting %K technology %K parenting program %K engagement %K support %K adverse childhood experiences %D 2024 %7 3.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38959025 %R 10.2196/60513 %U https://www.jmir.org/2024/1/e60513 %U https://doi.org/10.2196/60513 %U http://www.ncbi.nlm.nih.gov/pubmed/38959025 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e52993 %T A Proposed Decision-Making Framework for the Translation of In-Person Clinical Care to Digital Care: Tutorial %A DeLaRosby,Anna %A Mulcahy,Julie %A Norwood,Todd %K clinical decision-making %K digital health %K telehealth %K telerehab %K framework %K digital medicine %K cognitive process %K telemedicine %K clinical training %D 2024 %7 26.6.2024 %9 %J JMIR Med Educ %G English %X The continued demand for digital health requires that providers adapt thought processes to enable sound clinical decision-making in digital settings. Providers report that lack of training is a barrier to providing digital health care. Physical examination techniques and hands-on interventions must be adjusted in safe, reliable, and feasible ways to provide digital care, and decision-making may be impacted by modifications made to these techniques. We have proposed a framework to determine whether a procedure can be modified to obtain a comparable result in a digital environment or whether a referral to in-person care is required. The decision-making framework was developed using program outcomes of a digital physical therapy platform and aims to alleviate barriers to delivering digital care that providers may experience. This paper describes the unique considerations a provider must make when collecting background information, selecting and executing procedures, assessing results, and determining whether they can proceed with clinical care in digital settings. %R 10.2196/52993 %U https://mededu.jmir.org/2024/1/e52993 %U https://doi.org/10.2196/52993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56241 %T Clinical Simulation in the Regulation of Software as a Medical Device: An eDelphi Study %A O'Driscoll,Fiona %A O'Brien,Niki %A Guo,Chaohui %A Prime,Matthew %A Darzi,Ara %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, Room 1035, Queen Elizabeth Queen Mother Wing, St Mary's Campus, South Wharf Road, London, W2 1NY, United Kingdom, 44 020 7594 1419, saira.ghafur13@imperial.ac.uk %K digital health technology %K software as a medical device %K clinical simulation %K Delphi study %K eDelphi study %K artificial intelligence %K digital health %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision. Objective: The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD. Methods: An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10% of the panelists deemed the criteria as “not important” or “not important at all” and >60% “important” or “very important.” Results: In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains—background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages. Conclusions: This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges. %M 38917454 %R 10.2196/56241 %U https://formative.jmir.org/2024/1/e56241 %U https://doi.org/10.2196/56241 %U http://www.ncbi.nlm.nih.gov/pubmed/38917454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54265 %T Making Science Computable Using Evidence-Based Medicine on Fast Healthcare Interoperability Resources: Standards Development Project %A Soares,Andrey %A Schilling,Lisa M %A Richardson,Joshua %A Kommadi,Bhagvan %A Subbian,Vignesh %A Dehnbostel,Joanne %A Shahin,Khalid %A Robinson,Karen A %A Afzal,Muhammad %A Lehmann,Harold P %A Kunnamo,Ilkka %A Alper,Brian S %+ Department of Medicine, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Mailstop F443, Aurora, CO, 80045, United States, 1 3037242825, andrey.soares@cuanschutz.edu %K evidence-based medicine %K FHIR %K Fast Healthcare Interoperability Resources %K computable evidence %K EBMonFHIR %K evidence-based medicine on Fast Healthcare Interoperability Resources %D 2024 %7 25.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence-based medicine (EBM) has the potential to improve health outcomes, but EBM has not been widely integrated into the systems used for research or clinical decision-making. There has not been a scalable and reusable computer-readable standard for distributing research results and synthesized evidence among creators, implementers, and the ultimate users of that evidence. Evidence that is more rapidly updated, synthesized, disseminated, and implemented would improve both the delivery of EBM and evidence-based health care policy. Objective: This study aimed to introduce the EBM on Fast Healthcare Interoperability Resources (FHIR) project (EBMonFHIR), which is extending the methods and infrastructure of Health Level Seven (HL7) FHIR to provide an interoperability standard for the electronic exchange of health-related scientific knowledge. Methods: As an ongoing process, the project creates and refines FHIR resources to represent evidence from clinical studies and syntheses of those studies and develops tools to assist with the creation and visualization of FHIR resources. Results: The EBMonFHIR project created FHIR resources (ie, ArtifactAssessment, Citation, Evidence, EvidenceReport, and EvidenceVariable) for representing evidence. The COVID-19 Knowledge Accelerator (COKA) project, now Health Evidence Knowledge Accelerator (HEvKA), took this work further and created FHIR resources that express EvidenceReport, Citation, and ArtifactAssessment concepts. The group is (1) continually refining FHIR resources to support the representation of EBM; (2) developing controlled terminology related to EBM (ie, study design, statistic type, statistical model, and risk of bias); and (3) developing tools to facilitate the visualization and data entry of EBM information into FHIR resources, including human-readable interfaces and JSON viewers. Conclusions: EBMonFHIR resources in conjunction with other FHIR resources can support relaying EBM components in a manner that is interoperable and consumable by downstream tools and health information technology systems to support the users of evidence. %M 38916936 %R 10.2196/54265 %U https://www.jmir.org/2024/1/e54265 %U https://doi.org/10.2196/54265 %U http://www.ncbi.nlm.nih.gov/pubmed/38916936 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55443 %T Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study %A Weichelt,Bryan P %A Burke,Rick %A Kieke,Burney %A Pilz,Matt %A Shimpi,Neel %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@marshfieldresearch.org %K mHealth %K clinician %K physician %K rural %K patient %K mobile %K health care %K adoption %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K mobile health %K app %K apps %K provider %K providers %K physicians %K survey %K surveys %K barrier %K barriers %K digital health %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. Objective: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. Methods: We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. Results: We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients’ internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system’s barriers were largely privacy, confidentiality, and legal review concerns. Conclusions: These findings echo similar studies in other health systems, surrounding providers’ lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients’ internet access to fully use mHealth in their delivery of care. %M 38913992 %R 10.2196/55443 %U https://humanfactors.jmir.org/2024/1/e55443 %U https://doi.org/10.2196/55443 %U http://www.ncbi.nlm.nih.gov/pubmed/38913992 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55061 %T Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis %A Jiang,Jiayi %A Zheng,Zexing %+ Law School, Central South University, Number 932 Lushan South Road, Yuelu District, Changsha, 410083, China, 86 18718479720, xing986@126.com %K hospital apps %K privacy policy %K personal information protection %K policy evaluation %K content analysis %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. Objective: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. Methods: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. Results: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users’ explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%). Conclusions: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps’ privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages. %M 38904994 %R 10.2196/55061 %U https://mhealth.jmir.org/2024/1/e55061 %U https://doi.org/10.2196/55061 %U http://www.ncbi.nlm.nih.gov/pubmed/38904994 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e49978 %T Effect of Implementing an Informatization Case Management Model on the Management of Chronic Respiratory Diseases in a General Hospital: Retrospective Controlled Study %A Xiao,Yi-Zhen %A Chen,Xiao-Jia %A Sun,Xiao-Ling %A Chen,Huan %A Luo,Yu-Xia %A Chen,Yuan %A Liang,Ye-Mei %K chronic disease management %K chronic respiratory disease %K hospital information system %K informatization %K information system %K respiratory %K pulmonary %K breathing %K implementation %K care management %K disease management %K chronic obstructive pulmonary disease %K case management %D 2024 %7 19.6.2024 %9 %J JMIR Med Inform %G English %X Background: The use of chronic disease information systems in hospitals and communities plays a significant role in disease prevention, control, and monitoring. However, there are several limitations to these systems, including that the platforms are generally isolated, the patient health information and medical resources are not effectively integrated, and the “Internet Plus Healthcare” technology model is not implemented throughout the patient consultation process. Objective: The aim of this study was to evaluate the efficiency of the application of a hospital case management information system in a general hospital in the context of chronic respiratory diseases as a model case. Methods: A chronic disease management information system was developed for use in general hospitals based on internet technology, a chronic disease case management model, and an overall quality management model. Using this system, the case managers provided sophisticated inpatient, outpatient, and home medical services for patients with chronic respiratory diseases. Chronic respiratory disease case management quality indicators (number of managed cases, number of patients accepting routine follow-up services, follow-up visit rate, pulmonary function test rate, admission rate for acute exacerbations, chronic respiratory diseases knowledge awareness rate, and patient satisfaction) were evaluated before (2019‐2020) and after (2021‐2022) implementation of the chronic disease management information system. Results: Before implementation of the chronic disease management information system, 1808 cases were managed in the general hospital, and an average of 603 (SD 137) people were provided with routine follow-up services. After use of the information system, 5868 cases were managed and 2056 (SD 211) patients were routinely followed-up, representing a significant increase of 3.2 and 3.4 times the respective values before use (U=342.779; P<.001). With respect to the quality of case management, compared to the indicators measured before use, the achievement rate of follow-up examination increased by 50.2%, the achievement rate of the pulmonary function test increased by 26.2%, the awareness rate of chronic respiratory disease knowledge increased by 20.1%, the retention rate increased by 16.3%, and the patient satisfaction rate increased by 9.6% (all P<.001), while the admission rate of acute exacerbation decreased by 42.4% (P<.001) after use of the chronic disease management information system. Conclusions: Use of a chronic disease management information system improves the quality of chronic respiratory disease case management and reduces the admission rate of patients owing to acute exacerbations of their diseases. %R 10.2196/49978 %U https://medinform.jmir.org/2024/1/e49978 %U https://doi.org/10.2196/49978 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54518 %T Key Considerations for Designing Clinical Studies to Evaluate Digital Health Solutions %A Bolinger,Elaina %A Tyl,Benoit %+ Integrated Evidence Generation & Business Innovation, Bayer HealthCare SAS, 10 Place de Belgique, La Garenne Colombes, F-92254, France, 33 6 80 29 07 79, benoit.tyl@bayer.com %K evidence generation %K clinical robustness %K clinical trials %K digital health %K solutions %K digital health solutions %K DHS %K health care system %K patients %K patient %K individuals %K individual %K healthcare system %K control arm adaptations %K randomization methods %K real-world data %K platform research %D 2024 %7 17.6.2024 %9 Viewpoint %J J Med Internet Res %G English %X Evidence of clinical impact is critical to unlock the potential of digital health solutions (DHSs), yet many solutions are failing to deliver positive clinical results. We argue in this viewpoint that this failure is linked to current approaches to DHS evaluation design, which neglect numerous key characteristics (KCs) requiring specific scientific and design considerations. We first delineate the KCs of DHSs: (1) they are implemented at health care system and patient levels; (2) they are “complex” interventions; (3) they can drive multiple clinical outcomes indirectly through a multitude of smaller clinical benefits; (4) their mechanism of action can vary between individuals and change over time based on patient needs; and (5) they develop through short, iterative cycles—optimally within a real-world use context. Following our objective to drive better alignment between clinical evaluation design and the unique traits of DHSs, we then provide methodological suggestions that better address these KCs, including tips on mechanism-of-action mapping, alternative randomization methods, control-arm adaptations, and novel end-point selection, as well as innovative methods utilizing real-world data and platform research. %M 38885020 %R 10.2196/54518 %U https://www.jmir.org/2024/1/e54518 %U https://doi.org/10.2196/54518 %U http://www.ncbi.nlm.nih.gov/pubmed/38885020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49581 %T Differences in Physicians’ Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study %A Wekenborg,Magdalena Katharina %A Förster,Katharina %A Schweden,Florian %A Weidemann,Robin %A Bechtolsheim,Felix von %A Kirschbaum,Clemens %A Weitz,Jürgen %A Ditzen,Beate %+ Else Kröner Fresenius Center for Digital Health, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 0351 45819581, magdalena.wekenborg@tu-dresden.de %K physicians %K digital transformation %K chronic stress %K hair cortisol concentration %K work stressors %K work resources %D 2024 %7 17.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. Objective: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. Methods: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55% women) submitted self-collected hair samples for cortisol analysis. Results: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. Conclusions: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics. %M 38885014 %R 10.2196/49581 %U https://www.jmir.org/2024/1/e49581 %U https://doi.org/10.2196/49581 %U http://www.ncbi.nlm.nih.gov/pubmed/38885014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53159 %T Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study %A Stang,Garrett S %A Tanner,Nichole T %A Hatch,Ashley %A Godbolt,Jakarri %A Toll,Benjamin A %A Rojewski,Alana M %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, Box G-S121-3, Providence, RI, 02912, United States, 1 4018633375, garrett_stang@brown.edu %K lung cancer screening %K LCS %K electronic health records %K EHR %K Health Belief Model %K HBM %K self-refer %K tobacco treatment %K cancer screening %K development %K self-referral tool %K electronic health record %K decision-making %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment. %M 38865702 %R 10.2196/53159 %U https://formative.jmir.org/2024/1/e53159 %U https://doi.org/10.2196/53159 %U http://www.ncbi.nlm.nih.gov/pubmed/38865702 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47631 %T Evaluation of a Computer-Aided Clinical Decision Support System for Point-of-Care Use in Low-Resource Primary Care Settings: Acceptability Evaluation Study %A Tegenaw,Geletaw Sahle %A Sori,Demisew Amenu %A Teklemariam,Girum Ketema %A Verbeke,Frank %A Cornelis,Jan %A Jansen,Bart %+ Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, Brussel, 1050, Belgium, 32 485744961, gtegenaw@vub.be %K low-resource setting %K clinical decision support system %K point-of-care instrument %K evaluation %K user acceptance %K structural equation modeling %K partial least squares structural equation modeling %K decision-making %K decision making %K decision support %K caregiver %K users %K acceptance %K system quality %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A clinical decision support system (CDSS) based on the logic and philosophy of clinical pathways is critical for managing the quality of health care and for standardizing care processes. Using such a system at a point-of-care setting is becoming more frequent these days. However, in a low-resource setting (LRS), such systems are frequently overlooked. Objective: The purpose of the study was to evaluate the user acceptance of a CDSS in LRSs. Methods: The CDSS evaluation was carried out at the Jimma Health Center and the Jimma Higher Two Health Center, Jimma, Ethiopia. The evaluation was based on 22 parameters organized into 6 categories: ease of use, system quality, information quality, decision changes, process changes, and user acceptance. A Mann-Whitney U test was used to investigate whether the difference between the 2 health centers was significant (2-tailed, 95% CI; α=.05). Pearson correlation and partial least squares structural equation modeling (PLS-SEM) was used to identify the relationship and factors influencing the overall acceptance of the CDSS in an LRS. Results: On the basis of 116 antenatal care, pregnant patient care, and postnatal care cases, 73 CDSS evaluation responses were recorded. We found that the 2 health centers did not differ significantly on 16 evaluation parameters. We did, however, detect a statistically significant difference in 6 parameters (P<.05). PLS-SEM results showed that the coefficient of determination, R2, of perceived user acceptance was 0.703. More precisely, the perceived ease of use (β=.015, P=.91) and information quality (β=.149, P=.25) had no positive effect on CDSS acceptance but, rather, on the system quality and perceived benefits of the CDSS, with P<.05 and β=.321 and β=.486, respectively. Furthermore, the perceived ease of use was influenced by information quality and system quality, with an R2 value of 0.479, indicating that the influence of information quality on the ease of use is significant but the influence of system quality on the ease of use is not, with β=.678 (P<.05) and β=.021(P=.89), respectively. Moreover, the influence of decision changes (β=.374, P<.05) and process changes (β=.749, P<.05) both was significant on perceived benefits (R2=0.983). Conclusions: This study concludes that users are more likely to accept and use a CDSS at the point of care when it is easy to grasp the perceived benefits and system quality in terms of health care professionals’ needs. We believe that the CDSS acceptance model developed in this study reveals specific factors and variables that constitute a step toward the effective adoption and deployment of a CDSS in LRSs. %M 38861298 %R 10.2196/47631 %U https://humanfactors.jmir.org/2024/1/e47631 %U https://doi.org/10.2196/47631 %U http://www.ncbi.nlm.nih.gov/pubmed/38861298 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e55377 %T Bringing the Public Health Informatics and Technology Workforce Together: The PHIAT Conference %A Moreno Arellano,April %A Shih,Huan-ju %A Williams,Karmen S %+ Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th Street, New York, NY, 10027, United States, 1 6463649659, Karmen.Williams@sph.cuny.edu %K public health informatics %K health informatics %K technology %K health technology %K digital health %K digital intervention %K digital interventions %K conference %K health conference %K health conferences %K public health workforce %K public health worker %K public health workers %K PHIAT Conference %K PHIAT %K public health %K health surveillance %D 2024 %7 11.6.2024 %9 Viewpoint %J Online J Public Health Inform %G English %X The field of public health informatics has undergone significant evolution in recent years, and advancements in technology and its applications are imperative to address emerging public health challenges. Interdisciplinary approaches and training can assist with these challenges. In 2023, the inaugural Public Health Informatics and Technology (PHIAT) Conference was established as a hybrid 3-day conference at the University of California, San Diego, and online. The conference’s goal was to establish a forum for academics and public health organizations to discuss and tackle new opportunities and challenges in public health informatics and technology. This paper provides an overview of the quest for interest, speakers and topics, evaluations from the attendees, and lessons learned to be implemented in future conferences. %M 38861316 %R 10.2196/55377 %U https://ojphi.jmir.org/2024/1/e55377 %U https://doi.org/10.2196/55377 %U http://www.ncbi.nlm.nih.gov/pubmed/38861316 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49040 %T Doctors’ Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study %A Chen,Dongjin %A Han,Wenchao %A Yang,Yili %A Pan,Jay %+ West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China, 86 28 85501096, panjie.jay@scu.edu.cn %K medical platforms %K doctor-patient communication %K social networking apps %K thematic content analysis %K China %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients’ mobile app adoption behavior; however, they offer limited insights into doctors’ personal preferences among a variety of choices of mobile apps. Objective: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? Methods: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. Results: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees’ perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors’ affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Conclusions: Our findings contribute to a nuanced understanding of doctors’ adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns. %M 38857491 %R 10.2196/49040 %U https://mhealth.jmir.org/2024/1/e49040 %U https://doi.org/10.2196/49040 %U http://www.ncbi.nlm.nih.gov/pubmed/38857491 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53855 %T Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches %A Burns,Kara %A Bloom,Shoshana %A Gilbert,Cecily %A Merner,Bronwen %A Kalla,Mahima %A Sheri,Sreshta %A Villanueva,Cleva %A Matenga Ikihele,Amio %A Nazer,Lama %A Sarmiento,Raymond Francis %A Stevens,Lindsay %A Blow,Ngaree %A Chapman,Wendy %+ Centre for Digital Transformation of Health, University of Melbourne, 700 Swanston St, Carlton, 3053, Australia, kara.burns@unimelb.edu.au %K digital health technology %K eHealth %K mHealth %K health informatics %K equity %K inclusion %K participatory design %K universal design %K Validitron %K digital health %K cost %K technology %K technology innovation %K innovation %K evidence-based tools %K evidence-based %K tools %K digital innovation %K cost-effective %K accessibility %K digital inequity %K digital health equity %D 2024 %7 5.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the rush to develop health technologies for the COVID-19 pandemic, the unintended consequence of digital health inequity or the inability of priority communities to access, use, and receive equal benefits from digital health technologies was not well examined. Objective: This scoping review will examine tools and approaches that can be used during digital technology innovation to improve equitable inclusion of priority communities in the development of digital health technologies. The results from this study will provide actionable insights for professionals in health care, health informatics, digital health, and technology development to proactively center equity during innovation. Methods: Based on the Arksey and O’Malley framework, this scoping review will consider priority communities’ equitable involvement in digital technology innovation. Bibliographic databases in health, medicine, computing, and information sciences will be searched. Retrieved citations will be double screened against the inclusion and exclusion criteria using Covidence (Veritas Health Innovation). Data will be charted using a tailored extraction tool and mapped to a digital health innovation pathway defined by the Centre for eHealth Research roadmap for eHealth technologies. An accompanying narrative synthesis will describe the outcomes in relation to the review’s objectives. Results: This scoping review is currently in progress. The search of databases and other sources returned a total of 4868 records. After the initial screening of titles and abstracts, 426 studies are undergoing dual full-text review. We are aiming to complete the full-text review stage by May 30, 2024, data extraction in October 2024, and subsequent synthesis in December 2024. Funding was received on October 1, 2023, from the Centre for Health Equity Incubator Grant Scheme, University of Melbourne, Australia. Conclusions: This paper will identify and recommend a series of validated tools and approaches that can be used by health care stakeholders and IT developers to produce equitable digital health technology across the Centre for eHealth Research roadmap. Identified evidence gaps, possible implications, and further research will be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/53855 %M 38838333 %R 10.2196/53855 %U https://www.researchprotocols.org/2024/1/e53855 %U https://doi.org/10.2196/53855 %U http://www.ncbi.nlm.nih.gov/pubmed/38838333 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53918 %T Chinese Oncologists’ Perspectives on Integrating AI into Clinical Practice: Cross-Sectional Survey Study %A Li,Ming %A Xiong,XiaoMin %A Xu,Bo %A Dickson,Conan %+ Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3543, cdickso1@jh.edu %K artificial intelligence %K AI %K machine learning %K oncologist %K concern %K clinical practice %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid development of artificial intelligence (AI) has brought significant interest to its potential applications in oncology. Although AI-powered tools are already being implemented in some Chinese hospitals, their integration into clinical practice raises several concerns for Chinese oncologists. Objective: This study aims to explore the concerns of Chinese oncologists regarding the integration of AI into clinical practice and to identify the factors influencing these concerns. Methods: A total of 228 Chinese oncologists participated in a cross-sectional web-based survey from April to June in 2023 in mainland China. The survey gauged their worries about AI with multiple-choice questions. The survey evaluated their views on the statements of “The impact of AI on the doctor-patient relationship” and “AI will replace doctors.” The data were analyzed using descriptive statistics, and variate analyses were used to find correlations between the oncologists’ backgrounds and their concerns. Results: The study revealed that the most prominent concerns were the potential for AI to mislead diagnosis and treatment (163/228, 71.5%); an overreliance on AI (162/228, 71%); data and algorithm bias (123/228, 54%); issues with data security and patient privacy (123/228, 54%); and a lag in the adaptation of laws, regulations, and policies in keeping up with AI’s development (115/228, 50.4%). Oncologists with a bachelor’s degree expressed heightened concerns related to data and algorithm bias (34/49, 69%; P=.03) and the lagging nature of legal, regulatory, and policy issues (32/49, 65%; P=.046). Regarding AI’s impact on doctor-patient relationships, 53.1% (121/228) saw a positive impact, whereas 35.5% (81/228) found it difficult to judge, 9.2% (21/228) feared increased disputes, and 2.2% (5/228) believed that there is no impact. Although sex differences were not significant (P=.08), perceptions varied—male oncologists tended to be more positive than female oncologists (74/135, 54.8% vs 47/93, 50%). Oncologists with a bachelor’s degree (26/49, 53%; P=.03) and experienced clinicians (≥21 years; 28/56, 50%; P=.054). found it the hardest to judge. Those with IT experience were significantly more positive (25/35, 71%) than those without (96/193, 49.7%; P=.02). Opinions regarding the possibility of AI replacing doctors were diverse, with 23.2% (53/228) strongly disagreeing, 14% (32/228) disagreeing, 29.8% (68/228) being neutral, 16.2% (37/228) agreeing, and 16.7% (38/228) strongly agreeing. There were no significant correlations with demographic and professional factors (all P>.05). Conclusions: Addressing oncologists’ concerns about AI requires collaborative efforts from policy makers, developers, health care professionals, and legal experts. Emphasizing transparency, human-centered design, bias mitigation, and education about AI’s potential and limitations is crucial. Through close collaboration and a multidisciplinary strategy, AI can be effectively integrated into oncology, balancing benefits with ethical considerations and enhancing patient care. %M 38838307 %R 10.2196/53918 %U https://formative.jmir.org/2024/1/e53918 %U https://doi.org/10.2196/53918 %U http://www.ncbi.nlm.nih.gov/pubmed/38838307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50376 %T eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey %A Turnbull,Joanne %A Prichard,Jane %A MacLellan,Jennifer %A Pope,Catherine %+ School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 2380597940, j.c.turnbull@soton.ac.uk %K urgent care %K digital health %K access to health care %K eHealth %K health care system %K COVID-19 %K urgent %K emergency %K health literacy %K eHealth literacy %K digital literacy %K access %K cross-sectional %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. “Digital first” may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. %M 38833297 %R 10.2196/50376 %U https://www.jmir.org/2024/1/e50376 %U https://doi.org/10.2196/50376 %U http://www.ncbi.nlm.nih.gov/pubmed/38833297 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e54355 %T Addressing Hospital Overwhelm During the COVID-19 Pandemic by Using a Primary Health Care–Based Integrated Health System: Modeling Study %A Huang,Jiaoling %A Qian,Ying %A Yan,Yuge %A Liang,Hong %A Zhao,Laijun %K hospital overwhelm %K primary health care %K modeling study %K policy mix %K pandemic %K model %K simulation %K simulations %K integrated %K health system %K hospital %K hospitals %K management %K service %K services %K health systems %K develop %K development %K bed %K beds %K overwhelm %K death %K deaths %K mortality %K primary care %D 2024 %7 3.6.2024 %9 %J JMIR Med Inform %G English %X Background: After strict COVID-19–related restrictions were lifted, health systems globally were overwhelmed. Much has been discussed about how health systems could better prepare for future pandemics; however, primary health care (PHC) has been largely ignored. Objective: We aimed to investigate what combined policies PHC could apply to strengthen the health care system via a bottom-up approach, so as to better respond to a public health emergency. Methods: We developed a system dynamics model to replicate Shanghai’s response when COVID-19–related restrictions were lifted. We then simulated an alternative PHC-based integrated health system and tested the following three interventions: first contact in PHC with telemedicine services, recommendation to secondary care, and return to PHC for recovery. Results: The simulation results showed that each selected intervention could alleviate hospital overwhelm. Increasing the rate of first contact in PHC with telemedicine increased hospital bed availability by 6% to 12% and reduced the cumulative number of deaths by 35%. More precise recommendations had a limited impact on hospital overwhelm (<1%), but the simulation results showed that underrecommendation (rate: 80%) would result in a 19% increase in cumulative deaths. Increasing the rate of return to PHC from 5% to 20% improved hospital bed availability by 6% to 16% and reduced the cumulative number of deaths by 46%. Moreover, combining all 3 interventions had a multiplier effect; bed availability increased by 683%, and the cumulative number of deaths dropped by 75%. Conclusions: Rather than focusing on the allocation of medical resources in secondary care, we determined that an optimal PHC-based integrated strategy would be to have a 60% rate of first contact in PHC, a 110% recommendation rate, and a 20% rate of return to PHC. This could increase health system resilience during public health emergencies. %R 10.2196/54355 %U https://medinform.jmir.org/2024/1/e54355 %U https://doi.org/10.2196/54355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50715 %T Patients’ Perspectives on the Data Confidentiality, Privacy, and Security of mHealth Apps: Systematic Review %A Alhammad,Nasser %A Alajlani,Mohannad %A Abd-alrazaq,Alaa %A Epiphaniou,Gregory %A Arvanitis,Theodoros %+ Institute of Digital Healthcare, WMG, University of Warwick, Millburn House, Coventry, CV47AL, United Kingdom, 66 558885007, N.alhammad@seu.edu.sa %K mobile health apps %K mHealth apps %K mobile health %K privacy %K confidentiality %K security %K awareness %K perspectives %K mobile phone %D 2024 %7 31.5.2024 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps have the potential to enhance health care service delivery. However, concerns regarding patients’ confidentiality, privacy, and security consistently affect the adoption of mHealth apps. Despite this, no review has comprehensively summarized the findings of studies on this subject matter. Objective: This systematic review aims to investigate patients’ perspectives and awareness of the confidentiality, privacy, and security of the data collected through mHealth apps. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in 3 electronic databases: PubMed, Ovid, and ScienceDirect. All the retrieved articles were screened according to specific inclusion criteria to select relevant articles published between 2014 and 2022. Results: A total of 33 articles exploring mHealth patients’ perspectives and awareness of data privacy, security, and confidentiality issues and the associated factors were included in this systematic review. Thematic analyses of the retrieved data led to the synthesis of 4 themes: concerns about data privacy, confidentiality, and security; awareness; facilitators and enablers; and associated factors. Patients showed discordant and concordant perspectives regarding data privacy, security, and confidentiality, as well as suggesting approaches to improve the use of mHealth apps (facilitators), such as protection of personal data, ensuring that health status or medical conditions are not mentioned, brief training or education on data security, and assuring data confidentiality and privacy. Similarly, awareness of the subject matter differed across the studies, suggesting the need to improve patients’ awareness of data security and privacy. Older patients, those with a history of experiencing data breaches, and those belonging to the higher-income class were more likely to raise concerns about the data security and privacy of mHealth apps. These concerns were not frequent among patients with higher satisfaction levels and those who perceived the data type to be less sensitive. Conclusions: Patients expressed diverse views on mHealth apps’ privacy, security, and confidentiality, with some of the issues raised affecting technology use. These findings may assist mHealth app developers and other stakeholders in improving patients’ awareness and adjusting current privacy and security features in mHealth apps to enhance their adoption and use. Trial Registration: PROSPERO CRD42023456658; https://tinyurl.com/ytnjtmca %M 38820572 %R 10.2196/50715 %U https://www.jmir.org/2024/1/e50715 %U https://doi.org/10.2196/50715 %U http://www.ncbi.nlm.nih.gov/pubmed/38820572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52921 %T Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians’ and Specialists’ Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study %A Nabelsi,Véronique %A Lévesque-Chouinard,Annabelle %+ Department of Administrative Sciences, Université du Québec en Outaouais, C.P. 1240, Succ. Hull, Gatineau, QC, J8X 3X7, Canada, 1 819 595 3900 ext 1915, veronique.nabelsi@uqo.ca %K eConsult %K electronic consultation %K digital health solutions %K primary care providers %K specialists %K United Theory of Acceptance and Use of Technology %K UTAUT %K Task-Technology Fit %K TTF %K technology acceptance %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients’ medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs’, specialists’, and patients’ satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs’ and specialists’ acceptance of eConsult services in Quebec, Canada, and worldwide. Objective: This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. Methods: A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. Results: Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. Conclusions: This study provides a better understanding of the factors influencing PCPs’ and specialists’ intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users’ need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service. %M 38814689 %R 10.2196/52921 %U https://formative.jmir.org/2024/1/e52921 %U https://doi.org/10.2196/52921 %U http://www.ncbi.nlm.nih.gov/pubmed/38814689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50853 %T The Effect of Artificial Intelligence on Patient-Physician Trust: Cross-Sectional Vignette Study %A Zondag,Anna G M %A Rozestraten,Raoul %A Grimmelikhuijsen,Stephan G %A Jongsma,Karin R %A van Solinge,Wouter W %A Bots,Michiel L %A Vernooij,Robin W M %A Haitjema,Saskia %+ Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 631117922, a.g.m.zondag@umcutrecht.nl %K patient-physician relationship %K trust %K clinical decision support %K artificial intelligence %K digital health %K decision support system %D 2024 %7 28.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical decision support systems (CDSSs) based on routine care data, using artificial intelligence (AI), are increasingly being developed. Previous studies focused largely on the technical aspects of using AI, but the acceptability of these technologies by patients remains unclear. Objective: We aimed to investigate whether patient-physician trust is affected when medical decision-making is supported by a CDSS. Methods: We conducted a vignette study among the patient panel (N=860) of the University Medical Center Utrecht, the Netherlands. Patients were randomly assigned into 4 groups—either the intervention or control groups of the high-risk or low-risk cases. In both the high-risk and low-risk case groups, a physician made a treatment decision with (intervention groups) or without (control groups) the support of a CDSS. Using a questionnaire with a 7-point Likert scale, with 1 indicating “strongly disagree” and 7 indicating “strongly agree,” we collected data on patient-physician trust in 3 dimensions: competence, integrity, and benevolence. We assessed differences in patient-physician trust between the control and intervention groups per case using Mann-Whitney U tests and potential effect modification by the participant’s sex, age, education level, general trust in health care, and general trust in technology using multivariate analyses of (co)variance. Results: In total, 398 patients participated. In the high-risk case, median perceived competence and integrity were lower in the intervention group compared to the control group but not statistically significant (5.8 vs 5.6; P=.16 and 6.3 vs 6.0; P=.06, respectively). However, the effect of a CDSS application on the perceived competence of the physician depended on the participant’s sex (P=.03). Although no between-group differences were found in men, in women, the perception of the physician’s competence and integrity was significantly lower in the intervention compared to the control group (P=.009 and P=.01, respectively). In the low-risk case, no differences in trust between the groups were found. However, increased trust in technology positively influenced the perceived benevolence and integrity in the low-risk case (P=.009 and P=.04, respectively). Conclusions: We found that, in general, patient-physician trust was high. However, our findings indicate a potentially negative effect of AI applications on the patient-physician relationship, especially among women and in high-risk situations. Trust in technology, in general, might increase the likelihood of embracing the use of CDSSs by treating professionals. %M 38805702 %R 10.2196/50853 %U https://www.jmir.org/2024/1/e50853 %U https://doi.org/10.2196/50853 %U http://www.ncbi.nlm.nih.gov/pubmed/38805702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53056 %T Health Care Professionals’ Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study %A Cermak,Carly A %A Read,Heather %A Jeffs,Lianne %+ Science of Care Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada, 1 4165864800, carly.cermak@mail.utoronto.ca %K COVID-19 %K information and communication technology %K health care provider experiences %K web-based care %K interview %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. %M 38805250 %R 10.2196/53056 %U https://formative.jmir.org/2024/1/e53056 %U https://doi.org/10.2196/53056 %U http://www.ncbi.nlm.nih.gov/pubmed/38805250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54705 %T AI Quality Standards in Health Care: Rapid Umbrella Review %A Kuziemsky,Craig E %A Chrimes,Dillon %A Minshall,Simon %A Mannerow,Michael %A Lau,Francis %+ MacEwan University, 10700 104 Avenue, 7-257, Edmonton, AB, T5J4S2, Canada, 1 7806333290, kuziemskyc@macewan.ca %K artificial intelligence %K health care artificial intelligence %K health care AI %K rapid review %K umbrella review %K quality standard %D 2024 %7 22.5.2024 %9 Review %J J Med Internet Res %G English %X Background: In recent years, there has been an upwelling of artificial intelligence (AI) studies in the health care literature. During this period, there has been an increasing number of proposed standards to evaluate the quality of health care AI studies. Objective: This rapid umbrella review examines the use of AI quality standards in a sample of health care AI systematic review articles published over a 36-month period. Methods: We used a modified version of the Joanna Briggs Institute umbrella review method. Our rapid approach was informed by the practical guide by Tricco and colleagues for conducting rapid reviews. Our search was focused on the MEDLINE database supplemented with Google Scholar. The inclusion criteria were English-language systematic reviews regardless of review type, with mention of AI and health in the abstract, published during a 36-month period. For the synthesis, we summarized the AI quality standards used and issues noted in these reviews drawing on a set of published health care AI standards, harmonized the terms used, and offered guidance to improve the quality of future health care AI studies. Results: We selected 33 review articles published between 2020 and 2022 in our synthesis. The reviews covered a wide range of objectives, topics, settings, designs, and results. Over 60 AI approaches across different domains were identified with varying levels of detail spanning different AI life cycle stages, making comparisons difficult. Health care AI quality standards were applied in only 39% (13/33) of the reviews and in 14% (25/178) of the original studies from the reviews examined, mostly to appraise their methodological or reporting quality. Only a handful mentioned the transparency, explainability, trustworthiness, ethics, and privacy aspects. A total of 23 AI quality standard–related issues were identified in the reviews. There was a recognized need to standardize the planning, conduct, and reporting of health care AI studies and address their broader societal, ethical, and regulatory implications. Conclusions: Despite the growing number of AI standards to assess the quality of health care AI studies, they are seldom applied in practice. With increasing desire to adopt AI in different health topics, domains, and settings, practitioners and researchers must stay abreast of and adapt to the evolving landscape of health care AI quality standards and apply these standards to improve the quality of their AI studies. %M 38776538 %R 10.2196/54705 %U https://www.jmir.org/2024/1/e54705 %U https://doi.org/10.2196/54705 %U http://www.ncbi.nlm.nih.gov/pubmed/38776538 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56125 %T Human-Centered Design and Benefit Realization Management in Digital Health Care Solution Development: Protocol for a Systematic Review %A Kauppinen,Kaisa %A Keikhosrokiani,Pantea %A Khan,Sehrish %+ Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran katu 1, Oulu, 90570, Finland, 358 405433476, kaisa.kauppinen@student.oulu.fi %K human-centered design %K digital health care solution %K electronic health record %K benefit realization management %K digital health care %K health care software %K digital health %K information technology %K IT %K usability %D 2024 %7 21.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Earlier research shows that a significant number of resources are wasted on software projects delivering less than the planned benefits. It has, however, been evidenced that adopting a human-centered design approach when designing health devices can be beneficial. This understanding from earlier research has raised our interest in investigating how human-centered design might contribute to realizing the potential benefits of health care software projects. To our current knowledge, this intersection of human-centered design and benefit realization management has not yet comprehensively and consistently been researched within the context of digital health care solutions. Therefore, there is a need for evidence synthesis using systematic reviews to address this potential research gap. Objective: The objective of this study is to examine if human-centered design helps benefit realization management processes in the development of digital health care solutions and thereby enables better benefit realization. We explore the evidence of assumed or confirmed benefits of using human-centered design in the health care domain and whether better results have been reported when the benefit realization management process is followed. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent studies (reported in English) to see if there is evidence that using human-centered design and benefit realization management has a positive effect on realizing set benefits in those projects. We will commence a systematic literature search using human-centered design, benefit realization management, and health care–related search terms within 5 repositories (ACM Digital Library, PubMed Central, Scopus, PubMed, and Web of Science). After removing duplicate results, a preliminary scan for titles and abstracts will be done by at least 2 reviewers. Any incongruities regarding whether to include articles for full-text review will be resolved by a third reviewer based on the predefined criteria. Results: Initial queries of 2086 records have been executed and papers are being prescreened for inclusion. The search was initiated in December 2023 and the results are expected in 2024. We anticipate finding evidence of the use of human-centered design in the development of digital health care solutions. However, we expect evidence of benefitting from both human-centered design and benefit realization management in this context to be scarce. Conclusions: This protocol will guide the review of existing literature on the use of human-centered design and benefit realization management when developing digital health care solutions. The review will specifically focus on finding evidence of confirmed benefits derived from the use of human-centered design and benefit realization management. There may be an opportunity to gain a broader understanding of the tools or approaches that provide evidence of increased benefit realization within the health care domain. International Registered Report Identifier (IRRID): DERR1-10.2196/56125 %M 38772023 %R 10.2196/56125 %U https://www.researchprotocols.org/2024/1/e56125 %U https://doi.org/10.2196/56125 %U http://www.ncbi.nlm.nih.gov/pubmed/38772023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53206 %T Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study %A Bozorgmehr,Arezoo %A Thiem,Simon-Konstantin %A Wild,Dorothea %A Reinsdorff,Melanie %A Vollmar,Horst Christian %A Kappernagel,Annika %A Schloessler,Kathrin %A Weissbach,Sabine %A Pentzek,Michael %A Dehnen,Dorothea %A Drexler,Julia %A Mueller,Beate Sigrid %A Pilic,Larisa %A Lehmann,Lion %A Loescher,Susanne %A Hohmann,Elena Darinka %A Frank,Friederike %A Ates,Gülay %A Kersten,Susanne %A Mortsiefer,Achim %A Aretz,Benjamin %A Weltermann,Birgitta %+ Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus1, Bonn, 53127, Germany, 49 228 287 10173, arezoo.bozorgmehr@ukbonn.de %K primary care %K general practice research network %K physicians %K feasibility study %K IT infrastructure %K usability %K FallAkte %K FallAkte Plus system %K mixed methods usability study %K North Rhine-Westphalian general practice research network %K NRW-GPRN %K Germany %K German %K universities %K survey %K questionnaire %K participants %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. Objective: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany’s largest state. Methods: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. Results: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system’s emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. Conclusions: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI. %M 38767942 %R 10.2196/53206 %U https://formative.jmir.org/2024/1/e53206 %U https://doi.org/10.2196/53206 %U http://www.ncbi.nlm.nih.gov/pubmed/38767942 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47280 %T Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review %A Nassehi,Damoun %A Gripsrud,Birgitta Haga %A Ramvi,Ellen %+ Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4036, Norway, 47 45426096, damoun.nassehi@uis.no %K digital health %K mobile health %K telemedicine %K physician-patient relations %K relational ethics %K primary care %K patient-provider %K physician-patient %K telehealth %K relationship %K eHealth %K scoping review %K review method %K mobile phone %D 2024 %7 15.5.2024 %9 Review %J Interact J Med Res %G English %X Background: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. Objective: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. Results: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. Conclusions: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies. %M 38748465 %R 10.2196/47280 %U https://www.i-jmr.org/2024/1/e47280 %U https://doi.org/10.2196/47280 %U http://www.ncbi.nlm.nih.gov/pubmed/38748465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45593 %T The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study %A Bienzeisler,Jonas %A Becker,Guido %A Erdmann,Bernadett %A Kombeiz,Alexander %A Majeed,Raphael W %A Röhrig,Rainer %A Greiner,Felix %A Otto,Ronny %A Otto-Sobotka,Fabian %A , %+ Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany, 49 24180 ext 88870, jbienzeisler@ukaachen.de %K EHR %K emergency medicine %K AKTIN, process management %K crowding %K triage system %K electronic health record %K health care %K treatment %K emergency department %D 2024 %7 14.5.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38743464 %R 10.2196/45593 %U https://www.jmir.org/2024/1/e45593 %U https://doi.org/10.2196/45593 %U http://www.ncbi.nlm.nih.gov/pubmed/38743464 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53122 %T Exploring the Impact of In Basket Metrics on the Adoption of a New Electronic Health Record System Among Specialists in a Tertiary Hospital in Alberta: Descriptive Study %A Avdagovska,Melita %A Kuziemsky,Craig %A Koosha,Helia %A Hadizadeh,Maliheh %A Pauly,Robert P %A Graham,Timothy %A Stafinski,Tania %A Bigam,David %A Kassam,Narmin %A Menon,Devidas %+ School of Public Health, University of Alberta, 11405 87 Avenue, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 780 908 3334, avdagovs@ualberta.ca %K electronic health records %K In Basket %K metrics %K descriptive study %K inpatients %D 2024 %7 29.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout. Objective: This study aims to document metrics related to the In Basket communication hub (time in In Basket per day, time in In Basket per appointment, In Basket messages received per day, and turnaround time) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities. Methods: A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into medical and surgical based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: medical FTE <0.5, medical FTE >0.5, and surgical (all of whom reported FTE >0.5). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities. Results: A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the time in In Basket per day metric and 1.84 minutes on average in the time in In Basket per appointment metric. The time for the providers to mark messages as done (turnaround time) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less connected time (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as done (turnaround time). Conclusions: We observed a range of patterns with no consistent direction. There does not seem to be evidence of a “learning curve,” which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers’ satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area. %M 38684079 %R 10.2196/53122 %U https://www.jmir.org/2024/1/e53122 %U https://doi.org/10.2196/53122 %U http://www.ncbi.nlm.nih.gov/pubmed/38684079 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50889 %T Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool %A Hellstrand Tang,Ulla %A Smith,Frida %A Karilampi,Ulla Leyla %A Gremyr,Andreas %+ Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Falkenbergsgatan 3, Gothenburg, SE-412 85, Sweden, 46 706397913, ulla.tang@vgregion.se %K digital %K bottom-up innovation %K complexity %K eHealth %K health care %K nonadoption, abandonment, scale-up, spread, and sustainability complexity assessment tool %K NASSS-CAT %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. Objective: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. Methods: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. Results: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization’s readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization’s system and its setting. Conclusions: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations. %M 38669076 %R 10.2196/50889 %U https://humanfactors.jmir.org/2024/1/e50889 %U https://doi.org/10.2196/50889 %U http://www.ncbi.nlm.nih.gov/pubmed/38669076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49982 %T Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study %A Giebel,Godwin Denk %A Abels,Carina %A Plescher,Felix %A Speckemeier,Christian %A Schrader,Nils Frederik %A Börchers,Kirstin %A Wasem,Jürgen %A Neusser,Silke %A Blase,Nikola %+ Institute for Health Care Management and Research, Universität Duisburg-Essen, Weststadt-Carree, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 20118 ext 33180, godwin.giebel@medman.uni-due.de %K mobile health %K mHealth %K mHealth app %K patient %K problems %K barriers %K digital health applications %K DiGA %K app %K barrier %K mobile app %K health care system %K economic outcome %K context %K mobile phone %D 2024 %7 23.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. Objective: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. Methods: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories (“validity,” “usability,” “technology,” “use and adherence,” “data privacy and security,” “patient-physician relationship,” “knowledge and skills,” “individuality,” “implementation,” and “costs”) identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. Results: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. Conclusions: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients. %M 38652508 %R 10.2196/49982 %U https://www.jmir.org/2024/1/e49982 %U https://doi.org/10.2196/49982 %U http://www.ncbi.nlm.nih.gov/pubmed/38652508 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e50092 %T The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents %A Benjamins,Janine %A de Vet,Emely %A de Mortier,Chloe A %A Haveman-Nies,Annemien %+ Stichting Jeugd Noord Veluwe, Stationsplein 18E, Nunspeet, 8071 CH, Netherlands, 31 612329494, j.benjamins@cjgnoordveluwe.nl %K electronic health record %K EHR %K personal health record %K child health services %K child health %K child welfare %K adolescent health services %K pediatrics %K parent %K care quality %K perceived quality of care %K patient experience %K client perception %K quality of care %K parent %K adolescent %K patient portal %K client portal %K qualitative study %D 2024 %7 23.4.2024 %9 Original Paper %J J Particip Med %G English %X Background: Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. Objective: This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client’s perspective. Methods: We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. Results: Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. Conclusions: Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence. %M 38652532 %R 10.2196/50092 %U https://jopm.jmir.org/2024/1/e50092 %U https://doi.org/10.2196/50092 %U http://www.ncbi.nlm.nih.gov/pubmed/38652532 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52592 %T Academic Detailing as a Health Information Technology Implementation Method: Supporting the Design and Implementation of an Emergency Department–Based Clinical Decision Support Tool to Prevent Future Falls %A Barton,Hanna J %A Maru,Apoorva %A Leaf,Margaret A %A Hekman,Daniel J %A Wiegmann,Douglas A %A Shah,Manish N %A Patterson,Brian W %+ BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, 800 University Bay Dr., Madison, WI, 53705, United States, 1 (608) 890 8682, hbarton@wisc.edu %K emergency medicine %K clinical decision support %K health IT %K human factors %K work systems %K SEIPS %K Systems Engineering Initiative for Patient Safety %K educational outreach %K academic detailing %K implementation method %K department-based %K CDS %K clinical care %K evidence-based %K CDS tool %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K preventative intervention %K team-based analysis %K machine learning %K high-risk patient %K high-risk patients %K pharmaceutical %K pharmaceutical sales %K United States %K fall-risk prediction %K EHR %K electronic health record %K interview %K ED environment %K emergency department %D 2024 %7 18.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Clinical decision support (CDS) tools that incorporate machine learning–derived content have the potential to transform clinical care by augmenting clinicians’ expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing—personal visits to clinicians by an expert in a specific health IT tool—as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool’s implementation. Objective: This study aimed to assess academic detailing as a method for simultaneously ensuring the correct understanding of an emergency department–based CDS tool to prevent future falls and identifying factors impacting clinicians’ use of the tool through an analysis of the resultant qualitative data. Methods: Previously, our team designed a CDS tool to identify patients aged 65 years and older who are at the highest risk of future falls and prompt an interruptive alert to clinicians, suggesting the patient be referred to a mobility and falls clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians’ use of the CDS tool. Results: The following categories of factors that impacted clinicians’ use of the CDS were identified: (1) aspects of the CDS tool’s design (2) clinicians’ understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the emergency department environment, (4) clinicians’ perceptions of the patient and their associated fall risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, for example, demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to. Conclusions: Our study demonstrates the use of academic detailing for supporting the implementation of health information technologies, allowing us to identify factors that impacted clinicians’ use of the CDS while concurrently educating clinicians to ensure the correct understanding of the CDS tool and intervention. Thus, academic detailing can inform both real-time adjustments of a tool’s implementation, for example, refinement of the language used to introduce the tool, and larger scale redesign of the CDS tool to better fit the dynamic work environment of clinicians. %M 38635318 %R 10.2196/52592 %U https://humanfactors.jmir.org/2024/1/e52592 %U https://doi.org/10.2196/52592 %U http://www.ncbi.nlm.nih.gov/pubmed/38635318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47278 %T Patients’ Experiences With Digitalization in the Health Care System: Qualitative Interview Study %A Gybel Jensen,Christian %A Gybel Jensen,Frederik %A Loft,Mia Ingerslev %+ Department of Neurology, Rigshospitalet, Inge Lehmanns Vej 8, Copenhagen, Denmark, 45 35457076, belle.mia.ingerslev.loft@regionh.dk %K digitalization %K digital health %K eHealth %K digital health literacy %K digital practices %K patient experiences %K digital health services %K inequity in health %K qualitative research %K interview %K implementation %K tool %K neurology %K digital tool %K communication %K mobile phone %D 2024 %7 11.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients’ digital practices and experiences with digital health services. Objective: This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? Methods: We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. Results: The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. Conclusions: Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged. %M 38602748 %R 10.2196/47278 %U https://www.jmir.org/2024/1/e47278 %U https://doi.org/10.2196/47278 %U http://www.ncbi.nlm.nih.gov/pubmed/38602748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48694 %T Methodological Frameworks and Dimensions to Be Considered in Digital Health Technology Assessment: Scoping Review and Thematic Analysis %A Segur-Ferrer,Joan %A Moltó-Puigmartí,Carolina %A Pastells-Peiró,Roland %A Vivanco-Hidalgo,Rosa Maria %+ Agency for Health Quality and Assessment of Catalonia, Roc Boronat Street, 81-95, 2nd Fl, Barcelona, 08005, Spain, 34 935 513 900, joan.segur@gencat.cat %K digital health %K eHealth %K mHealth %K mobile health %K AI %K artificial intelligence %K framework %K health technology assessment %K scoping review %K technology %K health care system %K methodological framework %K thematic analysis %D 2024 %7 10.4.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health technologies (dHTs) offer a unique opportunity to address some of the major challenges facing health care systems worldwide. However, the implementation of dHTs raises some concerns, such as the limited understanding of their real impact on health systems and people’s well-being or the potential risks derived from their use. In this context, health technology assessment (HTA) is 1 of the main tools that health systems can use to appraise evidence and determine the value of a given dHT. Nevertheless, due to the nature of dHTs, experts highlight the need to reconsider the frameworks used in traditional HTA. Objective: This scoping review (ScR) aimed to identify the methodological frameworks used worldwide for digital health technology assessment (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework based on the most frequently described domains in the literature. Methods: The ScR was performed in accordance with the guidelines established in the PRISMA-ScR guidelines. We searched 7 databases for peer reviews and gray literature published between January 2011 and December 2021. The retrieved studies were screened using Rayyan in a single-blind manner by 2 independent authors, and data were extracted using ATLAS.ti software. The same software was used for thematic analysis. Results: The systematic search retrieved 3061 studies (n=2238, 73.1%, unique), of which 26 (0.8%) studies were included. From these, we identified 102 methodological frameworks designed for dHTA. These frameworks revealed great heterogeneity between them due to their different structures, approaches, and items to be considered in dHTA. In addition, we identified different wording used to refer to similar concepts. Through thematic analysis, we reduced this heterogeneity. In the first phase of the analysis, 176 provisional codes related to different assessment items emerged. In the second phase, these codes were clustered into 86 descriptive themes, which, in turn, were grouped in the third phase into 61 analytical themes and organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions, and level 3 formed by 11 subdimensions. From these 61 analytical themes, we developed a proposal for a methodological framework for dHTA. Conclusions: There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of dHTs. Through this ScR, we identified 26 studies including 102 methodological frameworks and tools for dHTA. The thematic analysis of those 26 studies led to the definition of 12 domains, 38 dimensions, and 11 subdimensions that should be considered in dHTA. %M 38598288 %R 10.2196/48694 %U https://www.jmir.org/2024/1/e48694 %U https://doi.org/10.2196/48694 %U http://www.ncbi.nlm.nih.gov/pubmed/38598288 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e52198 %T Insider Threats to the Military Health System: A Systematic Background Check of TRICARE West Providers %A Bychkov,David %K TRICARE %K health care fraud %K Defense Health Agency %K fraud %K fraudulent %K insurance %K coverage %K beneficiary %K beneficiaries %K background check %K background checks %K demographic %K security clearance %K FDA %K Medicaid %K Medicare %K provider %K provider referral %K military %K false claims act %K HIPAA breach %K OIG-LEIE %K inspector general %K misconduct %K insider threat %K information system %K zero trust %K data management %K Food and Drug Administration %K Health Insurance Portability and Accountability Act breach %K Office of the Inspector General's List of Excluded Individuals and Entities %D 2024 %7 9.4.2024 %9 %J JMIRx Med %G English %X Background: To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1%. In 2022, the DHA Annual Report stated that TRICARE’s provider directories were only 80% accurate. Unlike Medicare, the DHA does not publicly reveal National Provider Identification (NPI) numbers. As a result, TRICARE’s 9.6 million beneficiaries lack the means to verify their doctor’s credentials. Since 2013, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) has excluded 17,706 physicians and other providers from federal health programs due to billing fraud, neglect, drug-related convictions, and other offenses. These providers and their NPIs are included on the OIG’s List of Excluded Individuals and Entities (LEIE). Patients who receive care from excluded providers face higher risks of hospitalization and mortality. Objective: We sought to assess the extent to which TRICARE screens health care provider names on their referral website against criminal databases. Methods: Between January 1-31, 2023, we used TRICARE West’s provider directory to search for all providers within a 5-mile radius of 798 zip codes (38 per state, ≥10,000 residents each, randomly entered). We then copied and pasted all directory results’ first and last names, business names, addresses, phone numbers, fax numbers, degree types, practice specialties, and active or closed statuses into a CSV file. We cross-referenced the search results against US and state databases for medical and criminal misconduct, including the OIG-LEIE and General Services Administration’s (GSA) SAM.gov exclusion lists, the HHS Office of Civil Rights Health Insurance Portability and Accountability Act (HIPAA) breach reports, 15 available state Medicaid exclusion lists (state), the International Trade Administration’s Consolidated Screening List (CSL), 3 Food and Drug Administration (FDA) debarment lists, the Federal Bureau of Investigation’s (FBI) list of January 6 federal defendants, and the OIG-HHS list of fugitives (FUG). Results: Our provider search yielded 111,619 raw results; 54 zip codes contained no data. After removing 72,156 (64.65%) duplicate entries, closed offices, and non-TRICARE West locations, we identified 39,463 active provider names. Within this baseline sample group, there were 2398 (6.08%) total matches against all exclusion and sanction databases, including 2197 on the OIG-LEIE, 2311 on the GSA-SAM.gov list, 2 on the HIPAA list, 54 on the state Medicaid exclusion lists, 69 on the CSL, 3 on the FDA lists, 53 on the FBI list, and 10 on the FUG. Conclusions: TRICARE’s civilian provider roster merits further scrutiny by law enforcement. Following the National Institute of Standards and Technology 800, the DHA can mitigate privacy, safety, and security clearance threats by implementing an insider threat management model, robust enforcement of the False Claims Act, and mandatory security risk assessments. These are the views of the author, not the Department of Defense or the US government. %R 10.2196/52198 %U https://xmed.jmir.org/2024/1/e52198 %U https://doi.org/10.2196/52198 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53888 %T Exploring the Use and Implications of AI in Sexual and Reproductive Health and Rights: Protocol for a Scoping Review %A Tamrat,Tigest %A Zhao,Yu %A Schalet,Denise %A AlSalamah,Shada %A Pujari,Sameer %A Say,Lale %+ UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Geneva, 1218, Switzerland, 41 22 791 4417, tamratt@who.int %K artificial intelligence %K AI %K sexual health %K reproductive health %K maternal health %K gender %K machine learning %K natural language processing %K review %K systematic documentation %K protocol %K scoping review %K electronic database %K technical consultation %K intervention %K methodology %K qualitative %K World Health Organization %K WHO %K decision-making %D 2024 %7 9.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Artificial intelligence (AI) has emerged as a transformative force across the health sector and has garnered significant attention within sexual and reproductive health and rights (SRHR) due to polarizing views on its opportunities to advance care and the heightened risks and implications it brings to people’s well-being and bodily autonomy. As the fields of AI and SRHR evolve, clarity is needed to bridge our understanding of how AI is being used within this historically politicized health area and raise visibility on the critical issues that can facilitate its responsible and meaningful use. Objective: This paper presents the protocol for a scoping review to synthesize empirical studies that focus on the intersection of AI and SRHR. The review aims to identify the characteristics of AI systems and tools applied within SRHR, regarding health domains, intended purpose, target users, AI data life cycle, and evidence on benefits and harms. Methods: The scoping review follows the standard methodology developed by Arksey and O’Malley. We will search the following electronic databases: MEDLINE (PubMed), Scopus, Web of Science, and CINAHL. Inclusion criteria comprise the use of AI systems and tools in sexual and reproductive health and clear methodology describing either quantitative or qualitative approaches, including program descriptions. Studies will be excluded if they focus entirely on digital interventions that do not explicitly use AI systems and tools, are about robotics or nonhuman subjects, or are commentaries. We will not exclude articles based on geographic location, language, or publication date. The study will present the uses of AI across sexual and reproductive health domains, the intended purpose of the AI system and tools, and maturity within the AI life cycle. Outcome measures will be reported on the effect, accuracy, acceptability, resource use, and feasibility of studies that have deployed and evaluated AI systems and tools. Ethical and legal considerations, as well as findings from qualitative studies, will be synthesized through a narrative thematic analysis. We will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) format for the publication of the findings. Results: The database searches resulted in 12,793 records when the searches were conducted in October 2023. Screening is underway, and the analysis is expected to be completed by July 2024. Conclusions: The findings will provide key insights on usage patterns and evidence on the use of AI in SRHR, as well as convey key ethical, safety, and legal considerations. The outcomes of this scoping review are contributing to a technical brief developed by the World Health Organization and will guide future research and practice in this highly charged area of work. Trial Registration: OSF Registries osf.io/ma4d9; https://osf.io/ma4d9 International Registered Report Identifier (IRRID): PRR1-10.2196/53888 %M 38593433 %R 10.2196/53888 %U https://www.researchprotocols.org/2024/1/e53888 %U https://doi.org/10.2196/53888 %U http://www.ncbi.nlm.nih.gov/pubmed/38593433 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48144 %T Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study %A Mabetha,Khuthala %A Soepnel,Larske M %A Mabena,Gugulethu %A Motlhatlhedi,Molebogeng %A Nyati,Lukhanyo %A Norris,Shane A %A Draper,Catherine E %+ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa, 27 011 717 2382, khuthala.mabetha@wits.ac.za %K mobile technologies %K health promotion %K mixed methods %K clinical practice %K mobile phone %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. %M 38588527 %R 10.2196/48144 %U https://formative.jmir.org/2024/1/e48144 %U https://doi.org/10.2196/48144 %U http://www.ncbi.nlm.nih.gov/pubmed/38588527 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54008 %T Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System %A Palakshappa,Jessica A %A Hale,Erica R %A Brown,Joshua D %A Kittel,Carol A %A Dressler,Emily %A Rosenthal,Gary E %A Cutrona,Sarah L %A Foley,Kristie L %A Haines,Emily R %A Houston II,Thomas K %+ Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston Salem, NC, 27157, United States, 1 336 716 8465, jpalaksh@wakehealth.edu %K telehealth %K telemedicine %K e-health %K eHealth %K video visits %K video %K ICT %K information and communication technology %K survey %K surveys %K adoption %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K COVID-19 %D 2024 %7 8.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (“Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?”) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. %M 38587889 %R 10.2196/54008 %U https://www.jmir.org/2024/1/e54008 %U https://doi.org/10.2196/54008 %U http://www.ncbi.nlm.nih.gov/pubmed/38587889 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54340 %T Responding to the Return of Influenza in the United States by Applying Centers for Disease Control and Prevention Surveillance, Analysis, and Modeling to Inform Understanding of Seasonal Influenza %A Borchering,Rebecca K %A Biggerstaff,Matthew %A Brammer,Lynnette %A Budd,Alicia %A Garg,Shikha %A Fry,Alicia M %A Iuliano,A Danielle %A Reed,Carrie %+ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS H24-7, Atlanta, GA, 30329, United States, 1 4046395214, xhq2@cdc.gov %K disease burden %K modeling %K seasonal influenza %K surveillance %D 2024 %7 8.4.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X We reviewed the tools that have been developed to characterize and communicate seasonal influenza activity in the United States. Here we focus on systematic surveillance and applied analytics, including seasonal burden and disease severity estimation, short-term forecasting, and longer-term modeling efforts. For each set of activities, we describe the challenges and opportunities that have arisen because of the COVID-19 pandemic. In conclusion, we highlight how collaboration and communication have been and will continue to be key components of reliable and actionable influenza monitoring, forecasting, and modeling activities. %M 38587882 %R 10.2196/54340 %U https://publichealth.jmir.org/2024/1/e54340 %U https://doi.org/10.2196/54340 %U http://www.ncbi.nlm.nih.gov/pubmed/38587882 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e51171 %T Scalable Approach to Consumer Wearable Postmarket Surveillance: Development and Validation Study %A Yoo,Richard M %A Viggiano,Ben T %A Pundi,Krishna N %A Fries,Jason A %A Zahedivash,Aydin %A Podchiyska,Tanya %A Din,Natasha %A Shah,Nigam H %K consumer wearable devices %K atrial fibrillation %K postmarket surveillance %K surveillance %K monitoring %K artificial intelligence %K machine learning %K natural language processing %K NLP %K wearable %K wearables %K labeler %K heart %K cardiology %K arrhythmia %K diagnose %K diagnosis %K labeling %K classifier %K EHR %K electronic health record %K electronic health records %K consumer %K consumers %K device %K devices %K evaluation %D 2024 %7 4.4.2024 %9 %J JMIR Med Inform %G English %X Background: With the capability to render prediagnoses, consumer wearables have the potential to affect subsequent diagnoses and the level of care in the health care delivery setting. Despite this, postmarket surveillance of consumer wearables has been hindered by the lack of codified terms in electronic health records (EHRs) to capture wearable use. Objective: We sought to develop a weak supervision–based approach to demonstrate the feasibility and efficacy of EHR-based postmarket surveillance on consumer wearables that render atrial fibrillation (AF) prediagnoses. Methods: We applied data programming, where labeling heuristics are expressed as code-based labeling functions, to detect incidents of AF prediagnoses. A labeler model was then derived from the predictions of the labeling functions using the Snorkel framework. The labeler model was applied to clinical notes to probabilistically label them, and the labeled notes were then used as a training set to fine-tune a classifier called Clinical-Longformer. The resulting classifier identified patients with an AF prediagnosis. A retrospective cohort study was conducted, where the baseline characteristics and subsequent care patterns of patients identified by the classifier were compared against those who did not receive a prediagnosis. Results: The labeler model derived from the labeling functions showed high accuracy (0.92; F1-score=0.77) on the training set. The classifier trained on the probabilistically labeled notes accurately identified patients with an AF prediagnosis (0.95; F1-score=0.83). The cohort study conducted using the constructed system carried enough statistical power to verify the key findings of the Apple Heart Study, which enrolled a much larger number of participants, where patients who received a prediagnosis tended to be older, male, and White with higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, sex category) scores (P<.001). We also made a novel discovery that patients with a prediagnosis were more likely to use anticoagulants (525/1037, 50.63% vs 5936/16,560, 35.85%) and have an eventual AF diagnosis (305/1037, 29.41% vs 262/16,560, 1.58%). At the index diagnosis, the existence of a prediagnosis did not distinguish patients based on clinical characteristics, but did correlate with anticoagulant prescription (P=.004 for apixaban and P=.01 for rivaroxaban). Conclusions: Our work establishes the feasibility and efficacy of an EHR-based surveillance system for consumer wearables that render AF prediagnoses. Further work is necessary to generalize these findings for patient populations at other sites. %R 10.2196/51171 %U https://medinform.jmir.org/2024/1/e51171 %U https://doi.org/10.2196/51171 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54787 %T Understanding Physician’s Perspectives on AI in Health Care: Protocol for a Sequential Multiple Assignment Randomized Vignette Study %A Kim,Jane Paik %A Yang,Hyun-Joon %A Kim,Bohye %A Ryan,Katie %A Roberts,Laura Weiss %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94304, United States, 1 650 736 8996, janepkim@stanford.edu %K AI-based clinical decision support %K decision-making %K hypothetical vignettes %K physician perspective %K web-based survey %K hypothesis-driven research %K ethics %K stakeholder attitudes %D 2024 %7 4.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the availability and performance of artificial intelligence (AI)–based clinical decision support (CDS) systems improve, physicians and other care providers poised to be on the front lines will be increasingly tasked with using these tools in patient care and incorporating their outputs into clinical decision-making processes. Vignette studies provide a means to explore emerging hypotheses regarding how context-specific factors, such as clinical risk, the amount of information provided about the AI, and the AI result, may impact physician acceptance and use of AI-based CDS tools. To best anticipate how such factors influence the decision-making of frontline physicians in clinical scenarios involving AI decision-support tools, hypothesis-driven research is needed that enables scenario testing before the implementation and deployment of these tools. Objective: This study’s objectives are to (1) design an original, web-based vignette-based survey that features hypothetical scenarios based on emerging or real-world applications of AI-based CDS systems that will vary systematically by features related to clinical risk, the amount of information provided about the AI, and the AI result; and (2) test and determine causal effects of specific factors on the judgments and perceptions salient to physicians’ clinical decision-making. Methods: US-based physicians with specialties in family or internal medicine will be recruited through email and mail (target n=420). Through a web-based survey, participants will be randomized to a 3-part “sequential multiple assignment randomization trial (SMART) vignette” detailing a hypothetical clinical scenario involving an AI decision support tool. The SMART vignette design is similar to the SMART design but adapted to a survey design. Each respondent will be randomly assigned to 1 of the possible vignette variations of the factors we are testing at each stage, which include the level of clinical risk, the amount of information provided about the AI, and the certainty of the AI output. Respondents will be given questions regarding their hypothetical decision-making in response to the hypothetical scenarios. Results: The study is currently in progress and data collection is anticipated to be completed in 2024. Conclusions: The web-based vignette study will provide information on how contextual factors such as clinical risk, the amount of information provided about an AI tool, and the AI result influence physicians’ reactions to hypothetical scenarios that are based on emerging applications of AI in frontline health care settings. Our newly proposed “SMART vignette” design offers several benefits not afforded by the extensively used traditional vignette design, due to the 2 aforementioned features. These advantages are (1) increased validity of analyses targeted at understanding the impact of a factor on the decision outcome, given previous outcomes and other contextual factors; and (2) balanced sample sizes across groups. This study will generate a better understanding of physician decision-making within this context. International Registered Report Identifier (IRRID): DERR1-10.2196/54787 %M 38573756 %R 10.2196/54787 %U https://www.researchprotocols.org/2024/1/e54787 %U https://doi.org/10.2196/54787 %U http://www.ncbi.nlm.nih.gov/pubmed/38573756 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50036 %T Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis %A Zhang,Chunyu %A Hu,Ning %A Li,Rui %A Zhu,Aiping %A Yu,Zhongguang %+ Respiratory Centre, China-Japan Friendship Hospital, Yinghua Road 2#, Beijing, 100013, China, 86 84206468, yzg081892@163.com %K web-based consultation %K Andersen Behavioral Model %K qualitative comparative analysis %K perceived convenience %K complementary role %K user's confidence %K China %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. Objective: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users’ perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. Methods: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. Results: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user’s confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user’s confidence. Conclusions: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user’s confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations’ application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations. %M 38551645 %R 10.2196/50036 %U https://formative.jmir.org/2024/1/e50036 %U https://doi.org/10.2196/50036 %U http://www.ncbi.nlm.nih.gov/pubmed/38551645 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e47914 %T A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report %A Dietrich,Damien %A Bornet dit Vorgeat,Helena %A Perrin Franck,Caroline %A Ligier,Quentin %+ Geneva Hub for Global Digital Health, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, Geneva, 1202, Switzerland, 41 227714730, damien.dietrich@gmail.com %K patient empowerment %K mobile apps %K digital health %K mobile health %K implementation science %K health care system %K hospital information system %K health promotion %D 2024 %7 28.3.2024 %9 Implementation Report %J JMIR Med Inform %G English %X Background: Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. Objective: Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. Methods: The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. Implementation (Results): The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. Conclusions: This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a “key success” indicator. %M 38546728 %R 10.2196/47914 %U https://medinform.jmir.org/2024/1/e47914 %U https://doi.org/10.2196/47914 %U http://www.ncbi.nlm.nih.gov/pubmed/38546728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47133 %T Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach %A Strumann,Christoph %A Pfau,Lisa %A Wahle,Laila %A Schreiber,Raphael %A Steinhäuser,Jost %+ Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany, 49 451 3101 8005, c.strumann@uni-luebeck.de %K digitalization %K intersectoral %K discharge management %K readmission %K mixed methods design %D 2024 %7 26.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 Sektorübergreifende 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. %M 38530343 %R 10.2196/47133 %U https://www.jmir.org/2024/1/e47133 %U https://doi.org/10.2196/47133 %U http://www.ncbi.nlm.nih.gov/pubmed/38530343 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e46813 %T Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study %A Yan,Yiwei %A Xing,Congyan %A Chen,Jian %A Zheng,Yingbin %A Li,Xiaobin %A Liu,Yirong %A Wang,Zhanxiang %A Gong,Kai %+ Biomedical Big Data Center, The First Affiliated Hospital of Xiamen University, 10 Shanggu Road, Siming District, Xiamen, 361003, China, 86 15160003918, freatink@xmu.edu.cn %K information system %K maternal and child health care %K system construction %K system implementation %K regional health %K Inner Mongolia Autonomous Region %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap. Objective: This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia. Methods: We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS. Results: The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI≥28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020. Conclusions: The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide. %M 38526553 %R 10.2196/46813 %U https://pediatrics.jmir.org/2024/1/e46813 %U https://doi.org/10.2196/46813 %U http://www.ncbi.nlm.nih.gov/pubmed/38526553 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e41557 %T Exploring the Use of Persuasive System Design Principles to Enhance Medication Incident Reporting and Learning Systems: Scoping Reviews and Persuasive Design Assessment %A Oyibo,Kiemute %A Gonzalez,Paola A %A Ejaz,Sarah %A Naheyan,Tasneem %A Beaton,Carla %A O’Donnell,Denis %A Barker,James R %+ Department of Electrical Engineering and Computer Science, Lassonde Research Centre, York University, 4751 Keele Street, North York, ON, M3J 2N9, Canada, 1 416 736 5053, kiemute.oyibo@yorku.ca %K medication incident %K reporting system %K persuasive technology %K persuasive design %K medication %K persuasive system design %K pharmacy %K pharmaceutic %K pharmacology %K drug reporting %K drug event %K adverse event %K incident management %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Medication incidents (MIs) causing harm to patients have far-reaching consequences for patients, pharmacists, public health, business practice, and governance policy. Medication Incident Reporting and Learning Systems (MIRLS) have been implemented to mitigate such incidents and promote continuous quality improvement in community pharmacies in Canada. They aim to collect and analyze MIs for the implementation of incident preventive strategies to increase safety in community pharmacy practice. However, this goal remains inhibited owing to the persistent barriers that pharmacies face when using these systems. Objective: This study aims to investigate the harms caused by medication incidents and technological barriers to reporting and identify opportunities to incorporate persuasive design strategies in MIRLS to motivate reporting. Methods: We conducted 2 scoping reviews to provide insights on the relationship between medication errors and patient harm and the information system–based barriers militating against reporting. Seven databases were searched in each scoping review, including PubMed, Public Health Database, ProQuest, Scopus, ACM Library, Global Health, and Google Scholar. Next, we analyzed one of the most widely used MIRLS in Canada using the Persuasive System Design (PSD) taxonomy—a framework for analyzing, designing, and evaluating persuasive systems. This framework applies behavioral theories from social psychology in the design of technology-based systems to motivate behavior change. Independent assessors familiar with MIRLS reported the degree of persuasion built into the system using the 4 categories of PSD strategies: primary task, dialogue, social, and credibility support. Results: Overall, 17 articles were included in the first scoping review, and 1 article was included in the second scoping review. In the first review, significant or serious harm was the most frequent harm (11/17, 65%), followed by death or fatal harm (7/17, 41%). In the second review, the authors found that iterative design could improve the usability of an MIRLS; however, data security and validation of reports remained an issue to be addressed. Regarding the MIRLS that we assessed, participants considered most of the primary task, dialogue, and credibility support strategies in the PSD taxonomy as important and useful; however, they were not comfortable with some of the social strategies such as cooperation. We found that the assessed system supported a number of persuasive strategies from the PSD taxonomy; however, we identified additional strategies such as tunneling, simulation, suggestion, praise, reward, reminder, authority, and verifiability that could further enhance the perceived persuasiveness and value of the system. Conclusions: MIRLS, equipped with persuasive features, can become powerful motivational tools to promote safer medication practices in community pharmacies. They have the potential to highlight the value of MI reporting and increase the readiness of pharmacists to report incidents. The proposed persuasive design guidelines can help system developers and community pharmacy managers realize more effective MIRLS. %M 38512325 %R 10.2196/41557 %U https://humanfactors.jmir.org/2024/1/e41557 %U https://doi.org/10.2196/41557 %U http://www.ncbi.nlm.nih.gov/pubmed/38512325 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e52073 %T Preliminary Evidence of the Use of Generative AI in Health Care Clinical Services: Systematic Narrative Review %A Yim,Dobin %A Khuntia,Jiban %A Parameswaran,Vijaya %A Meyers,Arlen %+ University of Colorado Denver, 1475 Lawrence St., Denver, CO, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K generative artificial intelligence tools and applications %K GenAI %K service %K clinical %K health care %K transformation %K digital %D 2024 %7 20.3.2024 %9 Review %J JMIR Med Inform %G English %X Background: Generative artificial intelligence tools and applications (GenAI) are being increasingly used in health care. Physicians, specialists, and other providers have started primarily using GenAI as an aid or tool to gather knowledge, provide information, train, or generate suggestive dialogue between physicians and patients or between physicians and patients’ families or friends. However, unless the use of GenAI is oriented to be helpful in clinical service encounters that can improve the accuracy of diagnosis, treatment, and patient outcomes, the expected potential will not be achieved. As adoption continues, it is essential to validate the effectiveness of the infusion of GenAI as an intelligent technology in service encounters to understand the gap in actual clinical service use of GenAI. Objective: This study synthesizes preliminary evidence on how GenAI assists, guides, and automates clinical service rendering and encounters in health care The review scope was limited to articles published in peer-reviewed medical journals. Methods: We screened and selected 0.38% (161/42,459) of articles published between January 1, 2020, and May 31, 2023, identified from PubMed. We followed the protocols outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to select highly relevant studies with at least 1 element on clinical use, evaluation, and validation to provide evidence of GenAI use in clinical services. The articles were classified based on their relevance to clinical service functions or activities using the descriptive and analytical information presented in the articles. Results: Of 161 articles, 141 (87.6%) reported using GenAI to assist services through knowledge access, collation, and filtering. GenAI was used for disease detection (19/161, 11.8%), diagnosis (14/161, 8.7%), and screening processes (12/161, 7.5%) in the areas of radiology (17/161, 10.6%), cardiology (12/161, 7.5%), gastrointestinal medicine (4/161, 2.5%), and diabetes (6/161, 3.7%). The literature synthesis in this study suggests that GenAI is mainly used for diagnostic processes, improvement of diagnosis accuracy, and screening and diagnostic purposes using knowledge access. Although this solves the problem of knowledge access and may improve diagnostic accuracy, it is oriented toward higher value creation in health care. Conclusions: GenAI informs rather than assisting or automating clinical service functions in health care. There is potential in clinical service, but it has yet to be actualized for GenAI. More clinical service–level evidence that GenAI is used to streamline some functions or provides more automated help than only information retrieval is needed. To transform health care as purported, more studies related to GenAI applications must automate and guide human-performed services and keep up with the optimism that forward-thinking health care organizations will take advantage of GenAI. %M 38506918 %R 10.2196/52073 %U https://medinform.jmir.org/2024/1/e52073 %U https://doi.org/10.2196/52073 %U http://www.ncbi.nlm.nih.gov/pubmed/38506918 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52071 %T An Electronic Health Record–Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study %A Ganeshan,Smitha %A Liu,Andrew W %A Kroeger,Anne %A Anand,Prerna %A Seefeldt,Richard %A Regner,Alexis %A Vaughn,Diana %A Odisho,Anobel Y %A Mourad,Michelle %+ Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, #M1493, San Francisco, CA, 94117‭, United States, 1 415 514 1000, smitha.ganeshan@ucsf.edu %K appointment %K consultation %K cost %K digital health %K digital tools %K electronic health record %K EHR %K informatics %K patient access %K retrospective review %K revenue %K self-rescheduling tool %K self-scheduling %K waiting time %D 2024 %7 19.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician’s schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. Objective: We evaluated an electronic health record (EHR)–based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. Methods: In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. Results: From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. Conclusions: Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access. %M 38502159 %R 10.2196/52071 %U https://www.jmir.org/2024/1/e52071 %U https://doi.org/10.2196/52071 %U http://www.ncbi.nlm.nih.gov/pubmed/38502159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48504 %T The EMPOWER Occupational e–Mental Health Intervention Implementation Checklist to Foster e–Mental Health Interventions in the Workplace: Development Study %A Raggi,Alberto %A Bernard,Renaldo M %A Toppo,Claudia %A Sabariego,Carla %A Salvador Carulla,Luis %A Lukersmith,Sue %A Hakkaart-van Roijen,Leona %A Merecz-Kot,Dorota %A Olaya,Beatriz %A Antunes Lima,Rodrigo %A Gutiérrez-Marín,Desirée %A Vorstenbosch,Ellen %A Curatoli,Chiara %A Cacciatore,Martina %+ Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, 20133, Italy, 39 0223943105, alberto.raggi@istituto-besta.it %K implementation %K workplace %K mental health %K well-being %K digital health %K mobile health %K mHealth %K eHealth %K e–mental health %K stakeholder consultation %K intervention %K occupational %K stakeholders %K consultation %K barrier %K checklist %D 2024 %7 15.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Occupational e–mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. Objective: The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. Methods: Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing “elements that positively affect implementation” and 17 barriers presented as statements addressing “concerns toward implementation.” If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from “very difficult to implement” to “very easy to implement.” In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders’ responses to the open survey’s questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. Results: In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. Conclusions: Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist. %M 38488846 %R 10.2196/48504 %U https://www.jmir.org/2024/1/e48504 %U https://doi.org/10.2196/48504 %U http://www.ncbi.nlm.nih.gov/pubmed/38488846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47715 %T The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis %A Canfell,Oliver J %A Woods,Leanna %A Meshkat,Yasaman %A Krivit,Jenna %A Gunashanhar,Brinda %A Slade,Christine %A Burton-Jones,Andrew %A Sullivan,Clair %+ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Level 5 Health Sciences Building, Central, Fig Tree Cres, Brisbane, 4006, Australia, 61 731765530, o.canfell@uq.edu.au %K electronic medical record %K electronic health record %K health care professionals %K patients %K patient satisfaction %K hospitals %K eHealth %K attitude %K perception %K systematic %K digital hospital %K digital hospitals %K experience %K satisfaction %D 2024 %7 11.3.2024 %9 Review %J J Med Internet Res %G English %X Background: The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. Objective: This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. Results: A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians’ ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. Conclusions: Clinicians’ experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care. %M 38466978 %R 10.2196/47715 %U https://www.jmir.org/2024/1/e47715 %U https://doi.org/10.2196/47715 %U http://www.ncbi.nlm.nih.gov/pubmed/38466978 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53391 %T Health Care Professionals’ Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study %A Jensen,Lili Worre Høpfner %A Rahbek,Ole %A Lauritsen,Rikke Emilie Kildahl %A Kold,Søren %A Dinesen,Birthe %+ Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark, 45 60229406, lili.jensen@rn.dk %K CFIR %K Consolidated Framework for Implementation Research %K digital communication %K hospital discharge %K implementation science %K interdisciplinary communication %K orthopedic surgery %K patient-provider communication %K postoperative care %K qualitative research %K text messaging %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs’ needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. Objective: This study aimed to (1) investigate HCPs’ perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). Methods: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. Results: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. Conclusions: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources. %M 38457798 %R 10.2196/53391 %U https://humanfactors.jmir.org/2024/1/e53391 %U https://doi.org/10.2196/53391 %U http://www.ncbi.nlm.nih.gov/pubmed/38457798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47685 %T The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study %A Jiang,Yun %A Hwang,Misun %A Cho,Youmin %A Friese,Christopher R %A Hawley,Sarah T %A Manojlovich,Milisa %A Krauss,John C %A Gong,Yang %+ School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109, United States, 1 734 763 3705, jiangyu@umich.edu %K digital technology %K patient safety %K patient participation %K patient-reported outcomes %K drug-related side effects and adverse reactions %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients’ various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients’ just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients’ transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. Objective: We aim to assess oncology patients’ perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. Methods: A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants’ perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants’ technology acceptance through bivariate correlation analyses and multiple logistic regressions. Results: Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). Conclusions: In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care. %M 38457204 %R 10.2196/47685 %U https://www.jmir.org/2024/1/e47685 %U https://doi.org/10.2196/47685 %U http://www.ncbi.nlm.nih.gov/pubmed/38457204 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52766 %T Investigating Digital Patient-Reported Outcome Measures in Patient-Centered Diabetes Specialist Outpatient Care (DigiDiaS): Protocol for a Multimethod Prospective Observational Study %A Torbjørnsen,Astrid %A Spildo,Ingeborg %A Mollestad,Maria Aadland %A Jensen,Annesofie Lunde %A Singstad,Tone %A Weldingh,Nina Mickelson %A Joranger,Pål %A Ribu,Lis %A Holmen,Heidi %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University – OsloMet, Postboks 4, St. Olavs plass, Oslo, 0130, Norway, 47 67236199, astridto@oslomet.no %K patient-reported outcome measures %K PROMs %K diabetes mellitus %K DM %K type 1 %K patient acceptance of health care %K telemedicine %K mobile apps %K mobile phone %D 2024 %7 5.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Living with type 1 diabetes is challenging, and to support self-management, repeated consultations in specialist outpatient care are often required. The emergence of new digital solutions has revolutionized how health care services can be patient centered, providing unprecedented opportunities for flexible, high-quality care. However, there is a lack of studies exploring how the use of digital patient-reported outcome measures (PROMs) for flexible specialist care affects diabetes self-management. To provide new knowledge on the relevance of using PROMs in standard care, we have designed a multimethod prospective study. Objective: The overall aim of this protocol is to describe our prospective multimethod observational study designed to investigate digital PROMs in a routine specialist outpatient setting for flexible patient-centered diabetes care (DigiDiaS). Methods: This protocol outlines the design of a multimethod prospective observational cohort study that includes data from electronic health records, self-reported questionnaires, clinical consultation field observations, and individual in-depth interviews with patients and diabetes health care personnel. All patients with type 1 diabetes at a designated outpatient clinic were invited to participate and use the digital PROM implemented in clinical care. Both users and nonusers of the digital PROM were eligible for the prospective study, allowing for a comparison of the two groups. Data were collected at baseline and after 12 months, including self-management as the primary outcome assessed using the Patient Activation Measure, along with the secondary outcomes of digital health literacy, quality of life, health economy, and clinical variables such as glycated hemoglobin. Results: The digital solution was implemented for routine clinical care in the department in November 2021, and data collection for the prospective study started in October 2022. As of September 6, 2023, 84.6% (186/220) of patients among those in the digital PROM and 15.5% (34/220) of patients among the nonusers have consented to participate. We expect the study to have enough participants by the autumn of 2023. With 1 year of follow-up, the results are expected by spring 2025. Conclusions: In conclusion, a multimethod prospective observational cohort study can offer valuable insights into the relevance, effectiveness, and acceptability of digital tools using PROMs in diabetes specialist care. Such knowledge is crucial for achieving broad and successful implementation and use of these tools in a large diabetes outpatient clinic. International Registered Report Identifier (IRRID): DERR1-10.2196/52766 %M 38441955 %R 10.2196/52766 %U https://www.researchprotocols.org/2024/1/e52766 %U https://doi.org/10.2196/52766 %U http://www.ncbi.nlm.nih.gov/pubmed/38441955 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47081 %T Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model %A Hailemariam,Tesfahun %A Atnafu,Asmamaw %A Gezie,Lemma %A Kaasbøll,Jens %A Klein,Jorn %A Tilahun,Binyam %+ Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Chechela street, Gondar, 196, Ethiopia, 251 913305250, tesfahunhailemariam@gmail.com %K data capturing %K data use %K eCHIS %K electronic community health information system %K health extension worker %K HEW %K intention to use %K service provision %K Unified Theory of Acceptance and Use of Technology 2 %K UTAUT2 model %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. Objective: This study aimed to assess HEWs’ intentions to use the eCHIS for health data management and service provision. Methods: A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs’ intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. Results: A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs’ intention to use the eCHIS. Conclusions: HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management. %M 38437008 %R 10.2196/47081 %U https://humanfactors.jmir.org/2024/1/e47081 %U https://doi.org/10.2196/47081 %U http://www.ncbi.nlm.nih.gov/pubmed/38437008 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52284 %T Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study %A Lussier,Maxime %A Couture,Mélanie %A Giroux,Sylvain %A Aboujaoudé,Aline %A Ngankam,Hubert Kenfack %A Pigot,Hélène %A Gaboury,Sébastien %A Bouchard,Kevin %A Bottari,Carolina %A Belchior,Patricia %A Paré,Guy %A Bier,Nathalie %+ Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Université de Montréal, 4545 Queen Mary Road, Montreal, QC, H3W 1W6, Canada, 1 514 343 6416, lussier.maxime@gmail.com %K action design research %K protocol %K activities of daily living %K older adults %K cognitive deficits %K telemonitoring %K public health care system %K home care services %D 2024 %7 29.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors’ Autonomy program (SAPA [Soutien à l’autonomie des personnes âgées]) project was initiated within this context, embracing an innovative research approach that combines action research and design science. Objective: This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context. Methods: This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project. Results: The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients’ ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients’ homes, and detailed results will be presented in future papers. Conclusions: To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging. International Registered Report Identifier (IRRID): RR1-10.2196/52284 %M 38422499 %R 10.2196/52284 %U https://www.researchprotocols.org/2024/1/e52284 %U https://doi.org/10.2196/52284 %U http://www.ncbi.nlm.nih.gov/pubmed/38422499 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48507 %T Occupational Therapy Students’ Evidence-Based Practice Skills as Reported in a Mobile App: Cross-Sectional Study %A Johnson,Susanne G %A Espehaug,Birgitte %A Larun,Lillebeth %A Ciliska,Donna %A Olsen,Nina Rydland %+ Department of Health and Functioning, Western Norway University of Applied Sciences, Inndalseveien 28, Bergen, 5063, Norway, 47 92213202, susanne.grodem.johnson@hvl.no %K active learning strategies %K application %K cross-sectional study %K development %K education %K higher education %K interactive %K mobile application %K mobile app %K occupational therapy students %K occupational therapy %K students %K usability %K use %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Evidence-based practice (EBP) is an important aspect of the health care education curriculum. EBP involves following the 5 EBP steps: ask, assess, appraise, apply, and audit. These 5 steps reflect the suggested core competencies covered in teaching and learning programs to support future health care professionals applying EBP. When implementing EBP teaching, assessing outcomes by documenting the student’s performance and skills is relevant. This can be done using mobile devices. Objective: The aim of this study was to assess occupational therapy students’ EBP skills as reported in a mobile app. Methods: We applied a cross-sectional design. Descriptive statistics were used to present frequencies, percentages, means, and ranges of data regarding EBP skills found in the EBPsteps app. Associations between students’ ability to formulate the Population, Intervention, Comparison, and Outcome/Population, Interest, and Context (PICO/PICo) elements and identifying relevant research evidence were analyzed with the chi-square test. Results: Of 4 cohorts with 150 students, 119 (79.3%) students used the app and produced 240 critically appraised topics (CATs) in the app. The EBP steps “ask,” “assess,” and “appraise” were often correctly performed. The clinical question was formulated correctly in 53.3% (128/240) of the CATs, and students identified research evidence in 81.2% (195/240) of the CATs. Critical appraisal checklists were used in 81.2% (195/240) of the CATs, and most of these checklists were assessed as relevant for the type of research evidence identified (165/195, 84.6%). The least frequently correctly reported steps were “apply” and “audit.” In 39.6% (95/240) of the CATs, it was reported that research evidence was applied. Only 61% (58/95) of these CATs described how the research was applied to clinical practice. Evaluation of practice changes was reported in 38.8% (93/240) of the CATs. However, details about practice changes were lacking in all these CATs. A positive association was found between correctly reporting the "population" and "interventions/interest" elements of the PICO/PICo and identifying research evidence (P<.001). Conclusions: We assessed the students’ EBP skills based on how they documented following the EBP steps in the EBPsteps app, and our results showed variations in how well the students mastered the steps. “Apply” and “audit” were the most difficult EBP steps for the students to perform, and this finding has implications and gives directions for further development of the app and educational instruction in EBP. The EBPsteps app is a new and relevant app for students to learn and practice EBP, and it can be used to assess students’ EBP skills objectively. %M 38381475 %R 10.2196/48507 %U https://mededu.jmir.org/2024/1/e48507 %U https://doi.org/10.2196/48507 %U http://www.ncbi.nlm.nih.gov/pubmed/38381475 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e46740 %T Evaluating the Impact of the National Health Service Digital Academy on Participants’ Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study %A Acharya,Amish %A Black,Ruth Claire %A Smithies,Alisdair %A Darzi,Ara %+ Institute of Global Health Innovation, Imperial College London, 10th Floor, St Mary's Hospital, Paddington, London, W2 1NY, United Kingdom, 44 207 886 2125, aa2107@ic.ac.uk %K digital leadership %K professional identity %K dissertation of practice %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership. Objective: This study aims to examine the impact of the NHSDA program on participants’ perceptions of themselves as digital health leaders. Methods: We recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals’ perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework. Results: Of the 41 participants, 42% (17/41) were in clinical roles, 34% (14/41) were in program delivery or management roles, 20% (8/41) were in data science roles, and 5% (2/41) were in “other” roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants’ values and direction within the wider digital health community. According to the questionnaire, after graduation, 59% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46% (11/24) reporting that the course was a strong determinant of this change. Conclusions: A digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development. %M 38381477 %R 10.2196/46740 %U https://mededu.jmir.org/2024/1/e46740 %U https://doi.org/10.2196/46740 %U http://www.ncbi.nlm.nih.gov/pubmed/38381477 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50012 %T Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study %A Chang,Jinghui %A Mai,Yanshan %A Zhang,Dayi %A Yang,Xixi %A Li,Anqi %A Yan,Wende %A Wu,Yibo %A Chen,Jiangyun %+ School of Health Management, Southern Medical University, Number 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China, 86 1 858 822 0304, cjy112@i.smu.edu.cn %K older adults %K family health %K media use %K intention to use mobile health devices %K China %D 2024 %7 19.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices. Objective: This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide. Methods: The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices. Results: A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels. Conclusions: The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices. %M 38373031 %R 10.2196/50012 %U https://www.jmir.org/2024/1/e50012 %U https://doi.org/10.2196/50012 %U http://www.ncbi.nlm.nih.gov/pubmed/38373031 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45817 %T Attitudes Toward and Use of eHealth Technologies Among German Dermatologists: Repeated Cross-Sectional Survey in 2019 and 2021 %A Augustin,Matthias %A Reinders,Patrick %A Janke,Toni Maria %A Strömer,Klaus %A von Kiedrowski,Ralph %A Kirsten,Natalia %A Zink,Alexander %A Otten,Marina %+ Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20251, Germany, 49 40741024721, p.reinders@uke.de %K acceptance %K adoption %K attitude %K COVID-19 %K dermatology %K digital medicine %K digitalization %K pandemic %K perception %K teledermatology %K telehealth %K telemedicine %D 2024 %7 12.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, legal and infrastructural conditions have been set to improve the adoption of digital applications in health care in Germany. The impact of these actions was amplified by the COVID-19 pandemic. So far, no studies have confirmed this progress in dermatology. Objective: The aim of this study was to measure changes in knowledge, interest, expectation, and use of digital applications in health care among dermatologists in Germany in 2019 and 2021. Methods: We administered a repeated cross-sectional survey among dermatologists in medical practices and clinics in Germany at 2 time points: t1 (2019; before the COVID-19 pandemic) and t2 (2021; during the COVID-19 pandemic). We used a standardized questionnaire, including items on respondents’ knowledge, interest, expectation, and use of digital applications, as well as their demographics. The survey was distributed by post and email. The data were analyzed descriptively as well as with multiple logistic regressions. Results: At t1, 585 (272/571, 47.6% female; mean age 52.4, SD 8.9 years) dermatologists and at t2, 792 (360/736, 48.9% female; mean age 54.3, SD 8.6 years) dermatologists participated in this survey. Interest in digital medicine was higher at t1 than at t2 (381/585, 65.1% vs 458/792, 57.8%; P≤.001). Nevertheless, 38.6% (306/792) had used digital applications more often since the beginning of the pandemic. For example, real-time telemedicine with patients (12/585, 2.1% vs 160/792, 7.6%; P≤.001) and other specialists did increase (33/385, 5.7% vs 181/792, 22.8%; P≤.001). Almost one-third expressed great concerns about digitalization (272/792, 34.3% vs 294/792, 37.1%; P=.21). Spatial analysis revealed higher interest in, more positive expectations toward, and higher use of digital applications in urban areas in comparison to rural areas. For instance, dermatologists from urban areas assessed future applications as having less risk (adjusted odds ratio [aOR] 0.51, 95% CI 0.35-0.76) than did dermatologists from rural areas. The situation was similar with the age groups, as, for example, dermatologists aged <50 years also expected lower risks (aOR 0.51, 95% CI 0.34-0.77) than those aged ≥50 years. There were no differences between sexes in use, but there were differences in knowledge and expectation; for example, male participants assessed their confidence in using digital applications as higher (aOR 1.44, 95% CI 1.01-2.04) than did female participants. Conclusions: During the pandemic, the use of digital applications in dermatology increased but still remained at a moderate level. The regional and age-related disparities identified indicate the need for further action to ensure equal access to digital care. %M 38345855 %R 10.2196/45817 %U https://www.jmir.org/2024/1/e45817 %U https://doi.org/10.2196/45817 %U http://www.ncbi.nlm.nih.gov/pubmed/38345855 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51980 %T Defining the Dimensions of Diversity to Promote Inclusion in the Digital Era of Health Care: A Lexicon %A Sharma,Yashoda %A Saha,Anindita %A Goldsack,Jennifer C %+ Digital Medicine Society, 90 Canal Street, 4th Floor, Boston, MA, 02114, United States, 1 765 234 3463, yashoda@dimesociety.org %K digital medicine %K inclusion %K digital health technology/product %K digital health %K digital technology %K health care system %K innovation %K equity %K quality %K disparity %K digital era %K digital access %K digital literacy %D 2024 %7 9.2.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The pandemic provided a stark reminder of the inequities faced by populations historically marginalized by the health care system and accelerated the adoption of digital health technologies to drive innovation. Digital health technologies’ purported promises to reduce inefficiencies and costs, improve access and health outcomes, and empower patients add a new level of urgency to health equity. As conventional medicine shifts toward digital medicine, we have the opportunity to intentionally develop and deploy digital health technologies with an inclusion focus. The first step is ensuring that the multiple dimensions of diversity are captured. We propose a lexicon that encompasses elements critical for implementing an inclusive approach to advancing health care quality and health services research in the digital era. %M 38335013 %R 10.2196/51980 %U https://publichealth.jmir.org/2024/1/e51980 %U https://doi.org/10.2196/51980 %U http://www.ncbi.nlm.nih.gov/pubmed/38335013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51098 %T Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review %A Rouleau,Geneviève %A Wu,Kelly %A Ramamoorthi,Karishini %A Boxall,Cherish %A Liu,Rebecca H %A Maloney,Shelagh %A Zelmer,Jennifer %A Scott,Ted %A Larsen,Darren %A Wijeysundera,Harindra C %A Ziegler,Daniela %A Bhatia,Sacha %A Kishimoto,Vanessa %A Steele Gray,Carolyn %A Desveaux,Laura %+ Nursing department, Université du Québec en Outaouais, 5, rue Saint-Joseph, Saint-Jérôme, QC, J7Z 0B7, Canada, 1 819 595 3900, genevieve.rouleau02@uqo.ca %K digital health interventions %K evaluation %K implementation %K integrated knowledge translation, theories %K models %K frameworks %K scoping review %D 2024 %7 5.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations. Objective: This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users. Methods: This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid). Results: A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52). Conclusions: As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven. %M 38315515 %R 10.2196/51098 %U https://www.jmir.org/2024/1/e51098 %U https://doi.org/10.2196/51098 %U http://www.ncbi.nlm.nih.gov/pubmed/38315515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46308 %T Timing, Indicators, and Approaches to Digital Patient Experience Evaluation: Umbrella Systematic Review %A Wang,Tingting %A Giunti,Guido %A Goossens,Richard %A Melles,Marijke %+ Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Gebouw 32, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 623018218, t.wang-8@tudelft.nl %K digital health %K eHealth %K telemedicine %K mobile health %K mHealth %K patient experience %K user experience %K evaluation timing %K evaluation indicators %K evaluation approaches %K user-centered design %K patient-centered care %K human-computer interaction %K mobile phone %D 2024 %7 5.2.2024 %9 Review %J J Med Internet Res %G English %X Background: The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required. Objective: This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation. Methods: This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials. Results: Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx. Conclusions: Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx. %M 38315545 %R 10.2196/46308 %U https://www.jmir.org/2024/1/e46308 %U https://doi.org/10.2196/46308 %U http://www.ncbi.nlm.nih.gov/pubmed/38315545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53302 %T Clinical Informatics Team Members’ Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study %A Recsky,Chantelle %A Rush,Kathy L %A MacPhee,Maura %A Stowe,Megan %A Blackburn,Lorraine %A Muniak,Allison %A Currie,Leanne M %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 7417, chantelle.recsky@ubc.ca %K informatics %K community health services %K knowledge translation %K qualitative research %K patient safety %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). Objective: This study aimed to explore clinical informaticians’ experiences of incorporating safety practices into their work. Methods: We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. Results: A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. Conclusions: As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work. %M 38315544 %R 10.2196/53302 %U https://formative.jmir.org/2024/1/e53302 %U https://doi.org/10.2196/53302 %U http://www.ncbi.nlm.nih.gov/pubmed/38315544 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52946 %T Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study %A Castillo-Rodenas,Marta %A Vidal-Alaball,Josep %A Solanas-Bacardit,Núria %A Farràs-Company,Clotilde %A Fuster-Casanovas,Aïna %A Miró Catalina,Queralt %A López Seguí,Francesc %+ Cap de la Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Carrer Pica d'Estats, 13-15, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K primary health care %K pediatrics %K remote consultation %K telemedicine %K rural health services %K video consultation %D 2024 %7 1.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non–face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families’ access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications. Objective: The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals. Methods: We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family’s side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard. Results: Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits. Conclusions: We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/52946 %M 38300693 %R 10.2196/52946 %U https://www.researchprotocols.org/2024/1/e52946 %U https://doi.org/10.2196/52946 %U http://www.ncbi.nlm.nih.gov/pubmed/38300693 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47197 %T Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis %A Yu,Yang %A Wang,Sufen %A You,Lijue %+ Glorious Sun School of Business and Management, Donghua University, 1882 West Yan-an Road, Shanghai, 200051, China, 86 18116350361, sf_wang@dhu.edu.cn %K integrated health management system %K medical association %K medical consortium %K policy tools %K content analysis %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %D 2024 %7 24.1.2024 %9 Review %J J Med Internet Res %G English %X Background: The integrated health management system (IHMS), which unites all health care–related institutions under a health-centered organizational framework, is of great significance to China in promoting the hierarchical treatment system and improving the new health care reform. China’s IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China. Objective: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of China’s IHMS policy to inform the design and improvement of the system. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis. Results: First, we found that, regarding the coordination of policy tools and stakeholders, China’s IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22% and 11/2019, 0.54%, respectively). Second, in terms of level differences, Shanghai’s IHMS policy used fewer demand-based policy tools (43/483, 8.9%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1% and 248/357, 69.5%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7% and 4/158, 2.5%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of China’s IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021). Conclusions: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization. %M 38265862 %R 10.2196/47197 %U https://www.jmir.org/2024/1/e47197 %U https://doi.org/10.2196/47197 %U http://www.ncbi.nlm.nih.gov/pubmed/38265862 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e52524 %T Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study %A Modi,Shikha %A Feldman,Sue S %A Berner,Eta S %A Schooley,Benjamin %A Johnston,Allen %+ The University of Alabama in Huntsville, 1610 Ben Graves Dr NW, Huntsville, AL, 35816, United States, 1 2568242437, ssm0031@uah.edu %K acceptance %K admission %K adoption %K clinical outcome %K cost %K economic %K EHR adoption %K EHR %K electronic health record %K finance %K financial outcome %K financial %K health outcome %K health record %K hospital %K hospitalization %K length of stay %K margin %K moderation analysis %K multivariate %K operating margin %K operating %K operation %K operational %K profit %K project management %K readmission rate %K readmission %K total margin %K value analysis %K value engineering %K value management %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 38265848 %R 10.2196/52524 %U https://medinform.jmir.org/2024/1/e52524 %U https://doi.org/10.2196/52524 %U http://www.ncbi.nlm.nih.gov/pubmed/38265848 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52085 %T Big 5 Personality Traits and Individual- and Practice-Related Characteristics as Influencing Factors of Digital Maturity in General Practices: Quantitative Web-Based Survey Study %A Weik,Lisa %A Fehring,Leonard %A Mortsiefer,Achim %A Meister,Sven %+ Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Pferdebachstr. 11, Witten, 58448, Germany, 49 230292678629, sven.meister@uni-wh.de %K digital health %K eHealth %K digital maturity %K maturity assessment %K general practitioners %K primary care physicians %K primary care %K family medicine %K personality %K digital affinity %K digital health adoption %D 2024 %7 22.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Various studies propose the significance of digital maturity in ensuring effective patient care and enabling improved health outcomes, a successful digital transformation, and optimized service delivery. Although previous research has centered around inpatient health care settings, research on digital maturity in general practices is still in its infancy. Objective: As general practitioners (GPs) are the first point of contact for most patients, we aimed to shed light on the pivotal role of GPs’ inherent characteristics, especially their personality, in the digital maturity of general practices. Methods: In the first step, we applied a sequential mixed methods approach involving a literature review and expert interviews with GPs to construct the digital maturity scale used in this study. Next, we designed a web-based survey to assess digital maturity on a 5-point Likert-type scale and analyze the relationship with relevant inherent characteristics using ANOVAs and regression analysis. Results: Our web-based survey with 219 GPs revealed that digital maturity was overall moderate (mean 3.31, SD 0.64) and substantially associated with several characteristics inherent to the GP. We found differences in overall digital maturity based on GPs’ gender, the expected future use of digital health solutions, the perceived digital affinity of medical assistants, GPs’ level of digital affinity, and GPs’ level of extraversion and neuroticism. In a regression model, a higher expected future use, a higher perceived digital affinity of medical assistants, a higher digital affinity of GPs, and lower neuroticism were substantial predictors of overall digital maturity. Conclusions: Our study highlights the impact of GPs’ inherent characteristics, especially their personality, on the digital maturity of general practices. By identifying these inherent influencing factors, our findings support targeted approaches to drive digital maturity in general practice settings. %M 38252468 %R 10.2196/52085 %U https://www.jmir.org/2024/1/e52085 %U https://doi.org/10.2196/52085 %U http://www.ncbi.nlm.nih.gov/pubmed/38252468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47430 %T The Reporting Quality of Machine Learning Studies on Pediatric Diabetes Mellitus: Systematic Review %A Zrubka,Zsombor %A Kertész,Gábor %A Gulácsi,László %A Czere,János %A Hölgyesi,Áron %A Nezhad,Hossein Motahari %A Mosavi,Amir %A Kovács,Levente %A Butte,Atul J %A Péntek,Márta %+ HECON Health Economics Research Center, University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary, 36 302029415, zrubka.zsombor@uni-obuda.hu %K diabetes mellitus %K children %K adolescent %K pediatric %K machine learning %K Minimum Information About Clinical Artificial Intelligence Modelling %K MI-CLAIM %K reporting quality %D 2024 %7 19.1.2024 %9 Review %J J Med Internet Res %G English %X Background: Diabetes mellitus (DM) is a major health concern among children with the widespread adoption of advanced technologies. However, concerns are growing about the transparency, replicability, biasedness, and overall validity of artificial intelligence studies in medicine. Objective: We aimed to systematically review the reporting quality of machine learning (ML) studies of pediatric DM using the Minimum Information About Clinical Artificial Intelligence Modelling (MI-CLAIM) checklist, a general reporting guideline for medical artificial intelligence studies. Methods: We searched the PubMed and Web of Science databases from 2016 to 2020. Studies were included if the use of ML was reported in children with DM aged 2 to 18 years, including studies on complications, screening studies, and in silico samples. In studies following the ML workflow of training, validation, and testing of results, reporting quality was assessed via MI-CLAIM by consensus judgments of independent reviewer pairs. Positive answers to the 17 binary items regarding sufficient reporting were qualitatively summarized and counted as a proxy measure of reporting quality. The synthesis of results included testing the association of reporting quality with publication and data type, participants (human or in silico), research goals, level of code sharing, and the scientific field of publication (medical or engineering), as well as with expert judgments of clinical impact and reproducibility. Results: After screening 1043 records, 28 studies were included. The sample size of the training cohort ranged from 5 to 561. Six studies featured only in silico patients. The reporting quality was low, with great variation among the 21 studies assessed using MI-CLAIM. The number of items with sufficient reporting ranged from 4 to 12 (mean 7.43, SD 2.62). The items on research questions and data characterization were reported adequately most often, whereas items on patient characteristics and model examination were reported adequately least often. The representativeness of the training and test cohorts to real-world settings and the adequacy of model performance evaluation were the most difficult to judge. Reporting quality improved over time (r=0.50; P=.02); it was higher than average in prognostic biomarker and risk factor studies (P=.04) and lower in noninvasive hypoglycemia detection studies (P=.006), higher in studies published in medical versus engineering journals (P=.004), and higher in studies sharing any code of the ML pipeline versus not sharing (P=.003). The association between expert judgments and MI-CLAIM ratings was not significant. Conclusions: The reporting quality of ML studies in the pediatric population with DM was generally low. Important details for clinicians, such as patient characteristics; comparison with the state-of-the-art solution; and model examination for valid, unbiased, and robust results, were often the weak points of reporting. To assess their clinical utility, the reporting standards of ML studies must evolve, and algorithms for this challenging population must become more transparent and replicable. %M 38241075 %R 10.2196/47430 %U https://www.jmir.org/2024/1/e47430 %U https://doi.org/10.2196/47430 %U http://www.ncbi.nlm.nih.gov/pubmed/38241075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43994 %T Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review %A Aldridge,Grace %A Tomaselli,Alessandra %A Nowell,Clare %A Reupert,Andrea %A Jorm,Anthony %A Yap,Marie Bee Hui %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Australia, 61 3 9905 0723, marie.yap@monash.edu %K systematic review %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K engagement %K support %K adverse childhood experiences %D 2024 %7 19.1.2024 %9 Review %J J Med Internet Res %G English %X Background: Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent’s capacity to modify. However, engagement with such programs is suboptimal. Objective: This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent’s capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. Results: We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program’s design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. Conclusions: This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. Trial Registration: PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819 %M 38241066 %R 10.2196/43994 %U https://www.jmir.org/2024/1/e43994 %U https://doi.org/10.2196/43994 %U http://www.ncbi.nlm.nih.gov/pubmed/38241066 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e53002 %T Application of Failure Mode and Effects Analysis to Improve the Quality of the Front Page of Electronic Medical Records in China: Cross-Sectional Data Mapping Analysis %A Zhan,Siyi %A Ding,Liping %A Li,Hui %A Su,Aonan %+ Zhejiang Provincial People's Hospital, No. 158, Shangtang Rd, Hangzhou, 310000, China, 86 18814885258, suaonan_512917@126.com %K front page %K EMR system %K electronic medical record %K failure mode and effects analysis %K FMEA %K measures %D 2024 %7 19.1.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: The completeness and accuracy of the front pages of electronic medical records (EMRs) are crucial for evaluating hospital performance and for health insurance payments to inpatients. However, the quality of the first page of EMRs in China's medical system is not satisfactory, which can be partly attributed to deficiencies in the EMR system. Failure mode and effects analysis (FMEA) is a proactive risk management tool that can be used to investigate the potential failure modes in an EMR system and analyze the possible consequences. Objective: The purpose of this study was to preemptively identify the potential failures of the EMR system in China and their causes and effects in order to prevent such failures from recurring. Further, we aimed to implement corresponding improvements to minimize system failure modes. Methods: From January 1, 2020, to May 31, 2022, 10 experts, including clinicians, engineers, administrators, and medical record coders, in Zhejiang People’s Hospital conducted FMEA to improve the quality of the front page of the EMR. The completeness and accuracy of the front page and the risk priority numbers were compared before and after the implementation of specific improvement measures. Results: We identified 2 main processes and 6 subprocesses for improving the EMR system. We found that there were 13 potential failure modes, including data messaging errors, data completion errors, incomplete quality control, and coding errors. A questionnaire survey administered to random physicians and coders showed 7 major causes for these failure modes. Therefore, we established quality control rules for medical records and embedded them in the system. We also integrated the medical insurance system and the front page of the EMR on the same interface and established a set of intelligent front pages in the EMR management system. Further, we revamped the quality management systems such as communicating with physicians regularly and conducting special training seminars. The overall accuracy and integrity rate of the front page (P<.001) of the EMR increased significantly after implementation of the improvement measures, while the risk priority number decreased. Conclusions: In this study, we were able to identify the potential failure modes in the front page of the EMR system by using the FMEA method and implement corresponding improvement measures in order to minimize recurring errors in the health care services in China. %M 38241064 %R 10.2196/53002 %U https://medinform.jmir.org/2024/1/e53002 %U https://doi.org/10.2196/53002 %U http://www.ncbi.nlm.nih.gov/pubmed/38241064 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48345 %T Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study %A Schroeder,Tanja %A Haug,Maximilian %A Georgiou,Andrew %A Seaman,Karla %A Gewald,Heiko %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 2 9850 ext 6281, tanja.schroeder@mq.edu.au %K mobile health apps %K DiGA %K adoption %K prescription %K mHealth %K aging and individual differences %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The enactment of the “Act to Improve Healthcare Provision through Digitalisation and Innovation ” (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany’s medical landscape. Objective: This study aims to investigate physicians’ responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps. Methods: Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021. Results: The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians’ self-perceived digital competence and their evaluation of patients’ digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps. Conclusions: Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians’ and patients’ sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice. %M 38231550 %R 10.2196/48345 %U https://mhealth.jmir.org/2024/1/e48345 %U https://doi.org/10.2196/48345 %U http://www.ncbi.nlm.nih.gov/pubmed/38231550 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e44199 %T The Report of Access and Engagement With Digital Health Interventions Among Children and Young People: Systematic Review %A Whitehead,Lisa %A Robinson,Suzanne %A Arabiat,Diana %A Jenkins,Mark %A Morelius,Evalotte %+ School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 438145638, l.whitehead@ecu.edu.au %K access %K engagement %K digital health technology %K mobile phone %K children %D 2024 %7 17.1.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: Digital health interventions are increasingly used to deliver health-related interventions for children and young people to change health behaviors and improve health outcomes. Digital health interventions have the potential to enhance access to and engagement with children and young people; however, they may also increase the divide between those who can access technology and are supported to engage and those who are not. This review included studies that reported on the access to or engagement with digital health interventions among children and young people. Objective: This review aims to identify and report on access and engagement in studies involving digital health interventions among children and young people. Methods: A systematic review following the Joanna Briggs Institute methods for conducting systematic reviews was conducted. An electronic literature search was conducted for all studies published between January 1, 2010, and August 2022, across sources, including MEDLINE, CINAHL, and PsycINFO. Studies were included if they examined any aspect of access or engagement in relation to interventions among children and young people. The quality of the included papers was assessed, and data were extracted. Data were considered for meta-analysis, where possible. Results: A total of 3292 references were identified using search terms. Following the exclusion of duplicates and review by inclusion criteria, 40 studies were independently appraised for their methodological quality. A total of 16 studies were excluded owing to their low assessed quality and flawed critical elements in the study design. The studies focused on a variety of health conditions; type 1 diabetes, weight management and obesity, mental health issues, and sexual health were the predominant conditions. Most studies were conducted in developed countries, with most of them being conducted in the United States. Two studies reported data related to access and considered ethnicity and social determinants. No studies used strategies to enhance or increase access. All studies included in the review reported on at least 1 aspect of engagement. Engagement with interventions was measured in relation to frequency of engagement, with no reference to the concept of effective engagement. Conclusions: Most digital health interventions do not consider the factors that can affect access and engagement. Of those studies that measured either access or engagement or both, few sought to implement strategies to improve access or engagement to address potential disparities between groups. Although the literature to date provides some insight into access and engagement and how these are addressed in digital health interventions, there are major limitations in understanding how both can be enhanced to promote equity. Consideration of both access and engagement is vital to ensure that children and young people have the ability to participate in studies. Trial Registration: PROSPERO CRD42020170874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170874 %M 38231560 %R 10.2196/44199 %U https://pediatrics.jmir.org/2024/1/e44199 %U https://doi.org/10.2196/44199 %U http://www.ncbi.nlm.nih.gov/pubmed/38231560 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42850 %T The Association Between Linguistic Characteristics of Physicians’ Communication and Their Economic Returns: Mixed Method Study %A Geng,Shuang %A He,Yuqin %A Duan,Liezhen %A Yang,Chen %A Wu,Xusheng %A Liang,Gemin %A Niu,Ben %+ College of Management, Shenzhen University, Xueyuan Road 1066, Shenzhen, 518055, China, 86 18565859968, yangc@szu.edu.cn %K web-based health care %K instrumental communication %K affective communication %K linguistic features %K economic returns %K linguistic inquiry and word count %D 2024 %7 11.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based health care has the potential to improve health care access and convenience for patients with limited mobility, but its success depends on active physician participation. The economic returns of internet-based health care initiatives are an important factor that can motivate physicians to continue their participation. Although several studies have examined the communication patterns and influences of web-based health consultations, the correlation between physicians’ communication characteristics and their economic returns remains unexplored. Objective: This study aims to investigate how the linguistic features of 2 modes of physician-patient communication, instrumental and affective, determine the physician’s economic returns, measured by the honorarium their patients agree to pay per consultation. We also examined the moderating effects of communication media (web-based text messages and voice messages) and the compounding effects of different communication features on economic returns. Methods: We collected 40,563 web-based consultations from 528 physicians across 4 disease specialties on a large, web-based health care platform in China. Communication features were extracted using linguistic inquiry and word count, and we used multivariable linear regression and K-means clustering to analyze the data. Results: We found that the use of cognitive processing language (ie, words related to insight, causation, tentativeness, and certainty) in instrumental communication and positive emotion–related words in affective communication were positively associated with the economic returns of physicians. However, the extensive use of discrepancy-related words could generate adverse effects. We also found that the use of voice messages for service delivery magnified the effects of cognitive processing language but did not moderate the effects of affective processing language. The highest economic returns were associated with consultations in which the physicians used few expressions related to negative emotion; used more terms associated with positive emotions; and later, used instrumental communication language. Conclusions: Our study provides empirical evidence about the relationship between physicians’ communication characteristics and their economic returns. It contributes to a better understanding of patient-physician interactions from a professional-client perspective and has practical implications for physicians and web-based health care platform executives. %M 38206657 %R 10.2196/42850 %U https://www.jmir.org/2024/1/e42850 %U https://doi.org/10.2196/42850 %U http://www.ncbi.nlm.nih.gov/pubmed/38206657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45020 %T Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis %A He,Xianying %A Cui,Fangfang %A Lyu,Minzhao %A Sun,Dongxu %A Zhang,Xu %A Shi,Jinming %A Zhang,Yinglan %A Jiang,Shuai %A Zhao,Jie %+ National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China, 86 037167966286, zhaojie@zzu.edu.cn %K telemedicine %K service statistics %K efficiency %K quality management %D 2024 %7 5.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. Objective: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. Methods: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. Results: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. Conclusions: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions. %M 38180795 %R 10.2196/45020 %U https://www.jmir.org/2024/1/e45020 %U https://doi.org/10.2196/45020 %U http://www.ncbi.nlm.nih.gov/pubmed/38180795 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e51148 %T Pure Wisdom or Potemkin Villages? A Comparison of ChatGPT 3.5 and ChatGPT 4 on USMLE Step 3 Style Questions: Quantitative Analysis %A Knoedler,Leonard %A Alfertshofer,Michael %A Knoedler,Samuel %A Hoch,Cosima C %A Funk,Paul F %A Cotofana,Sebastian %A Maheta,Bhagvat %A Frank,Konstantin %A Brébant,Vanessa %A Prantl,Lukas %A Lamby,Philipp %+ Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, 93053, Germany, 49 151 44824958, leonardknoedler@t-online.de %K ChatGPT %K United States Medical Licensing Examination %K artificial intelligence %K USMLE %K USMLE Step 1 %K OpenAI %K medical education %K clinical decision-making %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The United States Medical Licensing Examination (USMLE) has been critical in medical education since 1992, testing various aspects of a medical student’s knowledge and skills through different steps, based on their training level. Artificial intelligence (AI) tools, including chatbots like ChatGPT, are emerging technologies with potential applications in medicine. However, comprehensive studies analyzing ChatGPT’s performance on USMLE Step 3 in large-scale scenarios and comparing different versions of ChatGPT are limited. Objective: This paper aimed to analyze ChatGPT’s performance on USMLE Step 3 practice test questions to better elucidate the strengths and weaknesses of AI use in medical education and deduce evidence-based strategies to counteract AI cheating. Methods: A total of 2069 USMLE Step 3 practice questions were extracted from the AMBOSS study platform. After including 229 image-based questions, a total of 1840 text-based questions were further categorized and entered into ChatGPT 3.5, while a subset of 229 questions were entered into ChatGPT 4. Responses were recorded, and the accuracy of ChatGPT answers as well as its performance in different test question categories and for different difficulty levels were compared between both versions. Results: Overall, ChatGPT 4 demonstrated a statistically significant superior performance compared to ChatGPT 3.5, achieving an accuracy of 84.7% (194/229) and 56.9% (1047/1840), respectively. A noteworthy correlation was observed between the length of test questions and the performance of ChatGPT 3.5 (ρ=–0.069; P=.003), which was absent in ChatGPT 4 (P=.87). Additionally, the difficulty of test questions, as categorized by AMBOSS hammer ratings, showed a statistically significant correlation with performance for both ChatGPT versions, with ρ=–0.289 for ChatGPT 3.5 and ρ=–0.344 for ChatGPT 4. ChatGPT 4 surpassed ChatGPT 3.5 in all levels of test question difficulty, except for the 2 highest difficulty tiers (4 and 5 hammers), where statistical significance was not reached. Conclusions: In this study, ChatGPT 4 demonstrated remarkable proficiency in taking the USMLE Step 3, with an accuracy rate of 84.7% (194/229), outshining ChatGPT 3.5 with an accuracy rate of 56.9% (1047/1840). Although ChatGPT 4 performed exceptionally, it encountered difficulties in questions requiring the application of theoretical concepts, particularly in cardiology and neurology. These insights are pivotal for the development of examination strategies that are resilient to AI and underline the promising role of AI in the realm of medical education and diagnostics. %M 38180782 %R 10.2196/51148 %U https://mededu.jmir.org/2024/1/e51148 %U https://doi.org/10.2196/51148 %U http://www.ncbi.nlm.nih.gov/pubmed/38180782 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47755 %T Usability of an App for Medical History Taking in General Practice From the Patients’ Perspective: Cross-Sectional Study %A Albrink,Klara %A Schröder,Dominik %A Joos,Carla %A Müller,Frank %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 551 39 65745, evamaria.noack@med.uni-goettingen.de %K digitization %K application software %K usability %K mHealth %K history of present illness %K medical history taking %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients’ medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice’s electronic medical record, allowing for the general practitioner to review structured information of the patients’ complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. Objective: The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients’ perspective. Methods: Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. Results: We analyzed data from 397 patients (56.7% female, 43.3% male). The mean total SUS score was 77.8 points; 54.4% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. Conclusions: Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. Trial Registration: German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659 %M 38180798 %R 10.2196/47755 %U https://humanfactors.jmir.org/2024/1/e47755 %U https://doi.org/10.2196/47755 %U http://www.ncbi.nlm.nih.gov/pubmed/38180798 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e46501 %T Design and Implementation of an Inpatient Fall Risk Management Information System %A Wang,Ying %A Jiang,Mengyao %A He,Mei %A Du,Meijie %+ School of Management, Wuhan University of Technology, 122 Luoshi Road, Hongshan District, Wuhan, 430070, China, 86 027 83662317, wangying_tjh@hotmail.com %K fall %K hospital information system %K patient safety %K quality improvement %K management %K implementation %D 2024 %7 2.1.2024 %9 Implementation Report %J JMIR Med Inform %G English %X Background: Falls had been identified as one of the nursing-sensitive indicators for nursing care in hospitals. With technological progress, health information systems make it possible for health care professionals to manage patient care better. However, there is a dearth of research on health information systems used to manage inpatient falls. Objective: This study aimed to design and implement a novel hospital-based fall risk management information system (FRMIS) to prevent inpatient falls and improve nursing quality. Methods: This implementation was conducted at a large academic medical center in central China. We established a nurse-led multidisciplinary fall prevention team in January 2016. The hospital’s fall risk management problems were summarized by interviewing fall-related stakeholders, observing fall prevention workflow and post–fall care process, and investigating patients' satisfaction. The FRMIS was developed using an iterative design process, involving collaboration among health care professionals, software developers, and system architects. We used process indicators and outcome indicators to evaluate the implementation effect. Results: The FRMIS includes a fall risk assessment platform, a fall risk warning platform, a fall preventive strategies platform, fall incident reporting, and a tracking improvement platform. Since the implementation of the FRMIS, the inpatient fall rate was significantly lower than that before implementation (P<.05). In addition, the percentage of major fall-related injuries was significantly lower than that before implementation. The implementation rate of fall-related process indicators and the reporting rate of high risk of falls were significantly different before and after system implementation (P<.05). Conclusions: The FRMIS provides support to nursing staff in preventing falls among hospitalized patients while facilitating process control for nursing managers. %M 38165733 %R 10.2196/46501 %U https://medinform.jmir.org/2024/1/e46501 %U https://doi.org/10.2196/46501 %U http://www.ncbi.nlm.nih.gov/pubmed/38165733 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e51199 %T Empathy and Equity: Key Considerations for Large Language Model Adoption in Health Care %A Koranteng,Erica %A Rao,Arya %A Flores,Efren %A Lev,Michael %A Landman,Adam %A Dreyer,Keith %A Succi,Marc %+ Massachusetts General Hospital, 55 Fruit St, Boston, 02114, United States, 1 617 935 9144, msucci@mgh.harvard.edu %K ChatGPT %K AI %K artificial intelligence %K large language models %K LLMs %K ethics %K empathy %K equity %K bias %K language model %K health care application %K patient care %K care %K development %K framework %K model %K ethical implication %D 2023 %7 28.12.2023 %9 Viewpoint %J JMIR Med Educ %G English %X The growing presence of large language models (LLMs) in health care applications holds significant promise for innovative advancements in patient care. However, concerns about ethical implications and potential biases have been raised by various stakeholders. Here, we evaluate the ethics of LLMs in medicine along 2 key axes: empathy and equity. We outline the importance of these factors in novel models of care and develop frameworks for addressing these alongside LLM deployment. %M 38153778 %R 10.2196/51199 %U https://mededu.jmir.org/2023/1/e51199 %U https://doi.org/10.2196/51199 %U http://www.ncbi.nlm.nih.gov/pubmed/38153778 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e49301 %T The Necessity of Interoperability to Uncover the Full Potential of Digital Health Devices %A Schwab,Julian D %A Werle,Silke D %A Hühne,Rolf %A Spohn,Hannah %A Kaisers,Udo X %A Kestler,Hans A %+ Ulm University, Albert-Einstein-Allee 11, Ulm, 89081, Germany, 49 731 500 24500, hans.kestler@uni-ulm.de %K semantic terminology %K semantic %K terminology %K terminologies %K data linkage %K interoperability %K data exchange %K SNOMED CT %K LOINC %K eHealth %K patient-reported outcome questionnaires %K requirement for standards %K standard %K standards %K PRO %K PROM %K patient reported %D 2023 %7 22.12.2023 %9 Viewpoint %J JMIR Med Inform %G English %X Personalized health care can be optimized by including patient-reported outcomes. Standardized and disease-specific questionnaires have been developed and are routinely used. These patient-reported outcome questionnaires can be simple paper forms given to the patient to fill out with a pen or embedded in digital devices. Regardless of the format used, they provide a snapshot of the patient’s feelings and indicate when therapies need to be adjusted. The advantage of digitizing these questionnaires is that they can be automatically analyzed, and patients can be monitored independently of doctor visits. Although the questions of most clinical patient-reported outcome questionnaires follow defined standards and are evaluated by clinical trials, these standards do not exist for data processing. Interoperable data formats and structures would benefit multilingual and cross-study data exchange. Linking questionnaires to standardized terminologies such as the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Logical Observation Identifiers, Names, and Codes (LOINC) would improve this interoperability. However, linking clinically validated patient-reported outcome questionnaires to clinical terms available in SNOMED CT or LOINC is not as straightforward as it sounds. Here, we report our approach to link patient-reported outcomes from health applications to SNOMED CT or LOINC codes. We highlight current difficulties in this process and outline ways to minimize them. %M 38133917 %R 10.2196/49301 %U https://medinform.jmir.org/2023/1/e49301 %U https://doi.org/10.2196/49301 %U http://www.ncbi.nlm.nih.gov/pubmed/38133917 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50550 %T Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study %A Fridriksdottir,Nanna %A Ingadottir,Brynja %A Skuladottir,Kristin %A Zoëga,Sigridur %A Gunnarsdottir,Sigridur %+ Landspitali- The National University Hospital of Iceland, Hringbraut, Reykjavik, 101, Iceland, 354 543 1000 ext 6065, nannafri@landspitali.is %K web portal for patients with cancer %K supportive digital health service %K symptom monitoring %K self-management support %K feasibility %K usability %K acceptability %K patient education %K health engagement %K patient-reported outcomes %K digital health service %K patient portal %K electronic health records %K mobile phone %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System–Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients’ Knowledge Expectations), and received knowledge (Hospital Patients’ Received Knowledge). Health care professionals were interviewed regarding portal feasibility. Results: The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=−.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=−.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted. %M 38015268 %R 10.2196/50550 %U https://formative.jmir.org/2023/1/e50550 %U https://doi.org/10.2196/50550 %U http://www.ncbi.nlm.nih.gov/pubmed/38015268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50158 %T Holistic Human-Serving Digitization of Health Care Needs Integrated Automated System-Level Assessment Tools %A Welzel,Cindy %A Cotte,Fabienne %A Wekenborg,Magdalena %A Vasey,Baptiste %A McCulloch,Peter %A Gilbert,Stephen %+ Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Fetscherstraße 74, Dresden, 01307, Germany, 49 35145819630, stephen.gilbert@ukdd.de %K health technology assessment %K human factors %K postmarket surveillance %K software as a medical device %K digital health tools %K quality assessment %K quality improvement %K regulatory framework %K user experience %K health care %D 2023 %7 20.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X Digital health tools, platforms, and artificial intelligence– or machine learning–based clinical decision support systems are increasingly part of health delivery approaches, with an ever-greater degree of system interaction. Critical to the successful deployment of these tools is their functional integration into existing clinical routines and workflows. This depends on system interoperability and on intuitive and safe user interface design. The importance of minimizing emergent workflow stress through human factors research and purposeful design for integration cannot be overstated. Usability of tools in practice is as important as algorithm quality. Regulatory and health technology assessment frameworks recognize the importance of these factors to a certain extent, but their focus remains mainly on the individual product rather than on emergent system and workflow effects. The measurement of performance and user experience has so far been performed in ad hoc, nonstandardized ways by individual actors using their own evaluation approaches. We propose that a standard framework for system-level and holistic evaluation could be built into interacting digital systems to enable systematic and standardized system-wide, multiproduct, postmarket surveillance and technology assessment. Such a system could be made available to developers through regulatory or assessment bodies as an application programming interface and could be a requirement for digital tool certification, just as interoperability is. This would enable health systems and tool developers to collect system-level data directly from real device use cases, enabling the controlled and safe delivery of systematic quality assessment or improvement studies suitable for the complexity and interconnectedness of clinical workflows using developing digital health technologies. %M 38117545 %R 10.2196/50158 %U https://www.jmir.org/2023/1/e50158 %U https://doi.org/10.2196/50158 %U http://www.ncbi.nlm.nih.gov/pubmed/38117545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42235 %T Effects of Acute Phase Intensive Physical Activity (ACTIVE-PA) Monitoring and Education for Cardiac Patients: Pilot Study of a Randomized Controlled Trial %A Yamashita,Masashi %A Kamiya,Kentaro %A Hamazaki,Nobuaki %A Uchida,Shota %A Noda,Takumi %A Maekawa,Emi %A Ako,Junya %+ Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0373, Japan, 81 427788883, k-kamiya@kitasato-u.ac.jp %K physical activity %K monitoring %K information and communication technology %K cardiovascular disease %K cardiovascular %K cardiology %K exercise %K RCT %K randomized %K cardiac rehabilitation %K fitness %K accelerometer %K physiotherapy %K hospitalized %K hospitalization %K in-patient %D 2023 %7 20.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although physical activity (PA) decreases dramatically during hospitalization, an effective intervention method has not yet been established for this issue. We recently developed a multiperson PA monitoring system using information and communication technology (ICT) that can provide appropriate management and feedback about PA at the bedside or during rehabilitation. This ICT-based PA monitoring system can store accelerometer data on a tablet device within a few seconds and automatically display a graphical representation of activity trends during hospitalization. Objective: This randomized pilot study aims to estimate the feasibility and effect size of an educational PA intervention using our ICT monitoring system for in-hospital patients undergoing cardiac rehabilitation. Methods: A total of 41 patients (median age 70 years; 24 men) undergoing inpatient cardiac rehabilitation were randomly assigned to 2 groups as follows: wearing an accelerometer only (control) and using both an accelerometer and an ICT-based PA monitoring system. Patients assigned to the ICT group were instructed to gradually increase their step counts according to their conditions. Adherence to wearing the accelerometer was defined as having enough wear records for at least 2 days to allow for adequate analysis during the lending period. An analysis of covariance was performed to compare the change in average step count during hospitalization as a primary outcome and the 6-minute walking distance at discharge. Results: The median duration of wearing the accelerometer was 4 days in the ICT group and 6 days in the control group. Adherence was 100% (n=22) in the ICT group but 83% (n=20) in the control group. The ICT group was more active (mean difference=1370 steps, 95% CI 437-2303) and had longer 6-minute walking distances (mean difference=81.6 m, 95% CI 18.1-145.2) than the control group. Conclusions: Through this study, the possibility of introducing a multiperson PA monitoring system in a hospital and promoting PA during hospitalization was demonstrated. These findings support the rationale and feasibility of a future clinical trial to test the efficacy of this educational intervention in improving the PA and physical function of in-hospital patients. Trial Registration: University Hospital Medical Information Network UMIN000043312; http://tinyurl.com/m2bw8vkz %M 38117552 %R 10.2196/42235 %U https://www.jmir.org/2023/1/e42235 %U https://doi.org/10.2196/42235 %U http://www.ncbi.nlm.nih.gov/pubmed/38117552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46306 %T Testing and Practical Implementation of a User-Friendly Personalized and Long-Term Electronic Informed Consent Prototype in Clinical Research: Mixed Methods Study %A De Sutter,Evelien %A Geerts,David %A Yskout,Koen %A Verreydt,Stef %A Borry,Pascal %A Barbier,Liese %A Huys,Isabelle %+ Catholic University (KU) Leuven Digital Society Institute, Catholic University (KU) Leuven, Parkstraat 45, Box 3605, Leuven, 3000, Belgium, 32 16323195, david.geerts@kuleuven.be %K human-centered design %K digital health %K qualitative research %K informed consent %K trial %K stakeholders %K implementation %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the years, there has been increasing interest in electronic informed consent (eIC) in clinical research. The user-friendliness of an eIC application and its acceptance by stakeholders plays a central role in achieving successful implementation. Objective: This study aims to identify insights for the design and implementation of a user-friendly, personalized, and long-term eIC application based on a usability study with (potential) research participants and semistructured interviews with stakeholders on the practical integration of such an application into their daily practice. Methods: An eIC prototype was evaluated and refined through usability testing among Belgian citizens and iterative redesign. On the basis of a digital literacy questionnaire, a heterogeneous sample of participants was established. Participants needed to complete a series of usability tasks related to personalization and long-term interaction with the research team while using the “think aloud” technique. In addition, usability tests involved completing the System Usability Scale questionnaire and taking part in a semistructured feedback interview. Furthermore, semistructured interviews were conducted with ethics committee members, health care professionals, and pharmaceutical industry representatives active in Belgium and involved in clinical research. Thematic analysis was undertaken using the NVivo software (Lumivero). Results: In total, 3 iterations of usability tests were conducted with 10 participants each. Each cycle involved some participants who reported having low digital skills. The System Usability Scale scores related to the tasks on personalization and long-term interaction increased after each iteration and reached 69.5 (SD 8.35) and 71.3 (SD 16.1) out of 100, respectively, which represents above-average usability. Semistructured interviews conducted with health care professionals (n=4), ethics committee members (n=8), and pharmaceutical industry representatives (n=5) identified the need for an eIC system that can be easily set up. For example, a library could be established enabling stakeholders to easily provide background information about a clinical study, presented in the second layer of the interface. In contrast, some functionalities, such as informing participants about new studies through an eIC system, were not considered useful by stakeholders. Conclusions: This study provides insights for the implementation of a user-friendly personalized and long-term eIC application. The study findings showed that usability testing is key to assessing and increasing the user-friendliness of an eIC application. Although this eIC system has the potential to be usable by a wide audience, participants with low digital literacy may not be able to use it successfully, highlighting the need for additional support for participants or other alternatives to an eIC system. In addition, key lessons emerging from the interviews included ensuring that the application is easy to implement in practice and is interoperable with other established systems. %M 38113088 %R 10.2196/46306 %U https://www.jmir.org/2023/1/e46306 %U https://doi.org/10.2196/46306 %U http://www.ncbi.nlm.nih.gov/pubmed/38113088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49277 %T Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience %A Beesoon,Sanjay %A Drobot,Ashley %A Smokeyday,Melissa %A Ali,Al-Bakir %A Collins,Zoe %A Reynolds,Colin %A Berzins,Sandra %A Gibson,Alison %A Nelson,Gregg %+ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, 3260 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada, 1 5877170011, gregg.nelson@ahs.ca %K app %K digital health %K patient experience %K provider satisfaction %K application %K recovery %K cost-effective %K evaluation %K implementation %K gynecologic oncology %K colorectal surgery %K surgery %K care %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. Objective: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. Methods: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. Results: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. Conclusions: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world. %R 10.2196/49277 %U https://formative.jmir.org/2023/1/e49277/ %U https://doi.org/10.2196/49277 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47997 %T Understanding the Value of a Proactive Telecare System in Supporting Older Adults’ Independence at Home: Qualitative Interview Study Among Key Interest Groups %A Fothergill,Lauren %A Holland,Carol %A Latham,Yvonne %A Hayes,Niall %+ Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University,, Lancaster, LA1 4AT, United Kingdom, 44 1524 5931, l.fothergill1@lancaster.ac.uk %K older adults %K telecare %K independent living %K health and well-being %D 2023 %7 14.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults’ health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals’ needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare. Objective: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are. Methods: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis. Results: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service. Conclusions: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources. %M 38096023 %R 10.2196/47997 %U https://www.jmir.org/2023/1/e47997 %U https://doi.org/10.2196/47997 %U http://www.ncbi.nlm.nih.gov/pubmed/38096023 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48845 %T A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study %A Seinsche,Julia %A de Bruin,Eling D %A Saibene,Enrico %A Rizzo,Francesco %A Carpinella,Ilaria %A Ferrarin,Maurizio %A Moza,Sotiria %A Ritter,Tanja %A Giannouli,Eleftheria %+ Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, HCP H 24.3, Zurich, 8093, Switzerland, 41 44 633 08 52, julia.seinsche@hest.ethz.ch %K older adults %K motor-cognitive intervention %K exergame %K telerehabilitation %K information and communications technologies %K user-centered design %K usability %K technology acceptance %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). Objective: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. Methods: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants’ perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire–3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. Results: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system’s usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=−0.35; P=.02) and the UTAUT total score (ρ=−0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. Conclusions: The study’s findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system’s feasibility and effectiveness. %M 38060283 %R 10.2196/48845 %U https://humanfactors.jmir.org/2023/1/e48845 %U https://doi.org/10.2196/48845 %U http://www.ncbi.nlm.nih.gov/pubmed/38060283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47847 %T The Adoption of AI in Mental Health Care–Perspectives From Mental Health Professionals: Qualitative Descriptive Study %A Zhang,Melody %A Scandiffio,Jillian %A Younus,Sarah %A Jeyakumar,Tharshini %A Karsan,Inaara %A Charow,Rebecca %A Salhia,Mohammad %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, R Fraser Elliot Building RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.wiljer@uhn.ca %K artificial intelligence %K education %K mental health %K behavioral health %K educators %K curriculum %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) is transforming the mental health care environment. AI tools are increasingly accessed by clients and service users. Mental health professionals must be prepared not only to use AI but also to have conversations about it when delivering care. Despite the potential for AI to enable more efficient and reliable and higher-quality care delivery, there is a persistent gap among mental health professionals in the adoption of AI. Objective: A needs assessment was conducted among mental health professionals to (1) understand the learning needs of the workforce and their attitudes toward AI and (2) inform the development of AI education curricula and knowledge translation products. Methods: A qualitative descriptive approach was taken to explore the needs of mental health professionals regarding their adoption of AI through semistructured interviews. To reach maximum variation sampling, mental health professionals (eg, psychiatrists, mental health nurses, educators, scientists, and social workers) in various settings across Ontario (eg, urban and rural, public and private sector, and clinical and research) were recruited. Results: A total of 20 individuals were recruited. Participants included practitioners (9/20, 45% social workers and 1/20, 5% mental health nurses), educator scientists (5/20, 25% with dual roles as professors/lecturers and researchers), and practitioner scientists (3/20, 15% with dual roles as researchers and psychiatrists and 2/20, 10% with dual roles as researchers and mental health nurses). Four major themes emerged: (1) fostering practice change and building self-efficacy to integrate AI into patient care; (2) promoting system-level change to accelerate the adoption of AI in mental health; (3) addressing the importance of organizational readiness as a catalyst for AI adoption; and (4) ensuring that mental health professionals have the education, knowledge, and skills to harness AI in optimizing patient care. Conclusions: AI technologies are starting to emerge in mental health care. Although many digital tools, web-based services, and mobile apps are designed using AI algorithms, mental health professionals have generally been slower in the adoption of AI. As indicated by this study’s findings, the implications are 3-fold. At the individual level, digital professionals must see the value in digitally compassionate tools that retain a humanistic approach to care. For mental health professionals, resistance toward AI adoption must be acknowledged through educational initiatives to raise awareness about the relevance, practicality, and benefits of AI. At the organizational level, digital professionals and leaders must collaborate on governance and funding structures to promote employee buy-in. At the societal level, digital and mental health professionals should collaborate in the creation of formal AI training programs specific to mental health to address knowledge gaps. This study promotes the design of relevant and sustainable education programs to support the adoption of AI within the mental health care sphere. %M 38060307 %R 10.2196/47847 %U https://formative.jmir.org/2023/1/e47847 %U https://doi.org/10.2196/47847 %U http://www.ncbi.nlm.nih.gov/pubmed/38060307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51603 %T How Can the Clinical Aptitude of AI Assistants Be Assayed? %A Thirunavukarasu,Arun James %+ Oxford University Clinical Academic Graduate School, University of Oxford, John Radcliffe Hospital, Level 3, Oxford, OX3 9DU, United Kingdom, 44 1865 289 467, ajt205@cantab.ac.uk %K artificial intelligence %K AI %K validation %K clinical decision aid %K artificial general intelligence %K foundation models %K large language models %K LLM %K language model %K ChatGPT %K chatbot %K chatbots %K conversational agent %K conversational agents %K pitfall %K pitfalls %K pain point %K pain points %K implementation %K barrier %K barriers %K challenge %K challenges %D 2023 %7 5.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X Large language models (LLMs) are exhibiting remarkable performance in clinical contexts, with exemplar results ranging from expert-level attainment in medical examination questions to superior accuracy and relevance when responding to patient queries compared to real doctors replying to queries on social media. The deployment of LLMs in conventional health care settings is yet to be reported, and there remains an open question as to what evidence should be required before such deployment is warranted. Early validation studies use unvalidated surrogate variables to represent clinical aptitude, and it may be necessary to conduct prospective randomized controlled trials to justify the use of an LLM for clinical advice or assistance, as potential pitfalls and pain points cannot be exhaustively predicted. This viewpoint states that as LLMs continue to revolutionize the field, there is an opportunity to improve the rigor of artificial intelligence (AI) research to reward innovation, conferring real benefits to real patients. %M 38051572 %R 10.2196/51603 %U https://www.jmir.org/2023/1/e51603 %U https://doi.org/10.2196/51603 %U http://www.ncbi.nlm.nih.gov/pubmed/38051572 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42354 %T Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study %A Alkuran,Oqba %A Al-Mehaisen,Lama %A Abu Mahfouz,Ismaiel %A Al-Kuran,Lena %A Asali,Fida %A Khamees,Almu’atasim %A AL-Shatanawi,Tariq %A Jaber,Hatim %+ Medical School, Al-Balqa Applied University, PO box 206, Assalt, Amman, 19117, Jordan, 962 799051387, hjabber@bau.edu.jo %K COVID-19 %K distant electronic learning %K medical %K medicine %K school %K medical school %K medical education %K clinical skill %K teaching hospital %K questionnaire %K distance learning %K distance education %K web-based education %K web-based learning %K medical student %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions. Objective: This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan. Methods: We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL. Results: A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice. Conclusions: DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction. %M 38051556 %R 10.2196/42354 %U https://mededu.jmir.org/2023/1/e42354 %U https://doi.org/10.2196/42354 %U http://www.ncbi.nlm.nih.gov/pubmed/38051556 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49374 %T Investigating the Impact of Automation on the Health Care Workforce Through Autonomous Telemedicine in the Cataract Pathway: Protocol for a Multicenter Study %A Khavandi,Sarah %A Zaghloul,Fatema %A Higham,Aisling %A Lim,Ernest %A de Pennington,Nick %A Celi,Leo Anthony %+ Ufonia, 104 Gloucester Green, Oxford, OX1 2BU, United Kingdom, 44 07931531022, sk@ufonia.co %K artificial intelligence %K autonomous telemedicine %K clinician burnout %K clinician wellbeing %K conversational agent %K digital health %K health communication %K health information technology %K health services %K healthcare %K medical informatics %K socio-technical system approach %K systems approach %K technology acceptability %D 2023 %7 5.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: While digital health innovations are increasingly being adopted by health care organizations, implementation is often carried out without considering the impacts on frontline staff who will be using the technology and who will be affected by its introduction. The enthusiasm surrounding the use of artificial intelligence (AI)–enabled digital solutions in health care is tempered by uncertainty around how it will change the working lives and practices of health care professionals. Digital enablement can be viewed as facilitating enhanced effectiveness and efficiency by improving services and automating cognitive labor, yet the implementation of such AI technology comes with challenges related to changes in work practices brought by automation. This research explores staff experiences before and after care pathway automation with an autonomous clinical conversational assistant, Dora (Ufonia Ltd), that is able to automate routine clinical conversations. Objective: The primary objective is to examine the impact of AI-enabled automation on clinicians, allied health professionals, and administrators who provide or facilitate health care to patients in high-volume, low-complexity care pathways. In the process of transforming care pathways through automation of routine tasks, staff will increasingly “work at the top of their license.” The impact of this fundamental change on the professional identity, well-being, and work practices of the individual is poorly understood at present. Methods: We will adopt a multiple case study approach, combining qualitative and quantitative data collection methods, over 2 distinct phases, namely phase A (preimplementation) and phase B (postimplementation). Results: The analysis is expected to reveal the interrelationship between Dora and those affected by its introduction. This will reveal how tasks and responsibilities have changed or shifted, current tensions and contradictions, ways of working, and challenges, benefits, and opportunities as perceived by those on the frontlines of the health care system. The findings will enable a better understanding of the resistance or susceptibility of different stakeholders within the health care workforce and encourage managerial awareness of differing needs, demands, and uncertainties. Conclusions: The implementation of AI in the health care sector, as well as the body of research on this topic, remain in their infancy. The project’s key contribution will be to understand the impact of AI-enabled automation on the health care workforce and their work practices. International Registered Report Identifier (IRRID): PRR1-10.2196/49374 %M 38051569 %R 10.2196/49374 %U https://www.researchprotocols.org/2023/1/e49374 %U https://doi.org/10.2196/49374 %U http://www.ncbi.nlm.nih.gov/pubmed/38051569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48461 %T Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach %A Faber,Jasper S %A Al-Dhahir,Isra %A Kraal,Jos J %A Breeman,Linda D %A van den Berg-Emons,Rita J G %A Reijnders,Thomas %A van Dijk,Sandra %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Visch,Valentijn T %A Chavannes,Niels H %A Evers,Andrea W M %+ Department of Human-Centered Design, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 0640850881, j.s.faber@tudelft.nl %K eHealth %K guide %K guidelines professionals %K intervention development %K intervention evaluation %K low socioeconomic position %K low socioeconomic status %K risk groups %K tailored care %D 2023 %7 4.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. Objective: We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. Methods: This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide’s content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide’s design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. Results: The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of “the inclusive eHealth guide.” Conclusions: The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality. %M 38048148 %R 10.2196/48461 %U https://www.jmir.org/2023/1/e48461 %U https://doi.org/10.2196/48461 %U http://www.ncbi.nlm.nih.gov/pubmed/38048148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48987 %T Implementing Telemedicine in Clinical Practice in the First Digital Hematology Unit: Feasibility Study %A Santamaria,Amparo %A Antón Maldonado,Cristina %A Sánchez-Quiñones,Beatriz %A Ibarra Vega,Nataly %A Ayo González,Maikel %A Gonzalez Cabezas,Pedro %A Carrasco Moreno,Rafael %+ Hematology Department, University Hospital Vinalopó, Carrer Tonico Sansano Mora, 14, Alicante, 03293, Spain, 34 966 67 98 00, masantamaria@vinaloposalud.com %K telemedicine %K digital unit %K hybrid hematology department %K hematology %K hybrid %K implementation %K telehealth %K monitor %K monitoring %K remote care %K virtual care %K hematological %K hematologist %K hematologists %K service %K services %K delivery %K holistic %K digital health intervention %K digital transformation %D 2023 %7 4.12.2023 %9 Short Paper %J JMIR Form Res %G English %X Background: Currently, there are no telemedicine models that fully integrate all areas of hematology into daily practice. Objective: The objectives of this feasibility study were to assess the practicality of implementing telemedicine into our clinical practice in the first Digital Hematology Unit and propose an innovative integrative design for clinical practice. Methods: We designed the Digital Hematology Unit, which is a specific physical space dedicated to carrying out telemedicine and monitoring patients in a holistic way. Also, a satisfaction questionnaire was performed and health care indicators were measured. Results: In 2021, there were 1331 first visits and 7534 follow-up visits. Of the first visits, 12.2% (n=163) were face-to-face and 87.8% (n=1168) were telematic. For follow-up visits, 29.9% (n=2251) were face-to-face and 70.1% (n=5283) were telematic. The health care management indicators showed that we had a waiting time of less than 4 days and took less than 4 hours to answer interconsultations among specialists. Moreover, patients reported a high level of satisfaction with the services provided. Conclusions: Our Digital Hematology Unit, as a case of success, serves as an example of how innovative digital solutions can contribute to the quality of care and excellence in health care achieved through a digital transformation process led by hematologists. %M 38048143 %R 10.2196/48987 %U https://formative.jmir.org/2023/1/e48987 %U https://doi.org/10.2196/48987 %U http://www.ncbi.nlm.nih.gov/pubmed/38048143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51450 %T Professionals Evaluating Clients’ Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments %A Kaihlanen,Anu-Marja %A Virtanen,Lotta %A Kainiemi,Emma %A Heponiemi,Tarja %+ Finnish Institute for Health and Welfare, PO Box 30, Helsinki, FI-00271, Finland, 358 295246033, anu.kaihlanen@thl.fi %K access %K accessibility %K assessment %K clients %K digital health %K digital social care %K eHealth %K evaluation tool %K evaluation %K evaluator %K instrument %K knowledge synthesis %K patients %K professionals %K review methodology %K review methods %K scoping %K social care %K suitability %D 2023 %7 30.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Increased digital health and social care services are generally considered to improve people’s access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients’ suitability for digital solutions, but to succeed, they need information about what to evaluate and how. Objective: This scoping review aimed to identify evaluation tools that professionals can use when assessing clients’ suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments. Methods: The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute’s Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients’ suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals’ practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed. Results: A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client’s suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals’ possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients. Conclusions: Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients’ prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals’ busy work (both in health and social care) with defined threshold values for suitability. %M 38032707 %R 10.2196/51450 %U https://www.jmir.org/2023/1/e51450 %U https://doi.org/10.2196/51450 %U http://www.ncbi.nlm.nih.gov/pubmed/38032707 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e51387 %T Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation %A McCormack,Heather %A Wand,Handan %A Newman,Christy E %A Bourne,Christopher %A Kennedy,Catherine %A Guy,Rebecca %+ Kirby Institute, University of New South Wales, Wallace Wurth Building (C27), High St, Kensington, 2052, Australia, 61 93481086, hmccormack@kirby.unsw.edu.au %K sexual health %K sexually transmitted infection %K STI %K primary care %K Indigenous health %K electronic medical record %K EMR %K medical records %K electronic health record %K EHR %K health record %K health records %K Indigenous %K Native %K Aboriginal %K sexual transmission %K sexually transmitted %K time series %K testing %K uptake %K acceptance %K acceptability %K adoption %K syphilis %K sexually transmitted disease %K STD %K systems change %K health assessment %K health assessments %K prompt %K prompts %K implementation %K youth %K young people %K adolescent %K adolescents %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. Objective: We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. Methods: We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. Results: Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner–led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. Conclusions: This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability. %M 38032729 %R 10.2196/51387 %U https://medinform.jmir.org/2023/1/e51387 %U https://doi.org/10.2196/51387 %U http://www.ncbi.nlm.nih.gov/pubmed/38032729 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e50148 %T Correlation Between the Social Network Structure and Well-Being of Health Care Workers in Intensive Care Units: Prospective Observational Study %A Esumi,Ryo %A Ito-Masui,Asami %A Kawamoto,Eiji %A Ito,Mami %A Hayashi,Tomoyo %A Shinkai,Toru %A Hane,Atsuya %A Okuno,Fumito %A Park,Eun Jeong %A Kaku,Ryuji %A Shimaoka,Motomu %+ Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-0001, Japan, 81 59 232 1111, a-2@umin.net %K social network analysis %K Center for Epidemiological Studies–Depression %K CES-D %K distributed leadership %K intensive care unit %K wearable sensor %K face-to-face interaction %D 2023 %7 29.11.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Effective communication strategies are becoming increasingly important in intensive care units (ICUs) where patients at high risk are treated. Distributed leadership promotes effective communication among health care professionals (HCPs). Moreover, beyond facilitating patient care, it may improve well-being among HCPs by fostering teamwork. However, the impact of distributed leadership on the communication structure and well-being of HCPs remains unclear. Objective: We performed a social network analysis (SNA) to assess the characteristics of each HCP in the network, identify the number of HCP connections, analyze 4 centralities that can measure an HCP’s importance, and evaluate the impact of distributed leadership structure on the well-being and communication structure of the medical staff. Methods: Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at Mie University Hospital, Japan. Participants wore a badge on the front of their clothing during working hours to measure the total frequency of face-to-face interactions. We collected data about the well-being of medical staff using the Center for Epidemiological Studies–Depression (CES-D) questionnaire and measured 4 centralities using SNA analysis. A CES-D questionnaire was administered during the study to measure the well-being of the HCPs. Results: Overall, 247 ICU workers participated in this clinical study for 4 weeks yearly in February 2016, 2017, and 2018. The distributed leadership structure was established within the ICU in 2017 and 2018. We compared these results with those of the traditional leadership structure used in 2016. Most face-to-face interactions in the ICU were among nurses or between nurses and other professionals. In 2016, overall, 10 nurses could perform leadership tasks, which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, SNA in 2018 showed that the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared with those in 2016. However, the eigenvector centrality significantly decreased in 2018 compared with that in 2016 (P=.01). The CES-D scores in 2018 also significantly decreased compared with those in 2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively correlated in 2016, whereas the closeness centrality and CES-D scores were negatively correlated (r=−0.318; P=.01). In 2018, the degree (r=−0.280; P=.01) and eigenvector (r=−0.284; P=.01) centralities were negatively correlated with CES-D scores. Conclusions: Face-to-face interactions of HCPs in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the introduction of distributed leadership created collaboration and informal leadership in the organization, altering the social network structure of HCPs and increasing organizational well-being. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000037046; https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000042211 %M 37935050 %R 10.2196/50148 %U https://www.i-jmr.org/2023/1/e50148 %U https://doi.org/10.2196/50148 %U http://www.ncbi.nlm.nih.gov/pubmed/37935050 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50886 %T Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study %A Bibi,Igor %A Schaffert,Daniel %A Blauth,Mara %A Lull,Christian %A von Ahnen,Jan Alwin %A Gross,Georg %A Weigandt,Wanja Alexander %A Knitza,Johannes %A Kuhn,Sebastian %A Benecke,Johannes %A Leipe,Jan %A Schmieder,Astrid %A Olsavszky,Victor %+ Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 6213832280, victor.olsavszky@medma.uni-heidelberg.de %K automated machine learning %K psoriasis %K hand and foot eczema %K medical smartphone app %K application %K smartphone %K machine learning %K digitalization %K skin %K skin disease %K use %K hand %K foot %K mobile phone %D 2023 %7 28.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid digitalization in health care has led to the adoption of digital technologies; however, limited trust in internet-based health decisions and the need for technical personnel hinder the use of smartphones and machine learning applications. To address this, automated machine learning (AutoML) is a promising tool that can empower health care professionals to enhance the effectiveness of mobile health apps. Objective: We used AutoML to analyze data from clinical studies involving patients with chronic hand and/or foot eczema or psoriasis vulgaris who used a smartphone monitoring app. The analysis focused on itching, pain, Dermatology Life Quality Index (DLQI) development, and app use. Methods: After extensive data set preparation, which consisted of combining 3 primary data sets by extracting common features and by computing new features, a new pseudonymized secondary data set with a total of 368 patients was created. Next, multiple machine learning classification models were built during AutoML processing, with the most accurate models ultimately selected for further data set analysis. Results: Itching development for 6 months was accurately modeled using the light gradient boosted trees classifier model (log loss: 0.9302 for validation, 1.0193 for cross-validation, and 0.9167 for holdout). Pain development for 6 months was assessed using the random forest classifier model (log loss: 1.1799 for validation, 1.1561 for cross-validation, and 1.0976 for holdout). Then, the random forest classifier model (log loss: 1.3670 for validation, 1.4354 for cross-validation, and 1.3974 for holdout) was used again to estimate the DLQI development for 6 months. Finally, app use was analyzed using an elastic net blender model (area under the curve: 0.6567 for validation, 0.6207 for cross-validation, and 0.7232 for holdout). Influential feature correlations were identified, including BMI, age, disease activity, DLQI, and Hospital Anxiety and Depression Scale-Anxiety scores at follow-up. App use increased with BMI >35, was less common in patients aged >47 years and those aged 23 to 31 years, and was more common in those with higher disease activity. A Hospital Anxiety and Depression Scale-Anxiety score >8 had a slightly positive effect on app use. Conclusions: This study provides valuable insights into the relationship between data characteristics and targeted outcomes in patients with chronic eczema or psoriasis, highlighting the potential of smartphone and AutoML techniques in improving chronic disease management and patient care. %M 38015608 %R 10.2196/50886 %U https://www.jmir.org/2023/1/e50886 %U https://doi.org/10.2196/50886 %U http://www.ncbi.nlm.nih.gov/pubmed/38015608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48483 %T Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes %A Govindaraj,Ramkumar %A Agar,Meera %A Currow,David %A Luckett,Tim %+ Department of Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia, 61 411813083, ramkumar.govindaraj@sa.gov.au %K patient-reported outcome measure %K PROM %K PROMs %K realist synthesis %K oncology %K eHealth %K patient reported %K outcome measure %K outcome measures %K realist %K literature review %K narrative review %K search strategy %K review methods %K review methodology %K electronic patient-reported outcome measure %K ePROM %K cancer %K oncology %K self-reporting %K mobile phone %D 2023 %7 28.11.2023 %9 Review %J J Med Internet Res %G English %X Background: The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. Objective: This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. Methods: A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. Results: Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions—remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. Conclusions: The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters. %M 38015606 %R 10.2196/48483 %U https://www.jmir.org/2023/1/e48483 %U https://doi.org/10.2196/48483 %U http://www.ncbi.nlm.nih.gov/pubmed/38015606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49358 %T Learnings in Digital Health Design: Insights From a Pilot Web App for Structured Note-Taking for Patients With Rheumatoid Arthritis %A Srivastava,Ujwal %A Dasari,Shobha %A Shah,Neha %+ Department of Computer Science, Stanford University, 900 Blake Wilbur Dr Rm W2081 2nd Fl, Stanford, CA, 94305, United States, 1 (650) 723 6961, ujwal@stanford.edu %K digital health %K biodesign %K technology %K software %K web app %K codesign %K patient empowerment %K note-taking %K medical information %K web application %K web-based %K technology engagement %D 2023 %7 28.11.2023 %9 Viewpoint %J JMIR Form Res %G English %X Background: Patients fail to accurately remember 40% to 80% of medical information relayed during doctor appointments, and most standard after-visit summaries fail to effectively help patients comply with behaviors to manage their health conditions. The value of technology to empower and engage patients in their health management has been shown, and here we apply technology to help patients remember and act upon information communicated during their medical appointments. Objective: We describe the development of WellNote, a digital notebook designed for patients to create a customized plan to manage their condition, plan for their appointments, track important actions (eg, medications and labs), and receive reminders for appointments and labs. Methods: For this pilot, we chose to focus on rheumatoid arthritis, a chronic condition that relies on many of these features. The development of WellNote followed a structured method based on design thinking and co-design principles, with the app built in close collaboration with patients and a physician partner to ensure clinical relevance. Our design process consisted of 3 rounds: patient and physician interviews, visual prototypes, and a functional pilot app. Results: Over the course of the design process, WellNote’s features were refined, with the final version being a digital notebook designed for patients with rheumatoid arthritis to manage their health by helping them track medications and labs and plan for appointments. It features several pages, like a dashboard, patient profile, appointment notes, preplanning, medication management, lab tracking, appointment archives, reminders, and a pillbox for medication visualization. Conclusions: WellNote’s active and structured note-taking features allow patients to clearly document the information from their physician without detracting from the conversation, helping the patient to become more empowered and engaged in their health management. The co-design process empowered these stakeholders to share their needs and participate in the development of a solution that truly solves pain points for these groups. This viewpoint highlights the role of digital health tools and the co-design of new health care innovations to empower patients and support clinicians. %M 38015609 %R 10.2196/49358 %U https://formative.jmir.org/2023/1/e49358 %U https://doi.org/10.2196/49358 %U http://www.ncbi.nlm.nih.gov/pubmed/38015609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45968 %T Co-design of a Mobile App for Engaging Breast Cancer Patients in Reporting Health Experiences: Qualitative Case Study %A Taramasco,Carla %A Rimassa,Carla %A Noël,René %A Bravo Storm,María Loreto %A Sánchez,César %+ Instituto de Tecnologías para la Innovación en Salud y Bienestar, Facultad de Ingeniería, Universidad Andrés Bello, Quillota 980, Viña del Mar, 2531015, Chile, 56 322507000, carla.taramasco@unab.cl %K cancer %K registration systems %K patient-reported outcome measures %K patient-reported experience measures %K software analysis and design %K cancer patient report %K adverse event reporting %K quality of life %K eHealth %K mHealth %K mobile health %D 2023 %7 27.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients’ adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people. Objective: We present a qualitative case study documenting the process of identifying the information needs of breast cancer patients and health care professionals during the treatment process in a Chilean cancer institution. The study aims to identify patients’ information requirements for integration into a mobile app that accompanies patients throughout their treatment while also providing features for reporting adverse symptoms. Methods: We conducted focus groups with breast cancer patients who were undergoing chemotherapy (n=3) or who completed chemotherapy between 3 months and 1 year (n=1). We also surveyed health care professionals (n=9) who were involved in patient care and who belonged to the oncology committee of the cancer center where the study took place. Content analysis was applied to the responses to categorize the information needs and the means to satisfy them. A user interface was designed according to the findings of the focus groups and was assessed by 3 trained information system and user interaction design experts from 2 countries, using heuristic evaluation guidelines for mobile apps. Results: Patients’ information needs were classified into 4 areas: an overview of the disease, information on treatment and day-to-day affairs, assistance on the normality and abnormality of symptoms during treatment, and symptoms relevant to report. Health care professionals required patients to be provided with information on the administrative and financial process. We noted that the active involvement of the following 4 main actors is required to satisfy the information needs: patients, caregivers, social network moderators, and health professionals. Seven usability guidelines were extracted from the heuristic evaluation recommendations. Conclusions: A mobile app that seeks to accompany breast cancer patients to report symptoms requires the involvement of multiple participants to handle the reports and day-to-day information needs. User interfaces must be designed with consideration of the patient’s social conventions and the emotional load of the disease information. %M 38010791 %R 10.2196/45968 %U https://www.jmir.org/2023/1/e45968 %U https://doi.org/10.2196/45968 %U http://www.ncbi.nlm.nih.gov/pubmed/38010791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47505 %T Innovation Process and Industrial System of US Food and Drug Administration–Approved Software as a Medical Device: Review and Content Analysis %A Yu,Jiakan %A Zhang,Jiajie %A Sengoku,Shintaro %+ Department of Innovation Science, School of Environment and Society, Tokyo Institute of Technology, Tokyo Campus Innovation Center 9th Floor Room 908N, 3-3-6 Shibaura, Minato-ku, Tokyo, 108-0023, Japan, 81 03 3454 8907, sengoku.s.aa@m.titech.ac.jp %K digital health %K digital therapeutics %K software as a medical device %K innovation process %K artificial intelligence %D 2023 %7 24.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a surge in academic and business interest in software as a medical device (SaMD). SaMD enables medical professionals to streamline existing medical practices and make innovative medical processes such as digital therapeutics a reality. Furthermore, SaMD is a billion-dollar market. However, SaMD is not clearly understood as a technological change and emerging industry. Objective: This study aims to review the landscape of SaMD in response to increasing interest in SaMD within health systems and regulation. The objectives of the study are to (1) clarify the innovation process of SaMD, (2) identify the prevailing typology of such innovation, and (3) elucidate the underlying mechanisms driving the SaMD innovation process. Methods: We collected product information on 581 US Food and Drug Administration–approved SaMDs from the OpenFDA website and 268 company profiles of the corresponding manufacturers from Crunchbase, Bloomberg, PichBook.com, and other company websites. In addition to assessing the metadata of SaMD, we used correspondence and business process analysis to assess the distribution of intended use and how SaMDs interact with other devices in the medical process. Results: The current SaMD industry is highly concentrated in medical image processing and radiological analysis. Incumbents in the medical device industry currently lead the market and focus on incremental innovation, whereas new entrants, particularly startups, produce more disruptive innovation. We found that hardware medical device functions as a complementary asset for SaMD, whereas how SaMD interacts with the complementary asset differs according to its intended use. Based on these findings, we propose a regime map that illustrates the SaMD innovation process. Conclusions: SaMD, as an industry, is nascent and dominated by incremental innovation. The innovation process of the present SaMD industry is shaped by data accessibility, which is key to building disruptive innovation. %M 37999948 %R 10.2196/47505 %U https://www.jmir.org/2023/1/e47505 %U https://doi.org/10.2196/47505 %U http://www.ncbi.nlm.nih.gov/pubmed/37999948 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51123 %T Evaluating a Public Health Information Service According to Users’ Socioeconomic Position and Health Status: Protocol for a Cross-Sectional Study %A Estevez,Mégane %A Domecq,Sandrine %A Montagni,Ilaria %A Ramel,Viviane %+ Bordeaux University, Inserm, Bordeaux Population Health Research Center, U1219, 146 Rue Léo Saignat, Bordeaux, 33300, France, 33 0631690669, megane.estevez@gmail.com %K internet %K health information seeking %K literacy %K social health inequalities %K evaluation %K digital health %K public health %K socioeconomic position %K health status %K user %K empowerment %K social inequality %K mobile phone %D 2023 %7 24.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increasing use of information technology in the field of health is supposed to promote users’ empowerment but can also reinforce social inequalities. Some health authorities in various countries have developed mechanisms to offer accurate and relevant information to health care system users, often through health websites. However, the evaluation of these sociotechnical tools is inadequate, particularly with respect to differences and inequalities in use by social groups. Objective: Our study aims to evaluate the access, understanding, appraisal, and use of the French website Santé.fr by users according to their socioeconomic position and perceived health status. Methods: This cross-sectional study involves the entire French population to which Santé.fr is offered. Data will be collected through mixed methods, including a web-based questionnaire for quantitative data and interviews and focus groups for qualitative data. Collected data will cover users’ access, understanding, appraisal, and use of Santé.fr, as well as sociodemographic and socioeconomic characteristics, health status, and digital health literacy. A validation of the dimensions of access, understanding, appraisal, and use of Santé.fr will be conducted, followed by principal component analysis and ascendant hierarchical classification based on the 2 main components of principal component analysis to characterize homogeneous users’ profiles. Regression models will be used to investigate the relationships between each dimension and socioeconomic position and health status variables. NVivo 11 software (Lumivero) will be used to categorize interviewees’ comments into preidentified themes or themes emerging from the discourse and compare them with the comments of various types of interviewees to understand the factors influencing people’s access, understanding, appraisal, and use of Santé.fr. Results: Recruitment is scheduled to begin in January 2024 and will conclude when the required number of participants is reached. Data collection is expected to be finalized approximately 7 months after recruitment, with the final data analysis programmed to be completed around December 2024. Conclusions: This study would be the first in France and in Europe to evaluate a public health information service, in this case the Santé.fr website (the official website of the French Ministry of Health), according to users’ socioeconomic position and health status. The study could discover issues related to inequalities in access to, and the use of, digital technologies for obtaining health information on the internet. Given that access to health information on the internet is crucial for health decision-making and empowerment, inequalities in access may have subsequent consequences on health inequalities among social categories. Therefore, it is important to ensure that all social categories have access to Santé.fr. International Registered Report Identifier (IRRID): PRR1-10.2196/51123 %M 37999943 %R 10.2196/51123 %U https://www.researchprotocols.org/2023/1/e51123 %U https://doi.org/10.2196/51123 %U http://www.ncbi.nlm.nih.gov/pubmed/37999943 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47043 %T Quality of Digital Health Interventions Across Different Health Care Domains: Secondary Data Analysis Study %A Hyzy,Maciej %A Bond,Raymond %A Mulvenna,Maurice %A Bai,Lu %A Dix,Alan %A Daly,Robert %A Frey,Anna-Lena %A Leigh,Simon %+ School of Computing, Ulster University, Ulster University, York St, Belfast, BT15 1ED, United Kingdom, 44 7526852505, maciejmarekzych@gmail.com %K digital health interventions scoring %K digital health interventions %K digital health %K mHealth assessment %K mobile health %K ORCHA assessment %K Organisation for the Review of Care and Health Apps %K quality assessment %K quantifying DHIs %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are more than 350,000 digital health interventions (DHIs) in the app stores. To ensure that they are effective and safe to use, they should be assessed for compliance with best practice standards. Objective: The objective of this paper was to examine and compare the compliance of DHIs with best practice standards and adherence to user experience (UX), professional and clinical assurance (PCA), and data privacy (DP). Methods: We collected assessment data from 1574 DHIs using the Organisation for the Review of Care and Health Apps Baseline Review (OBR) assessment tool. As part of the assessment, each DHI received a score out of 100 for each of the abovementioned areas (ie, UX, PCA, and DP). These 3 OBR scores are combined to make up the overall ORCHA score (a proxy for quality). Inferential statistics, probability distributions, Kruskal-Wallis, Wilcoxon rank sum test, Cliff delta, and Dunn tests were used to conduct the data analysis. Results: We found that 57.3% (902/1574) of the DHIs had an Organisation for the Review of Care and Health Apps (ORCHA) score below the threshold of 65. The overall median OBR score (ORCHA score) for all DHIs was 61.5 (IQR 51.0-73.0) out of 100. A total of 46.2% (12/26) of DHI’s health care domains had a median equal to or above the ORCHA threshold score of 65. For the 3 assessment areas (UX, DP, and PCA), DHIs scored the highest for the UX assessment 75.2 (IQR 70.0-79.6), followed by DP 65.1 (IQR 55.0-73.4) and PCA 49.6 (IQR 31.9-76.1). UX scores had the least variance (SD 13.9), while PCA scores had the most (SD 24.8). Respiratory and urology DHIs were consistently highly ranked in the National Institute for Health and Care Excellence Evidence Standards Framework tiers B and C based on their ORCHA score. Conclusions: There is a high level of variability in the ORCHA scores of DHIs across different health care domains. This suggests that there is an urgent need to improve compliance with best practices in some health care areas. Possible explanations for the observed differences might include varied market maturity and commercial interests within the different health care domains. More investment to support the development of higher-quality DHIs in areas such as ophthalmology, allergy, women’s health, sexual health, and dental care may be needed. %M 37995121 %R 10.2196/47043 %U https://mhealth.jmir.org/2023/1/e47043 %U https://doi.org/10.2196/47043 %U http://www.ncbi.nlm.nih.gov/pubmed/37995121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46089 %T Guidelines, Consensus Statements, and Standards for the Use of Artificial Intelligence in Medicine: Systematic Review %A Wang,Ying %A Li,Nian %A Chen,Lingmin %A Wu,Miaomiao %A Meng,Sha %A Dai,Zelei %A Zhang,Yonggang %A Clarke,Mike %+ Department of Periodical Press, National Clinical Research Center for Geriatrics, Chinese Evidence-based Medicine Center, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China, 86 28 85421729, jebm_zhang@yahoo.com %K artificial intelligence %K clinical practice %K guidelines %K consensus statements %K standards %K systematic review %D 2023 %7 22.11.2023 %9 Review %J J Med Internet Res %G English %X Background: The application of artificial intelligence (AI) in the delivery of health care is a promising area, and guidelines, consensus statements, and standards on AI regarding various topics have been developed. Objective: We performed this study to assess the quality of guidelines, consensus statements, and standards in the field of AI for medicine and to provide a foundation for recommendations about the future development of AI guidelines. Methods: We searched 7 electronic databases from database establishment to April 6, 2022, and screened articles involving AI guidelines, consensus statements, and standards for eligibility. The AGREE II (Appraisal of Guidelines for Research & Evaluation II) and RIGHT (Reporting Items for Practice Guidelines in Healthcare) tools were used to assess the methodological and reporting quality of the included articles. Results: This systematic review included 19 guideline articles, 14 consensus statement articles, and 3 standard articles published between 2019 and 2022. Their content involved disease screening, diagnosis, and treatment; AI intervention trial reporting; AI imaging development and collaboration; AI data application; and AI ethics governance and applications. Our quality assessment revealed that the average overall AGREE II score was 4.0 (range 2.2-5.5; 7-point Likert scale) and the mean overall reporting rate of the RIGHT tool was 49.4% (range 25.7%-77.1%). Conclusions: The results indicated important differences in the quality of different AI guidelines, consensus statements, and standards. We made recommendations for improving their methodological and reporting quality. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews (CRD42022321360); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321360 %M 37991819 %R 10.2196/46089 %U https://www.jmir.org/2023/1/e46089 %U https://doi.org/10.2196/46089 %U http://www.ncbi.nlm.nih.gov/pubmed/37991819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47895 %T Reduction of Mental Health–Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis %A Gliske,Kate %A Ballard,Jaime %A Berry,Katie R %A Killian,Michael %A Kroll,Elizabeth %A Fenkel,Caroline %+ Charlie Health Inc, 233 East Main Street, Suite 233, Bozeman, MT, 59715-5045, United States, 1 19523341411, kgliske@umn.edu %K mental health %K emergency room %K emergency department %K ED %K readmission %K intensive outpatient treatment %K IOP %K pediatric %K youth %K young adult %K emergency %K evaluation %K readmission %K sexual identity %K race %K ethnicity %K care %K outpatient %K treatment %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth’s mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED’s in order to prevent readmissions. Objective: The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Methods: Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). Results: Mental health–related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health–related ED admissions at IOP intake reported no mental health–related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. Conclusions: This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults. %M 37943600 %R 10.2196/47895 %U https://formative.jmir.org/2023/1/e47895 %U https://doi.org/10.2196/47895 %U http://www.ncbi.nlm.nih.gov/pubmed/37943600 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50216 %T A Framework to Guide Implementation of AI in Health Care: Protocol for a Cocreation Research Project %A Nilsen,Per %A Svedberg,Petra %A Neher,Margit %A Nair,Monika %A Larsson,Ingrid %A Petersson,Lena %A Nygren,Jens %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 706341151, per.nilsen@liu.se %K artificial intelligence %K AI %K health care %K implementation %K process models %K frameworks %K framework %K process model %D 2023 %7 8.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Artificial intelligence (AI) has the potential in health care to transform patient care and administrative processes, yet health care has been slow to adopt AI due to many types of barriers. Implementation science has shown the importance of structured implementation processes to overcome implementation barriers. However, there is a lack of knowledge and tools to guide such processes when implementing AI-based applications in health care. Objective: The aim of this protocol is to describe the development, testing, and evaluation of a framework, “Artificial Intelligence-Quality Implementation Framework” (AI-QIF), intended to guide decisions and activities related to the implementation of various AI-based applications in health care. Methods: The paper outlines the development of an AI implementation framework for broad use in health care based on the Quality Implementation Framework (QIF). QIF is a process model developed in implementation science. The model guides the user to consider implementation-related issues in a step-by-step design and plan and perform activities that support implementation. This framework was chosen for its adaptability, usability, broad scope, and detailed guidance concerning important activities and considerations for successful implementation. The development will proceed in 5 phases with primarily qualitative methods being used. The process starts with phase I, in which an AI-adapted version of QIF is created (AI-QIF). Phase II will produce a digital mockup of the AI-QIF. Phase III will involve the development of a prototype of the AI-QIF with an intuitive user interface. Phase IV is dedicated to usability testing of the prototype in health care environments. Phase V will focus on evaluating the usability and effectiveness of the AI-QIF. Cocreation is a guiding principle for the project and is an important aspect in 4 of the 5 development phases. The cocreation process will enable the use of both on research-based and practice-based knowledge. Results: The project is being conducted within the frame of a larger research program, with the overall objective of developing theoretically and empirically informed frameworks to support AI implementation in routine health care. The program was launched in 2021 and has carried out numerous research activities. The development of AI-QIF as a tool to guide the implementation of AI-based applications in health care will draw on knowledge and experience acquired from these activities. The framework is being developed over 2 years, from January 2023 to December 2024. It is under continuous development and refinement. Conclusions: The development of the AI implementation framework, AI-QIF, described in this study protocol aims to facilitate the implementation of AI-based applications in health care based on the premise that implementation processes benefit from being well-prepared and structured. The framework will be coproduced to enhance its relevance, validity, usefulness, and potential value for application in practice. International Registered Report Identifier (IRRID): DERR1-10.2196/50216 %M 37938896 %R 10.2196/50216 %U https://www.researchprotocols.org/2023/1/e50216 %U https://doi.org/10.2196/50216 %U http://www.ncbi.nlm.nih.gov/pubmed/37938896 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45958 %T Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review %A Stanic,Tijana %A Saygin Avsar,Tuba %A Gomes,Manuel %+ Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 203103080, m.gomes@ucl.ac.uk %K digital health %K cost-effectiveness %K economic evaluation %K children %K adolescents %D 2023 %7 3.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions. Objective: This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities. Methods: We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation. Results: We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%). Conclusions: This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes. %M 37921844 %R 10.2196/45958 %U https://www.jmir.org/2023/1/e45958 %U https://doi.org/10.2196/45958 %U http://www.ncbi.nlm.nih.gov/pubmed/37921844 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51884 %T Developing Health Management Competency for Digital Health Transformation: Protocol for a Qualitative Study %A Brommeyer,Mark %A Liang,Zhanming %A Whittaker,Maxine %A Mackay,Mark %+ College of Public Health, Medical and Veterinary Science, James Cook University, James Cook Drive, Townsville, 4810, Australia, 61 400825555, mark.brommeyer@flinders.edu.au %K health care management %K health service manager %K digital health %K health informatics %K competency %K workforce development %K innovation %K research protocol %K informatics %K manager %K managers %K service %K services %K delivery %K organization %K organizational %K workforce %K management %K managerial %K qualification %K qualifications %K focus group %K focus groups %K interview %K interviews %K scoping %K review methods %K review methodology %D 2023 %7 3.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, the health care system is experiencing a period of rapid and radical change. In response, innovative service models have been adopted for the delivery of high-quality care that require a health workforce with skills to support transformation and new ways of working. Objective: The aim of this research protocol is to describe research that will contribute to developing the capability of health service managers in the digital health era and enabling digital transformation within the Australian health care environment. It also explains the process of preparing and finalizing the research design and methodologies by seeking answers to the following three research questions: (1) To what extent can the existing health service management and digital health competency frameworks guide the development of competence for health service managers in understanding and managing in the digital health space? (2) What are the competencies that are necessary for health service managers to acquire in order to effectively work with and manage in the digital health context? (3) What are the key factors that enable and inhibit health service managers to develop and demonstrate digital health competence in the workplace? Methods: The study has adopted a qualitative approach, guided by the empirically validated management competency identification process, using four steps: (1) health management and digital health competency mapping, (2) scoping review of literature and policy analysis, (3) focus group discussions with health service managers, and (4) semistructured interviews with digital health leaders. The first 2 steps were to confirm the need for updating the current health service management curriculum to address changing competency requirements of health service managers in the digital health context. Results: Two initial steps have been completed confirming the significance of the study and study design. Step 1, competency mapping, found that nearly half of the digital competencies were only partially or not addressed at all by the health management competency framework. The scoping review articulated the competencies health service managers need to effectively demonstrate digital health competence in the workplace. The findings effectively support the importance of the current research and also the appropriateness of the proposed steps 3 and 4 in answering the research questions and achieving the research aim. Conclusions: This study will provide insights into the health service management workforce performance and development needs for digital health and inform credentialing and professional development requirements. This will guide health service managers in leading and managing the adoption and implementation of digital health as a contemporary tool for health care delivery. The study will develop an in-depth understanding of Australian health service managers’ experiences and views. This research process could be applied in other contexts, noting that the results need contextualization to individual country jurisdictions and environments. International Registered Report Identifier (IRRID): DERR1-10.2196/51884 %M 37921855 %R 10.2196/51884 %U https://www.researchprotocols.org/2023/1/e51884 %U https://doi.org/10.2196/51884 %U http://www.ncbi.nlm.nih.gov/pubmed/37921855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49324 %T Large Language Models for Therapy Recommendations Across 3 Clinical Specialties: Comparative Study %A Wilhelm,Theresa Isabelle %A Roos,Jonas %A Kaczmarczyk,Robert %+ Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Biedersteiner Str 29, Munich, 80802, Germany, 49 08941403033, Robert.Kaczmarczyk@tum.de %K dermatology %K ophthalmology %K orthopedics %K therapy %K large language models %K artificial intelligence %K LLM %K ChatGPT %K chatbot %K chatbots %K orthopedic %K recommendation %K recommendations %K medical information %K health information %K quality %K reliability %K accuracy %K safety %K reliable %K medical advice %D 2023 %7 30.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: As advancements in artificial intelligence (AI) continue, large language models (LLMs) have emerged as promising tools for generating medical information. Their rapid adaptation and potential benefits in health care require rigorous assessment in terms of the quality, accuracy, and safety of the generated information across diverse medical specialties. Objective: This study aimed to evaluate the performance of 4 prominent LLMs, namely, Claude-instant-v1.0, GPT-3.5-Turbo, Command-xlarge-nightly, and Bloomz, in generating medical content spanning the clinical specialties of ophthalmology, orthopedics, and dermatology. Methods: Three domain-specific physicians evaluated the AI-generated therapeutic recommendations for a diverse set of 60 diseases. The evaluation criteria involved the mDISCERN score, correctness, and potential harmfulness of the recommendations. ANOVA and pairwise t tests were used to explore discrepancies in content quality and safety across models and specialties. Additionally, using the capabilities of OpenAI’s most advanced model, GPT-4, an automated evaluation of each model’s responses to the diseases was performed using the same criteria and compared to the physicians’ assessments through Pearson correlation analysis. Results: Claude-instant-v1.0 emerged with the highest mean mDISCERN score (3.35, 95% CI 3.23-3.46). In contrast, Bloomz lagged with the lowest score (1.07, 95% CI 1.03-1.10). Our analysis revealed significant differences among the models in terms of quality (P<.001). Evaluating their reliability, the models displayed strong contrasts in their falseness ratings, with variations both across models (P<.001) and specialties (P<.001). Distinct error patterns emerged, such as confusing diagnoses; providing vague, ambiguous advice; or omitting critical treatments, such as antibiotics for infectious diseases. Regarding potential harm, GPT-3.5-Turbo was found to be the safest, with the lowest harmfulness rating. All models lagged in detailing the risks associated with treatment procedures, explaining the effects of therapies on quality of life, and offering additional sources of information. Pearson correlation analysis underscored a substantial alignment between physician assessments and GPT-4’s evaluations across all established criteria (P<.01). Conclusions: This study, while comprehensive, was limited by the involvement of a select number of specialties and physician evaluators. The straightforward prompting strategy (“How to treat…”) and the assessment benchmarks, initially conceptualized for human-authored content, might have potential gaps in capturing the nuances of AI-driven information. The LLMs evaluated showed a notable capability in generating valuable medical content; however, evident lapses in content quality and potential harm signal the need for further refinements. Given the dynamic landscape of LLMs, this study’s findings emphasize the need for regular and methodical assessments, oversight, and fine-tuning of these AI tools to ensure they produce consistently trustworthy and clinically safe medical advice. Notably, the introduction of an auto-evaluation mechanism using GPT-4, as detailed in this study, provides a scalable, transferable method for domain-agnostic evaluations, extending beyond therapy recommendation assessments. %M 37902826 %R 10.2196/49324 %U https://www.jmir.org/2023/1/e49324 %U https://doi.org/10.2196/49324 %U http://www.ncbi.nlm.nih.gov/pubmed/37902826 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46639 %T Scenario-Based e-Simulation Design for Global Health Education: Theoretical Foundation and Practical Recommendations %A Bahattab,Awsan %A Caviglia,Marta %A Martini,Daniela %A Hubloue,Ives %A Della Corte,Francesco %A Ragazzoni,Luca %+ Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health (CRIMEDIM), Università del Piemonte Orientale, Via Lanino, 1, Novara, 28100, Italy, 39 333 9252944, awsan.bahattab@uniupo.it %K global health %K education %K medical %K computer simulation %K scenario-based learning %K scenario-based e-simulation %K simulation %K design %K education %K training %K development %K medical educator %D 2023 %7 30.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Electronic simulation (e-simulation)—particularly scenario-based e-simulation (SBES)—is an increasingly used, promising educational strategy for global health education that can address gaps in training access, effectiveness, and cost. However, there is little guidance for educators on how to develop an SBES, and guidance is lacking outside the clinical context. Moreover, literature on medical education rarely uses the theoretical basis for e-simulation design and development, including for SBES. Hence, we aim to differentiate and describe the concept, design elements, and theoretical basis of SBES with examples from different topics in global health. In addition to enhancing the understanding of the potential of SBES for global health education, this manuscript also provides practical recommendations for global health educators in designing and developing SBESs based on the existing literature and authors’ experiences. Overall, this manuscript will be useful for global health educators as well as other medical educators seeking to develop an SBES for similar skill sets. %M 37902810 %R 10.2196/46639 %U https://www.jmir.org/2023/1/e46639 %U https://doi.org/10.2196/46639 %U http://www.ncbi.nlm.nih.gov/pubmed/37902810 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e49973 %T A Pragmatic Mapping of Perceptions and Use of Digital Information Systems in Primary Care in Sweden: Survey Study %A Sant’Anna,Anita %A Nygren,Jens %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K digital information systems %K implementation %K primary care %K health care professionals %K information system %K information systems %K usability %K adoption %K perception %K perceptions %K technology use %K perspective %K perspectives %D 2023 %7 25.10.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Electronic health records and IT infrastructure in primary care allow for digital documentation and access to information, which can be used to guide evidence-based care and monitor patient safety and quality of care. Quality indicators specified by regulatory authorities can be automatically computed and presented to primary care staff. However, the implementation of digital information systems (DIS) in health care can be challenging, and understanding factors such as relative advantage, compatibility, complexity, trialability, and observability is needed to improve the success and rate of adoption and diffusion. Objective: This study aims to explore how DIS are used and perceived by health care professionals in primary care. Methods: This study used quantitative assessment to gather survey data on the use and potential of DIS in health care in Sweden from the perspectives of primary care personnel in various roles. The digital questionnaire was designed to be short and contained 3 sections covering respondent characteristics, current use of platforms, and perceptions of decision support tools. Data were analyzed using descriptive statistics, nonparametric hypothesis testing, ordinal coefficient α, and confirmatory factor analysis. Results: The study collected responses from participants across 10 regions of Sweden, comprising 31.9% (n=22) from private clinics and 68.1% (n=47) from public clinics. Participants included administrators (18/69, 26.1%), a medical strategist (1/69, 1.4%), and physicians (50/69, 72.5%). Usage frequency varied as follows: 11.6% (n=8) used DIS weekly, 24.6% (n=17) monthly, 27.5% (n=19) a few times a year, 26.1% (n=18) very rarely, and 10.1% (n=7) lacked access. Administrators used DIS more frequently than physicians (P=.005). DIS use centered on quality improvement and identifying high-risk patients, with differences by role. Physicians were more inclined to use DIS out of curiosity (P=.01). Participants desired DIS for patient follow-up, lifestyle guidance, treatment suggestions, reminders, and shared decision-making. Administrators favored predictive analysis (P<.001), while physicians resisted immediate patient identification (P=.03). The 5 innovation attributes showed high internal consistency (α>.7). These factors explained 78.5% of questionnaire variance, relating to complexity, competitive advantage, compatibility, trialability, and observability. Factors 2, 3, and 4 predicted intention to use DIS, with factor 2 alone achieving the best accuracy (root-mean-square=0.513). Conclusions: Administrators and physicians exhibited role-based DIS use patterns highlighting the need for tailored approaches to promote DIS adoption. The study reveals a link between positive perceptions and intention to use DIS, emphasizing the significance of considering all factors for successful health care integration. The results suggest various directions for future studies. These include refining the trialability and observability questions for increased reliability and validity, investigating a larger sample with more specific target groups to improve generalization, and exploring the relevance of different groups’ perspectives and needs in relation to decisions about and use of DIS. %M 37878357 %R 10.2196/49973 %U https://www.i-jmr.org/2023/1/e49973 %U https://doi.org/10.2196/49973 %U http://www.ncbi.nlm.nih.gov/pubmed/37878357 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e49025 %T Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study %A Ranusch,Allison %A Lin,Ying-Jen %A Dorsch,Michael P %A Allen,Arthur L %A Spoutz,Patrick %A Seagull,F Jacob %A Sussman,Jeremy B %A Barnes,Geoffrey D %+ Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109, United States, 1 734 763 0047, gbarnes@umich.edu %K direct oral anticoagulant %K population management %K implementation science %K medical informatics %K individual clinician authority %K electronic health record %K health records %K EHR %K EHRs %K implementation %K clotting %K clot %K clots %K anticoagulant %K anticoagulants %K dashboard %K DOAC %K satisfaction %K interview %K interviews %K pharmacist %K pharmacy %K pharmacology %K medication %K prescribe %K prescribing %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Direct oral anticoagulant (DOAC) medications are frequently associated with inappropriate prescribing and adverse events. To improve the safe use of DOACs, health systems are implementing population health tools within their electronic health record (EHR). While EHR informatics tools can help increase awareness of inappropriate prescribing of medications, a lack of empowerment (or insufficient empowerment) of nonphysicians to implement change is a key barrier. Objective: This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing. Methods: We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes. Results: A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant. Conclusions: Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation. International Registered Report Identifier (IRRID): RR2-10.1186/s13012-020-01044-5 %M 37874636 %R 10.2196/49025 %U https://humanfactors.jmir.org/2023/1/e49025 %U https://doi.org/10.2196/49025 %U http://www.ncbi.nlm.nih.gov/pubmed/37874636 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49955 %T e-Learning Evaluation Framework and Tools for Global Health and Public Health Education: Protocol for a Scoping Review %A Bahattab,Awsan %A Hanna,Michel %A Teo Voicescu,George %A Hubloue,Ives %A Della Corte,Francesco %A Ragazzoni,Luca %+ Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Via Lanino, 1, Novara, 28100, Italy, 39 3339252944, awsan.bahattab@uniupo.it %K computer-assisted instruction %K disaster medicine %K disaster %K e-learning %K educational assessment %K global health %K medical education %K public health %K evaluation %K scoping %K review methods %K review methodology %K education %K educational %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been a significant increase in the use of e-learning for global and public health education recently, especially following the COVID-19 pandemic. e-Learning holds the potential to offer equal opportunities, overcoming barriers like physical limitations and training costs. However, its effectiveness remains debated, with institutions unprepared for the sudden shift during the pandemic. To effectively evaluate the outcomes of e-learning, a standardized and rigorous approach is necessary. However, the existing literature on this subject often lacks standardized assessment tools and theoretical foundations, leading to ambiguity in the evaluation process. Consequently, it becomes imperative to identify a clear theoretical foundation and practical approach for evaluating global and public health e-learning outcomes. Objective: This protocol for a scoping review aims to map the state of e-learning evaluation in global and public health education to determine the existing theoretical evaluation frameworks, methods, tools, and domains and the gaps in research and practice. Methods: The scoping review will be conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The initial search was performed in PubMed, Education Resource Information Center, Web of Science, and Scopus to identify peer-reviewed articles that report on the use of evaluation and assessment for e-learning training. The search strings combined the concepts of e-learning, public health, and health science education, along with evaluation and frameworks. After the initial search, a screening process will be carried out to determine the relevance of the identified studies to the research question. Data related to the characteristics of the included studies, the characteristics of the e-learning technology used in the studies, and the study outcomes will be extracted from the eligible articles. The extracted data will then undergo a structured, descriptive, quantitative, and qualitative content analysis to synthesize the information from the selected studies. Results:  Initial database searches yielded a total of 980 results. Duplicates have been removed, and title and abstract screening of the 805 remaining extracted articles are underway. Quantitative and qualitative findings from the reviewed articles will be presented to answer the study objective. Conclusions: This scoping review will provide global and public health educators with a comprehensive overview of the current state of e-learning evaluation. By identifying existing e-learning frameworks and tools, the findings will offer valuable guidance for further advancements in global and public health e-learning evaluation. The study will also enable the creation of a comprehensive, evidence-based e-learning evaluation framework and tools, which will improve the quality and accountability of global health and public health education. Ultimately, this will contribute to better health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49955 %M 37874640 %R 10.2196/49955 %U https://www.researchprotocols.org/2023/1/e49955 %U https://doi.org/10.2196/49955 %U http://www.ncbi.nlm.nih.gov/pubmed/37874640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49842 %T Applying AI and Guidelines to Assist Medical Students in Recognizing Patients With Heart Failure: Protocol for a Randomized Trial %A Joo,Hyeon %A Mathis,Michael R %A Tam,Marty %A James,Cornelius %A Han,Peijin %A Mangrulkar,Rajesh S %A Friedman,Charles P %A Vydiswaran,VG Vinod %+ Department of Learning Health Sciences, University of Michigan, 1111 East Catherine Street, Ann Arbor, MI, 48109, United States, 1 7349361644, thejoo@umich.edu %K medical education %K clinical decision support systems %K artificial intelligence %K machine learning %K heart failure %K evidence-based medicine %K guidelines %K digital health interventions %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The integration of artificial intelligence (AI) into clinical practice is transforming both clinical practice and medical education. AI-based systems aim to improve the efficacy of clinical tasks, enhancing diagnostic accuracy and tailoring treatment delivery. As it becomes increasingly prevalent in health care for high-quality patient care, it is critical for health care providers to use the systems responsibly to mitigate bias, ensure effective outcomes, and provide safe clinical practices. In this study, the clinical task is the identification of heart failure (HF) prior to surgery with the intention of enhancing clinical decision-making skills. HF is a common and severe disease, but detection remains challenging due to its subtle manifestation, often concurrent with other medical conditions, and the absence of a simple and effective diagnostic test. While advanced HF algorithms have been developed, the use of these AI-based systems to enhance clinical decision-making in medical education remains understudied. Objective: This research protocol is to demonstrate our study design, systematic procedures for selecting surgical cases from electronic health records, and interventions. The primary objective of this study is to measure the effectiveness of interventions aimed at improving HF recognition before surgery, the second objective is to evaluate the impact of inaccurate AI recommendations, and the third objective is to explore the relationship between the inclination to accept AI recommendations and their accuracy. Methods: Our study used a 3 × 2 factorial design (intervention type × order of prepost sets) for this randomized trial with medical students. The student participants are asked to complete a 30-minute e-learning module that includes key information about the intervention and a 5-question quiz, and a 60-minute review of 20 surgical cases to determine the presence of HF. To mitigate selection bias in the pre- and posttests, we adopted a feature-based systematic sampling procedure. From a pool of 703 expert-reviewed surgical cases, 20 were selected based on features such as case complexity, model performance, and positive and negative labels. This study comprises three interventions: (1) a direct AI-based recommendation with a predicted HF score, (2) an indirect AI-based recommendation gauged through the area under the curve metric, and (3) an HF guideline-based intervention. Results: As of July 2023, 62 of the enrolled medical students have fulfilled this study’s participation, including the completion of a short quiz and the review of 20 surgical cases. The subject enrollment commenced in August 2022 and will end in December 2023, with the goal of recruiting 75 medical students in years 3 and 4 with clinical experience. Conclusions: We demonstrated a study protocol for the randomized trial, measuring the effectiveness of interventions using AI and HF guidelines among medical students to enhance HF recognition in preoperative care with electronic health record data. International Registered Report Identifier (IRRID): DERR1-10.2196/49842 %M 37874618 %R 10.2196/49842 %U https://www.researchprotocols.org/2023/1/e49842 %U https://doi.org/10.2196/49842 %U http://www.ncbi.nlm.nih.gov/pubmed/37874618 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43765 %T Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review %A Petrovskaya,Olga %A Karpman,Albina %A Schilling,Joanna %A Singh,Simran %A Wegren,Larissa %A Caine,Vera %A Kusi-Appiah,Elizabeth %A Geen,Willow %+ School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 472 4607, olgap@uvic.ca %K patient portal %K web portal %K MyChart %K electronic health records %K personal health records %K patient access to records %K laboratory tests %K radiology reports %K diagnostic imaging %K laboratory test results %K result release %K embargo %K the Cures Act %D 2023 %7 19.10.2023 %9 Review %J J Med Internet Res %G English %X Background: A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. Objective: This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles—20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. Results: Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients’ actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers’ view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. Conclusions: The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally. %M 37856174 %R 10.2196/43765 %U https://www.jmir.org/2023/1/e43765 %U https://doi.org/10.2196/43765 %U http://www.ncbi.nlm.nih.gov/pubmed/37856174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44065 %T Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study %A Solomon,Jeffrey %A Dauber-Decker,Katherine %A Richardson,Safiya %A Levy,Sera %A Khan,Sundas %A Coleman,Benjamin %A Persaud,Rupert %A Chelico,John %A King,D'Arcy %A Spyropoulos,Alex %A McGinn,Thomas %+ Institute of Health System Science, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, United States, 1 516 600 1422, jsolomon6@northwell.edu %K clinical decision support system %K cloud based %K decision support %K development %K EHR %K electronic health record %K evidence-based medicine %K health information technology %K platform %K user-centered design %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. Objective: The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. Methods: We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. Results: The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells’ criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform’s flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells’ criteria tool will be reported in a future publication. Conclusions: The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics “nudges” on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint. %M 37856193 %R 10.2196/44065 %U https://formative.jmir.org/2023/1/e44065 %U https://doi.org/10.2196/44065 %U http://www.ncbi.nlm.nih.gov/pubmed/37856193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45163 %T Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review %A Fernando,Manasha %A Abell,Bridget %A Tyack,Zephanie %A Donovan,Thomasina %A McPhail,Steven M %A Naicker,Sundresan %+ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Q Block, 60 Musk Avenue, Kelvin Grove QLD, Brisbane, 4059, Australia, 61 3138 6454, sundresan.naicker@qut.edu.au %K computerized clinical decision support systems %K CDSS %K implementation science %K hospital %K theories %K models %K frameworks %K mobile phone %D 2023 %7 18.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. Objective: This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. Methods: A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the “Active Implementation Framework stages”: exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. Results: A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. Conclusions: Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs. %M 37851492 %R 10.2196/45163 %U https://www.jmir.org/2023/1/e45163 %U https://doi.org/10.2196/45163 %U http://www.ncbi.nlm.nih.gov/pubmed/37851492 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47663 %T Health Care Professionals’ Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation %A Castor,Charlotte %A Lindkvist,Rose-Marie %A Hallström,Inger Kristensson %A Holmberg,Robert %+ Department of Health Sciences, Lund University, Box 117, Sölvegatan 19, Lund, 22100, Sweden, 46 703668523, charlotte.castor@med.lu.se %K communication %K digital %K experiences %K eHealth %K health care professionals %K implementation %K NASSS %K pediatric care %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The development and evaluation of eHealth interventions in clinical care should be accompanied by a thorough assessment of their implementation. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was designed to facilitate the implementation and scale-up of health technology programs, providing an option for analyzing the progression of these initiatives as they are implemented in real-time. Considering health care provider perspectives within the framework for implementation offers valuable insights into the early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. Nevertheless, there is a dearth of studies on eHealth interventions that encompass longer time frames and delve into the complexities of scaling up and sustaining such interventions within real-world health care environments. Objective: This study aims to investigate the perspectives and insights of health care professionals (HCPs) regarding the implementation of an eHealth intervention in pediatric health care while applying the NASSS framework to theorize and evaluate the conditions influencing the implementation of eHealth solutions. Methods: Semistructured interviews were performed with health care providers, including both staff and management personnel, within a university pediatric hospital (N=10). The data collection process occurred concurrently with a clinical trial focused on developing and assessing an eHealth app for self-management in pediatric care following hospital discharge. Using an abductive approach, the interviews were initially analyzed qualitatively and subsequently mapped onto the 7 domains of the NASSS framework to identify factors influencing implementation, encompassing facilitators, barriers, and varying levels of complexity. Results: In the realm of pediatric care, the family was identified as the primary unit of care, and patient heterogeneity was a prominent feature. The implementation of eHealth tools, while deemed usable and flexible, was also seen as a delicate balance between safety and adaptability, highlighting challenges related to health care integration. Child participation and secrecy, especially for adolescents, contributed to the complexity of using eHealth. HCPs had high eHealth literacy, and thus challenges concerning adoption were related to work adaptations and the risk of “app overload.” The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, HCPs raised concerns related to regulatory requirements for documentation, public procurement, and data safety. Implementation became more complex due to a lack of overview in a large organization. Conclusions: Important perspectives for implementation were considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular health care. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological, and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/ct2/show/NCT04150120 %M 37851500 %R 10.2196/47663 %U https://pediatrics.jmir.org/2023/1/e47663 %U https://doi.org/10.2196/47663 %U http://www.ncbi.nlm.nih.gov/pubmed/37851500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44171 %T An Overview of Adaptive Designs and Some of Their Challenges, Benefits, and Innovative Applications %A Zhu,Hongjian %A Wong,Weng Kee %+ Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles, 605 Charles Young Drive, Los Angeles, CA, 90095, United States, 1 2069622, wkwong@ucla.edu %K doubly adaptive biased coin designs %K model-based optimal designs %K particle swarm optimization %K repair mechanism %D 2023 %7 16.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Adaptive designs are increasingly developed and used to improve all phases of clinical trials and in biomedical studies in various ways to address different statistical issues. We first present an overview of adaptive designs and note their numerous advantages over traditional clinical trials. In particular, we provide a concrete demonstration that shows how recent adaptive design strategies can further improve an adaptive trial implemented 13 years ago. Despite their usefulness, adaptive designs are still not widely implemented in clinical trials. We offer a few possible reasons and propose some ways to use them more broadly in practice, which include greater availability of software tools and interactive websites to generate optimal adaptive trials freely and effectively, including the use of metaheuristics to facilitate the search for an efficient trial design. To this end, we present several web-based tools for finding various adaptive and nonadaptive optimal designs and discuss nature-inspired metaheuristics. Metaheuristics are assumptions-free general purpose optimization algorithms widely used in computer science and engineering to tackle all kinds of challenging optimization problems, and their use in designing clinical trials is just emerging. We describe a few recent such applications and some of their capabilities for designing various complex trials. Particle swarm optimization is an exemplary nature-inspired algorithm, and similar to others, it has a simple definition but many moving parts, making it hard to study its properties analytically. We investigated one of its hitherto unstudied issues on how to bring back out-of-range candidates during the search for the optimum of the search domain and show that different strategies can impact the success and time of the search. We conclude with a few caveats on the use of metaheuristics for a successful search. %M 37843888 %R 10.2196/44171 %U https://www.jmir.org/2023/1/e44171 %U https://doi.org/10.2196/44171 %U http://www.ncbi.nlm.nih.gov/pubmed/37843888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50728 %T Knowledge and Perception of the Use of AI and its Implementation in the Field of Radiology: Cross-Sectional Study %A Miró Catalina,Queralt %A Femenia,Joaquim %A Fuster-Casanovas,Aïna %A Marin-Gomez,Francesc X %A Escalé-Besa,Anna %A Solé-Casals,Jordi %A Vidal-Alaball,Josep %+ Data and Signal Processing group, Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia, Carrer de la Laura, 13, Vic, 08500, Spain, 34 938 86 12 22, jordi.sole@uvic.cat %K artificial intelligence %K perception %K knowledge %K survey %K digital health %K radiology %K public health %D 2023 %7 13.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial Intelligence (AI) has been developing for decades, but in recent years its use in the field of health care has experienced an exponential increase. Currently, there is little doubt that these tools have transformed clinical practice. Therefore, it is important to know how the population perceives its implementation to be able to propose strategies for acceptance and implementation and to improve or prevent problems arising from future applications. Objective: This study aims to describe the population’s perception and knowledge of the use of AI as a health support tool and its application to radiology through a validated questionnaire, in order to develop strategies aimed at increasing acceptance of AI use, reducing possible resistance to change and identifying possible sociodemographic factors related to perception and knowledge. Methods: A cross-sectional observational study was conducted using an anonymous and voluntarily validated questionnaire aimed at the entire population of Catalonia aged 18 years or older. The survey addresses 4 dimensions defined to describe users’ perception of the use of AI in radiology, (1) “distrust and accountability,” (2) “personal interaction,” (3) “efficiency,” and (4) “being informed,” all with questions in a Likert scale format. Results closer to 5 refer to a negative perception of the use of AI, while results closer to 1 express a positive perception. Univariate and bivariate analyses were performed to assess possible associations between the 4 dimensions and sociodemographic characteristics. Results: A total of 379 users responded to the survey, with an average age of 43.9 (SD 17.52) years and 59.8% (n=226) of them identified as female. In addition, 89.8% (n=335) of respondents indicated that they understood the concept of AI. Of the 4 dimensions analyzed, “distrust and accountability” obtained a mean score of 3.37 (SD 0.53), “personal interaction” obtained a mean score of 4.37 (SD 0.60), “efficiency” obtained a mean score of 3.06 (SD 0.73) and “being informed” obtained a mean score of 3.67 (SD 0.57). In relation to the “distrust and accountability” dimension, women, people older than 65 years, the group with university studies, and the population that indicated not understanding the AI concept had significantly more distrust in the use of AI. On the dimension of “being informed,” it was observed that the group with university studies rated access to information more positively and those who indicated not understanding the concept of AI rated it more negatively. Conclusions: The majority of the sample investigated reported being familiar with the concept of AI, with varying degrees of acceptance of its implementation in radiology. It is clear that the most conflictive dimension is “personal interaction,” whereas “efficiency” is where there is the greatest acceptance, being the dimension in which there are the best expectations for the implementation of AI in radiology. %M 37831495 %R 10.2196/50728 %U https://www.jmir.org/2023/1/e50728 %U https://doi.org/10.2196/50728 %U http://www.ncbi.nlm.nih.gov/pubmed/37831495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41035 %T Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults %A Stara,Vera %A Soraci,Luca %A Takano,Eiko %A Kondo,Izumi %A Möller,Johanna %A Maranesi,Elvira %A Luzi,Riccardo %A Riccardi,Giovanni Renato %A Browne,Ryan %A Dacunha,Sébastien %A Palmier,Cecilia %A Wieching,Rainer %A Ogawa,Toshimi %A Bevilacqua,Roberta %+ Medical Direction, IRCCS, INRCA, Via Santa Margherita 5, Ancona, 60124, Italy, 39 0718004767, e.maranesi@inrca.it %K intrinsic capacity %K functional ability, active and healthy aging %K digital coaching %K eHealth interventions %K older adults %D 2023 %7 12.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. Objective: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers’ perspectives about technology-based interventions to support intrinsic capacity. Methods: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. Results: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. Conclusions: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults. %M 37824183 %R 10.2196/41035 %U https://www.jmir.org/2023/1/e41035 %U https://doi.org/10.2196/41035 %U http://www.ncbi.nlm.nih.gov/pubmed/37824183 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46379 %T Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians %A Curran,Janet %A Wozney,Lori %A Tavender,Emma %A Wilson,Catherine %A Ritchie,Krista C %A Wong,Helen %A Gallant,Allyson %A Somerville,Mari %A Archambault,Patrick M %A Cassidy,Christine %A Jabbour,Mona %A Mackay,Rebecca %A Plint,Amy C %+ IWK Health Centre, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada, 1 9027199285, lori.wozney@iwk.nshealth.ca %K discharge communication %K pediatric %K emergency department %K medical informatics %K implementation science %K electronic medical record %K mobile phone %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. Objective: This study aimed to survey nurse and physician readiness to adopt these tools. Methods: An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. Results: Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. Conclusions: Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort. %M 37819696 %R 10.2196/46379 %U https://humanfactors.jmir.org/2023/1/e46379 %U https://doi.org/10.2196/46379 %U http://www.ncbi.nlm.nih.gov/pubmed/37819696 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e48097 %T The Journey of Zanzibar’s Digitally Enabled Community Health Program to National Scale: Implementation Report %A Layer,Erica %A Slim,Salim %A Mussa,Issa %A Al-Mafazy,Abdul-Wahid %A Besana,Giulia V R %A Msellem,Mwinyi %A Fulcher,Isabel %A Hornung,Heiko %A Lampariello,Riccardo %+ D-tree International, 167 Washington Street, Suite 5, Norwell, MA, 02061, United States, 1 786314859, elayer@d-tree.org %K Zanzibar %K digital health %K community health %K health systems strengthening %K maternal health %K child health %K data for decision-making %K implementation science %K health systems %K healthcare infrastructure %K health care %K implementation report %D 2023 %7 9.10.2023 %9 Implementation Report %J JMIR Med Inform %G English %X Background: While high-quality primary health care services can meet 80%-90% of health needs over a person’s lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. Objective: In this implementation report, we describe the design and rollout of Zanzibar’s national, digitally enabled community health program–Jamii ni Afya. Methods: Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. Results: The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. Conclusions: Jamii ni Afya represents one of the world’s first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems. %M 37812488 %R 10.2196/48097 %U https://medinform.jmir.org/2023/1/e48097 %U https://doi.org/10.2196/48097 %U http://www.ncbi.nlm.nih.gov/pubmed/37812488 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47390 %T Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study %A López Seguí,Francesc %A Cos Codina,Joan %A Ricou Ríos,Laura %A Martínez Segura,María Isabel %A Miró Mezquita,Laura %A Escrich Navarro,Raquel %A Davins Riu,Meritxell %A Estrada Cuxart,Oriol %A Anashkin Kachalin,German %A Moreno-Martínez,Daniel %+ Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Camí de les Escoles, s/n, Badalona, 08916, Spain, 34 644 26 91 34, dmorenom.germanstrias@gencat.cat %K change management %K normalization process theory %K NPT %K 3D printing %K readiness for change %K Normalization Measure Development questionnaire %K NoMAD %K implementation %K tertiary hospital %K barrier %K readiness %K printing %K survey %K development %K questionnaire %K support %K communicate %K assessment %K users %K transformation %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. Objective: This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. Methods: We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. Results: In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. Conclusions: The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation. %M 37801353 %R 10.2196/47390 %U https://humanfactors.jmir.org/2023/1/e47390 %U https://doi.org/10.2196/47390 %U http://www.ncbi.nlm.nih.gov/pubmed/37801353 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e49675 %T The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design %A Rego,Chryselle %A Montague,Enid %+ Jarvis College of Computing and Digital Media, DePaul University, 1 E Jackson Blvd, Chicago, IL, 60604, United States, 1 3126873958, crego@depaul.edu %K physician-patient interaction %K cognitive load %K visual feedback %K haptic feedback %K postsession feedback %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors’ ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors’ ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes. Objective: Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants. Methods: This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques. Results: Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual’s cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of −3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of −2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score. Conclusions: Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted. %M 37796596 %R 10.2196/49675 %U https://humanfactors.jmir.org/2023/1/e49675 %U https://doi.org/10.2196/49675 %U http://www.ncbi.nlm.nih.gov/pubmed/37796596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48232 %T Assumptions, Perceptions, and Experiences of Behavioral Health Providers Using Telemedicine: Qualitative Study %A Ainslie,Marcy %A Corvini,Marguerite %A Chadbourne,Jennifer %+ Department of Nursing, University of New Hampshire, Hewitt Hall, #241, 4 Library Way, Durham, NH, 03824, United States, 1 603 862 1261, marcy.ainslie@unh.edu %K telemedicine %K behavioral health %K implementation research %K implementation %K adoption %K telepsychiatry %K mental health %K psychiatry %K clinicians %K providers %K telehealth %K provider %K clinician %K integration %K recommendations %K recommendation %K guidelines %K guideline %K perspective %K experience %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The urgent and reactive implementation of telemedicine during the pandemic does not represent a long-term, strategic, and proactive approach to optimizing this technology. The assumptions, perceptions, and experiences of the behavioral health providers using telemedicine can inform system-wide and institutional-level strategies to promote longitudinal maintenance of care delivery, which can reduce the use of high-cost care due to new symptom onset and symptom exacerbation related to service interruptions. Objective: We aim to identify the assumptions, perspectives, and experiences of behavioral health clinicians and providers using telemedicine to inform the development of an optimized, sustainable approach to telemedicine implementation. Methods: This qualitative study applies the domains of the Consolidated Framework for Implementation Research (CFIR) to structure data collection and analysis from behavioral health providers using telemedicine via an audiovisual connection in the New England region. In total, 12 providers across levels of care were recruited for a 60-minute interview, developed from the CFIR interview guide. Atlas Ti Qualitative Software (version 23; ATLAS.ti Scientific Software Development GmbH) was used to coordinate and facilitate coding among 3 reviewers. Deductive coding was provided from the CFIR interview guide, allowing for data to be categorized by domain and construct. Constructs were analyzed for descriptive themes and tabulated for response frequency. Uncoded data were reviewed and coded in vivo to explore variables contributing to participant perceptions of experience with telemedicine use. Descriptive themes, then analytical themes, were identified. Analytical themes and tabulated frequency of response data were summarized. Finally, a sentiment analysis was completed to derive tone and meaning from the data. Results: Results are reported within the CFIR domains: intervention characteristic, outer setting, inner setting, characteristics of individuals, and process. The findings with ≥90% agreement include “best practice standards were not known”; “telemedicine was believed to be efficient and time-saving for the patient and provider, maximizing productivity and thus increasing access to care”; “telemedicine provided an additional option for patients to access services, promoting sustained continuity and timeliness of care”; “participants did not identify any clear goals related to telemedicine use”; “demonstrated positive affective responses to telemedicine use”; “expressed high efficacy with telemedicine utilization”; and “strong leadership support.” Conclusions: These findings support the development of interstate compacts advancing licensure across state lines; payment parity across modalities of care to ensure the financial vitality of behavioral health services; improved dissemination of telehealth training and resources, and telehealth training in academic programs of the health professions; seamless, dynamic workflows to accommodate the changing needs of patient and care continuity; emergency response protocols; and community partnerships to provide private spaces needed for a therapeutic encounter. Future research exploring the patient’s experience with telemedicine is needed for all stakeholders to be represented in developing a sustainable, integrated system. %M 37788059 %R 10.2196/48232 %U https://formative.jmir.org/2023/1/e48232 %U https://doi.org/10.2196/48232 %U http://www.ncbi.nlm.nih.gov/pubmed/37788059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46491 %T Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study %A Green,James B %A Rodriguez,Joey %A Keshavan,Matcheri %A Lizano,Paulo %A Torous,John %+ Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, United States, 1 508 397 0853, jgreen8@bidmc.harvard.edu %K psychosis %K digital health %K digital mental health %K coordinated specialty care %K digital navigator %K clinical high risk %K schizophrenia %K implementation science %K technology %K mobile phone %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. Objective: In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Methods: Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode–psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. Results: In total, 5 patients (ASPIRE: n=3, 60%; CEDAR: n=2, 40%) were included: 3 (60%) White individuals, 2 (40%) male and 2 (40%) female patients, and 1 (20%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Conclusions: Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care. %M 37788066 %R 10.2196/46491 %U https://formative.jmir.org/2023/1/e46491 %U https://doi.org/10.2196/46491 %U http://www.ncbi.nlm.nih.gov/pubmed/37788066 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e47228 %T Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study %A Bui,Dung T %A Barnett,Tony %A Hoang,Ha %A Chinthammit,Winyu %+ Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, E Block, Newnham Campus, Launceston, 7248, Australia, 61 363243318, dungtrung.bui@utas.edu.au %K augmented reality %K mentorship %K patient simulation %K patient care management %K quasi-experimental study %K telehealth %D 2023 %7 2.10.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. Objective: This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. Methods: This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR’s usability, mentorship effectiveness, and mentees’ self-confidence and skill performance. Results: A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees’ confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees’ individual skill performance rates ranged from 98% in the ACS scenario to 97% in the AMI, PSRA, and HE scenarios. Conclusions: This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research. %M 37782533 %R 10.2196/47228 %U https://mededu.jmir.org/2023/1/e47228 %U https://doi.org/10.2196/47228 %U http://www.ncbi.nlm.nih.gov/pubmed/37782533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45250 %T The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems %A Thomas,Verghese %A Kalidindi,Bharat %A Waghmare,Abijeet %A Bhatia,Abhishek %A Raj,Tony %A Balsari,Satchit %+ Division of Medical Informatics, St John's Research Institute, 100 Feet Rd, John Nagar, Koramangala, Bangalore, 560034, India, 91 080 4946 7000, verghese.t@sjri.res.in %K community health workers %K digital health %K focus group discussions %K health care workers %K human centered design %K key informant interviews %K LMICs %K low- and middle-income countries %K mHealth %K mobile health %K qualitative research %D 2023 %7 2.10.2023 %9 Viewpoint %J JMIR Form Res %G English %X Background: mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users’ perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. Objective: To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. Methods: We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. Results: We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system’s users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system—the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. Conclusions: The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption. %M 37607881 %R 10.2196/45250 %U https://formative.jmir.org/2023/1/e45250 %U https://doi.org/10.2196/45250 %U http://www.ncbi.nlm.nih.gov/pubmed/37607881 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49003 %T Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping %A van Kessel,Robin %A Srivastava,Divya %A Kyriopoulos,Ilias %A Monti,Giovanni %A Novillo-Ortiz,David %A Milman,Ran %A Zhang-Czabanowski,Wojciech Wilhelm %A Nasi,Greta %A Stern,Ariel Dora %A Wharton,George %A Mossialos,Elias %+ LSE Health, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom, 44 7772 707841, e.a.mossialos@lse.ac.uk %K digital health %K telehealth %K telemedicine %K reimbursement %K policy %K Europe %K policy mapping %K mapping %K pricing %K digital health app %K application %K health care ecosystem %K framework %K integration %D 2023 %7 29.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through videoconferencing and asynchronous care (eg, digital apps), research so far has primarily focused on the policy innovations that facilitated this outside of Europe. Objective: This study examines the digital health reimbursement strategies in 8 European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel. Methods: We mapped available digital health reimbursement strategies using a scoping review and policy mapping framework. We reviewed the literature on the MEDLINE, Embase, Global Health, and Web of Science databases. Supplementary records were identified through Google Scholar and country experts. Results: Our search strategy yielded a total of 1559 records, of which 40 (2.57%) were ultimately included in this study. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, although the mechanism of reimbursement differs significantly across countries. At the time of writing, the pricing of digital health solutions was mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in the absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurs via health innovation or digital health–specific funding schemes. European countries have value-based pricing frameworks that range from nonexistent to embryonic. Conclusions: Studied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country health care in another country, even if a digital health app is available in both countries. Furthermore, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualization of digital health, as well as value-based pricing and reimbursement mechanisms, is needed for the sustainable integration of digital health. This study can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves. %M 37773610 %R 10.2196/49003 %U https://mhealth.jmir.org/2023/1/e49003 %U https://doi.org/10.2196/49003 %U http://www.ncbi.nlm.nih.gov/pubmed/37773610 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e40959 %T Successes and Barriers of Health Information Exchange Participation Across Hospitals in South Carolina From 2014 to 2020: Longitudinal Observational Study %A Li,Zhong %A Merrell,Melinda A %A Eberth,Jan M %A Wu,Dezhi %A Hung,Peiyin %+ Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr, Suite 204, Columbia, SC, 29210, United States, 1 8037779867, hungp@mailbox.sc.edu %K health information exchange %K electronic health records %K interoperability %K meaningful use %K hospital %D 2023 %7 28.9.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: The 2009 Health Information Technology for Economic and Clinical Health Act sets three stages of Meaningful Use requirements for the electronic health records incentive program. Health information exchange (HIE) technologies are critical in the meaningful use of electronic health records to support patient care coordination. However, HIE use trends and barriers remain unclear across hospitals in South Carolina (SC), a state with the earliest HIE implementation. Objective: This study aims to explore changes in the proportion of HIE participation and factors associated with HIE participation, and barriers to exchange and interoperability across SC hospitals. Methods: This study derived data from a longitudinal data set of the 2014-2020 American Hospital Association Information Technology Supplement for 69 SC hospitals. The primary outcome was whether a hospital participated in HIE in a year. A cross-sectional multivariable logistic regression model, clustered at the hospital level and weighted by bed size, was used to identify factors associated with HIE participation. The second outcome was barriers to sending, receiving, or finding patient health information to or from other organizations or hospital systems. The frequency of hospitals reporting each barrier related to exchange and interoperability were then calculated. Results: Hospitals in SC have been increasingly participating in HIE, improving from 43% (24/56) in 2014 to 82% (54/66) in 2020. After controlling for other hospital factors, teaching hospitals (adjusted odds ratio [AOR] 3.7, 95% CI 1.0-13.3), system-affiliated hospitals (AOR 6.6, 95% CI 3.2-13.7), and rural referral hospitals (AOR 8.0, 95% CI 1.2-53.4) had higher odds to participate in HIE than their counterparts, whereas critical access hospitals (AOR 0.1, 95% CI 0.02-0.6) were less likely to participate in HIE than their counterparts reimbursed by the prospective payment system. Hospitals with greater ratios of Medicare or Medicaid inpatient days to total inpatient days also reported higher odds of HIE participation. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, including lack of provider contacts (27/40, 68%), difficulty in finding patient health information (27/40, 68%), adapting different vendor platforms (26/40, 65%), difficulty matching or identifying same patients between systems (23/40, 58%), and providers that do not typically exchange patient data (23/40, 58%). Conclusions: HIE participation has been widely adopted in SC hospitals. Our findings highlight the need to incentivize optimization of HIE and seamless information exchange by facilitating and implementing standardization of health information across various HIE systems and by addressing other technical issues, including providing providers’ addresses and training HIE stakeholders to find relevant information. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information. %M 37768730 %R 10.2196/40959 %U https://medinform.jmir.org/2023/1/e40959 %U https://doi.org/10.2196/40959 %U http://www.ncbi.nlm.nih.gov/pubmed/37768730 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e48039 %T Performance of ChatGPT on the Peruvian National Licensing Medical Examination: Cross-Sectional Study %A Flores-Cohaila,Javier A %A García-Vicente,Abigaíl %A Vizcarra-Jiménez,Sonia F %A De la Cruz-Galán,Janith P %A Gutiérrez-Arratia,Jesús D %A Quiroga Torres,Blanca Geraldine %A Taype-Rondan,Alvaro %+ Academic Department, USAMEDIC, Jiron Leon Velarde 171. Lince, Lima, 15073, Peru, 51 924 341 073, javierfloresmed@gmail.com %K medical education %K generative pre-trained transformer %K ChatGPT %K licensing examination %K assessment %K Peru %K Examen Nacional de Medicina %K ENAM %K learning model %K artificial intelligence %K AI %K medical examination %D 2023 %7 28.9.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: ChatGPT has shown impressive performance in national medical licensing examinations, such as the United States Medical Licensing Examination (USMLE), even passing it with expert-level performance. However, there is a lack of research on its performance in low-income countries’ national licensing medical examinations. In Peru, where almost one out of three examinees fails the national licensing medical examination, ChatGPT has the potential to enhance medical education. Objective: We aimed to assess the accuracy of ChatGPT using GPT-3.5 and GPT-4 on the Peruvian National Licensing Medical Examination (Examen Nacional de Medicina [ENAM]). Additionally, we sought to identify factors associated with incorrect answers provided by ChatGPT. Methods: We used the ENAM 2022 data set, which consisted of 180 multiple-choice questions, to evaluate the performance of ChatGPT. Various prompts were used, and accuracy was evaluated. The performance of ChatGPT was compared to that of a sample of 1025 examinees. Factors such as question type, Peruvian-specific knowledge, discrimination, difficulty, quality of questions, and subject were analyzed to determine their influence on incorrect answers. Questions that received incorrect answers underwent a three-step process involving different prompts to explore the potential impact of adding roles and context on ChatGPT’s accuracy. Results: GPT-4 achieved an accuracy of 86% on the ENAM, followed by GPT-3.5 with 77%. The accuracy obtained by the 1025 examinees was 55%. There was a fair agreement (κ=0.38) between GPT-3.5 and GPT-4. Moderate-to-high-difficulty questions were associated with incorrect answers in the crude and adjusted model for GPT-3.5 (odds ratio [OR] 6.6, 95% CI 2.73-15.95) and GPT-4 (OR 33.23, 95% CI 4.3-257.12). After reinputting questions that received incorrect answers, GPT-3.5 went from 41 (100%) to 12 (29%) incorrect answers, and GPT-4 from 25 (100%) to 4 (16%). Conclusions: Our study found that ChatGPT (GPT-3.5 and GPT-4) can achieve expert-level performance on the ENAM, outperforming most of our examinees. We found fair agreement between both GPT-3.5 and GPT-4. Incorrect answers were associated with the difficulty of questions, which may resemble human performance. Furthermore, by reinputting questions that initially received incorrect answers with different prompts containing additional roles and context, ChatGPT achieved improved accuracy. %M 37768724 %R 10.2196/48039 %U https://mededu.jmir.org/2023/1/e48039 %U https://doi.org/10.2196/48039 %U http://www.ncbi.nlm.nih.gov/pubmed/37768724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44886 %T Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care %A Karampatakis,Georgios Dimitrios %A Wood,Helen E %A Griffiths,Chris J %A Lea,Nathan C %A Ashcroft,Richard E %A Day,Bill %A Walker,Neil %A Coulson,Neil S %A De Simoni,Anna %+ Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, United Kingdom, 44 207 882 2520, g.karampatakis@qmul.ac.uk %K data governance %K digital health %K digital intervention %K digital social interventions %K ethics %K information governance %K online health communities %K peer support %K primary care %K social intervention %D 2023 %7 27.9.2023 %9 Viewpoint %J J Med Internet Res %G English %X Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics. %M 37756051 %R 10.2196/44886 %U https://www.jmir.org/2023/1/e44886 %U https://doi.org/10.2196/44886 %U http://www.ncbi.nlm.nih.gov/pubmed/37756051 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44885 %T Preferences of Patients With Musculoskeletal Disorders Regarding the Timing and Channel of eHealth and Factors Influencing Its Use: Mixed Methods Study %A van der Ven,Jeffrey %A van den Bemt,Bart J F %A van Dijk,Liset %A Opdam,Merel %A Haegens,Lex L %A Vriezekolk,Johanna E %A Verhoef,Lise M %+ Department of Research, Sint Maartenskliniek, Hengstdal 3, Ubbergen, 6574NA, Netherlands, 31 243528101, j.vanderven@maartenskliniek.nl %K eHealth %K telehealth %K telemedicine %K chronic diseases %K chronic illness %K musculoskeletal disorders %K multiple methods %K perspectives %K preferences %K citizen science %K digital hospital services %K musculoskeletal %K orthopedic %K citizen %K civic %K society %K health tech %K Capability, Opportunity, Motivation and Behavior Model %K COM-B %K focus group %K rheumatoid arthritis %K arthritis %K rehabilitation %K kinesio %K physio %K rheuma %K thematic analysis %K semistructured interview %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Implementation of eHealth is progressing slowly. In-depth insight into patients’ preferences and needs regarding eHealth might improve its use. Objective: This study aimed to describe when patients want to use eHealth, how patients want to communicate and receive information digitally, and what factors influence the use of eHealth in clinical practice. Methods: A multimethod study was conducted. Two meetings of ~5.5 hours with plenary information sessions and focus groups were held with 22 patients from the rheumatology, orthopedics, and rehabilitation departments of a Dutch hospital specialized in musculoskeletal disorders. Assignments were performed during the focus groups in which qualitative (eg, semistructured interview questions) and quantitative (ie, voting and ranking factors) data were collected. Results: The way patients want to use eHealth varies between patients and moments of a patient’s care pathway. Patients’ digital channel preferences depended on the need for interaction with a health care provider (HCP). The interaction need is in turn influenced by the degree to which information or communication is specific to an individual patient and leads to consequences for the patient. The 5 most important factors influencing the use of eHealth were access to medical information (eg, electronic health records), perceived control over disease management, correctness and completeness of information, data security, and access to information or an HCP at any time. The 5 least important factors influencing eHealth use were help with using digital devices, having internet or equipment, digital skills, attitude or emotions toward eHealth, and societal benefits. Conclusions: Patients identified opportunities for using eHealth during all moments of their care pathway. However, preferences for eHealth varied between patients and phases in the care pathway. As a consequence, eHealth should be tailored to fit individual patients’ preferences but also the need for interaction regarding different topics by offering a variety of digital channels with a gradient of interaction possibilities. Furthermore, digital skills and access to the internet might become less important to focus on in the future. Improving eHealth use by patients may be achieved by providing patients access to correct and safe (medical) information and more control over their care. %M 37756049 %R 10.2196/44885 %U https://humanfactors.jmir.org/2023/1/e44885 %U https://doi.org/10.2196/44885 %U http://www.ncbi.nlm.nih.gov/pubmed/37756049 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49476 %T Usability of Electronic Patient-Reported Outcome Measures for Older Patients With Cancer: Secondary Analysis of Data from an Observational Single Center Study %A Riedl,David %A Lehmann,Jens %A Rothmund,Maria %A Dejaco,Daniel %A Grote,Vincent %A Fischer,Michael J %A Rumpold,Gerhard %A Holzner,Bernhard %A Licht,Thomas %+ Ludwig Boltzmann Institute for Rehabilitation Research, Kurbadstrasse 14, Vienna, 1100, Austria, 43 13615220, david.riedl@rehabilitation.lbg.ac.at %K patient-reported outcomes %K completion rate %K geriatric %K age %K patient reported %K elderly %K older adults %K older adult %K cancer %K oncology %K survivor %K survivors %K questionnaire %K questionnaires %K self-reported %K geriatrics %K gerontology %K survey %K surveys %K mobile phone %D 2023 %7 21.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-reported outcomes are considered the gold standard for assessing subjective health status in oncology patients. Electronic assessment of patient-reported outcomes (ePRO) has become increasingly popular in recent years in both clinical trials and practice. However, there is limited evidence on how well older patients with cancer can complete ePRO assessments. Objective: We aimed to investigate how well adult patients with cancer of different age ranges could complete ePRO assessments at home and in a treatment facility and to identify factors associated with the ability to complete questionnaires electronically. Methods: This retrospective longitudinal single-center study involved survivors of cancer who participated in inpatient rehabilitation. Patients completed ePRO assessments before rehabilitation at home (T1) and after rehabilitation at the facility (T2). We analyzed the rate of patients who could complete the ePRO assessment at T1 and T2, the proportion of patients who required assistance, and the time it took patients to complete standardized questionnaires. Multivariate logistic regression analyses were conducted to identify predictors of ePRO completion rate and the need for assistance. Results: Between 2017 and 2022, a total of 5571 patients were included in this study. Patients had a mean age of 60.3 (SD 12.2) years (range 18 to 93 years), and 1135 (20.3%) of them were classified as geriatric patients (>70 years). While more than 90% (5060/5571) of all patients completed the ePRO assessment, fewer patients in the age group of >70 years (924/1135, 81.4% at T1 vs 963/1135, 84.8% at T2) completed the assessment. Approximately 19% (1056/5571) of patients reported a need for assistance with the ePRO assessment at home, compared to 6.8% (304/4483) at the institution. Patients older than 70 years had a significantly higher need for assistance than those in younger age groups. Moreover, a gender difference was observed, with older women reporting a higher need for assistance than men (71-80 years: women requiring assistance 215/482, 44.6% vs men 96/350, 27.4%; P<.001 and >80 years: women 102/141, 72.3% vs men 57/112, 50.9%; P<.001). On average, patients needed 4.9 (SD 3.20) minutes to remotely complete a 30-item questionnaire (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire) and patients in the older age groups took significantly longer compared to younger age groups. Lower age and higher physical functioning were the clearest predictors for both the ePRO completion rate and the need for assistance in the multivariate regression analysis. Conclusions: This study’s results indicate that ePRO assessment is feasible in older individuals with cancer, but older patients may require assistance (eg, from relatives) to complete home-based assessments. It may be more feasible to conduct assessments in-house in this population. Additionally, it is crucial to carefully consider which resources are necessary and available to support patients in using ePRO devices. %M 37733409 %R 10.2196/49476 %U https://www.jmir.org/2023/1/e49476 %U https://doi.org/10.2196/49476 %U http://www.ncbi.nlm.nih.gov/pubmed/37733409 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46847 %T Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study %A Ming,David Y %A Wong,Willis %A Jones,Kelley A %A Antonelli,Richard C %A Gujral,Nitin %A Gonzales,Sarah %A Rogers,Ursula %A Ratliff,William %A Shah,Nirmish %A King,Heather A %+ Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Rd, DUMC Box 102376, Durham, NC, 27710, United States, 1 9196683093, david.ming@duke.edu %K digital health %K personal health record %K children with special health care needs %K care coordination %K mixed methods %K mobile phone %D 2023 %7 20.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Electronic health record (EHR)–integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. Objective: This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. Methods: This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app’s use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child’s medical record, families’ abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child’s primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. Results: Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. Conclusions: Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. Trial Registration: ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235 International Registered Report Identifier (IRRID): DERR1-10.2196/46847 %M 37728977 %R 10.2196/46847 %U https://www.researchprotocols.org/2023/1/e46847 %U https://doi.org/10.2196/46847 %U http://www.ncbi.nlm.nih.gov/pubmed/37728977 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41409 %T Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study %A Noort,Bart A C %A Buijs,Paul %A Roemeling,Oskar %+ Department of Operations, Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, Netherlands, 31 631986866, a.c.noort@rug.nl %K health care logistics %K outsourcing %K web ordering portal %K medical devices %K feasibility study %K device management %D 2023 %7 19.9.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively. Objective: This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users’ acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention’s preliminary efficacy, thus benefiting practitioners and researchers. Methods: This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti–pressure ulcer mattresses. Results: Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti–pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (−2.7 min) and anti–pressure ulcer mattresses (−3.1 min), as well as shorter delivery times for wheelchairs (−0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful. Conclusions: This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions. %M 37725420 %R 10.2196/41409 %U https://www.i-jmr.org/2023/1/e41409 %U https://doi.org/10.2196/41409 %U http://www.ncbi.nlm.nih.gov/pubmed/37725420 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e51776 %T Shaping the Future of Older Adult Care: ChatGPT, Advanced AI, and the Transformation of Clinical Practice %A Fear,Kathleen %A Gleber,Conrad %+ UR Health Lab, University of Rochester Medical Center, 30 Corporate Woods, Suite 180, Rochester, NY, 14623, United States, 1 585 341 4954, kathleen_fear@urmc.rochester.edu %K generative AI %K artificial intelligence %K large language models %K ChatGPT %K Generative Pre-trained Transformer %D 2023 %7 13.9.2023 %9 Guest Editorial %J JMIR Aging %G English %X As the older adult population in the United States grows, new approaches to managing and streamlining clinical work are needed to accommodate their increased demand for health care. Deep learning and generative artificial intelligence (AI) have the potential to transform how care is delivered and how clinicians practice in geriatrics. In this editorial, we explore the opportunities and limitations of these technologies. %M 37703085 %R 10.2196/51776 %U https://aging.jmir.org/2023/1/e51776 %U https://doi.org/10.2196/51776 %U http://www.ncbi.nlm.nih.gov/pubmed/37703085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45437 %T Health Providers’ Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis %A Gu,Yu %A Guan,Yushan %A Meng,Zhaolin %+ School of Nursing, Capital Medical University, NO 10 Xi Toutiao Road, Beijing, 100069, China, 86 010 83916503, mengzhaolin@ccmu.edu.cn %K mHealth %K mobile health %K health providers %K adoption %K chronic noncommunicable diseases %K systematic review %K meta-synthesis %K mobile phone %D 2023 %7 12.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential. Objective: This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Methods: A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach. Results: A total of 18,242 studies were identified, of which 24 (0.13%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth. Conclusions: This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs. %M 37698902 %R 10.2196/45437 %U https://www.jmir.org/2023/1/e45437 %U https://doi.org/10.2196/45437 %U http://www.ncbi.nlm.nih.gov/pubmed/37698902 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47971 %T Implementation of Machine Learning Applications in Health Care Organizations: Protocol for a Systematic Review of Empirical Studies %A Ardito,Vittoria %A Cappellaro,Giulia %A Compagni,Amelia %A Petracca,Francesco %A Preti,Luigi Maria %+ Department of Social and Political Sciences, Bocconi University, Via Roentgen 1, Milan, 20136, Italy, 39 025836526, giulia.cappellaro@unibocconi.it %K artificial intelligence %K barriers %K facilitators %K health care organization %K implementation %K machine learning %D 2023 %7 12.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: An increasing interest in machine learning (ML) has been observed among scholars and health care professionals. However, while ML-based applications have been shown to be effective and have the potential to change the delivery of patient care, their implementation in health care organizations is complex. There are several challenges that currently hamper the uptake of ML in daily practice, and there is currently limited knowledge on how these challenges have been addressed in empirical studies on implemented ML-based applications. Objective: The aim of this systematic literature review is twofold: (1) to map the ML-based applications implemented in health care organizations, with a focus on investigating the organizational dimensions that are relevant in the implementation process; and (2) to analyze the processes and strategies adopted to foster a successful uptake of ML. Methods: We developed this protocol following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The search was conducted on 3 databases (PubMed, Scopus, and Web of Science), considering a 10-year time frame (2013-2023). The search strategy was built around 4 blocks of keywords (artificial intelligence, implementation, health care, and study type). Based on the detailed inclusion criteria defined, only empirical studies documenting the implementation of ML-based applications used by health care professionals in clinical settings will be considered. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). Results: The review is ongoing and is expected to be completed by September 2023. Data analysis is currently underway, and the first results are expected to be submitted for publication in November 2023. The study was funded by the European Union within the Multilayered Urban Sustainability Action (MUSA) project. Conclusions: ML-based applications involving clinical decision support and automation of clinical tasks present unique traits that add several layers of complexity compared with earlier health technologies. Our review aims at contributing to the existing literature by investigating the implementation of ML from an organizational perspective and by systematizing a conspicuous amount of information on factors influencing implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/47971 %M 37698910 %R 10.2196/47971 %U https://www.researchprotocols.org/2023/1/e47971 %U https://doi.org/10.2196/47971 %U http://www.ncbi.nlm.nih.gov/pubmed/37698910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44759 %T The Current Status of the Use of Internet Hospitals for Outpatients With Pain: Retrospective Study %A Sang,Ling %A Song,Li %+ Department of Pain Management, West China Hospital, Sichuan University, No 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, China, 86 18980601501, song_li76@163.com %K internet hospital %K internet + %K pain management %K online visit %K outpatient %K pain %D 2023 %7 11.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The national “Internet +” policies and the emergence of internet hospitals have created a new direction for the management of pain outside of the hospital. Nevertheless, there are no consolidated studies conducted by pain physicians on the current state of internet hospital–based online medical services used by patients with pain outside of a hospital setting. Objective: In this retrospective study, we aimed to examine the status of the use of internet hospitals by patients who experience pain. Moreover, we identified the factors that influenced patients' decisions to make an online visit through the internet hospital. Methods: Detailed information was collected online and offline from outpatients with pain at the information technology center of West China Hospital of Sichuan University from February 2020 to April 2022. Binary logistic regression analysis was conducted to identify the determinants that influenced patients' decisions to make an online visit to the internet hospital. Results: Over a 2-year period, 85,266 pain-related clinic visits were recorded. Ultimately, 39,260 patients were enrolled for the analysis, with 12.9% (5088/39,260) having online visits. Both online and offline clinics had a greater number of visits by women than men. The average age of patients attending the online clinic was 46.85 (SD 16.56) years, whereas the average age of patients attending the offline clinic was 51.48 (SD 16.12) years. The majority of online clinic visitors (3059/5088, 60.1%) were employed, and one of the most common occupations was farming (721/5088, 14.2%). In addition, 51.8% (2635/5088) of patients who participated in the online clinics lived outside the hospital vicinity. Young (odds ratio [OR] 1.35, 95% CI 1.01-1.81; P=.045) and middle-aged (OR 1.98, 95% CI 1.81-2.16; P<.001) patients, employed patients (OR 1.11, 95% CI 1.04-1.18; P=.002), nonlocal patients (OR 1.57, 95% CI 1.48-1.67; P<.001), and the ordinary staff (OR 1.19, 95%CI 1.01-1.39; P=.03) were more likely to have the intention to choose online visits through the internet hospitals. Conclusions: Internet hospitals are flourishing as a more efficient and promising method of pain management and follow-up for patients with pain outside the hospital. People with pain who are young, working, and not in the vicinity of hospitals are more likely to visit internet hospitals. %M 37695652 %R 10.2196/44759 %U https://www.jmir.org/2023/1/e44759 %U https://doi.org/10.2196/44759 %U http://www.ncbi.nlm.nih.gov/pubmed/37695652 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e47187 %T Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial %A Ester,Manuel %A Wagoner,Chad W %A Dreger,Julianna %A Chen,Guanmin %A McDonough,Meghan H %A McNeely,Margaret L %A Culos-Reed,S Nicole %+ Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada, 1 4032108482, manuel.ester@ucalgary.ca %K eHealth %K mHealth %K mobile health %K mobile apps %K self-monitoring %K cancer %K oncology %K physical activity %K exercise %K randomized controlled trial %K intervention %K mobile phone %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. Objective: This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. Methods: This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome—self-reported moderate-to-vigorous PA (MVPA) minutes—and secondary outcomes—objective MVPA minutes and steps and app usability ratings—were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. Results: Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). Conclusions: The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. Trial Registration: ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2021.106474 %M 37676714 %R 10.2196/47187 %U https://cancer.jmir.org/2023/1/e47187 %U https://doi.org/10.2196/47187 %U http://www.ncbi.nlm.nih.gov/pubmed/37676714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41635 %T Trust and Health Information Exchanges: Qualitative Analysis of the Intent to Share Personal Health Information %A Busch-Casler,Julia %A Radic,Marija %+ Fraunhofer Center for International Management and Knowledge Economy IMW, Neumarkt 9-19, Leipzig, 04109, Germany, 49 341231039249, julia.busch-casler@imw.fraunhofer.de %K trust %K eHealth %K data sharing %K sharing personal health information %K privacy %K security %K health information exchange %K consent %K data exchange %K belief-attitude-intention %K behavior formation %D 2023 %7 30.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health has the potential to improve the quality of care, reduce health care costs, and increase patient satisfaction. Patient acceptance and consent are a prerequisite for effective sharing of personal health information (PHI) through health information exchanges (HIEs). Patients need to form and retain trust in the system(s) they use to leverage the full potential of digital health. Germany is at the forefront of approving digital treatment options with cost coverage through statutory health insurance. However, the German population has a high level of technology skepticism and a low level of trust, providing a good basis to illuminate various facets of eHealth trust formation. Objective: In a German setting, we aimed to answer the question, How does an individual form a behavioral intent to share PHI with an HIE platform? We discussed trust and informed consent through (1) synthesizing the main influence factor models into a complex model of trust in HIE, (2) providing initial validation of influence factors based on a qualitative study with patient interviews, and (3) developing a model of trust formation for digital health apps. Methods: We developed a complex model of the formation of trust and the intent to share PHI. We provided initial validation of the influence factors through 20 qualitative, semistructured interviews in the German health care setting and used a deductive coding approach to analyze the data. Results: We found that German patients show a positive intent to share their PHI with HIEs under certain conditions. These include (perceived) information security and a noncommercial organization as the recipient of the PHI. Technology experience, age, policy and regulation, and a disposition to trust play an important role in an individual’s privacy concern, which, combined with social influence, affects trust formation on a cognitive and emotional level. We found a high level of cognitive trust in health care and noncommercial research institutions but distrust in commercial entities. We further found that in-person interactions with physicians increase trust in digital health apps and PHI sharing. Patients’ emotional trust depends on disposition and social influences. To form their intent to share, patients undergo a privacy calculus. Hereby, the individual’s benefit (eg, convenience), benefits for the individual’s own health, and the benefits for public welfare often outweigh the perceived risks of sharing PHI. Conclusions: With the higher demand for timely PHI, HIE providers will need to clearly communicate the benefits of their solutions and their information security measures to health care providers (physicians, nursing and administrative staff) and patients and include them as key partners to increase trust. Offering easy access and educational measures as well as the option for specific consent may increase patients’ trust and their intention to share PHI. %M 37647102 %R 10.2196/41635 %U https://www.jmir.org/2023/1/e41635 %U https://doi.org/10.2196/41635 %U http://www.ncbi.nlm.nih.gov/pubmed/37647102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44114 %T A Data Taxonomy for Adaptive Multifactor Authentication in the Internet of Health Care Things %A Suleski,Tance %A Ahmed,Mohiuddin %+ School of Science, Edith Cowan University, 270 Joondalup Dr, Joondalup WA, Perth, 6027, Australia, 61 13 43 28, tsuleski@our.ecu.edu.au %K health care %K authentication %K contextual data model %K Internet of Health Care Things %K multifactor %K mobile phone %D 2023 %7 29.8.2023 %9 Viewpoint %J J Med Internet Res %G English %X The health care industry has faced various challenges over the past decade as we move toward a digital future where services and data are available on demand. The systems of interconnected devices, users, data, and working environments are referred to as the Internet of Health Care Things (IoHT). IoHT devices have emerged in the past decade as cost-effective solutions with large scalability capabilities to address the constraints on limited resources. These devices cater to the need for remote health care services outside of physical interactions. However, IoHT security is often overlooked because the devices are quickly deployed and configured as solutions to meet the demands of a heavily saturated industry. During the COVID-19 pandemic, studies have shown that cybercriminals are exploiting the health care industry, and data breaches are targeting user credentials through authentication vulnerabilities. Poor password use and management and the lack of multifactor authentication security posture within IoHT cause a loss of millions according to the IBM reports. Therefore, it is important that health care authentication security moves toward adaptive multifactor authentication (AMFA) to replace the traditional approaches to authentication. We identified a lack of taxonomy for data models that particularly focus on IoHT data architecture to improve the feasibility of AMFA. This viewpoint focuses on identifying key cybersecurity challenges in a theoretical framework for a data model that summarizes the main components of IoHT data. The data are to be used in modalities that are suited for health care users in modern IoHT environments and in response to the COVID-19 pandemic. To establish the data taxonomy, a review of recent IoHT papers was conducted to discuss the related work in IoHT data management and use in next-generation authentication systems. Reports, journal articles, conferences, and white papers were reviewed for IoHT authentication data technologies in relation to the problem statement of remote authentication and user management systems. Only publications written in English from the last decade were included (2012-2022) to identify key issues within the current health care practices and their management of IoHT devices. We discuss the components of the IoHT architecture from the perspective of data management and sensitivity to ensure privacy for all users. The data model addresses the security requirements of IoHT users, environments, and devices toward the automation of AMFA in health care. We found that in health care authentication, the significant threats occurring were related to data breaches owing to weak security options and poor user configuration of IoHT devices. The security requirements of IoHT data architecture and identified impactful methods of cybersecurity for health care devices, data, and their respective attacks are discussed. Data taxonomy provides better understanding, solutions, and improvements of user authentication in remote working environments for security features. %M 37490633 %R 10.2196/44114 %U https://www.jmir.org/2023/1/e44114 %U https://doi.org/10.2196/44114 %U http://www.ncbi.nlm.nih.gov/pubmed/37490633 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46722 %T Changes in Documentation Due to Patient Access to Electronic Health Records: Protocol for a Scoping Review %A Meier-Diedrich,Eva %A Davidge,Gail %A Hägglund,Maria %A Kharko,Anna %A Lyckblad,Camilla %A McMillan,Brian %A Blease,Charlotte %A Schwarz,Julian %+ Brandenburg Medical School, Immanuel Hospital Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 176 22 65 26 2, julian.schwarz@mhb-fontane.de %K electronic health record %K patient-accessible electronic health record %K patient portal %K electronic portal %K scoping review %K patient access %K documentation change %K natural language processing %K patient-clinician relationship %K online record access %K review method %K library science %K librarian %D 2023 %7 28.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Internationally, patient-accessible electronic health records (PAEHRs) are increasingly being implemented. Despite reported benefits to patients, the innovation has prompted concerns among health care professionals (HCPs), including the possibility that access incurs a “dumbing down” of clinical records. Currently, no review has investigated empirical evidence of whether and how documentation changes after introducing PAEHRs. Objective: This paper presents the protocol for a scoping review examining potential subjective and objective changes in HCPs documentation after using PAEHRs. Methods: This scoping review will be carried out based on the framework of Arksey and O’Malley. Several databases will be used to conduct a literature search (APA PsycInfo, CINAHL, PubMed, and Web of Science Core Collection). Authors will participate in screening identified papers to explore the research questions: How do PAEHRs affect HCPs’ documentation practices? and What subjective and objective changes to the clinical notes arise after patient access? Only studies that relate to actual use experiences, and not merely prior expectations about PAEHRs, will be selected in the review. Data abstraction will include but will not be limited to publication type, publication year, country, sample characteristics, setting, study aim, research question, and conclusions. The Mixed Methods Appraisal Tool will be used to assess the quality of the studies included. Results: The results from this scoping review will be presented as a narrative synthesis structured along the key themes of the corpus of evidence. Additional data will be prepared in charts or tabular format. We anticipate the results to be presented in a scoping review at a later date. They will be disseminated at scientific conferences and through publication in a peer-reviewed journal. Conclusions: This is the first scoping review that considers potential change in documentation after implementation of PAEHRs. The results can potentially help affirm or refute prior opinions and expectations among various stakeholders about the use of PAEHRs and thereby help to address uncertainties. Results may help to provide guidance to clinicians in writing notes and thus have immediate practical relevance to care. In addition, the review will help to identify any substantive research gaps in this field of research. In the longer term, our findings may contribute to the development of shared documentation guidelines, which in turn are central to improving patient communication and safety. International Registered Report Identifier (IRRID): PRR1-10.2196/46722 %M 37639298 %R 10.2196/46722 %U https://www.researchprotocols.org/2023/1/e46722 %U https://doi.org/10.2196/46722 %U http://www.ncbi.nlm.nih.gov/pubmed/37639298 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47335 %T Barriers and Enablers for Implementation of an Artificial Intelligence–Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews %A Nair,Monika %A Andersson,Jonas %A Nygren,Jens M %A Lundgren,Lina E %+ School of Business, Innovation and Sustainability, Halmstad University, Kristian IV:s väg 3, Halmstad, 30118, Sweden, 46 707227544, lina.lundgren@hh.se %K implementation %K AI systems %K health care %K interviews %K artificial Intelligence %K AI %K decision support tool %K readmission %K prediction %K heart failure %K digital tool %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. Objective: This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Methods: Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Results: Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Conclusions: Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process. %M 37610799 %R 10.2196/47335 %U https://formative.jmir.org/2023/1/e47335 %U https://doi.org/10.2196/47335 %U http://www.ncbi.nlm.nih.gov/pubmed/37610799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46711 %T Key Considerations When Developing and Implementing Digital Technology for Early Detection of Dementia-Causing Diseases Among Health Care Professionals: Qualitative Study %A Wilson,Sarah %A Tolley,Clare %A Mc Ardle,Riona %A Beswick,Emily %A Slight,Sarah P %+ School of Pharmacy, Newcastle University, King George VI building, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 1912082358, sarah.wilson@newcastle.ac.uk %K qualitative %K health care professional %K early detection of disease %K dementia %K digital technology %K early detection of dementia %K digital health %K health care worker %K digital tool %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice. Objective: This study aimed to explore health care professionals’ perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS). Methods: Health care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made. Results: Eighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone. Conclusions: This study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity. %M 37606986 %R 10.2196/46711 %U https://www.jmir.org/2023/1/e46711 %U https://doi.org/10.2196/46711 %U http://www.ncbi.nlm.nih.gov/pubmed/37606986 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48155 %T Clinical Integration of Digital Patient-Reported Outcome Measures in Primary Health Care for Chronic Disease Management: Protocol for a Systematic Review %A Sasseville,Maxime %A Supper,Wilfried %A Gartner,Jean-Baptiste %A Layani,Géraldine %A Amil,Samira %A Sheffield,Peter %A Gagnon,Marie-Pierre %A Hudon,Catherine %A Lambert,Sylvie %A Attisso,Eugène %A Bureau Lagarde,Victoria %A Breton,Mylaine %A Poitras,Marie-Eve %A Pluye,Pierre %A Roux-Levy,Pierre-Henri %A Plaisimond,James %A Bergeron,Frédéric %A Ashcroft,Rachelle %A Wong,Sabrina %A Groulx,Antoine %A Beaudet,Nicolas %A Paquette,Jean-Sébastien %A D'Anjou,Natasha %A Langlois,Sylviane %A LeBlanc,Annie %+ Université Laval, 1050, rue de la Médecine, Québec, QC, G1V 0A6, Canada, 1 418 656 2131, maxime.sasseville@fsi.ulaval.ca %K systematic review %K patient-reported outcome measure %K primary healthcare %K health care %K implementation science %D 2023 %7 18.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health measurement guides policies and health care decisions are necessary to describe and attain the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. In the primary care setting, patient-reported outcome measurement allows outcome comparisons within and across settings and helps improve the clinical management of patients. However, these digital patient-reported outcome measures (PROMs) are still not adapted to the clinical context of primary health care, which is an indication of the complexity of integrating these tools in this context. We must then gather evidence of their impact on chronic disease management in primary health care and understand the characteristics of effective implementation. Objective: We will conduct a systematic review to identify and assess the impact of electronic PROMs (ePROMs) implementation in primary health care for chronic disease management. Our specific objectives are to (1) determine the impact of ePROMs in primary health care for chronic disease management and (2) compare and contrast characteristics of effective ePROMs’ implementation strategies. Methods: We will conduct a systematic review of the literature in accordance with the guidelines of the Cochrane Methods Group and in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for its reporting. A specific search strategy was developed for relevant databases to identify studies. Two reviewers will independently apply the inclusion criteria using full texts and will extract the data. We will use a 2-phase sequential mixed methods synthesis design by conducting a qualitative synthesis first, and use its results to perform a quantitative synthesis. Results: This study was initiated in June 2022 by assembling the research team and the knowledge transfer committee. The preliminary search strategy will be developed and completed in September 2022. The main search strategy, data collection, study selection, and application of inclusion criteria were completed between October and December 2022. Conclusions: Results from this review will help support implementation efforts to accelerate innovations and digital adoption for primary health care and will be relevant for improving clinical management of chronic diseases and health care services and policies. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022333513; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333513 International Registered Report Identifier (IRRID): DERR1-10.2196/48155 %M 37594780 %R 10.2196/48155 %U https://www.researchprotocols.org/2023/1/e48155 %U https://doi.org/10.2196/48155 %U http://www.ncbi.nlm.nih.gov/pubmed/37594780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47436 %T Design and Early Use of the Nationally Implemented Healthier You National Health Service Digital Diabetes Prevention Programme: Mixed Methods Study %A Ross,Jamie %A Hawkes,Rhiannon E %A Miles,Lisa M %A Cotterill,Sarah %A Bower,Peter %A Murray,Elizabeth %+ Centre for Primary Care, Wolfson Institute of Population Health Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, United Kingdom, 44 02080168037, jamie.ross@qmul.ac.uk %K digital health %K engagement %K diabetes prevention %K mobile phone %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Healthier You National Health Service Digital Diabetes Prevention Programme (NHS-digital-DPP) is a 9-month digital behavior change intervention delivered by 4 independent providers that is implemented nationally across England. No studies have explored the design features included by service providers of digital diabetes prevention programs to promote engagement, and little is known about how participants of nationally implemented digital diabetes prevention programs such as this one make use of them. Objective: This study aimed to understand engagement with the NHS-digital-DPP. The specific objectives were to describe how engagement with the NHS-digital-DPP is promoted via design features and strategies and describe participants’ early engagement with the NHS-digital-DPP apps. Methods: Mixed methods were used. The qualitative study was a secondary analysis of documents detailing the NHS-digital-DPP intervention design and interviews with program developers (n=6). Data were deductively coded according to an established framework of engagement with digital health interventions. For the quantitative study, anonymous use data collected over 9 months for each provider representing participants’ first 30 days of use of the apps were obtained for participants enrolled in the NHS-digital-DPP. Use data fields were categorized into 4 intervention features (Track, Learn, Coach Interactions, and Peer Support). The amount of engagement with the intervention features was calculated for the entire cohort, and the differences between providers were explored statistically. Results: Data were available for 12,857 participants who enrolled in the NHS-digital-DPP during the data collection phase. Overall, 94.37% (12,133/12,857) of those enrolled engaged with the apps in the first 30 days. The median (IQR) number of days of use was 11 (2-25). Track features were engaged with the most (number of tracking events: median 46, IQR 3-22), and Peer Support features were the least engaged with, a median value of 0 (IQR 0-0). Differences in engagement with features were observed across providers. Qualitative findings offer explanations for the variations, including suggesting the importance of health coaches, reminders, and regular content updates to facilitate early engagement. Conclusions: Almost all participants in the NHS-digital-DPP started using the apps. Differences across providers identified by the mixed methods analysis provide the opportunity to identify features that are important for engagement with digital health interventions and could inform the design of other digital behavior change interventions. %M 37590056 %R 10.2196/47436 %U https://www.jmir.org/2023/1/e47436 %U https://doi.org/10.2196/47436 %U http://www.ncbi.nlm.nih.gov/pubmed/37590056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45016 %T Patient Use, Experience, and Satisfaction With Telehealth in an Australian Population (Reimagining Health Care): Web-Based Survey Study %A Thomas,Elizabeth %A Lee,Crystal Man Ying %A Norman,Richard %A Wells,Leanne %A Shaw,Tim %A Nesbitt,Julia %A Frean,Isobel %A Baxby,Luke %A Bennett,Sabine %A Robinson,Suzanne %+ School of Population Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 428386285, libby.thomas@curtin.edu.au %K telehealth %K consumer experience %K demographic influence %K population survey %K health care survey %K telemedicine %K Australia %K participant recruitment %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. Objective: The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. Methods: A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. Results: Of the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor’s degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. Conclusions: There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor’s degree. %M 37590037 %R 10.2196/45016 %U https://www.jmir.org/2023/1/e45016 %U https://doi.org/10.2196/45016 %U http://www.ncbi.nlm.nih.gov/pubmed/37590037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46953 %T Association Between Online Health Information–Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China %A Wang,Jiamin %A Zhen,Xuemei %A Coyte,Peter C %A Shao,Di %A Zhao,Ni %A Chang,Lele %A Feng,Yujia %A Sun,Xiaojie %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, West-Wenhua Road, 44, Jinan, 250012, China, 86 531 88382526, xiaojiesun@sdu.edu.cn %K online health information–seeking behaviors %K patient delay %K diagnostic delay %K treatment delay %K mixed methods study %D 2023 %7 16.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information–seeking (OHIS) behaviors by caregivers. Objective: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children’s health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers’ OHIS behaviors impacted the cancer care pathway by influencing caregivers’ symptom appraisal before the first medical contact and caregivers’ acceptance of health care providers’ diagnostic and treatment decisions. Conclusions: Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers’ cancer symptom appraisal before the first medical contact. %M 37585244 %R 10.2196/46953 %U https://www.jmir.org/2023/1/e46953 %U https://doi.org/10.2196/46953 %U http://www.ncbi.nlm.nih.gov/pubmed/37585244 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e46819 %T Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study %A Livesay,Karen %A Petersen,Sacha %A Walter,Ruby %A Zhao,Lin %A Butler-Henderson,Kerryn %A Abdolkhani,Robab %+ School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, 289 McKimmies Rd, Bundoora, Melbourne, 3083, Australia, 61 98098654, robab.abdolkhani@rmit.edu.au %K nursing informatics %K digital health %K COVID-19 pandemic %K workforce %K sociotechnical approach %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic. Objective: This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce. Methods: Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use. Results: Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses’ lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making. Conclusions: Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce. %M 37585256 %R 10.2196/46819 %U https://nursing.jmir.org/2023/1/e46819 %U https://doi.org/10.2196/46819 %U http://www.ncbi.nlm.nih.gov/pubmed/37585256 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45504 %T Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review %A Bayshtok,Gabriella %A Tiosano,Shmuel %A Furer,Ariel %+ Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 972 52 927 7372, furera@gmail.com %K cardiac fitness %K cardiac patient %K cardiorespiratory fitness %K CRF %K clinical cardiology %K oxygen consumption %K peak VO2 %K smartwatch %K wearable device %D 2023 %7 15.8.2023 %9 Case Report %J Interact J Med Res %G English %X Background: Oxygen consumption is an important index to evaluate in cardiac patients, particularly those with heart failure, and is measured in the setting of advanced cardiopulmonary exercise testing. However, technological advances now allow for the estimation of this parameter in many consumer and medical-grade wearable devices, making it available for the medical provider at the initial evaluation of patients. We report a case of an apparently healthy male aged 40 years who presented for evaluation due to an Apple Watch (Apple Inc) notification of low cardiac fitness. This alert triggered a thorough workup, revealing a diagnosis of familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. While the use of wearable devices for the measurement of oxygen consumption and related parameters is promising, further studies are needed for validation. Objective: The aim of this report is to investigate the potential utility of wearable devices as a screening and risk stratification tool for cardiac fitness for the general population and those with increased cardiovascular risk, particularly through the measurement of peak oxygen consumption (VO2). We discuss the possible advantages of measuring oxygen consumption using wearables and propose its integration into routine patient evaluation and follow-up processes. With the current evidence and limitations, we encourage researchers and clinicians to explore bringing wearable devices into clinical practice. Methods: The case was identified at Sheba Medical Center, and the patient’s cardiac fitness was monitored through an Apple Watch Series 6. The patient underwent a comprehensive cardiac workup following his presentation. Subsequently, we searched the literature for articles relating to the clinical utility of peak VO2 monitoring and available wearable devices. Results: The Apple Watch data provided by the patient demonstrated reduced peak VO2, a surrogate index for cardiac fitness, which improved after treatment initiation. A cardiological workup confirmed familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. A review of the literature revealed the potential clinical benefit of peak VO2 monitoring in both cardiac and noncardiac scenarios. Additionally, several devices on the market were identified that could allow for accurate oxygen consumption measurement; however, future studies and approval by the Food and Drug Administration (FDA) are still necessary. Conclusions: This case report highlights the potential utility of peak VO2 measurements by wearable devices for early identification and screening of cardiac fitness for the general population and those at increased risk of cardiovascular disease. The integration of wearable devices into routine patient evaluation may allow for earlier presentation in the diagnostic workflow. Cardiac fitness can be serially measured using the wearable device, allowing for close monitoring of functional capacity parameters. Devices need to be used with caution, and further studies are warranted. %M 37581915 %R 10.2196/45504 %U https://www.i-jmr.org/2023/1/e45504 %U https://doi.org/10.2196/45504 %U http://www.ncbi.nlm.nih.gov/pubmed/37581915 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43727 %T Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review %A Forbes,Ainslie %A Keleher,Madeline Rose %A Venditto,Michael %A DiBiasi,Faith %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 301 956 2702, ainslie.forbes@otsuka-us.com %K digital therapeutics %K digital interventions %K digital health %K mobile health %K mobile phone %K depression %K major depressive disorder %K engagement %K adherence %K systematic literature review %D 2023 %7 11.8.2023 %9 Review %J J Med Internet Res %G English %X Background: New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. Objective: This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. Methods: We focused on a participant population of adults (aged ≥18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. Results: This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. Conclusions: Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations. %M 37566447 %R 10.2196/43727 %U https://www.jmir.org/2023/1/e43727 %U https://doi.org/10.2196/43727 %U http://www.ncbi.nlm.nih.gov/pubmed/37566447 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37136 %T Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial %A Coulibaly,Abou %A Kouanda,Séni %+ Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Ouagadougou, BP 7047, Burkina Faso, 226 71407789, samsoncoul@gmail.com %K telemedicine %K PANDA %K pregnancy and newborn diagnostic assessment %K quality %K antenatal care %K Burkina Faso %K trial %K pregnancy %K pregnant %K newborn %K diagnostic %K mobile app %K prenatal care %K randomized trial %K first trimester %K postpartum %K qualitative research %K maternity %K prenatal %K antenatal %K mobile phone %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. Objective: This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women’s satisfaction, women’s knowledge on birth preparedness and complication readiness, maternal and child health service use, men’s involvement in maternal health service utilization, and women’s contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. Methods: This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. Results: The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. Conclusions: The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374 International Registered Report Identifier (IRRID): DERR1-10.2196/37136 %M 37556195 %R 10.2196/37136 %U https://www.researchprotocols.org/2023/1/e37136 %U https://doi.org/10.2196/37136 %U http://www.ncbi.nlm.nih.gov/pubmed/37556195 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45602 %T Nurses’ Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey %A Zhang,Jinghui %A Peng,Sha %A Hou,Jianmei %A Ma,Guiyuan %A Liu,Yanhui %A Fan,Yuhua %A Luo,Lingxia %A Shi,Zhengkun %+ Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, China, 86 15874032339, zhangjh-1206@163.com %K Internet+home care services %K willingness %K demand %K clinical nurses %K municipal hospitals %D 2023 %7 4.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses’ willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses’ willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >¥10,000 increased the likelihood of nurses’ willingness to provide IHC services, by 1.187 times, compared with an income <¥5000. Nurses’ total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses’ demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of ¥5000 to ¥10,000 (B=0.894, P<.001) and >¥10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <¥5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses’ willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. %M 37540546 %R 10.2196/45602 %U https://www.jmir.org/2023/1/e45602 %U https://doi.org/10.2196/45602 %U http://www.ncbi.nlm.nih.gov/pubmed/37540546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47094 %T Economic Evaluation Associated With Clinical-Grade Mobile App–Based Digital Therapeutic Interventions: Systematic Review %A Sapanel,Yoann %A Tadeo,Xavier %A Brenna,Connor T A %A Remus,Alexandria %A Koerber,Florian %A Cloutier,L Martin %A Tremblay,Gabriel %A Blasiak,Agata %A Hardesty,Chris L %A Yoong,Joanne %A Ho,Dean %+ The Institute for Digital Medicine WisDM, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Dr, Singapore, 439944, Singapore, 65 66017766, yoann@nus.edu.sg %K digital health %K digital therapeutics %K economic evaluation %K cost-effectiveness %K mobile phone %K systematic review %D 2023 %7 1.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of medical disorders and diseases as well as deliver unprecedented portability for patients and scalability for health care providers. Their adoption and implementation were accelerated by the need for remote care during the COVID-19 pandemic, and awareness about their utility has rapidly grown among providers, payers, and regulators. Despite this, relatively little is known about the capacity of DTx to provide economic value in care. Objective: This study aimed to systematically review and summarize the published evidence regarding the cost-effectiveness of clinical-grade mobile app–based DTx and explore the factors affecting such evaluations. Methods: A systematic review of economic evaluations of clinical-grade mobile app–based DTx was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Major electronic databases, including PubMed, Cochrane Library, and Web of Science, were searched for eligible studies published from inception to October 28, 2022. Two independent reviewers evaluated the eligibility of all the retrieved articles for inclusion in the review. Methodological quality and risk of bias were assessed for each included study. Results: A total of 18 studies were included in this review. Of the 18 studies, 7 (39%) were nonrandomized study–based economic evaluations, 6 (33%) were model-based evaluations, and 5 (28%) were randomized clinical trial–based evaluations. The DTx intervention subject to assessment was found to be cost-effective in 12 (67%) studies, cost saving in 5 (28%) studies, and cost-effective in 1 (6%) study in only 1 of the 3 countries where it was being deployed in the final study. Qualitative deficiencies in methodology and substantial potential for bias, including risks of performance bias and selection bias in participant recruitment, were identified in several included studies. Conclusions: This systematic review supports the thesis that DTx interventions offer potential economic benefits. However, DTx economic analyses conducted to date exhibit important methodological shortcomings that must be addressed in future evaluations to reduce the uncertainty surrounding the widespread adoption of DTx interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022358616; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022358616 %M 37526973 %R 10.2196/47094 %U https://www.jmir.org/2023/1/e47094 %U https://doi.org/10.2196/47094 %U http://www.ncbi.nlm.nih.gov/pubmed/37526973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46621 %T Investigating Factors Influencing Medical Practitioners’ Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study %A Deng,Wenhao %A Yang,Tianan %A Deng,Jianwei %A Liu,Ran %A Sun,Xueqin %A Li,Gang %A Wen,Xinmei %+ School of Management and Economics, Beijing Institute of Technology, 5 South Zhongguancun Street, Beijing, 100081, China, 86 10 6893 8057, dengjianwei2006@163.com %K internet hospital %K conservation of resource theory %K medical practitioner %K Unified Theory of Acceptance and Use of Technology %K technostress %K resistance to change %K behavioral intention to use %D 2023 %7 31.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners. Objective: This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework. Methods: A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model. Results: On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (β=−.55; P<.001) and work overload (β=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms. Conclusions: This study investigated the factors that facilitate or hinder medical practitioners’ resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity. %M 37523226 %R 10.2196/46621 %U https://www.jmir.org/2023/1/e46621 %U https://doi.org/10.2196/46621 %U http://www.ncbi.nlm.nih.gov/pubmed/37523226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45681 %T The Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits: Quasi-Experimental Study %A Bo,Yan %A Liu,Qianqian Ben %A Tong,Yu %+ Department of Data Science and Engineering Management, School of Management, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China, 86 571 88206827, tong_yu@zju.edu.cn %K health and fitness apps %K app adoption %K app use %K hospital visit %K causal effect %K health behavior %K consumption level %K city tier %K digital literacy %K hospitalization %K admission %K adoption %K acceptance %K mobile health %K mHealth %K fitness %K exercise %K physical activity %K health app %K fitness app %K difference-in-differences %D 2023 %7 28.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Overcrowding in public hospitals, a common issue in many countries, leads to a range of negative outcomes, such as insufficient access to medical services and patient dissatisfaction. Prior literature regarding solutions to reducing hospital overcrowding primarily focuses on organizational-level operational efficiency. However, few studies have investigated the strategies from the individual patient perspective. Specifically, we considered using mobile health and fitness apps to promote users’ health behaviors and produce health benefits, thereby reducing hospital visits. Objective: This study estimated the causal effect of health and fitness app adoption on hospital visits by exploiting the staggered timing of adoption. We also investigated how the effect varied with users’ socioeconomic status and digital literacy. This study provides causal evidence for the effects of health apps, extends the digital health literature, and sheds light on mobile health policies. Methods: This study used a data set containing health and fitness app use and hospital-related geolocation data of 267,651 Chinese mobile phone users from January to December 2019. We used the difference-in-differences and difference-in-difference-in-differences designs to estimate the causal effect. We performed a sensitivity analysis to establish the robustness of the findings. We also conducted heterogeneity analyses based on the interactions of postadoption indicators with users’ consumption levels, city tiers, and digital literacy. Results: The preferred model (difference-in-difference-in-differences) showed a significant decrease in hospital visits after the adoption of health and fitness apps. App adoption led to a 5.8% (P<.001), 13.1% (P<.001), and 18.4% reduction (P<.001) in hospital visits 1, 2, and 3 months after adoption, respectively. In addition, the moderation analysis shows that the effect is greater for users with high consumption levels, in high-tier cities, or with high digital literacy. Conclusions: This study estimated the causal effect of health and fitness app adoption on hospital visits. The results and sensitivity analysis showed that app adoption can reduce users’ hospital visits. The effect varies with users’ consumption levels, city tiers, and digital literacy. These findings provide useful insights for multiple stakeholders in the Chinese health care context. %M 37505809 %R 10.2196/45681 %U https://www.jmir.org/2023/1/e45681 %U https://doi.org/10.2196/45681 %U http://www.ncbi.nlm.nih.gov/pubmed/37505809 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e40891 %T Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study %A Weis,Joachim %A Wolf,Lucy Raphaela %A Boerries,Melanie %A Kassahn,Daniela %A Boeker,Martin %A Dresch,Carolin %+ Chair for Self-Help Research, Comprehensive Cancer Center, Medical Faculty, University Clinic Freiburg, Hugstetter Str. 49, Freiburg, 79106, Germany, 49 761270 ext 71561, joachim.weis@uniklinik-freiburg.de %K cancer %K mobile app %K mHealth %K mobile health %K needs assessment %K patient-centered care %K PROM %K patient-reported outcome measures %K qualitative methods %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients’ needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients’ perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 %M 37498653 %R 10.2196/40891 %U https://cancer.jmir.org/2023/1/e40891 %U https://doi.org/10.2196/40891 %U http://www.ncbi.nlm.nih.gov/pubmed/37498653 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e41032 %T Underestimated Factors Regarding the Use of Technology in Daily Practice of Long-Term Care: Qualitative Study Among Health Care Professionals %A Groeneveld,Sjors W M %A den Ouden,Marjolein E M %A van Gemert-Pijnen,J E W C %A Verdaasdonk,Rudolph M %A van Os-Medendorp,Harmieke %+ Research Group Technology, Health & Care, School of Social Work, Saxion University of Applied Sciences, Postbus 70000, Enschede, 7500 KB, Netherlands, 31 88 019 8888, s.w.m.groeneveld@saxion.nl %K health technology %K eHealth %K digital health %K nurse %K nurse assistant %K health care professionals %K implementation %K adoption %K acceptance %K competencies %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Increasing life expectancy is resulting in a growing demand for long-term care; however, there is a shortage of qualified health care professionals (HCPs) to deliver it. If used optimally, technology can provide a solution to this challenge. HCPs play an important role in the use of technology in long-term care. However, technology influences several core aspects of the work that HCPs do, and it is therefore important to have a good understanding of their viewpoint regarding the use of technology in daily practice of long-term care. Objective: The aim of this study was to identify the factors that HCPs consider as relevant for using technology in daily practice of long-term care. Methods: In this qualitative study, 11 focus groups were organized with 73 HCPs. The focus group discussions were guided by an innovative game, which was specifically developed for this study. The content of the game was categorized into 4 categories: health care technology and me; health care technology, the patient, and me; health care technology, the organization, and me; and facilitating conditions. The perspectives of HCPs about working with technology were discussed based on this game. The focus groups were recorded and transcribed, followed by an inductive thematic analysis using ATLAS.ti 9x (ATLAS.ti Scientific Software Development GmbH). Results: Overall, 2 main domain summaries were developed from the data: technology should improve the quality of care and acceptance and use of technology in care. The first factor indicates the need for tailored and personalized care and balance between human contact and technology. The second factor addresses several aspects regarding working with technology such as trusting technology, learning to work with technology, and collaboration with colleagues. Conclusions: HCPs are motivated to use technology in daily practice of long-term care when it adds value to the quality of care and there is sufficient trust, expertise, and collaboration with colleagues. Their perspectives need to be considered as they play a crucial part in the successful use of technology, transcending their role as an actor in implementation. On the basis of the findings from this study, we recommend focusing on developing technology for situations where both efficiency and quality of care can be improved; redefining the roles of HCPs and the impact of technology hereon; involving HCPs in the design process of technology to enable them to link it to their daily practice; and creating ambassadors in care teams who are enthusiastic about working with technology and can support and train their colleagues. %M 37494092 %R 10.2196/41032 %U https://nursing.jmir.org/2023/1/e41032 %U https://doi.org/10.2196/41032 %U http://www.ncbi.nlm.nih.gov/pubmed/37494092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48000 %T Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review %A van Kessel,Robin %A Roman-Urrestarazu,Andres %A Anderson,Michael %A Kyriopoulos,Ilias %A Field,Samantha %A Monti,Giovanni %A Reed,Shelby D %A Pavlova,Milena %A Wharton,George %A Mossialos,Elias %+ LSE Health, Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom, 44 7772 707841, e.a.mossialos@lse.ac.uk %K digital health %K uptake %K implementation %K adoption %K framework %K digital therapeutics %K scoping review %K thematic analysis %K digital medicine %K policy %D 2023 %7 25.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. Objective: In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. Methods: A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. Results: We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. Conclusions: The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system’s readiness for digital therapeutics. %M 37490322 %R 10.2196/48000 %U https://www.jmir.org/2023/1/e48000 %U https://doi.org/10.2196/48000 %U http://www.ncbi.nlm.nih.gov/pubmed/37490322 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46044 %T 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 %A Son,Elisa H %A Nahm,Eun-Shim %+ Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, 20892, United States, 1 667 701 5768, hyojin.son@nih.gov %K patient portal %K patient engagement %K user review %K content analysis %K qualitative %K perception %K privacy %K security %D 2023 %7 25.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 37490316 %R 10.2196/46044 %U https://humanfactors.jmir.org/2023/1/e46044 %U https://doi.org/10.2196/46044 %U http://www.ncbi.nlm.nih.gov/pubmed/37490316 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41092 %T Video-Based Educational Interventions for Patients With Chronic Illnesses: Systematic Review %A Deshpande,Nikita %A Wu,Meng %A Kelly,Colleen %A Woodrick,Nicole %A Werner,Debra A %A Volerman,Anna %A Press,Valerie G %+ Section of General Internal Medicine, Department of Medicine, University of Chicago, MC 2007, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 (773) 702 5170, vpress@bsd.uchicago.edu %K chronic disease %K patient education %K video-based interventions %K video education %K technology %K health literacy %K self-management %D 2023 %7 19.7.2023 %9 Review %J J Med Internet Res %G English %X Background: With rising time constraints, health care professionals increasingly depend on technology to provide health advice and teach patients how to manage chronic disease. The effectiveness of video-based tools in improving knowledge, health behaviors, disease severity, and health care use for patients with major chronic illnesses is not well understood. Objective: The aim of this study was to assess the current literature regarding the efficacy of video-based educational tools for patients in improving process and outcome measures across several chronic illnesses. Methods: A systematic review was conducted using CINAHL and PubMed with predefined search terms. The search included studies published through October 2021. The eligible studies were intervention studies of video-based self-management patient education for an adult patient population with the following chronic health conditions: asthma, chronic kidney disease, chronic obstructive pulmonary disease, chronic pain syndromes, diabetes, heart failure, HIV infection, hypertension, inflammatory bowel disease, and rheumatologic disorders. The eligible papers underwent full extraction of study characteristics, study design, sample demographics, and results. Bias was assessed with the Cochrane risk-of-bias tools. Summary statistics were synthesized in Stata SE (StataCorp LLC). Data reporting was conducted per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Results: Of the 112 studies fully extracted, 59 (52.7%) were deemed eligible for inclusion in this review. The majority of the included papers were superiority randomized controlled trials (RCTs; 39/59, 66%), with fewer pre-post studies (13/59, 22%) and noninferiority RCTs (7/59, 12%). The most represented conditions of interest were obstructive lung disease (18/59, 31%), diabetes (11/59, 19%), and heart failure (9/59, 15%). The plurality (28/59, 47%) of video-based interventions only occurred once and occurred alongside adjunct interventions that included printed materials, in-person counseling, and interactive modules. The most frequently studied outcomes were disease severity, health behavior, and patient knowledge. Video-based tools were the most effective in improving patient knowledge (30/40, 75%). Approximately half reported health behavior (21/38, 56%) and patient self-efficacy (12/23, 52%) outcomes were improved by video-based tools, and a minority of health care use (11/28, 39%) and disease severity (23/69, 33%) outcomes were improved by video-based tools. In total, 48% (22/46) of the superiority and noninferiority RCTs and 54% (7/13) of the pre-post trials had moderate or high risk of bias. Conclusions: There is robust evidence that video-based tools can improve patient knowledge across several chronic illnesses. These tools less consistently improve disease severity and health care use outcomes. Additional study is needed to identify features that maximize the efficacy of video-based interventions for patients across the spectrum of digital competencies to ensure optimized and equitable patient education and outcomes. %M 37467015 %R 10.2196/41092 %U https://www.jmir.org/2023/1/e41092 %U https://doi.org/10.2196/41092 %U http://www.ncbi.nlm.nih.gov/pubmed/37467015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45868 %T Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study %A Woods,Leanna %A Dendere,Ronald %A Eden,Rebekah %A Grantham,Brittany %A Krivit,Jenna %A Pearce,Andrew %A McNeil,Keith %A Green,Damian %A Sullivan,Clair %+ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, L5 Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, 4006, Australia, 61 731765530, lee.woods@uq.edu.au %K digital health %K health information systems %K digital maturity %K digital hospital %K evaluation study %K impact %K outcome assessment %K qualitative research %K health services research %D 2023 %7 18.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. Objective: We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. Methods: A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker’s facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. Results: DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. Conclusions: This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim. %M 37463008 %R 10.2196/45868 %U https://www.jmir.org/2023/1/e45868 %U https://doi.org/10.2196/45868 %U http://www.ncbi.nlm.nih.gov/pubmed/37463008 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44681 %T Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study %A Lukka,Lauri %A Karhulahti,Veli-Matti %A Palva,J Matias %+ Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland, 358 440375666, lauri.lukka@aalto.fi %K clinical practice %K digital mental health interventions %K intervention design %K mental health applications %K mental health professionals %K teletherapy %K mobile phone %D 2023 %7 10.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. Objective: This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. Methods: A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. Results: We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability—it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs’ digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. Conclusions: MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them. %M 37428520 %R 10.2196/44681 %U https://humanfactors.jmir.org/2023/1/e44681 %U https://doi.org/10.2196/44681 %U http://www.ncbi.nlm.nih.gov/pubmed/37428520 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46562 %T Factors Influencing the Sharing of Personal Health Data Based on the Integrated Theory of Privacy Calculus and Theory of Planned Behaviors Framework: Results of a Cross-Sectional Study of Chinese Patients in the Yangtze River Delta %A Shi,Jingjin %A Yuan,Rui %A Yan,Xueming %A Wang,Miao %A Qiu,Jun %A Ji,Xinhua %A Yu,Guangjun %+ School of Medicine, The Chinese University of HongKong, No 2001 Longxiang Avenue, Shenzhen, 518172, China, 86 18917762998, guangjunyu@cuhk.edu.cn %K personal health data %K data sharing %K influencing factor %K privacy calculus %K Theory of Planned Behavior %D 2023 %7 6.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The health care system in China is fragmented, and the distribution of high-quality resources remains uneven and irrational. Information sharing is essential to the development of an integrated health care system and maximizing its benefits. Nevertheless, data sharing raises concerns regarding the privacy and confidentiality of personal health information, which affect the willingness of patients to share information. Objective: This study aims to investigate patients’ willingness to share personal health data at different levels of maternal and child specialized hospitals in China, to propose and test a conceptual model to identify key influencing factors, and to provide countermeasures and suggestions to improve the level of data sharing. Methods: A research framework based on the Theory of Privacy Calculus and the Theory of Planned Behavior was developed and empirically tested through a cross-sectional field survey from September 2022 to October 2022 in the Yangtze River Delta region, China. A 33-item measurement instrument was developed. Descriptive statistics, chi-square tests, and logistic regression analyses were conducted to characterize the willingness of sharing personal health data and differences by sociodemographic factors. Structural equation modeling was used to assess the reliability and validity of the measurement as well as to test the research hypotheses. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist for cross-sectional studies was applied for reporting results. Results: The empirical framework had a good fit with the chi-square/degree of freedom (χ2/df)=2.637, root-mean-square residual=0.032, root-mean-square error of approximation=0.048, goodness-of-fit index=0.950, and normed fit index=0.955. A total of 2060 completed questionnaires were received (response rate: 2060/2400, 85.83%). Moral motive (β=.803, P<.001), perceived benefit (β=.123, P=.04), and perceived effectiveness of government regulation (β=.110, P=.001) had a significantly positive association with sharing willingness, while perceived risk (β=–.143, P<.001) had a significant negative impact, with moral motive having the greatest impact. The estimated model explained 90.5% of the variance in sharing willingness. Conclusions: This study contributes to the literature on personal health data sharing by integrating the Theory of Privacy Calculus and the Theory of Planned Behavior. Most Chinese patients are willing to share their personal health data, which is primarily motivated by moral concerns to improve public health and assist in the diagnosis and treatment of illnesses. Patients with no prior experience with personal information disclosure and those who have tertiary hospital visits were more likely to share their health data. Practical guidelines are provided to health policy makers and health care practitioners to encourage patients to share their personal health information. %M 37410526 %R 10.2196/46562 %U https://www.jmir.org/2023/1/e46562 %U https://doi.org/10.2196/46562 %U http://www.ncbi.nlm.nih.gov/pubmed/37410526 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41113 %T Economic Evaluations of Digital Health Interventions for the Management of Musculoskeletal Disorders: Systematic Review and Meta-Analysis %A Fatoye,Francis %A Gebrye,Tadesse %A Mbada,Chidozie %A Useh,Ushotanefe %+ Department of Health Professions, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, Manchester, M156GX, United Kingdom, 44 0044161247296, f.fatoye@mmu.ac.uk %K musculoskeletal disorders %K digital health interventions %K cost-effectiveness %K systematic review %K digital health %K intervention %K management %K musculoskeletal %K muscles %K joints %K nerves %K blood %K pain %K knee %K hip %D 2023 %7 6.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Musculoskeletal disorders (MSDs) are widespread in many countries and their huge burden on the society has necessitated innovative approaches such as digital health interventions. However, no study has evaluated the findings of cost-effectiveness of these interventions. Objective: This study aims to synthesize the cost-effectiveness of digital health interventions for people with MSDs. Methods: Electronic databases including MEDLINE, AMED, CIHAHL, PsycINFO, Scopus, Web of Science, and Centre for Review and Dissemination were searched for cost-effectiveness of digital health published between inception and June 2022 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. References of all retrieved articles were checked for relevant studies. Quality appraisal of the included studies was performed using the Quality of Health Economic Studies (QHES) instrument. Results were presented using a narrative synthesis and random effects meta-analysis. Results: A total of 10 studies from 6 countries met the inclusion criteria. Using the QHES instrument, we found that the mean score of the overall quality of the included studies was 82.5. Included studies were on nonspecific chronic low back pain (n=4), chronic pain (n=2), knee and hip osteoarthritis (n=3), and fibromyalgia (n=1). The economic perspectives adopted in the included studies were societal (n=4), societal and health care (n=3), and health care (n=3). Of the 10 included studies, 5 (50%) used quality-adjusted life-years as the outcome measures. Except 1 study, all the included studies reported that digital health interventions were cost-effective compared with the control group. In a random effects meta-analysis (n=2), the pooled disability and quality-adjusted life-years were –0.176 (95% CI –0.317 to –0.035; P=.01) and 3.855 (95% CI 2.023 to 5.687; P<.001), respectively. The meta-analysis (n=2) for the costs was in favor of the digital health intervention compared with control: US $417.52 (95% CI –522.01 to –313.03). Conclusions: Studies indicate that digital health interventions are cost-effective for people with MSDs. Our findings suggest that digital health intervention could help improve access to treatment for patients with MSDs and as a result improve their health outcomes. Clinicians and policy makers should consider the use of these interventions for patients with MSDs. Trial Registration: PROSPERO CRD42021253221; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=253221 %M 37410542 %R 10.2196/41113 %U https://www.jmir.org/2023/1/e41113 %U https://doi.org/10.2196/41113 %U http://www.ncbi.nlm.nih.gov/pubmed/37410542 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47650 %T Designing and Evaluating IT Applications for Informal Caregivers: Protocol for a Scoping Review %A Premanandan,Shweta %A Ahmad,Awais %A Cajander,Åsa %A Ågerfalk,Pär %A van Gemert-Pijnen,Lisette %+ Department of Informatics and Media, Uppsala University, Kyrkogårdsgatan 10, Uppsala, 751 20, Sweden, 46 707689331, shweta.premanandan@im.uu.se %K burnout %K caregiver %K caregiving activity %K design guidelines %K design %K development %K digital health %K digital resources %K effectiveness %K evaluation %K health care services %K implementation %K informal caregiver %K IT applications %K long term care %K mobile app %K smartphone %K usability %K work-life balance %D 2023 %7 6.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: A growing number of informal caregivers in many countries are important for effective functioning of health care in our society. Hence, they must receive the required support and services to continue providing care. IT applications can be used to support informal caregivers in their caregiving activities. However, evidence-informed guidelines for developing such IT applications and their evaluation are scarce. Hence, this scoping review can aid researchers and designers by providing design recommendations for IT apps for caregivers and potentially improve the design of IT applications for caregivers to meet their needs better. Objective: This study aims to describe the proposal for a scoping review of current practices and recommendations in designing and evaluating IT applications for informal caregivers. The scoping review will also discuss the opportunities and challenges in designing these IT applications. Methods: We will use a 5-step scoping review methodology to map relevant literature published as follows: (1) identify the research question, (2) identify relevant studies, (3) select relevant studies for review, (4) chart the data from selected literature, and (5) summarize and report results. A structured search will be conducted in PubMed, Scopus, IEEE digital library, Web of Science, and ACM Digital Library databases. In addition, hand searches of reference lists and keyword searches in Google Scholar will also be conducted. Inclusion criteria will be researched (journal and conference) articles focused on IT applications designed for use by informal caregivers and study type to be qualitative studies. Two reviewers will independently identify articles for review and extract data. Conflicts will be discussed, and a third reviewer will be consulted if a consensus cannot be reached. These data will be analyzed using thematic analysis. Results: The results from this scoping review will be presented in a narrative form, and additional data on study characteristics will be presented in diagrams or tabular format. Uppsala University first initiated this scoping review protocol in December 2021 as part of the European Union–funded project ENTWINE. This work was also supported by the Swedish Research Council and the Swedish Cancer Society. The results will be presented in August 2023 and will be disseminated through a report to the European Union and a peer-reviewed journal publication. In addition, the team plans to share its findings on various public platforms, including social media, blog posts, and relevant conferences and workshops. Conclusions: This is, to our knowledge, the first study to map the literature on the design and evaluation of IT applications for informal caregivers. The scoping review’s results will detail the requirements, design suggestions, and user preferences, as well as the usability criteria and features of IT applications for informal caregivers. A mapping of studies could inform the design and implementation of future IT applications for informal caregivers. International Registered Report Identifier (IRRID): DERR1-10.2196/47650 %M 37410533 %R 10.2196/47650 %U https://www.researchprotocols.org/2023/1/e47650 %U https://doi.org/10.2196/47650 %U http://www.ncbi.nlm.nih.gov/pubmed/37410533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48166 %T Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis %A Dong,Qian %A Liu,Ting %A Liu,Ran %A Yang,Hongxia %A Liu,Cuiping %+ School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Changcheng Road, Taian, Shandong Province, 271016, China, 86 13854218960, lcping0926@126.com %K digital health literacy interventions %K older adults %K eHealth literacy efficacy %K knowledge %K self-efficacy %K skills %D 2023 %7 28.6.2023 %9 Review %J J Med Internet Res %G English %X Background: In a world of rapid digital technology development, the lack of digital health literacy (DHL) among older people cannot be ignored. DHL is becoming an essential competency that can facilitate the health status and health management of older adults. DHL interventions that are feasible and appropriate can be implemented on a large scale through the health care system for older people. Objective: The purpose of this meta-analysis was to assess the effectiveness of DHL interventions for older adults. Methods: English publications in PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to November 20, 2022. Two reviewers independently completed the data extraction and quality assessment. Review Manager (version 5.4; Cochrane Informatics & Technology Services) software was used for all meta-analyses. Results: A total of 7 studies, including 2 randomized controlled trials and 5 quasi-experimental studies, involving 710 older adults were considered eligible. The main outcome was scores on the eHealth Literacy Scale, and secondary outcomes were knowledge, self-efficacy, and skills. Quasi-experimental studies compared baseline and postintervention outcomes, while randomized controlled trials compared pre- and postintervention outcomes in the intervention group. Of the 7 studies, 3 used face-to-face instruction, while 4 adopted web-based interventions. Among them, 4 of the interventions were conducted using theoretical guidance, while 3 were not. Intervention duration varied from 2 to 8 weeks. In addition, the studies included were all conducted in developed countries, mainly in the United States. Pooled analysis presented that DHL interventions had positive effects on eHealth literacy efficacy (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001). Subgroup analysis revealed that DHL interventions that chose face-to-face teaching (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), were guided by a conceptual framework (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), and were sustained over 4 weeks (standardized mean difference 1.1, 95% CI 0.46 to 1.84; P=.001) had a more significant effect. Moreover, the outcomes showed considerable gains in knowledge (standardized mean difference 0.93, 95% CI 0.54 to 1.31; P<.001) and self-efficacy (standardized mean difference 0.96, 95% CI 0.16 to 1.77; P=.02). No statistically significant effect was found for skills (standardized mean difference 0.77, 95% CI –0.30 to 1.85; P=.16). The small number of studies, variable study quality, and heterogeneity are some limitations of this review. Conclusions: DHL interventions have positive effects on the health status and health management of older adults. Practical and effective DHL interventions are crucial for the use of modern digital information technology in managing the health of older people. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023410204; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410204 %M 37379077 %R 10.2196/48166 %U https://www.jmir.org/2023/1/e48166 %U https://doi.org/10.2196/48166 %U http://www.ncbi.nlm.nih.gov/pubmed/37379077 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45944 %T The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review %A Wiwatkunupakarn,Nutchar %A Aramrat,Chanchanok %A Pliannuom,Suphawita %A Buawangpong,Nida %A Pinyopornpanish,Kanokporn %A Nantsupawat,Nopakoon %A Mallinson,Poppy Alice Carson %A Kinra,Sanjay %A Angkurawaranon,Chaisiri %+ Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Chiang Mai, 50200, Thailand, 66 616852307, chaisiri.a@cmu.ac.th %K telemedicine %K clinical decision support system %K CDSS %K primary care %K multimorbidity %K polypharmacy %K chronic disease %K pharmacy %K pharmaceutic %K telehealth %K decision support %K scoping %K search strategy %K review %D 2023 %7 28.6.2023 %9 Review %J J Med Internet Res %G English %X Background: Multimorbidity, the presence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies that have been used to reduce the complexity of patient management. However, each element of telemedicine and CDSSs is often examined separately and with great variability. Telemedicine has been used for simple patient education as well as more complex consultations and case management. For CDSSs, there is variability in data inputs, intended users, and outputs. Thus, there are several gaps in knowledge about how to integrate CDSSs into telemedicine and to what extent these integrated technological interventions can help improve patient outcomes for those with multimorbidity. Objective: Our aims were to (1) broadly review system designs for CDSSs that have been integrated into each function of telemedicine for multimorbid patients in primary care, (2) summarize the effectiveness of the interventions, and (3) identify gaps in the literature. Methods: An online search for literature was conducted up to November 2021 on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference lists was done to find additional potential studies. The eligibility criterion was that the study focused on the use of CDSSs in telemedicine for patients with multimorbidity in primary care. The system design for the CDSS was extracted based on its software and hardware, source of input, input, tasks, output, and users. Each component was grouped by telemedicine functions: telemonitoring, teleconsultation, tele–case management, and tele-education. Results: Seven experimental studies were included in this review: 3 randomized controlled trials (RCTs) and 4 non-RCTs. The interventions were designed to manage patients with diabetes mellitus, hypertension, polypharmacy, and gestational diabetes mellitus. CDSSs can be used for various telemedicine functions: telemonitoring (eg, feedback), teleconsultation (eg, guideline suggestions, advisory material provisions, and responses to simple queries), tele–case management (eg, sharing information across facilities and teams), and tele-education (eg, patient self-management). However, the structure of CDSSs, such as data input, tasks, output, and intended users or decision-makers, varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions. Conclusions: Telemedicine and CDSSs have a role in supporting patients with multimorbidity. CDSSs can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined; examining tasks of CDSSs, particularly for screening and diagnosis of multiple conditions; and exploring the role of the patient as the direct user of the CDSS. %M 37379066 %R 10.2196/45944 %U https://www.jmir.org/2023/1/e45944 %U https://doi.org/10.2196/45944 %U http://www.ncbi.nlm.nih.gov/pubmed/37379066 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44164 %T Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study %A Boyle,Tehnaz %A Boggs,Krislyn %A Gao,Jingya %A McMahon,Maureen %A Bedenbaugh,Rachel %A Schmidt,Lauren %A Zachrison,Kori Sauser %A Goralnick,Eric %A Biddinger,Paul %A Camargo Jr,Carlos A %+ Department of Pediatrics, Boston Medical Center, 801 Albany Street, Rm 4025, Boston, MA, 02119, United States, 1 617 414 3682, tehnaz.boyle@bmc.org %K disaster medicine %K disaster %K telemedicine %K telehealth %K eHealth %K teleconsultation %K remote consultation %K health care delivery %K e-consult %K notification %K alert %K emergency %K health system %K hospital management %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. Objective: To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response. Methods: We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability. Results: Overall, 164 (87%) hospitals and EDs responded—126 (77%) completed telephone surveys. Most (n=148, 90%) receive emergency notifications from state-based systems. Forty (24%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18%); radiation specialists, 25 (15%); and trauma specialists, 20 (12%). Among critical access hospitals (CAHs) or EDs with <10,000 annual visits (n=36), 92% received routine nondisaster telehealth services but lacked toxicologist (25%), burn (22%), and radiation (17%) specialist access. Most hospitals and EDs (n=115, 70%) require disaster credentialing of teleconsultants before system use. Among 113 hospitals and EDs with written disaster credentialing procedures, 28% expected completing disaster credentialing within 24 hours, and 55% within 25-72 hours, which varied by state. Most (n=154, 94%) reported adequate internet or cellular service for video-streaming; 81% maintained cellular service despite internet disruption. Fewer rural hospitals and EDs reported reliable internet or cellular service (19/22, 86% vs 135/142, 95%) and ability to maintain cellular service with internet disruption (11/19, 58% vs 113/135, 84%) than urban hospitals and EDs. Overall, 133 (81%) were somewhat or very likely to use a regional disaster teleconsultation system. Large-volume EDs (annual visits ≥40,000) were less likely to use the service than smaller ones; all CAHs and nearly all rural hospitals or freestanding EDs were likely to use disaster consultation services. Among hospitals and EDs somewhat or very unlikely to use the system (n=26), sufficient consultant access (69%) and reluctance to use new technology or systems (27%) were common barriers. Potential delays (19%), liability (19%), privacy (15%), and hospital information system security restrictions (15%) were infrequent concerns. Conclusions: Most New England hospitals and EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. System developers should focus on ways to improve telecommunication redundancy in rural areas and use low-bandwidth technology to maintain service availability to CAHs and rural hospitals and EDs. Policies and procedures to accelerate and standardize disaster credentialing are needed for implementation across jurisdictions. %M 37368481 %R 10.2196/44164 %U https://publichealth.jmir.org/2023/1/e44164 %U https://doi.org/10.2196/44164 %U http://www.ncbi.nlm.nih.gov/pubmed/37368481 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44900 %T Factors Influencing Clinicians’ Use of Hospital Information Systems for Infection Prevention and Control: Cross-Sectional Study Based on the Extended DeLone and McLean Model %A Zheng,Feiyang %A Wang,Kang %A Wang,Qianning %A Yu,Tiantian %A Wang,Lu %A Zhang,Xinping %A Wu,Xiang %A Zhou,Qian %A Tan,Li %+ School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China, 86 15927562116, xpzhang602@hust.edu.cn %K hospital infection prevention and control %K information system %K information systems success model %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Healthcare-associated infections have become a serious public health problem. Various types of information systems have begun to be applied in hospital infection prevention and control (IPC) practice. Clinicians are the key users of these systems, but few studies have assessed the use of infection prevention and control information systems (IPCISs) from their perspective. Objective: This study aimed to (1) apply the extended DeLone and McLean Information Systems Success model (D&M model) that incorporates IPC culture to examine how technical factors like information quality, system quality, and service quality, as well as organizational culture factors affect clinicians’ use intention, satisfaction, and perceived net benefits, and (2) identify which factors are the most important for clinicians’ use intention. Methods: A total of 12,317 clinicians from secondary and tertiary hospitals were surveyed online. Data were analyzed using partial least squares-structural equation modeling and the importance-performance matrix analysis. Results: Among the technical factors, system quality (β=.089-.252; P<.001), information quality (β=.294-.102; P<.001), and service quality (β=.126-.411; P<.001) were significantly related to user satisfaction (R2=0.833), use intention (R2=0.821), and perceived net benefits (communication benefits [R2=0.676], decision-making benefits [R2=0.624], and organizational benefits [R2=0.656]). IPC culture had an effect on use intention (β=.059; P<.001), and it also indirectly affected perceived net benefits (β=.461-.474; P<.001). In the importance-performance matrix analysis, the attributes of service quality (providing user training) and information quality (readability) were present in the fourth quadrant, indicating their high importance and low performance. Conclusions: This study provides valuable insights into IPCIS usage among clinicians from the perspectives of technology and organization culture factors. It found that technical factors (system quality, information quality, and service quality) and hospital IPC culture have an impact on the successful use of IPCISs after evaluating the application of IPCISs based on the extended D&M model. Furthermore, service quality and information quality showed higher importance and lower performance for use intention. These findings provide empirical evidence and specific practical directions for further improving the construction of IPCISs. %M 37347523 %R 10.2196/44900 %U https://www.jmir.org/2023/1/e44900 %U https://doi.org/10.2196/44900 %U http://www.ncbi.nlm.nih.gov/pubmed/37347523 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42083 %T Exploring the Use of the Behavior Change Technique Taxonomy and the Persuasive System Design Model in Defining Parent-Focused eHealth Interventions: Scoping Review %A Silva,Mindy %A Hay-Smith,E Jean %A Graham,Fiona %+ Rehabilitation Teaching and Research Unit, University of Otago, 23A Mein Street, Newtown, Wellington, 6021, New Zealand, 64 4 385 5541, research@wiredon.ltd %K persuasive technology %K behavior change %K parent-focused eHealth %K Capability, Opportunity, and Motivation–Behavior %K COM-B %K Fogg Behavior Model %K FBM %K behavior intervention %K publications %K effectiveness %K usability %K active ingredient %K scoping review %K mobile phone %D 2023 %7 21.6.2023 %9 Review %J J Med Internet Res %G English %X Background: Taxonomies and models are useful tools for defining eHealth content and intervention features, enabling comparison and analysis of research across studies and disciplines. The Behavior Change Technique Taxonomy version 1 (BCTTv1) was developed to decrease ambiguity in defining specific characteristics inherent in health interventions, but it was developed outside the context of digital technology. In contrast, the Persuasive System Design Model (PSDM) was developed to define and evaluate the persuasive content in software solutions but did not have a specific focus on health. Both the BCTTv1 and PSDM have been used to define eHealth interventions in the literature, with some researchers combining or reducing the taxonomies to simplify their application. It is unclear how well the taxonomies accurately define eHealth and whether they should be used alone or in combination. Objective: This scoping review explored how the BCTTv1 and PSDM capture the content and intervention features of parent-focused eHealth as part of a program of studies investigating the use of technology to support parents with therapy home programs for children with special health care needs. It explored the active ingredients and persuasive technology features commonly found in parent-focused eHealth interventions for children with special health care needs and how the descriptions overlap and interact with respect to the BCTTv1 and PSDM taxonomies. Methods: A scoping review was used to clarify concepts in the literature related to these taxonomies. Keywords related to parent-focused eHealth were defined and used to systematically search several electronic databases for parent-focused eHealth publications. Publications referencing the same intervention were combined to provide comprehensive intervention details. The data set was coded using codebooks developed from the taxonomies in NVivo (version 12; QSR International) and qualitatively analyzed using matrix queries. Results: The systematic search found 23 parent-focused eHealth interventions described in 42 articles from various countries; delivered to parents with children aged 1 to 18 years; and covering medical, behavioral, and developmental issues. The predominant active ingredients and intervention features in parent-focused eHealth were concerned with teaching parents behavioral skills, encouraging them to practice and monitor the new skills, and tracking the outcomes of performing the new skills. No category had a complete set of active ingredients or intervention features coded. The two taxonomies conceptually captured different constructs even when their labels appeared to overlap in meaning. In addition, coding by category missed important active ingredients and intervention features. Conclusions: The taxonomies were found to code different constructs related to behavior change and persuasive technology, discouraging the merging or reduction of the taxonomies. This scoping review highlighted the benefit of using both taxonomies in their entirety to capture active ingredients and intervention features important for comparing and analyzing eHealth across different studies and disciplines. International Registered Report Identifier (IRRID): RR2-doi.org/10.15619/nzjp/47.1.05 %M 37342082 %R 10.2196/42083 %U https://www.jmir.org/2023/1/e42083 %U https://doi.org/10.2196/42083 %U http://www.ncbi.nlm.nih.gov/pubmed/37342082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43311 %T Artificial Intelligence Supporting the Training of Communication Skills in the Education of Health Care Professions: Scoping Review %A Stamer,Tjorven %A Steinhäuser,Jost %A Flägel,Kristina %+ Institute of Family Medicine, University Hospital Schleswig-Holstein Luebeck Campus, Ratzeburger Allee 160, Luebeck, 23562, Germany, 49 451 3101 8013, t.stamer@uni-luebeck.de %K communication %K education %K artificial intelligence %K machine learning %K health care %K skill %K use %K academic %K students %K training %K cost %K cost-effective %K health care professional %D 2023 %7 19.6.2023 %9 Review %J J Med Internet Res %G English %X Background: Communication is a crucial element of every health care profession, rendering communication skills training in all health care professions as being of great importance. Technological advances such as artificial intelligence (AI) and particularly machine learning (ML) may support this cause: it may provide students with an opportunity for easily accessible and readily available communication training. Objective: This scoping review aimed to summarize the status quo regarding the use of AI or ML in the acquisition of communication skills in academic health care professions. Methods: We conducted a comprehensive literature search across the PubMed, Scopus, Cochrane Library, Web of Science Core Collection, and CINAHL databases to identify articles that covered the use of AI or ML in communication skills training of undergraduate students pursuing health care profession education. Using an inductive approach, the included studies were organized into distinct categories. The specific characteristics of the studies, methods and techniques used by AI or ML applications, and main outcomes of the studies were evaluated. Furthermore, supporting and hindering factors in the use of AI and ML for communication skills training of health care professionals were outlined. Results: The titles and abstracts of 385 studies were identified, of which 29 (7.5%) underwent full-text review. Of the 29 studies, based on the inclusion and exclusion criteria, 12 (3.1%) were included. The studies were organized into 3 distinct categories: studies using AI and ML for text analysis and information extraction, studies using AI and ML and virtual reality, and studies using AI and ML and the simulation of virtual patients, each within the academic training of the communication skills of health care professionals. Within these thematic domains, AI was also used for the provision of feedback. The motivation of the involved agents played a major role in the implementation process. Reported barriers to the use of AI and ML in communication skills training revolved around the lack of authenticity and limited natural flow of language exhibited by the AI- and ML-based virtual patient systems. Furthermore, the use of educational AI- and ML-based systems in communication skills training for health care professionals is currently limited to only a few cases, topics, and clinical domains. Conclusions: The use of AI and ML in communication skills training for health care professionals is clearly a growing and promising field with a potential to render training more cost-effective and less time-consuming. Furthermore, it may serve learners as an individualized and readily available exercise method. However, in most cases, the outlined applications and technical solutions are limited in terms of access, possible scenarios, the natural flow of a conversation, and authenticity. These issues still stand in the way of any widespread implementation ambitions. %M 37335593 %R 10.2196/43311 %U https://www.jmir.org/2023/1/e43311 %U https://doi.org/10.2196/43311 %U http://www.ncbi.nlm.nih.gov/pubmed/37335593 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e41576 %T Using the H2O Automatic Machine Learning Algorithms to Identify Predictors of Web-Based Medical Record Nonuse Among Patients in a Data-Rich Environment: Mixed Methods Study %A Chen,Yang %A Liu,Xuejiao %A Gao,Lei %A Zhu,Miao %A Shia,Ben-Chang %A Chen,Mingchih %A Ye,Linglong %A Qin,Lei %+ School of Statistics, University of International Business and Economics, No.10, Huixin Dongjie, Chaoyang District, Beijing, 100029, China, 86 01064491146, qinlei@uibe.edu.cn %K web-based medical record %K predictors %K H2O’s automatic machine learning %K Health Information National Trends Survey %K HINTS %K mobile phone %D 2023 %7 19.6.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the advent of electronic storage of medical records and the internet, patients can access web-based medical records. This has facilitated doctor-patient communication and built trust between them. However, many patients avoid using web-based medical records despite their greater availability and readability. Objective: On the basis of demographic and individual behavioral characteristics, this study explores the predictors of web-based medical record nonuse among patients. Methods: Data were collected from the National Cancer Institute 2019 to 2020 Health Information National Trends Survey. First, based on the data-rich environment, the chi-square test (categorical variables) and 2-tailed t tests (continuous variables) were performed on the response variables and the variables in the questionnaire. According to the test results, the variables were initially screened, and those that passed the test were selected for subsequent analysis. Second, participants were excluded from the study if any of the initially screened variables were missing. Third, the data obtained were modeled using 5 machine learning algorithms, namely, logistic regression, automatic generalized linear model, automatic random forest, automatic deep neural network, and automatic gradient boosting machine, to identify and investigate factors affecting web-based medical record nonuse. The aforementioned automatic machine learning algorithms were based on the R interface (R Foundation for Statistical Computing) of the H2O (H2O.ai) scalable machine learning platform. Finally, 5-fold cross-validation was adopted for 80% of the data set, which was used as the training data to determine hyperparameters of 5 algorithms, and 20% of the data set was used as the test data for model comparison. Results: Among the 9072 respondents, 5409 (59.62%) had no experience using web-based medical records. Using the 5 algorithms, 29 variables were identified as crucial predictors of nonuse of web-based medical records. These 29 variables comprised 6 (21%) sociodemographic variables (age, BMI, race, marital status, education, and income) and 23 (79%) variables related to individual lifestyles and behavioral habits (such as electronic and internet use, individuals’ health status and their level of health concern, etc). H2O’s automatic machine learning methods have a high model accuracy. On the basis of the performance of the validation data set, the optimal model was the automatic random forest with the highest area under the curve in the validation set (88.52%) and the test set (82.87%). Conclusions: When monitoring web-based medical record use trends, research should focus on social factors such as age, education, BMI, and marital status, as well as personal lifestyle and behavioral habits, including smoking, use of electronic devices and the internet, patients’ personal health status, and their level of health concern. The use of electronic medical records can be targeted to specific patient groups, allowing more people to benefit from their usefulness. %M 37335616 %R 10.2196/41576 %U https://medinform.jmir.org/2023/1/e41576 %U https://doi.org/10.2196/41576 %U http://www.ncbi.nlm.nih.gov/pubmed/37335616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45822 %T The French General Population’s Perception of New Information and Communication Technologies for Medical Consultations: National Survey %A Touzani,Rajae %A Dembele,Elodie %A Schultz,Emilien %A Rouquette,Alexandra %A Seguin,Lorène %A Dufour,Jean-Charles %A Bannier,Marie %A Mancini,Julien %+ Institut Paoli-Calmettes, SESSTIM U1252, 232 Boulevard de Sainte-Marguerite, Marseille, 13009, France, 33 0491223502, rajae.touzani@inserm.fr %K new ICT %K video recording %K mHealth apps %K video broadcasting %K health literacy %K telehealth %K teleconsultation %K HLS19 %K COVID-19 %K France %D 2023 %7 16.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples’ current experience of health care. Objective: This study aimed to determine the French general population’s perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. Methods: Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. Results: The majority (1239/2003, 62%) of respondents considered the use of mHealth apps useful, while only 27.6% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (≤ 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95% CI 1.31-2.17; mHealth apps: aOR 1.88, 95% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. Conclusions: There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all. %M 37327032 %R 10.2196/45822 %U https://www.jmir.org/2023/1/e45822 %U https://doi.org/10.2196/45822 %U http://www.ncbi.nlm.nih.gov/pubmed/37327032 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e23287 %T Current Implementation Outcomes of Digital Surgical Simulation in Low- and Middle-Income Countries: Scoping Review %A Mahajan,Arnav %A Hawkins,Austin %+ Department of Medicine, University College Cork, Brookfield Health Sciences Complex, Cork City, T12 AK54, Ireland, 353 833517426, arnavmahajan99@outlook.com %K adaptation %K digital surgery %K global surgery %K simulation %K surgery %K systematic review %K technology %K video game %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Digital surgical simulation and telecommunication provides an attractive option for improving surgical skills, widening access to training, and improving patient outcomes; however, it is unclear whether sufficient simulations and telecommunications are accessible, effective, or feasible in low- and middle-income countries (LMICs). Objective: This study aims to determine which types of surgical simulation tools have been most widely used in LMICs, how surgical simulation technology is being implemented, and what the outcomes of these efforts have been. We also offer recommendations for the future development of digital surgical simulation implementation in LMICs. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials to look for qualitative studies in published literature discussing implementation and outcomes of surgical simulation training in LMICs. Eligible papers involved surgical trainees or practitioners who were based in LMICs. Papers that include allied health care professionals involved in task sharing were excluded. We focused specifically on digital surgical innovations and excluded flipped classroom models and 3D models. Implementation outcome had to be reported according to Proctor’s taxonomy. Results: This scoping review examined the outcomes of digital surgical simulation implementation in LMICs for 7 papers. The majority of participants were medical students and residents who were identified as male. Participants rated surgical simulators and telecommunications devices highly for acceptability and usefulness, and they believed that the simulators increased their anatomical and procedural knowledge. However, limitations such as image distortion, excessive light exposure, and video stream latency were frequently reported. Depending on the product, the implementation cost varied between US $25 and US $6990. Penetration and sustainability are understudied implementation outcomes, as all papers lacked long-term monitoring of the digital surgical simulations. Most authors are from high-income countries, suggesting that innovations are being proposed without a clear understanding of how they can be incorporated into surgeons’ practical training. Overall, the study indicates that digital surgical simulation is a promising tool for medical education in LMICs; however, additional research is required to address some of the limitations in order to achieve successful implementation, unless scaling efforts prove futile. Conclusions: This study indicates that digital surgical simulation is a promising tool for medical education in LMICs, but further research is necessary to address some of the limitations and ensure successful implementation. We urge more consistent reporting and understanding of implementation of science approaches in the development of digital surgical tools, as this is the critical factor that will determine whether we are able to meet the 2030 goals for surgical training in LMICs. Sustainability of implemented digital surgical tools is a pain point that must be focused on if we are to deliver digital surgical simulation tools to the populations that demand them the most. %M 37318901 %R 10.2196/23287 %U https://mededu.jmir.org/2023/1/e23287 %U https://doi.org/10.2196/23287 %U http://www.ncbi.nlm.nih.gov/pubmed/37318901 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47672 %T A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study %A Herranz,Carmen %A Martín-Moreno Banegas,Laura %A Dana Muzzio,Fernando %A Siso-Almirall,Antoni %A Roca,Josep %A Cano,Isaac %+ Physiopathological Mechanisms of Respiratory Illnesses Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, C/ del Rosselló, 149, Barcelona, 08036, Spain, 34 932275400, iscano@recerca.clinic.cat %K continuum of care management %K innovative healthcare services %K collaborative tools %K digital health transformation %K usability %K acceptability %K health care service %K Health Circuit %K health management %K management %K support %K digital aid %K aid %K care %K prototype %K surgery %K testing %D 2023 %7 14.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. Objective: The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. Methods: From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). Results: In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients’ empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Conclusions: Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. Trial Registration: ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663 %M 37314850 %R 10.2196/47672 %U https://www.jmir.org/2023/1/e47672 %U https://doi.org/10.2196/47672 %U http://www.ncbi.nlm.nih.gov/pubmed/37314850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47184 %T Investigating the Impact of User Trust on the Adoption and Use of ChatGPT: Survey Analysis %A Choudhury,Avishek %A Shamszare,Hamid %+ Industrial and Management Systems Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, 321 Engineering Sciences Building, 1306 Evansdale Drive, Morgantown, WV, 26506, United States, 1 304 293 9431, avishek.choudhury@mail.wvu.edu %K ChatGPT %K trust in AI %K artificial intelligence %K technology adoption %K behavioral intention %K chatbot %K human factors %K trust %K adoption %K intent %K survey %K shared accountability %K AI policy %D 2023 %7 14.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: ChatGPT (Chat Generative Pre-trained Transformer) has gained popularity for its ability to generate human-like responses. It is essential to note that overreliance or blind trust in ChatGPT, especially in high-stakes decision-making contexts, can have severe consequences. Similarly, lacking trust in the technology can lead to underuse, resulting in missed opportunities. Objective: This study investigated the impact of users’ trust in ChatGPT on their intent and actual use of the technology. Four hypotheses were tested: (1) users’ intent to use ChatGPT increases with their trust in the technology; (2) the actual use of ChatGPT increases with users’ intent to use the technology; (3) the actual use of ChatGPT increases with users’ trust in the technology; and (4) users’ intent to use ChatGPT can partially mediate the effect of trust in the technology on its actual use. Methods: This study distributed a web-based survey to adults in the United States who actively use ChatGPT (version 3.5) at least once a month between February 2023 through March 2023. The survey responses were used to develop 2 latent constructs: Trust and Intent to Use, with Actual Use being the outcome variable. The study used partial least squares structural equation modeling to evaluate and test the structural model and hypotheses. Results: In the study, 607 respondents completed the survey. The primary uses of ChatGPT were for information gathering (n=219, 36.1%), entertainment (n=203, 33.4%), and problem-solving (n=135, 22.2%), with a smaller number using it for health-related queries (n=44, 7.2%) and other activities (n=6, 1%). Our model explained 50.5% and 9.8% of the variance in Intent to Use and Actual Use, respectively, with path coefficients of 0.711 and 0.221 for Trust on Intent to Use and Actual Use, respectively. The bootstrapped results failed to reject all 4 null hypotheses, with Trust having a significant direct effect on both Intent to Use (β=0.711, 95% CI 0.656-0.764) and Actual Use (β=0.302, 95% CI 0.229-0.374). The indirect effect of Trust on Actual Use, partially mediated by Intent to Use, was also significant (β=0.113, 95% CI 0.001-0.227). Conclusions: Our results suggest that trust is critical to users’ adoption of ChatGPT. It remains crucial to highlight that ChatGPT was not initially designed for health care applications. Therefore, an overreliance on it for health-related advice could potentially lead to misinformation and subsequent health risks. Efforts must be focused on improving the ChatGPT’s ability to distinguish between queries that it can safely handle and those that should be redirected to human experts (health care professionals). Although risks are associated with excessive trust in artificial intelligence–driven chatbots such as ChatGPT, the potential risks can be reduced by advocating for shared accountability and fostering collaboration between developers, subject matter experts, and human factors researchers. %M 37314848 %R 10.2196/47184 %U https://www.jmir.org/2023/1/e47184 %U https://doi.org/10.2196/47184 %U http://www.ncbi.nlm.nih.gov/pubmed/37314848 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40425 %T The Use of Digital Health by South Asian Communities: Scoping Review %A Aldosari,Nasser %A Ahmed,Saima %A McDermott,Jane %A Stanmore,Emma %+ School of Health Sciences, University of Manchester, Oxford St, Manchester, M11 3DF, United Kingdom, 44 7580503020, nmdhaa@gmail.com %K South Asians %K Asia %K digital health %K eHealth %K mHealth %K mobile health %K aging %K ethnicity %K ethnic %K culturally sensitive %K cultural sensitivity %K inequality %K inequalities %K disparity %K disparities %K physical activity %K exercise %K immigrant %K scoping review %K experience %K attitude %K barrier %K facilitator %K opinion %K adoption %K digital divide %K accessibility %K minority %K mobile phone %D 2023 %7 12.6.2023 %9 Review %J J Med Internet Res %G English %X Background: South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. Objective: The aim of the review is to identify South Asian individuals’ experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services. Methods: The Arksey and O’Malley methodological framework was used to guide this scoping review. Five electronic databases were examined for pertinent papers, which were augmented by searching bibliographies of the retrieved papers and gray literature. A total of 1328 potentially relevant papers were retrieved from the initial search, and the supplemental search added 7 papers to the final list of potentially included papers. Each paper on the initial inclusion list was independently reviewed, leaving 15 papers to be included in the review. Results: Data were analyzed thematically leading to the development of two overarching themes: (1) barriers to uptake of digital health and (2) facilitators of use of digital health services. There was a general consensus that South Asian communities still struggle with inadequate access to digital health technologies. Some studies suggest multiple initiatives to improve accessibility and acceptability of digital health services within South Asian communities in order to mitigate health disparities and develop a more inclusive health care system. These include the development of multiple-language and culturally sensitive interventions and digital skill development sessions. Most studies were conducted in South Asian countries, focusing on measurable outcomes of digital health interventions. Few explored the experiences and views of South Asian community members residing in the West as a minority ethnic group, for example, British South Asians. Conclusions: Literature mapping proposes that South Asian people frequently struggle with a health care system that may limit their access to digital health services, and sometimes fails to consider social and cultural needs. There is growing evidence that digital health interventions have the potential to facilitate supported self-management, which is part of the plans to adopt person-centered care. These interventions are particularly important for overcoming some of the challenges, for example, time constraints, safety, and gender sensitivity, associated with the delivery of health care interventions in minority ethnic groups such as South Asians in the United Kingdom, and thus to improve minority ethnic groups’ access to health care services to support individual health needs, and consequently enhance health status. %M 37307045 %R 10.2196/40425 %U https://www.jmir.org/2023/1/e40425 %U https://doi.org/10.2196/40425 %U http://www.ncbi.nlm.nih.gov/pubmed/37307045 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45342 %T New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design %A Yoshioka-Maeda,Kyoko %A Matsumoto,Hiroshige %A Honda,Chikako %A Shiomi,Misa %A Taira,Kazuya %A Hosoya,Noriko %A Sato,Miki %A Sumikawa,Yuka %A Fujii,Hitoshi %A Miura,Takahiro %+ Department of Community Health Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033, Japan, 81 358413597, kyokoy-tky@g.ecc.u-tokyo.ac.jp %K community-based activity %K evidence-based practice %K individual care %K information and communication technology %K program development %K public health nursing %K quality assurance %K digitalization %K eHealth %K electronic record %D 2023 %7 12.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients’ and nursing interventions’ classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan’s lagging digitalization, supervisory PHNs face difficulties in monitoring each department’s activities and staff members’ performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices. Objective: We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices. Methods: We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system’s architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments. Results: This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones. Conclusions: This study will reveal PHNs’ tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management. Trial Registration: UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm International Registered Report Identifier (IRRID): DERR1-10.2196/45342 %M 37307040 %R 10.2196/45342 %U https://www.researchprotocols.org/2023/1/e45342 %U https://doi.org/10.2196/45342 %U http://www.ncbi.nlm.nih.gov/pubmed/37307040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40635 %T Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study %A Jackson-Triche,Maga %A Vetal,Don %A Turner,Eva-Marie %A Dahiya,Priya %A Mangurian,Christina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco, CA, 94143, United States, 1 628 206 5925, Christina.Mangurian@ucsf.edu %K chatbot technology %K health care workers %K mental health equity %K COVID-19 %K mental health chatbot %K behavioral health treatment %K mental health screening %K telehealth %K psychoeducation %K employee support %D 2023 %7 8.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. Objective: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. Methods: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. Results: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. Conclusions: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings. %M 37146178 %R 10.2196/40635 %U https://www.jmir.org/2023/1/e40635 %U https://doi.org/10.2196/40635 %U http://www.ncbi.nlm.nih.gov/pubmed/37146178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44326 %T Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist %A Martins,Ana Isabel %A Santinha,Gonçalo %A Almeida,Ana Margarida %A Ribeiro,Óscar %A Silva,Telmo %A Rocha,Nelson %A Silva,Anabela G %+ Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234370200, asilva@ua.pt %K usability evaluation %K Delphi study %K user-centered design %K design %K usability %K evaluation %K process %K development %K user %K digital %K efficient %K reporting %K quality %K applicability %D 2023 %7 6.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards. Objective: The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies. Methods: A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70% or more experienced participants scored an item 7 to 9 and less than 15% of participants scored the same item 1 to 3. Results: A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation–related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82%) of the procedures related to usability evaluation involving users and for 7 (70%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies. Conclusions: This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions. %M 37279047 %R 10.2196/44326 %U https://www.jmir.org/2023/1/e44326 %U https://doi.org/10.2196/44326 %U http://www.ncbi.nlm.nih.gov/pubmed/37279047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46721 %T Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021) %A Zhou,Weijiao %A Cho,Youmin %A Shang,Shaomei %A Jiang,Yun %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, UCT600 E635-3, 7000 Fannin St, Houston, TX, 77030, United States, 1 713 500 3591, youmcho@umich.edu %K digital health %K technology %K older adults %K cancer %K survivorship %K cancer survivor %K older cancer survivors %K digital health technology %D 2023 %7 31.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. Objective: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. Methods: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. Results: The prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. Conclusions: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty. %M 37256672 %R 10.2196/46721 %U https://www.jmir.org/2023/1/e46721 %U https://doi.org/10.2196/46721 %U http://www.ncbi.nlm.nih.gov/pubmed/37256672 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46595 %T Strengthening Digital Transformation and Innovation in the Health Care System: Protocol for the Design and Implementation of a Multidisciplinary National Health Innovation Research School %A Nygren,Jens M %A Lundgren,Lina %A Bäckström,Ingela %A Svedberg,Petra %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, SE 301 18, Sweden, 46 729773718, petra.svedberg@hh.se %K digital health technology %K doctoral education %K health %K health care %K health innovation %K implementation %K improvement %K innovation %K research school %D 2023 %7 31.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health technologies have the potential to transform health care services to be more cost-effective, coordinated, and accessible on equal terms for entire populations. In the future, people will be assisted by such technologies to monitor their health status, take preventive measures, and have more control of their health situation. An increase in digital supplementation or substitution of physical care visits can potentially add value to patients and care providers by increasing accessibility, safety, and quality of care. However, health care organizations struggle with the challenges of developing and implementing digital health technologies and services in practice. As a response to this, we have developed a national multidisciplinary research school to increase competence and capacity for research on the development, implementation, and dissemination of digital health technology solutions. The overall aim of the research school is to increase national competence and capacity for the development, implementation, and dissemination of digital health technology to increase the preparedness to support and facilitate the ongoing digital transformation in the health care system. Objective: The purpose of this paper is to outline the protocol for the development and implementation of a national multidisciplinary doctoral education program of health innovation supporting digital transformation in the health care system. Methods: A national multidisciplinary research school for health innovation was planned in collaboration between 7 Swedish universities and their partners from industry and the public sector. The research school will run over 6 years, of which 5 years are dedicated for the doctoral education program and 1 year for the project start-up and closing. In this paper, we outline the methodological approach of the research school; the combining of knowledge and expertise of the universities that are important to run the research school; the jointly formulated research-oriented and societally relevant research focus, goals, and objectives for the research school; the established and developed relationships with partners from industry and the public sector for joint research training projects; the forms of collaboration in the research school; and the format of the doctoral education process. Results: The research school was funded in December 2021 and started in March 2022. The research school starts with an initiation period from March 2022 to December 2022 where the infrastructure and the action plans to run the school are set up. The PhD projects start in January 2023, and these projects will be completed in 5 years. Additional activities within the research program are doctoral courses, networking activities, and dissemination of results. Conclusions: The network of several partners from industry, public sector, and academia enables the research school to pose research questions that can contribute to solving relevant societal problems related to the development, evaluation, implementation, and dissemination of methods and processes assisted by digital technologies. Ultimately, this will promote innovation to improve health outcomes, quality of care, and prioritizations of resources. International Registered Report Identifier (IRRID): PRR1-10.2196/46595 %M 37256654 %R 10.2196/46595 %U https://www.researchprotocols.org/2023/1/e46595 %U https://doi.org/10.2196/46595 %U http://www.ncbi.nlm.nih.gov/pubmed/37256654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42304 %T Offerings and User Demands of eHealth Services in Spain: National Survey %A Cernadas Ramos,Andrés %A Fernández Da Silva,Ángela %A Barral Buceta,Bran %A Bouzas-Lorenzo,Ramón %+ Department of Sociology, Political Science and Administration, and Philosophy, University of Vigo, Faculty of Public Management, Campus A Xunqueira S/N, Pontevedra, 36005, Spain, 34 881815163, angela.fernandez@uvigo.es %K Spanish eHealth %K health policies %K digital health %K COVID-19 %K eHealth offers %K eHealth demands %D 2023 %7 18.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The accelerated development of information and communication technologies has made health care one of the pioneering fields in the incorporation of these tools. As new technologies have been applied, existing technologies have been sophisticated and improved and the concept of eHealth has expanded. However, these advances and expansion of eHealth do not seem to have served to adapt the supply of services to users’ demands; rather, supply seems to be governed by other variables. Objective: The main objective of this work was to review the existing differences between user demands and the supply of eHealth services in Spain and their causes. The aim is to provide information on the level of use of the services and the causes of the variation in demand for these services, which can be useful in correcting existing differences and adapting them to the needs of users. Methods: A survey, “Use and Attitudes Toward eHealth in Spain,” was applied by telephone to a sample of 1695 people aged 18 years and over, taking into account sociodemographic profile characteristics (sex, age, habitat, educational level). The confidence level was set at 95% and the margin of error was ±2.45 for the whole sample. Results: The survey results showed that the online doctor’s appointment service is the most frequently used eHealth service by users: 72.48% of respondents used this service at some point and 21.28% stated that they use it regularly. The other services showed significantly lower percentages of use, including “managing health cards” (28.04%), “consulting medical history” (20.37%), “managing test results” (20.22%), “communicating with health professionals” (17.80%), and “requesting a change of doctor” (13.76%). Despite this low usage, a large majority of respondents (80.00%) attach great importance to all the services offered. Overall, 16.52% of the users surveyed were willing to make new service requests to the regional websites, with 9.33% of them highlighting services such as “the availability of a complaints and claims mailbox,” “the possibility of consulting medical records,” and “the availability of more detailed information on medical centers (location, medical directory, waiting lists, etc).” Other outstanding requests (8.00%) were to simplify the procedures for using certain existing services. Conclusions: The data from the survey show that eHealth services are widely known and highly valued by users, but not all services are used with the same frequency or intensity. It appears that users find it difficult to suggest new services that might be useful to them in terms of demand for new services that do not currently exist. It would be useful to use qualitative studies to gain a deeper understanding of currently unmet needs and the possibilities of eHealth. The lack of access to and use of these services and the unmet needs particularly affect more vulnerable populations who have the greatest difficulty in meeting their needs through alternative means to eHealth. %M 37200072 %R 10.2196/42304 %U https://www.jmir.org/2023/1/e42304 %U https://doi.org/10.2196/42304 %U http://www.ncbi.nlm.nih.gov/pubmed/37200072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43518 %T Factors Influencing Admission Decisions in Skilled Nursing Facilities: Retrospective Quantitative Study %A Strickland,Caroline %A Chi,Nancy %A Ditz,Laura %A Gomez,Luisa %A Wagner,Brittin %A Wang,Stanley %A Lizotte,Daniel J %+ Department of Computer Science, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 519 661 2111, cstrick4@uwo.ca %K decision-making %K skilled nursing facility %K patient admission %K decision %K nursing %K clinical %K database %K health informatics %K diagnosis %K modeling %K connection %K patient %D 2023 %7 17.5.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37195755 %R 10.2196/43518 %U https://www.jmir.org/2023/1/e43518 %U https://doi.org/10.2196/43518 %U http://www.ncbi.nlm.nih.gov/pubmed/37195755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40983 %T A Digital-First Health Care Approach to Managing Pandemics: Scoping Review of Pandemic Self-triage Tools %A Ziebart,Christina %A Kfrerer,Marisa L %A Stanley,Meagan %A Austin,Laurel C %+ Department of Physical Therapy, Faculty of Health Sciences, Western University, 1201 Western Rd, London, ON, N6G 1H1, Canada, 1 (519) 816 2190, cziebart@uwo.ca %K pandemic %K digital %K scoping review %K health care %K triage %K self-triage %K self-assessment %K patient navigation %K mobile phone %D 2023 %7 17.5.2023 %9 Review %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, many patient-facing digital self-triage tools were designed and deployed to alleviate the demand for pandemic virus triage in hospitals and physicians’ offices by providing a way for people to self-assess their health status and get advice on whether to seek care. These tools, provided via websites, apps, or patient portals, allow people to answer questions, for example, about symptoms and contact history, and receive guidance on appropriate care, which might be self-care. Objective: This scoping review aimed to explore the state of literature on digital self-triage tools that direct or advise care for adults during a pandemic and to explore what has been learned about the intended purpose, use, and quality of guidance; tool usability; impact on providers; and ability to forecast health outcomes or care demand. Methods: A literature search was conducted in July 2021 using MEDLINE, Embase, Scopus, PsycINFO, CINAHL, and Cochrane databases. A total of 1311 titles and abstracts were screened by 2 researchers using Covidence, and of these, 83 (6.76%) articles were reviewed via full-text screening. In total, 22 articles met the inclusion criteria; they allowed adults to self-assess for pandemic virus, and the adults were directed to care. Using Microsoft Excel, we extracted and charted the following data: authors, publication year and country, country the tool was used in, whether the tool was integrated into a health care system, number of users, research question and purpose, direction of care provided, and key findings. Results: All but 2 studies reported on tools developed since early 2020 during the COVID-19 pandemic. Studies reported on tools that were developed in 17 countries. The direction of care advice included directing to an emergency room, seeking urgent care, contacting or seeing a physician, being tested, or staying at home and self-isolating. Only 2 studies evaluated tool usability. No study demonstrated that the tools reduce demand on the health care system, although at least one study suggested that data can predict demand for care and that data allow monitoring public health. Conclusions: Although self-triage tools developed and used around the world have similarities in directing to care (emergency room, physician, and self-care), they differ in important ways. Some collect data to predict health care demand. Some are intended for use when concerned about health status; others are intended to be used repeatedly by users to monitor public health. The quality of triage may vary. The high use of such tools during the COVID-19 pandemic suggests that research is needed to assess and ensure the quality of advice given by self-triage tools and to assess intended or unintended consequences on public health and health care systems. %M 37018543 %R 10.2196/40983 %U https://www.jmir.org/2023/1/e40983 %U https://doi.org/10.2196/40983 %U http://www.ncbi.nlm.nih.gov/pubmed/37018543 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43808 %T Problems and Barriers Related to the Use of Digital Health Applications: Scoping Review %A Giebel,Godwin Denk %A Speckemeier,Christian %A Abels,Carina %A Plescher,Felix %A Börchers,Kirstin %A Wasem,Jürgen %A Blase,Nikola %A Neusser,Silke %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Universität Duisburg-Essen, Weststadt-Carree, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 201183 ext 3180, godwin.giebel@medman.uni-due.de %K mobile health %K mHealth %K app %K Digital Health Application %K DHA %K Digitale Gesundheitsanwendungen %K DiGA %K problem %K barrier %K mobile phone %D 2023 %7 12.5.2023 %9 Review %J J Med Internet Res %G English %X Background: The digitization of health care led to a steady increase in the adoption and use of mobile health (mHealth) apps. Germany is the first country in the world to cover the costs of mHealth apps through statutory health insurance. Although the benefits of mHealth apps are discussed in detail, aspects of problems and barriers are rarely studied. Objective: This scoping review aimed to map and categorize the evidence on problems and barriers related to the use of mHealth apps. Methods: Systematic searches were conducted in the MEDLINE, Embase, and PsycINFO databases. Additional searches were conducted on JMIR Publications and on websites of relevant international organizations. The inclusion criteria were publications dealing with apps similar to those approved in the German health care system, publications addressing problems and barriers related to the use of mHealth apps, and articles published between January 1, 2015, and June 8, 2021. Study selection was performed by 2 reviewers. The manuscript was drafted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The analysis of the included publications and categorization of problems and hurdles were performed using MAXQDA (VERBI Software GmbH). Results: The database search identified 1479 publications. Of the 1479 publications, 21 (1.42%) met the inclusion criteria. A further 8 publications were included from citation searching and searching in JMIR Publications. The identified publications were analyzed for problems and barriers. Problems and barriers were classified into 10 categories (“validity,” “usability,” “technology,” “use and adherence,” “data privacy and security,” “patient-physician relationship,” “knowledge and skills,” “individuality,” “implementation,” and “costs”). The most frequently mentioned categories were use and adherence (eg, incorporating the app into daily life or dropouts from use; n=22) and usability (eg, ease of use and design; n=19). Conclusions: The search identified various problems and barriers in the context of mHealth apps. Although problems at the app level (such as usability) are studied frequently, problems at the system level are addressed rather vaguely. To ensure optimal use of and care with mHealth apps, it is essential to consider all types of problems and barriers. Therefore, researchers and policy makers should have a special focus on this issue to identify the needs for quality assurance. International Registered Report Identifier (IRRID): RR2-10.2196/32702 %M 37171838 %R 10.2196/43808 %U https://www.jmir.org/2023/1/e43808 %U https://doi.org/10.2196/43808 %U http://www.ncbi.nlm.nih.gov/pubmed/37171838 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46694 %T iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations %A Perrin Franck,Caroline %A Babington-Ashaye,Awa %A Dietrich,Damien %A Bediang,Georges %A Veltsos,Philippe %A Gupta,Pramendra Prasad %A Juech,Claudia %A Kadam,Rigveda %A Collin,Maxime %A Setian,Lucy %A Serrano Pons,Jordi %A Kwankam,S Yunkap %A Garrette,Béatrice %A Barbe,Solenne %A Bagayoko,Cheick Oumar %A Mehl,Garrett %A Lovis,Christian %A Geissbuhler,Antoine %+ Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Chemin des Mines 9, Geneva, CH-1202, Switzerland, 41 0787997725, caroline.perrin@gmx.de %K implementation science %K knowledge management %K reporting standards %K publishing standards %K guideline %K Digital Health Hub %K reporting guideline %K digital health implementation %K health outcome %D 2023 %7 10.5.2023 %9 Implementation Report %J J Med Internet Res %G English %X 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. %M 37163336 %R 10.2196/46694 %U https://www.jmir.org/2023/1/e46694 %U https://doi.org/10.2196/46694 %U http://www.ncbi.nlm.nih.gov/pubmed/37163336 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43196 %T Effectiveness of a Mobile App (KhunLook) Versus the Maternal and Child Health Handbook on Thai Parents’ Health Literacy, Accuracy of Health Assessments, and Convenience of Use: Randomized Controlled Trial %A Areemit,Rosawan %A Saengnipanthkul,Suchaorn %A Sutra,Sumitr %A Lumbiganon,Pagakrong %A Pornprasitsakul,Phenphitcha %A Paopongsawan,Pongsatorn %A Sripanidkulchai,Kunwadee %+ Department of Pediatrics, Faculty of Medicine, Khon Kaen University, 123, Mittraphap Road, Muang District, Khon Kaen, 40002, Thailand, 66 885101031, suchsa@kku.ac.th %K health literacy %K mobile app %K mHealth %K KhunLook %K Maternal and Child Health Handbook %K parent %K health assessment %K child health supervision %K Thailand %D 2023 %7 9.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Children of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents’ HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child’s health in complement to the standard Maternal and Child Health Handbook (MCHH). Objective: This trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents’ HL. Data on accuracy of parents’ assessment of their child’s health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2). Methods: Parents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child’s handbook to assess their child’s growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire. Results: A total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; Δ 8.2%; P=.04), specifically in the health management (30/182; Δ 16.4%; P<.001) and child health management (18/182; Δ 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child’s head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit. Conclusions: Our results suggest the potential of a smartphone app (KhunLook) to improve parents’ HL as well as to promote superior accuracy of parents’ assessment of their child’s head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood. Trial Registration: Thai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR20200312003 %M 37159258 %R 10.2196/43196 %U https://www.jmir.org/2023/1/e43196 %U https://doi.org/10.2196/43196 %U http://www.ncbi.nlm.nih.gov/pubmed/37159258 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e32962 %T 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 %A Olaye,Iredia M %A Seixas,Azizi A %+ Department of Medicine, Weill Cornell Medicine, Cornell University, 1300 York Avenue, Box #46, New York, NY, 10065, United States, 1 646 962 5050, imo4001@med.cornell.edu %K digital health %K startups %K venture capital %K artificial intelligence %K AI translation %K clinical practice %K early-stage %K funding %K bedside %K machine learning %K technology %K tech %K qualitative %K workshop %K entrepreneurs %D 2023 %7 2.5.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37129947 %R 10.2196/32962 %U https://www.jmir.org/2023/1/e32962 %U https://doi.org/10.2196/32962 %U http://www.ncbi.nlm.nih.gov/pubmed/37129947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41225 %T Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study %A Ndlovu,Kagiso %A Mars,Maurice %A Scott,Richard E %+ Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa, 27 0312601075, ndlovuk@ub.ac.bw %K mobile health %K mHealth %K electronic record systems %K eRecord systems %K mHealth-eRecord Interoperability Framework %K mHeRIF %K interoperability architecture %K validation %K Botswana %K mobile phone %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. Objective: This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Methods: Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. Results: The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts’ suggestions led to 4 modest revisions of the mHeRIF. Conclusions: Overall, the experts’ reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana. %M 37129939 %R 10.2196/41225 %U https://formative.jmir.org/2023/1/e41225 %U https://doi.org/10.2196/41225 %U http://www.ncbi.nlm.nih.gov/pubmed/37129939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42966 %T Patient Experiences With Virtual Care During the COVID-19 Pandemic: Phenomenological Focus Group Study %A Curran,Vernon R %A Hollett,Ann %A Peddle,Emily %+ Faculty of Medicine, Memorial University, Prince Philip Drive, St John's, NL, A1B 3V6, Canada, 1 7098643346, vcurran@mun.ca %K virtual care %K focus group %K patients %K patient education %K qualitative study %K patient experience %K health care system %K digital literacy %K rural community %K technology adoption %K COVID-19 %D 2023 %7 1.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care has expanded during the COVID-19 pandemic and enabled greater access and continuity of care for many patients. From a patient-oriented research perspective, understanding the patient experience with virtual care appointments is an important first step in identifying ways to better support patient use and satisfaction. Objective: The purpose of this qualitative study was (1) to explore patients’ experiences and perspectives with the adoption and use of virtual care during COVID-19 in Newfoundland and Labrador, Canada, and (2) identify the education and informational needs of patients to inform future strategies for supporting patient use of virtual care. Methods: Using a phenomenological approach, we conducted a focus group interview with a purposive sample of patient representatives representing a cross-section of the population of the province of Newfoundland and Labrador. Five patient representatives were recruited from the Newfoundland and Labrador Support Patient Advisory Council and participated in the focus group. The focus group was conducted in February 2022 via videoconferencing technology. Using thematic analysis, we identified several recurrent themes that described respondents’ experiences with the use of virtual care during COVID-19, as well as their perceptions of education and informational needs to support more effective patient use of virtual care. Results: Respondents felt that virtual care is a beneficial addition to the health care system, enabling greater convenience and access to health care services. Key barriers and challenges in adopting and using virtual care appear to primarily arise from patients’ lack of knowledge, understanding, and familiarity with respect to virtual care. Cost, technological access, connectivity, and low digital literacy were challenges for some patients, particularly in rural communities and among older patient population. Patient education and support were critical and needed to be inclusive, easy to understand, and include information regarding privacy, security, consent, and the technology itself. The types of patient education experiences regarded as most helpful included peer support and knowledge sharing among patients themselves. Conclusions: Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing the continuity of care for patients through more convenient access. The education and informational needs of patients are important considerations in promoting the adoption and use of virtual care. Key education and informational needs and strategies were identified to enable and empower patients with the knowledge, digital literacy skills, and support to effectively use virtual care. %M 37036827 %R 10.2196/42966 %U https://formative.jmir.org/2023/1/e42966 %U https://doi.org/10.2196/42966 %U http://www.ncbi.nlm.nih.gov/pubmed/37036827 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40993 %T Influence of E-consultation on the Intention of First-Visit Patients to Select Medical Services: Results of a Scenario Survey %A Qi,Miaojie %A Cui,Jiyu %A Li,Xing %A Han,Youli %+ Department of Health Management and Policy, School of Public Health, Capital Medical University, Number 10, Xi Toutiao Road, Youanmenwai District, Beijing, 100069, China, 86 83911790, hanyouli@ccmu.edu.cn %K e-consultation %K medical selection %K influence mechanism %K scenario survey %D 2023 %7 28.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: E-consultation is expected to improve the information level of patients, affect patients’ subsequent judgments of medical services, and guide patients to make a reasonable medical selection in the future. Thus, it is important to understand the influence mechanism of e-consultation on patients’ medical selection. Objective: This study aims to explore the changes in first-visit patients’ understanding of disease and medical resources after e-consultation as well as the choice of follow-up medical services. Methods: Patients’ medical selection before and after e-consultation was compared using a scenario survey. Based on the service characteristics of the e-consultation platform, representative simulation scenarios were determined, and parallel control groups were set up considering the order effect in comparison. Finally, a total of 4 scenario simulation questionnaires were designed. A total of 4164 valid questionnaires were collected through the online questionnaire collection platform. Patients’ perception of disease severity, evaluation of treatment capacity of medical institutions, selection of hospitals and doctors, and other outcome indicators were tested to analyze the differences in patients’ evaluation and choice of medical services before and after e-consultation. Additionally, the results’ stability was tested by regression analysis. Results: In scenario 1 (mild case), before e-consultation, 14.1% (104/740) of participants considered their conditions as not serious. After e-consultation, 69.5% (539/775) of them considered their diseases as not serious. Furthermore, participants’ evaluation of the disease treatment capacity of medical institutions at all levels had improved after using e-consultation. In scenario 3 (severe case), before e-consultation, 54.1% (494/913) of the participants believed their diseases were very serious. After e-consultation, 16.6% (157/945) considered their diseases were very serious. The evaluation of disease treatment capacity of medical institutions in nontertiary hospitals decreased, whereas that of tertiary hospitals improved. In both mild and severe cases, before e-consultation, all of the participants were inclined to directly visit the hospital. After e-consultation, more than 71.4% (553/775) of the patients with mild diseases chose self-treatment, whereas those with severe diseases still opted for a face-to-face consultation. After e-consultation, patients who were set on being treated in a hospital, regardless of the disease severity, preferred to select the tertiary hospitals. Of the patients with mild diseases who chose to go to a hospital, 25.7% (57/222) wanted to consult online doctors face-to-face. By contrast, 56.4% (506/897) of the severe cases wanted to consult online doctors face-to-face. Conclusions: E-consultation can help patients accurately enhance their awareness of the disease and guide them to make a more reasonable medical selection. However, it is likely that e-consultation makes online medical services centralized. Additionally, the guiding effect of e-consultation is limited, and e-consultation needs to be combined with other supporting systems conducive to medical selection to play an improved role. %M 37115615 %R 10.2196/40993 %U https://www.jmir.org/2023/1/e40993 %U https://doi.org/10.2196/40993 %U http://www.ncbi.nlm.nih.gov/pubmed/37115615 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43314 %T Opportunities to Enhance the Implementation of Veterans Affairs Video-Based Care: Qualitative Perspectives of Providers from Diverse Specialties %A Slightam,Cindie %A Wray,Charlie %A Tisdale,Rebecca L %A Zulman,Donna M %A Gray,Caroline %+ Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 614 9997 ext 27155, cindie.slightam@va.gov %K implementation %K video visit %K VA %K qualitative %K adoption %K perspective %K health care provider %K physician %K health care professional %K veteran %K virtual visit %K virtual care %D 2023 %7 24.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing the adoption of digital care tools, including video visits, is a long-term goal for the US Department of Veterans Affairs (VA). While previous work has highlighted patient-specific barriers to the use of video visits, few have examined how clinicians view such barriers and how they have overcome them during the rapid uptake of web-based care. Objective: This study sought input from providers, given their role as critical participants in video visit implementation, to qualitatively describe successful strategies providers used to adapt their practices to a web-based care setting. Methods: We conducted interviews with 28 VA providers (physicians and nurse practitioners) from 4 specialties that represent diverse clinical services: primary care (n=11), cardiology (n=7), palliative care (n=5), and spinal cord injury (n=5). All interviews were audio recorded and transcribed, and transcripts were reviewed and coded according to an iteratively created codebook. To identify themes, codes were grouped together into categories, and participant comments were reviewed for repetition and emphasis on specific points. Finally, themes were mapped to Expert Recommendations for Implementing Change (ERIC) strategies to identify evidence-based opportunities to support video visit uptake in the VA. Results: Interviewees were mostly female (57%, 16/28), with an average age of 49 years and with 2-20 years of experience working in the VA across 16 unique VA facilities. Most providers (82%, 23/28) worked in urban facilities. Many interviewees (78%, 22/28) had some experience with video visits prior to the COVID-19 pandemic, though a majority (61%, 17/28) had conducted fewer than 50 video visits in the quarter prior to recruitment. We identified four primary themes related to how providers adapt their practices to a web-based care setting: (1) peer-based learning and support improved providers’ perceived value of and confidence in video visits, (2) providers developed new and refined existing communication and clinical skills to optimize video visits, (3) providers saw opportunities to revisit and refine team roles to optimize the value of video visits for their care teams, and (4) implementing and sustaining web-based care requires institutional and organizational support. We identified several ERIC implementation strategies to support the use of video visits across the individual-, clinic-, and system-levels that correspond to these themes: (1) individual-level strategies include the development of educational materials and conducting education meetings, (2) clinic-level strategies include identifying champions and revising workflows and professional roles, and (3) system-level strategies include altering incentive structures, preparing implementation blueprints, developing and implementing tools for quality monitoring, and involving executive leadership to encourage adoption. Conclusions: This work highlights strategies to support video visits that align with established ERIC implementation constructs, which can be used by health care systems to improve video visit implementation. %M 37093642 %R 10.2196/43314 %U https://www.jmir.org/2023/1/e43314 %U https://doi.org/10.2196/43314 %U http://www.ncbi.nlm.nih.gov/pubmed/37093642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41915 %T The Usage of Digital Health Technology Among Older Adults in Hong Kong and the Role of Technology Readiness and eHealth Literacy: Path Analysis %A Kim,Seungmo %A Chow,Bik Chu %A Park,Sanghyun %A Liu,Huaxuan %+ Department of Sport for All, Korea National Open University, Nanumgwan 507, 86 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea, 82 10 4817 4161, dslionspark@mail.knou.ac.kr %K older adults %K elderly %K digital health technology %K health technology %K digital health %K technology readiness %K eHealth literacy %K continuous usage intention %K usage intention %K intention-to-use %K attitude %K technology use %K elder %K digital literacy %K adoption %K acceptance %K readiness %K gerontology %K aging %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although digital health technologies (DHTs) help many people maintain a healthy life, including those of advanced age, these technologies are of little use to older adult populations if they are not being adopted in daily life. Thus, it is critical to identify ways to help older adults recognize and try new technologies and maintain their use of them to maximize the benefits of these technologies in a digital-based society. Objective: Our study aimed (1) to assess the current usage of DHT among older adults in Hong Kong and (2) to examine how high and low levels of eHealth literacy in this group affects the relationship between the Technology Readiness and Acceptance Model (TRAM) and attitudes and intention toward DHT. Methods: A total of 306 adults over 60 years of age in Hong Kong participated in this study. After conducting confirmatory factor analysis to validate the measurement model, the hypothesized model was tested using structural equation modeling. Results: Optimism was significantly related to perceived usefulness, while optimism, innovativeness, and discomfort were significantly associated with perceived ease of use. Both perceived usefulness and perceived ease of use were significantly linked to attitude toward the use of DHTs. Meanwhile, attitude significantly predicted usage intention. Additionally, the results revealed the differences in the relationships of the TRAM between participants with high and low levels of eHealth literacy. The influence of optimism and innovativeness on perceived ease of use was stronger for the higher-level group than for the lower-level group, and the influence of discomfort for the higher-level group was much weaker. Conclusions: The findings provided partial support for the impact of eHealth literacy on encouraging older adults to use DHT and obtain health benefits from it. This study also suggests providing assistance and guidelines for older adults to narrow the aging-related technology gap and to further explore the associations of eHealth literacy, the TRAM, and actual behaviors. %M 37043274 %R 10.2196/41915 %U https://www.jmir.org/2023/1/e41915 %U https://doi.org/10.2196/41915 %U http://www.ncbi.nlm.nih.gov/pubmed/37043274 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41832 %T General Practices’ Experiences With Patients’ Web-Based Access to Medical Records: Survey Study %A Keuper,Jelle %A Batenburg,Ronald %A van Tuyl,Lilian %A Verheij,Robert %+ Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513CR, Netherlands, 31 627460492, j.keuper@nivel.nl %K patient access to records %K electronic health record %K patient portals %K general practice %K administrative burden %K health information %K shared decision-making %K health care professionals %D 2023 %7 7.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ web-based access to their medical records is expected to promote their role and responsibility in managing their own health and treatments and supporting shared decision-making. As of July 2020, general practices in the Netherlands are legally obliged to provide their patients access to their electronic medical records. Web-based access provision is facilitated and stimulated through a national support program named OPEN. Objective: We aimed to investigate general practice staff experiences with providing web-based access; investigate its impact on patient consultations, administrative actions, and patient inquiries; and investigate how it affects routine general practice workflow processes. Methods: In October 2021, a total of 3813 general practices in the Netherlands were invited to complete a web-based survey that included questions regarding their experiences with the provision of web-based access to medical records and how it affects routine general practice workflow. Responses of general practices that started providing web-based access before 2020, in 2020, or in 2021 were analyzed to identify trends. Results: Of 3813 invited general practices, 523 (13.72%) completed the survey. Approximately all responding general practices (487/523, 93.1%) indicated that they provide web-based access. Experiences with patients’ web-based access were diverse, with 36.9% (178/482) primarily positive, 8.1% (39/482) primarily negative, 42.3% (204/482) neutral, and 12.7% (61/482) could not (yet) indicate how they experienced web-based access. Of the total, two-thirds (311/473, 65.8%) reported an increase in e-consultations and a similar percentage (302/474, 63.7%) indicated an increase in administrative actions associated with web-based access provision. A small proportion of the practices (≤10%) experienced a decrease in patient contacts. Earlier adoption of web-based access was associated with a more positive attitude toward web-based access and more positive experienced effects related to patient contacts and general practice workflow. Conclusions: The surveyed general practices mainly experienced providing web-based access as either neutral or mostly positive, despite an increased number of patient contacts and administrative burden that were associated with its adoption. Periodic monitoring of experiences is needed to understand the temporal or structural nature of both the intended and unintended effects of patients’ web-based access to medical records for general practices and their staff. %M 37027195 %R 10.2196/41832 %U https://www.jmir.org/2023/1/e41832 %U https://doi.org/10.2196/41832 %U http://www.ncbi.nlm.nih.gov/pubmed/37027195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43009 %T Digital Health at Enterprise Scale: Evaluation Framework for Selecting Patient-Facing Software in a Digital-First Health System %A Shapiro,Martin %A Renly,Sondra %A Maiorano,Ali %A Young,Jerry %A Medina,Eli %A Neinstein,Aaron %A Odisho,Anobel Y %+ Center for Digital Health Innovation, University of California, San Francisco, 550 16th Street Box 1695, San Francisco, CA, 94143, United States, 1 4155022018, anobel.odisho@ucsf.edu %K artificial intelligence %K digital health pathway %K eHealth %K enterprise digital health %K evaluation framework %K framework %K healthcare delivery %K healthcare system %K intelligent care %K intelligent system %K privacy %K security %K service delivery %K systems design %K telehealth %K telemedicine %D 2023 %7 7.4.2023 %9 Viewpoint %J JMIR Form Res %G English %X The digital transformation of our health care system will require not only digitization of existing tools but also a redesign of our care delivery system and collaboration with digital partners. Traditional patient journeys are reactive to symptom presentation and delayed by health care system–centric scheduling, leading to poor experience and avoidable adverse outcomes. Patient journeys will be reimagined to a digital health pathway that seamlessly integrates various care experiences from telemedicine, remote monitoring, to in-person clinic visits. Through centering the care delivery around the patients, they can have more delightful experiences and enjoy the quality of standardized condition pathways and outcomes. To design and implement digital health pathways at scale, enterprise health care systems need to develop capabilities and partnerships in human-centered design, operational workflow, clinical content management, communication channels and mechanisms, reporting and analytics, standards-based integration, security and data management, and scalability. Using a human-centered design methodology, care pathways will be built upon an understanding of the unmet needs of the patients to have a more enjoyable experience of care with improved clinical outcomes. To power this digital care pathway, enterprises will choose to build or partner for clinical content management to operationalize up-to-date, best-in-class pathways. With this clinical engine, this digital solution will engage with patients through multimodal communication modalities, including written, audio, photo, or video, throughout the patient journey. Leadership teams will review reporting and analytics functions to track that the digital care pathways will be iterated to improve patient experience, clinical metrics, and operational efficiency. On the backend, standards-based integration will allow this system to be built in conjunction with the electronic medical record and other data systems to provide safe and efficient use of the digital care solution. For protecting patient information and compliance, a security and data management strategy is critical to derisking breeches and preserving privacy. Finally, a framework of technical scalability will allow digital care pathways to proliferate throughout the enterprise and support the entire patient population. This framework empowers enterprise health care systems to avoid collecting a fragmented series of one-off solutions but develop a sustainable concerted roadmap to the future of proactive intelligent patient care. %M 37027184 %R 10.2196/43009 %U https://formative.jmir.org/2023/1/e43009 %U https://doi.org/10.2196/43009 %U http://www.ncbi.nlm.nih.gov/pubmed/37027184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43127 %T Asymmetric Interoperability as a Strategy Among Provider Group Health Information Exchange: Directional Analysis %A Shah,Rohin Rathin %A Bailey,Joseph Peter %+ The Robert H. Smith School of Business, University of Maryland, 7699 Mowatt Ln, College Park, MD, 20742-1815, United States, 1 301 405 2174, jpbailey@umd.edu %K health information exchange %K quality payment program %K electronic health records %K electronic referrals %K medical informatics %K technology adoption %K health information interoperability %D 2023 %7 6.4.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37023418 %R 10.2196/43127 %U https://www.jmir.org/2023/1/e43127 %U https://doi.org/10.2196/43127 %U http://www.ncbi.nlm.nih.gov/pubmed/37023418 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40429 %T Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals %A Westheimer,Jessa Lin %A Moukaddam,Nidal %A Lindsay,Jan A %A Sabharwal,Ashutosh %A Najafi,Bijan %A Iacobelli,Peter A %A Boland,Robert J %A Patriquin,Michelle A %+ Research Department, The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, United States, 1 832 738 8300, jwestheimer@menninger.edu %K digital transformation %K user-centered design %K innovation %K implementation science %K user acceptability %K wearables %K mental health %K implementation %K technology implementation %D 2023 %7 6.4.2023 %9 Viewpoint %J JMIR Ment Health %G English %X Digital transformation is the adoption of digital technologies by an entity in an effort to increase operational efficiency. In mental health care, digital transformation entails technology implementation to improve the quality of care and mental health outcomes. Most psychiatric hospitals rely heavily on “high-touch” interventions or those that require in-person, face-to-face interaction with the patient. Those that are exploring digital mental health care interventions, particularly for outpatient care, often copiously commit to the “high-tech” model, losing the crucial human element. The process of digital transformation, especially within acute psychiatric treatment settings, is in its infancy. Existing implementation models outline the development of patient-facing treatment interventions within the primary care system; however, to our knowledge, there is no proposed or established model for implementing a new provider-facing ministration tool within an acute inpatient psychiatric setting. Solving the complex challenges within mental health care demands that new mental health technology is developed in concert with a use protocol by and for the inpatient mental health professional (IMHP; the end user), allowing the “high-touch” to inform the “high-tech” and vice versa. Therefore, in this viewpoint article, we propose the Technology Implementation for Mental-Health End-Users framework, which outlines the process for developing a prototype of an IMHP-facing digital intervention tool in parallel with a protocol for the IMHP end user to deliver the intervention. By balancing the design of the digital mental health care intervention tool with IMHP end user resource development, we can significantly improve mental health outcomes and pioneer digital transformation nationwide. %M 37023415 %R 10.2196/40429 %U https://mental.jmir.org/2023/1/e40429 %U https://doi.org/10.2196/40429 %U http://www.ncbi.nlm.nih.gov/pubmed/37023415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42556 %T Patients’ Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study %A Bally,Esmee L S %A Cheng,Demi %A van Grieken,Amy %A Ferri Sanz,Mireia %A Zanutto,Oscar %A Carroll,Aine %A Darley,Andrew %A Roozenbeek,Bob %A Dippel,Diederik W J %A Raat,Hein %+ Department of Public Health, Erasmus MC University Medical Center, Dr Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 10 703 8580, h.raat@erasmusmc.nl %K stroke patients %K digital health technology %K self-management %K co-design %K user-requirements %K user-centered design %K qualitative research %D 2023 %7 4.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies such as mobile apps and robotics have the potential to involve stroke patients better in the care process and to promote self-management. However, barriers exist that constrain the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for health-related technology. To address these barriers, co-design can be used to enable patients to reflect on their experiences of a service and to tailor digital technologies to the needs and preferences of end users regarding content and usability. Objective: This study aims to explore the perspectives of stroke patients toward how digital health technology could support self-management regarding health and well-being, as well as integrated stroke care. Methods: A qualitative study was conducted to understand patient perspectives. Data were collected in co-design sessions during the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on sociodemographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach. Results: Patients held mixed attitudes toward digital health technologies. Some patients viewed digital technology as a convenient product or service, while others expressed no desire or need to use technology for self-management or care. Digital features suggested by stroke patients included (1) information about the causes of stroke, medication, prognosis, and follow-up care; (2) an online library with information regarding stroke-related health and care issues; (3) a personal health record by which patients can retrieve and manage their own health information; and (4) online rehabilitation support to empower patients to exercise at home. Regarding the user interface of future digital health technology, patients emphasized the need for easy-to-use and simple designs. Conclusions: Stroke patients mentioned credible health information, an online library with stroke-related health and care information, a personal health record, and online rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the “voice of the stroke patients” regarding both functionality and the characteristics of the interface. International Registered Report Identifier (IRRID): RR2-10.1186/s12877-022-03333-8 %M 37014677 %R 10.2196/42556 %U https://www.jmir.org/2023/1/e42556 %U https://doi.org/10.2196/42556 %U http://www.ncbi.nlm.nih.gov/pubmed/37014677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42453 %T Implementation of European Cross-border Electronic Prescription and Electronic Dispensing Service: Cross-sectional Survey %A Jõgi,Reelika %A Timonen,Johanna %A Saastamoinen,Leena %A Laius,Ott %A Volmer,Daisy %+ Department of Marketing Authorisations, The Estonian State Agency of Medicines, Nooruse 1, Tartu, 50411, Estonia, 372 737 4140, reelika.jogi@ravimiamet.ee %K electronic prescription %K ePrescription %K cross-border ePrescription %K electronic dispensing %K eDispensing %K eHealth %K digital health %K implementation %K European Union %D 2023 %7 4.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The European cross-border electronic prescription (CBeP) and cross-border electronic dispensing system was first implemented in January 2019 when it became possible to purchase medications from community pharmacies in Estonia using a Finnish ePrescription. In 2020, Estonian ePrescriptions became available to be dispensed in Finnish pharmacies. The CBeP is an important milestone in increasing access to medicines across the European Union, and it has been unstudied to date. Objective: This study aimed to investigate Estonian and Finnish pharmacists’ experiences of factors influencing access to, and dispensing of, CBePs. Methods: A web-based survey was conducted among Estonian and Finnish pharmacists between April and May 2021. The survey was distributed to all 664 community pharmacies (n=289, 43.5% in Estonia and n=375, 56.5% in Finland) where CBePs had been dispensed in 2020. The data were analyzed using frequencies and a chi-square test. Answers to open-ended questions were categorized using content analysis and then analyzed by frequency. Results: In total, 66.7% (84/126) of the responses from Estonia and 76.6% (154/201) of the responses from Finland were included in the study. The majority of Estonian (74/84, 88%) and Finnish (126/154, 81.8%) respondents agreed that CBePs have improved patients’ access to medications. Problems with the availability of medications when dispensing CBePs were reported by 76% (64/84) of the Estonian respondents and 35.1% (54/154) of the Finnish respondents. In Estonia, the most commonly reported availability problem concerned the same active ingredient (49/84, 58%) of the medication not being available in the market, whereas in Finland, the most common issue was the unavailability of equivalent package size in the market (30/154, 19.5%). Encountering ambiguities or errors in the CBePs was reported by 61% (51/84) of the Estonian respondents and 42.8% (66/154) of the Finnish respondents. Mostly, the availability issues and ambiguities or errors were encountered rarely. The most commonly encountered ambiguities or errors were incorrect pharmaceutical form (23/84, 27%) in Estonia and incorrect total amount of medication (21/154, 13.6%) in Finland. Technical problems with using the CBeP system were reported by 57% (48/84) of the Estonian respondents and 40.2% (62/154) of the Finnish respondents. Most of the Estonian and Finnish respondents (53/84, 63%, and 133/154, 86.4%, respectively) had access to guidelines for dispensing CBePs. More than half of the Estonian (52/84, 62%) and Finnish (95/154, 61.7%) respondents felt that they had received sufficient training on dispensing CBePs. Conclusions: Pharmacists in both Estonia and Finland agreed that CBePs improve access to medications. However, interfering factors, such as ambiguities or errors in CBePs and technical problems in the CBeP system, can reduce access to medications. The respondents had received sufficient training and were informed of the guidelines; however, they felt that the content of the guidelines could be improved. %M 37014689 %R 10.2196/42453 %U https://www.jmir.org/2023/1/e42453 %U https://doi.org/10.2196/42453 %U http://www.ncbi.nlm.nih.gov/pubmed/37014689 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e47695 %T “To Err Is Evolution”: We Need the Implementation Report to Learn %A Perrin Franck,Caroline %A Geissbuhler,Antoine %A Lovis,Christian %+ Campus Biotech, University of Geneva, Chemin des Mines 9, Geneva, 1202, Switzerland, 41 787997725, caroline.perrin@unige.ch %K implementation science %K knowledge management %K knowledge sharing %K digital health %K implementation report %D 2023 %7 4.4.2023 %9 Editorial %J JMIR Med Inform %G English %X JMIR Medical Informatics is pleased to offer implementation reports as a new article type. Implementation reports present real-world accounts of the implementation of health technologies and clinical interventions. This new article type is intended to promote the rapid documentation and dissemination of the perspectives and experiences of those involved in implementing digital health interventions and assessing the effectiveness of digital health projects. %M 37014675 %R 10.2196/47695 %U https://medinform.jmir.org/2023/1/e47695 %U https://doi.org/10.2196/47695 %U http://www.ncbi.nlm.nih.gov/pubmed/37014675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39383 %T Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study %A Wittenauer,Rachel %A Dolan,Samantha B %A Njoroge,Anne %A Onyango,Penina %A Owiso,George %A Rabinowitz,Peter %A Puttkammer,Nancy %+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 6502694771, rwitten1@uw.edu %K workflow %K digital health %K electronic immunization registry %K usability %K acceptability %K health care worker %K technology adoption %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. Objective: This study aimed to evaluate HCWs’ perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. Methods: We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. Results: HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs’ perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Conclusions: Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya’s program and for other efforts around the globe, as digital health interventions become more widely used. %M 36995755 %R 10.2196/39383 %U https://formative.jmir.org/2023/1/e39383 %U https://doi.org/10.2196/39383 %U http://www.ncbi.nlm.nih.gov/pubmed/36995755 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45143 %T Assessing the Quality and Impact of eHealth Tools: Systematic Literature Review and Narrative Synthesis %A Jacob,Christine %A Lindeque,Johan %A Klein,Alexander %A Ivory,Chris %A Heuss,Sabina %A Peter,Marc K %+ FHNW - University of Applied Sciences Northwestern Switzerland, Bahnhofstrasse 6, Windisch, 5210, Switzerland, 41 798769376, christine.k.jacob@gmail.com %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %D 2023 %7 23.3.2023 %9 Review %J JMIR Hum Factors %G English %X Background: Technological advancements have opened the path for many technology providers to easily develop and introduce eHealth tools to the public. The use of these tools is increasingly recognized as a critical quality driver in health care; however, choosing a quality tool from the myriad of tools available for a specific health need does not come without challenges. Objective: This review aimed to systematically investigate the literature to understand the different approaches and criteria used to assess the quality and impact of eHealth tools by considering sociotechnical factors (from technical, social, and organizational perspectives). Methods: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the PubMed, Cochrane, Web of Science, Scopus, and ProQuest databases for studies published between January 2012 and January 2022 in English, which yielded 675 results, of which 40 (5.9%) studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with a thematic analysis and narrative synthesis of emergent themes. Results: Similar measures from the different papers, frameworks, and initiatives were aggregated into 36 unique criteria grouped into 13 clusters. Using the sociotechnical approach, we classified the relevant criteria into technical, social, and organizational assessment criteria. Technical assessment criteria were grouped into 5 clusters: technical aspects, functionality, content, data management, and design. Social assessment criteria were grouped into 4 clusters: human centricity, health outcomes, visible popularity metrics, and social aspects. Organizational assessment criteria were grouped into 4 clusters: sustainability and scalability, health care organization, health care context, and developer. Conclusions: This review builds on the growing body of research that investigates the criteria used to assess the quality and impact of eHealth tools and highlights the complexity and challenges facing these initiatives. It demonstrates that there is no single framework that is used uniformly to assess the quality and impact of eHealth tools. It also highlights the need for a more comprehensive approach that balances the social, organizational, and technical assessment criteria in a way that reflects the complexity and interdependence of the health care ecosystem and is aligned with the factors affecting users’ adoption to ensure uptake and adherence in the long term. %M 36843321 %R 10.2196/45143 %U https://humanfactors.jmir.org/2023/1/e45143 %U https://doi.org/10.2196/45143 %U http://www.ncbi.nlm.nih.gov/pubmed/36843321 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e45631 %T Understanding Prospective Physicians’ Intention to Use Artificial Intelligence in Their Future Medical Practice: Configurational Analysis %A Wagner,Gerit %A Raymond,Louis %A Paré,Guy %+ Faculty Information Systems and Applied Computer Sciences, University of Bamberg, An der Weberei 5, Bamberg, 96047, Germany, 49 0951863 ext 27834, gerit.wagner@uni-bamberg.de %K artificial intelligence %K medical education %K attitudes and beliefs %K knowledge and experience %K behavioral intentions %K fuzzy-set qualitative comparative analysis %K fsQCA %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Prospective physicians are expected to find artificial intelligence (AI) to be a key technology in their future practice. This transformative change has caught the attention of scientists, educators, and policy makers alike, with substantive efforts dedicated to the selection and delivery of AI topics and competencies in the medical curriculum. Less is known about the behavioral perspective or the necessary and sufficient preconditions for medical students’ intention to use AI in the first place. Objective: Our study focused on medical students’ knowledge, experience, attitude, and beliefs related to AI and aimed to understand whether they are necessary conditions and form sufficient configurations of conditions associated with behavioral intentions to use AI in their future medical practice. Methods: We administered a 2-staged questionnaire operationalizing the variables of interest (ie, knowledge, experience, attitude, and beliefs related to AI, as well as intention to use AI) and recorded 184 responses at t0 (February 2020, before the COVID-19 pandemic) and 138 responses at t1 (January 2021, during the COVID-19 pandemic). Following established guidelines, we applied necessary condition analysis and fuzzy-set qualitative comparative analysis to analyze the data. Results: Findings from the fuzzy-set qualitative comparative analysis show that the intention to use AI is only observed when students have a strong belief in the role of AI (individually necessary condition); certain AI profiles, that is, combinations of knowledge and experience, attitudes and beliefs, and academic level and gender, are always associated with high intentions to use AI (equifinal and sufficient configurations); and profiles associated with nonhigh intentions cannot be inferred from profiles associated with high intentions (causal asymmetry). Conclusions: Our work contributes to prior knowledge by showing that a strong belief in the role of AI in the future of medical professions is a necessary condition for behavioral intentions to use AI. Moreover, we suggest that the preparation of medical students should go beyond teaching AI competencies and that educators need to account for the different AI profiles associated with high or nonhigh intentions to adopt AI. %M 36947121 %R 10.2196/45631 %U https://mededu.jmir.org/2023/1/e45631 %U https://doi.org/10.2196/45631 %U http://www.ncbi.nlm.nih.gov/pubmed/36947121 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39767 %T Factors Influencing the Clinical Adoption of Quantitative Gait Analysis Technologies for Adult Patient Populations With a Focus on Clinical Efficacy and Clinician Perspectives: Protocol for a Scoping Review %A Sharma,Yashoda %A Cheung,Lovisa %A Patterson,Kara K %A Iaboni,Andrea %+ KITE - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G2A2, Canada, 1 4165973422 ext 3027, andrea.iaboni@uhn.ca %K quantitative gait analysis %K clinical adoption %K clinical efficacy %K clinician perspectives %K barriers %K facilitators %K adults %D 2023 %7 22.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quantitative gait analysis can support clinical decision-making. These analyses can be performed using wearable sensors, nonwearable sensors, or a combination of both. However, to date, they have not been widely adopted in clinical practice. Technology adoption literature has highlighted the clinical efficacy of technology and the users’ perspective on the technology (eg, ease of use and usefulness) as some factors that influence their widespread adoption. Objective: To assist with the clinical adoption of quantitative gait technologies, this scoping review will synthesize the literature on their clinical efficacy and clinician perspectives on their use in the clinical care of adult patient populations. Methods: This scoping review protocol follows the Joanna Briggs Institute methodology for scoping reviews. The review will include both peer-reviewed and gray literature (ie, conference abstracts) regarding the clinical efficacy of quantitative gait technologies and clinician perspectives on their use in the clinical care of adult patient populations. A comprehensive search strategy was created in MEDLINE (Ovid), which was then translated to 4 other databases: CENTRAL (Ovid), Embase (Ovid), CINAHL (EBSCO), and SPORTDiscus (EBSCO). The title and abstract screening, full-text review, and data extraction of relevant articles will be performed independently by 2 reviewers, with a third reviewer involved to support the resolution of conflicts. Data will be analyzed using content analysis and summarized in tabular and diagram formats. Results: A search of relevant articles will be conducted in all 5 databases, and through hand-searching in Google Scholar and PEDro, including articles published up until December 2022. The research team plans to submit the final scoping review for publication in a peer-reviewed journal in 2023. Conclusions: The findings of this review will be presented at clinical science conferences and published in a peer-reviewed journal. This review will inform future studies designed to develop, evaluate, or implement quantitative gait analysis technologies in clinical practice. International Registered Report Identifier (IRRID): DERR1-10.2196/39767 %M 36947120 %R 10.2196/39767 %U https://www.researchprotocols.org/2023/1/e39767 %U https://doi.org/10.2196/39767 %U http://www.ncbi.nlm.nih.gov/pubmed/36947120 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e42736 %T The Effect of Implementation of Guideline Order Bundles Into a General Admission Order Set on Clinical Practice Guideline Adoption: Quasi-Experimental Study %A Mrosak,Justine %A Kandaswamy,Swaminathan %A Stokes,Claire %A Roth,David %A Gorbatkin,Jenna %A Dave,Ishaan %A Gillespie,Scott %A Orenstein,Evan %+ Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, United States, 1 6128891839, jmrosak@gmail.com %K clinical practice guideline %K user-centered design %K clinical decision support %K diagnostic uncertainty %K diagnostic %K decision support %K CPG %K clinical guideline %K order bundle %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: Clinical practice guidelines (CPGs) and associated order sets can help standardize patient care and lead to higher-value patient care. However, difficult access and poor usability of these order sets can result in lower use rates and reduce the CPGs’ impact on clinical outcomes. At our institution, we identified multiple CPGs for general pediatrics admissions where the appropriate order set was used in <50% of eligible encounters, leading to decreased adoption of CPG recommendations. Objective: We aimed to determine how integrating disease-specific order groups into a common general admission order set influences adoption of CPG-specific order bundles for patients meeting CPG inclusion criteria admitted to the general pediatrics service. Methods: We integrated order bundles for asthma, heavy menstrual bleeding, musculoskeletal infection, migraine, and pneumonia into a common general pediatrics order set. We compared pre- and postimplementation order bundle use rates for eligible encounters at both an intervention and nonintervention site for integrated CPGs. We also assessed order bundle adoption for nonintegrated CPGs, including bronchiolitis, acute gastroenteritis, and croup. In a post hoc analysis of encounters without order bundle use, we compared the pre- and postintervention frequency of diagnostic uncertainty at the time of admission. Results: CPG order bundle use rates for incorporated CPGs increased by +9.8% (from 629/856, 73.5% to 405/486, 83.3%) at the intervention site and by +5.1% (896/1351, 66.3% to 509/713, 71.4%) at the nonintervention site. Order bundle adoption for nonintegrated CPGs decreased from 84% (536/638) to 68.5% (148/216), driven primarily by decreases in bronchiolitis order bundle adoption in the setting of the COVID-19 pandemic. Diagnostic uncertainty was more common in admissions without CPG order bundle use after implementation (28/227, 12.3% vs 19/81, 23.4%). Conclusions: The integration of CPG-specific order bundles into a general admission order set improved overall CPG adoption. However, integrating only some CPGs may reduce adoption of order bundles for excluded CPGs. Diagnostic uncertainty at the time of admission is likely an underrecognized barrier to guideline adherence that is not addressed by an integrated admission order set. %M 36943348 %R 10.2196/42736 %U https://medinform.jmir.org/2023/1/e42736 %U https://doi.org/10.2196/42736 %U http://www.ncbi.nlm.nih.gov/pubmed/36943348 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43197 %T Understanding Older Adults’ Experiences With Technologies for Health Self-management: Interview Study %A Garcia Reyes,Elsy Paola %A Kelly,Ryan %A Buchanan,George %A Waycott,Jenny %+ School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville Victoria, Melbourne, 3010, Australia, 61 3 9035 5511, egarciareyes@student.unimelb.edu.au %K older adults %K technology %K health self-management %K motivator %K enabler %K barrier %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. Objective: This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. Methods: A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. Results: The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. Conclusions: This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them. %M 36943333 %R 10.2196/43197 %U https://aging.jmir.org/2023/1/e43197 %U https://doi.org/10.2196/43197 %U http://www.ncbi.nlm.nih.gov/pubmed/36943333 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e44784 %T Integrated Personal Health Record in Indonesia: Design Science Research Study %A Harahap,Nabila Clydea %A Handayani,Putu Wuri %A Hidayanto,Achmad Nizar %+ Faculty of Computer Science, University of Indonesia, Kampus UI Depok, Pondok Cina, Beji, Depok, 16424, Indonesia, 62 8571652699, nabila.clydea@ui.ac.id %K personal health record %K integrated %K Indonesia %K design science %K mobile phone %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: Personal health records (PHRs) are consumer-centric tools designed to facilitate the tracking, management, and sharing of personal health information. PHR research has mainly been conducted in high-income countries rather than in low- and middle-income countries. Moreover, previous studies that proposed PHR design in low- and middle-income countries did not describe integration with other systems, or there was no stakeholder involvement in exploring PHR requirements. Objective: This study developed an integrated PHR architecture and prototype in Indonesia using design science research. We conducted the research in Indonesia, a low- to middle-income country with the largest population in Southeast Asia and a tiered health system. Methods: This study followed the design science research guidelines. The requirements were identified through interviews with 37 respondents from health organizations and a questionnaire with 1012 patients. Afterward, the proposed architecture and prototype were evaluated via interviews with 6 IT or eHealth experts. Results: The architecture design refers to The Open Group Architecture Framework version 9.2 and comprises 5 components: architecture vision, business architecture, application architecture, data architecture, and technology architecture. We developed a high-fidelity prototype for patients and physicians. In the evaluation, improvements were made to add the stakeholders and the required functionality to the PHR and add the necessary information to the functions that were developed in the prototype. Conclusions: We used design science to illustrate PHR integration in Indonesia, which involves related stakeholders in requirement gathering and evaluation. We developed architecture and application prototypes based on health systems in Indonesia, which comprise routine health services, including disease treatment and health examinations, as well as promotive and preventive health efforts. %M 36917168 %R 10.2196/44784 %U https://medinform.jmir.org/2023/1/e44784 %U https://doi.org/10.2196/44784 %U http://www.ncbi.nlm.nih.gov/pubmed/36917168 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39775 %T Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability %A Dolan,Samantha B %A Wittenauer,Rachel  %A Shearer,Jessica C %A Njoroge,Anne %A Onyango,Penina %A Owiso,George %A Lober,William B %A Liu,Shan %A Puttkammer,Nancy %A Rabinowitz,Peter %+ Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA, 98109, United States, 1 206 709 3100, sdolan11@gmail.com %K immunizations %K electronic immunization registry %K workflow %K usability %K realist research %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. Objective: In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry’s usability. Methods: Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Results: Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1—ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2—confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3—identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4—make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. Conclusions: We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users’ workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users’ needs and again after scale-up to ensure that interventions are suitable for all user settings. %M 36917157 %R 10.2196/39775 %U https://formative.jmir.org/2023/1/e39775 %U https://doi.org/10.2196/39775 %U http://www.ncbi.nlm.nih.gov/pubmed/36917157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41430 %T Persuading Patients Using Rhetoric to Improve Artificial Intelligence Adoption: Experimental Study %A Sebastian,Glorin %A George,Amrita %A Jackson Jr,George %+ Georgia State University, Room 1713, 55 Park Place, Atlanta, GA, 30303, United States, 1 4048344213, ageorge12@gsu.edu %K communication strategies %K artificial intelligence adoption %K AI adoption %K privacy concerns %K trust %K technology acceptance %K health IT %D 2023 %7 13.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) can transform health care processes with its increasing ability to translate complex structured and unstructured data into actionable clinical decisions. Although it has been established that AI is much more efficient than a clinician, the adoption rate has been slower in health care. Prior studies have pointed out that the lack of trust in AI, privacy concerns, degrees of customer innovativeness, and perceived novelty value influence AI adoption. With the promotion of AI products to patients, the role of rhetoric in influencing these factors has received scant attention. Objective: The main objective of this study was to examine whether communication strategies (ethos, pathos, and logos) are more successful in overcoming factors that hinder AI product adoption among patients. Methods: We conducted experiments in which we manipulated the communication strategy (ethos, pathos, and logos) in promotional ads for an AI product. We collected responses from 150 participants using Amazon Mechanical Turk. Participants were randomly exposed to a specific rhetoric-based advertisement during the experiments. Results: Our results indicate that using communication strategies to promote an AI product affects users’ trust, customer innovativeness, and perceived novelty value, leading to improved product adoption. Pathos-laden promotions improve AI product adoption by nudging users’ trust (n=52; β=.532; P<.001) and perceived novelty value of the product (n=52; β=.517; P=.001). Similarly, ethos-laden promotions improve AI product adoption by nudging customer innovativeness (n=50; β=.465; P<.001). In addition, logos-laden promotions improve AI product adoption by alleviating trust issues (n=48; β=.657; P<.001). Conclusions: Promoting AI products to patients using rhetoric-based advertisements can help overcome factors that hinder AI adoption by assuaging user concerns about using a new AI agent in their care process. %M 36912869 %R 10.2196/41430 %U https://www.jmir.org/2023/1/e41430 %U https://doi.org/10.2196/41430 %U http://www.ncbi.nlm.nih.gov/pubmed/36912869 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37671 %T Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory %A Bian,Dongsheng %A Xiao,Yuyin %A Song,Keyu %A Dong,Minye %A Li,Li %A Millar,Ross %A Shi,Chenshu %A Li,Guohong %+ School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chong Qing Road, Shanghai, 200025, China, 86 21 63846590, guohongli@sjtu.edu.cn %K internet health care technology %K value-based adoption model %K employee burnout %K China %K health care %K health care workers %K internet %K technology %K cross-sectional study %K burnout %K internet hospitals %D 2023 %7 10.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals. Objective: This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor. Methods: A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses. Results: The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (β=.131, P=.01; β=.638, P<.001; β=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (β=.725, P<.001), perceived risk negatively correlated with perceived value (β=−.083, P<.001), and perceived value negatively correlated with employee burnout (β=−.308, P<.001). In addition, employee burnout was negatively related to adoption intention (β=−.170, P<.001) and mediated the relationship between perceived value and adoption intention (β=.052, P<.001). Conclusions: Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals’ adoption intention regarding IHT. %M 36897630 %R 10.2196/37671 %U https://www.jmir.org/2023/1/e37671 %U https://doi.org/10.2196/37671 %U http://www.ncbi.nlm.nih.gov/pubmed/36897630 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e42458 %T Barriers and Opportunities for the Use of Digital Tools in Medicines Optimization Across the Interfaces of Care: Stakeholder Interviews in the United Kingdom %A Tolley,Clare %A Seymour,Helen %A Watson,Neil %A Nazar,Hamde %A Heed,Jude %A Belshaw,Dave %+ Pharmacy Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road,, Newcastle upon Tyne, NE1 4LP, United Kingdom, 44 0191 282 4488, clare.brown@newcastle.ac.uk %K health information exchange %K patient safety %K medicines optimization %K transfer of care %K health informatics %K qualitative %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: People with long-term conditions frequently transition between care settings that require information about a patient’s medicines to be transferred or translated between systems. This process is currently error prone and associated with unintentional changes to medications and miscommunication, which can lead to serious patient consequences. One study estimated that approximately 250,000 serious medication errors occur in England when a patient transitions from hospital to home. Digital tools can equip health care professionals with the right information at the right time and place to support practice. Objective: This study aimed to answer the following questions: what systems are being used to transfer information across interfaces of care within a region of England? and what are the challenges and potential opportunities for more effective cross-sector working to support medicines optimization? Methods: A team of researchers at Newcastle University conducted a qualitative study by performing in-depth semistructured interviews with 23 key stakeholders in medicines optimization and IT between January and March 2022. The interviews lasted for approximately 1 hour. The interviews and field notes were transcribed and analyzed using the framework approach. The themes were discussed, refined, and applied systematically to the data set. Member checking was also performed. Results: This study revealed themes and subthemes pertaining to 3 key areas: transfer of care issues, challenges of digital tools, and future hopes and opportunities. We identified a major complexity in terms of the number of different medicine management systems used throughout the region. There were also important challenges owing to incomplete patient records. We also highlighted the barriers related to using multiple systems and their subsequent impact on user workflow, a lack of interoperability between systems, gaps in the availability of digital data, and poor IT and change management. Finally, participants described their hopes and opportunities for the future provision of medicines optimization services, and there was a clear need for a patient-centered consolidated integrated health record for use by all health and care professionals across different sectors, bridging those working in primary, secondary, and social care. Conclusions: The effectiveness and utility of shared records depend on the data within; therefore, health care and digital leaders must support and strongly encourage the adoption of established and approved digital information standards. Specific priorities regarding understanding of the vision for pharmacy services and supporting this with appropriate funding arrangements and strategic planning of the workforce were also described. In addition, the following were identified as key enablers to harness the benefits of digital tools to support future medicines optimization: development of minimal system requirements; enhanced IT system management to reduce unnecessary repetition; and importantly, meaningful and continued collaboration with clinical and IT stakeholders to optimize systems and share good practices across care sectors. %M 36897631 %R 10.2196/42458 %U https://medinform.jmir.org/2023/1/e42458 %U https://doi.org/10.2196/42458 %U http://www.ncbi.nlm.nih.gov/pubmed/36897631 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e43005 %T Identification of Postpartum Depression in Electronic Health Records: Validation in a Large Integrated Health Care System %A Slezak,Jeff %A Sacks,David %A Chiu,Vicki %A Avila,Chantal %A Khadka,Nehaa %A Chen,Jiu-Chiuan %A Wu,Jun %A Getahun,Darios %+ Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, United States, 1 626 564 3477, Jeff.M.Slezak@kp.org %K validation %K postpartum depression %K electronic health records %K pregnancy %K health care system %K diagnosis codes %K pharmacy records %K health data %K data collection %K implementation %K eHealth record %K depression %K mental well-being %K women's health %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: The accuracy of electronic health records (EHRs) for identifying postpartum depression (PPD) is not well studied. Objective: This study aims to evaluate the accuracy of PPD reporting in EHRs and compare the quality of PPD data collected before and after the implementation of the International Classification of Diseases, Tenth Revision (ICD-10) coding in the health care system. Methods: Information on PPD was extracted from a random sample of 400 eligible Kaiser Permanente Southern California patients’ EHRs. Clinical diagnosis codes and pharmacy records were abstracted for two time periods: January 1, 2012, through December 31, 2014 (International Classification of Diseases, Ninth Revision [ICD-9] period), and January 1, 2017, through December 31, 2019 (ICD-10 period). Manual chart reviews of clinical records for PPD were considered the gold standard and were compared with corresponding electronically coded diagnosis and pharmacy records using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Kappa statistic was calculated to measure agreement. Results: Overall agreement between the identification of depression using combined diagnosis codes and pharmacy records with that of medical record review was strong (κ=0.85, sensitivity 98.3%, specificity 83.3%, PPV 93.7%, NPV 95.0%). Using only diagnosis codes resulted in much lower sensitivity (65.4%) and NPV (50.5%) but good specificity (88.6%) and PPV (93.5%). Separately, examining agreement between chart review and electronic coding among diagnosis codes and pharmacy records showed sensitivity, specificity, and NPV higher with prescription use records than with clinical diagnosis coding for PPD, 96.5% versus 72.0%, 96.5% versus 65.0%, and 96.5% versus 65.0%, respectively. There was no notable difference in agreement between ICD-9 (overall κ=0.86) and ICD-10 (overall κ=0.83) coding periods. Conclusions: PPD is not reliably captured in the clinical diagnosis coding of EHRs. The accuracy of PPD identification can be improved by supplementing clinical diagnosis with pharmacy use records. The completeness of PPD data remained unchanged after the implementation of the ICD-10 diagnosis coding. %M 36857123 %R 10.2196/43005 %U https://medinform.jmir.org/2023/1/e43005 %U https://doi.org/10.2196/43005 %U http://www.ncbi.nlm.nih.gov/pubmed/36857123 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43966 %T Exploring Patient Journey Mapping and the Learning Health System: Scoping Review %A Joseph,Amanda L %A Monkman,Helen %A Kushniruk,Andre %A Quintana,Yuri %+ School of Health Information Science, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8575, amandalynnjoseph@uvic.ca %K patient journey map %K journey map %K patient health information %K learning health system %K learning health care system %K delivery of health care %K service delivery %K scoping review %K health informatics %K user experience %K data integration %D 2023 %7 27.2.2023 %9 Review %J JMIR Hum Factors %G English %X Background: Journey maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies may exist between journey maps and the concept of a learning health system (LHS). The overarching goal of an LHS is to use health care data to inform clinical practice and improve service delivery processes and patient outcomes. Objective: The purpose of this review was to assess the literature and establish a relationship between journey mapping techniques and LHSs. Specifically, in this study, we explored the current state of the literature to answer the following research questions: (1) Is there a relationship between journey mapping techniques and an LHS in the literature? (2) Is there a way to integrate the data from journey mapping activities into an LHS? (3) How can the data gleaned from journey map activities be used to inform an LHS? Methods: A scoping review was conducted by querying the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost). Two researchers applied the inclusion criteria and assessed all articles by title and abstract in the first screen, using Covidence. Following this, a full-text review of included articles was done, with relevant data extracted, tabulated, and assessed thematically. Results: The initial search yielded 694 studies. Of those, 179 duplicates were removed. Following this, 515 articles were assessed during the first screening phase, and 412 were excluded, as they did not meet the inclusion criteria. Next, 103 articles were read in full, and 95 were excluded, resulting in a final sample of 8 articles that satisfied the inclusion criteria. The article sample can be subsumed into 2 overarching themes: (1) the need to evolve service delivery models in health care, and (2) the potential value of using patient journey data in an LHS. Conclusions: This scoping review demonstrated the gap in knowledge regarding integrating the data from journey mapping activities into an LHS. Our findings highlighted the importance of using the data from patient experiences to enrich an LHS and provide holistic care. To satisfy this gap, the authors intend to continue this investigation to establish the relationship between journey mapping and the concept of LHSs. This scoping review will serve as phase 1 of an investigative series. Phase 2 will entail the creation of a holistic framework to guide and streamline data integration from journey mapping activities into an LHS. Lastly, phase 3 will provide a proof of concept to demonstrate how patient journey mapping activities could be integrated into an LHS. %M 36848189 %R 10.2196/43966 %U https://humanfactors.jmir.org/2023/1/e43966 %U https://doi.org/10.2196/43966 %U http://www.ncbi.nlm.nih.gov/pubmed/36848189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40685 %T Thought Leader Perspectives on the Benefits, Barriers, and Enablers for Routinely Collected Electronic Health Data to Support Professional Development: Qualitative Study %A Bucalon,Bernard %A Whitelock-Wainwright,Emma %A Williams,Chris %A Conley,Jeanette %A Veysey,Martin %A Kay,Judy %A Shaw,Tim %+ Human Centred Technology Research Cluster, School of Computer Science, The University of Sydney, Level 3, Computer Science Building J12, Sydney, 2006, Australia, 61 2 8627 0010, bernard.bucalon@sydney.edu.au %K practice analytics %K data visualization %K continuing professional development %K professional practice %K reflective practice %K lifelong learning %K electronic health records %K EHR %D 2023 %7 16.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. Objective: This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. Methods: We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. Results: Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. Conclusions: Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle. %M 36795463 %R 10.2196/40685 %U https://www.jmir.org/2023/1/e40685 %U https://doi.org/10.2196/40685 %U http://www.ncbi.nlm.nih.gov/pubmed/36795463 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e43567 %T The Impact of an Electronic Portal on Patient Encounters in Primary Care: Interrupted Time-Series Analysis %A Ferguson,Karen %A Fraser,Mark %A Tuna,Meltem %A Bruntz,Charles %A Dahrouge,Simone %+ Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent #201, Ottawa, ON, K1G 5Z3, Canada, 1 613 562 5800 ext 2982, karen@wcfht.ca %K electronic health records %K health care utilization %K patient portals %K primary care %K medical informatics %K office visits %K electronic %K patient %K online applications %K virtual care %K messaging %K clinical %K age %K sex %K education %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the use of traditional primary care services is unclear, but it is an important question at this juncture, when portals are being incorporated into many primary care practices. Objective: We sought to investigate how an electronic patient portal affected the use of traditional, synchronous primary care services over a much longer time period than any existing studies and to assess the impact of portal messaging on clinicians’ workload. Methods: We conducted a propensity-score–matched, open-cohort, interrupted time-series evaluation of a primary care portal from its implementation in 2010. We extracted information from the electronic medical record regarding age, sex, education, income, family health team enrollment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years before and after the index date and provider time spent on secure messaging through the portal. Results: A total of 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in annual number of visits to physicians in the portal arm (0.42 more visits/year vs control, P<.001) but not for visits to nurse practitioners and physician assistants. The annual number of calls to the practice triage nurses also showed a greater increase in the portal arm compared to the control arm after the index year (an additional 0.10 calls, P=.006). The average provider time spent on portal-related work was 5.7 minutes per patient per year. Conclusions: We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and an increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on use of traditional health care services and clerical burden must also be considered when they are incorporated into primary care. %M 36745495 %R 10.2196/43567 %U https://medinform.jmir.org/2023/1/e43567 %U https://doi.org/10.2196/43567 %U http://www.ncbi.nlm.nih.gov/pubmed/36745495 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39118 %T Pediatric Primary Care Providers’ Perspectives on Telehealth Platforms to Support Care for Transgender and Gender-Diverse Youths: Exploratory Qualitative Study %A Sequeira,Gina M %A Kahn,Nicole F %A Bocek,Kevin M %A Shafii,Taraneh %A Asante,Peter G %A Christakis,Dimitri A %A Pratt,Wanda %A Richardson,Laura P %+ Seattle Children's Research Institute, 4540 Sand Point Way NE Building 1, Seattle, WA, 98105, United States, 1 206 987 2028, gina.sequeira@seattlechildrens.org %K telehealth %K specialist-to-PCP consultation %K primary care provider %K gender-affirming care %K transgender youths %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs’ preferences regarding receiving this support. Objective: This study aimed to explore pediatric PCPs’ perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. Methods: PCPs who had previously requested support from the Seattle Children’s Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework. Results: The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record–related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP’s time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models. Conclusions: A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care. %M 36719714 %R 10.2196/39118 %U https://humanfactors.jmir.org/2023/1/e39118 %U https://doi.org/10.2196/39118 %U http://www.ncbi.nlm.nih.gov/pubmed/36719714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40194 %T Black and Latinx Primary Caregiver Considerations for Developing and Implementing a Machine Learning–Based Model for Detecting Child Abuse and Neglect With Implications for Racial Bias Reduction: Qualitative Interview Study With Primary Caregivers %A Landau,Aviv Y %A Blanchard,Ashley %A Atkins,Nia %A Salazar,Stephanie %A Cato,Kenrick %A Patton,Desmond U %A Topaz,Maxim %+ School of Social Policy & Practice, University of Pennsylvania, 3901 Walnut st, Philadelphia, PA, 19104, United States, 1 215 746 6290, landauay@upenn.edu %K child abuse and neglect %K pediatric emergency departments %K machine learning–based risk models %K electronic health records %K primary caregivers %K child %K abuse %K neglect %K model %K epidemic %K development %K implementation %K community %K machine learning %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Child abuse and neglect, once viewed as a social problem, is now an epidemic. Moreover, health providers agree that existing stereotypes may link racial and social class issues to child abuse. The broad adoption of electronic health records (EHRs) in clinical settings offers a new avenue for addressing this epidemic. To reduce racial bias and improve the development, implementation, and outcomes of machine learning (ML)–based models that use EHR data, it is crucial to involve marginalized members of the community in the process. Objective: This study elicited Black and Latinx primary caregivers' viewpoints regarding child abuse and neglect while living in underserved communities to highlight considerations for designing an ML-based model for detecting child abuse and neglect in emergency departments (EDs) with implications for racial bias reduction and future interventions. Methods: We conducted a qualitative study using in-depth interviews with 20 Black and Latinx primary caregivers whose children were cared for at a single pediatric tertiary-care ED to gain insights about child abuse and neglect and their experiences with health providers. Results: Three central themes were developed in the coding process: (1) primary caregivers’ perspectives on the definition of child abuse and neglect, (2) primary caregivers’ experiences with health providers and medical documentation, and (3) primary caregivers’ perceptions of child protective services. Conclusions: Our findings highlight essential considerations from primary caregivers for developing an ML-based model for detecting child abuse and neglect in ED settings. This includes how to define child abuse and neglect from a primary caregiver lens. Miscommunication between patients and health providers can potentially lead to a misdiagnosis, and therefore, have a negative impact on medical documentation. Additionally, the outcome and application of the ML-based models for detecting abuse and neglect may cause additional harm than expected to the community. Further research is needed to validate these findings and integrate them into creating an ML-based model. %M 36719717 %R 10.2196/40194 %U https://formative.jmir.org/2023/1/e40194 %U https://doi.org/10.2196/40194 %U http://www.ncbi.nlm.nih.gov/pubmed/36719717 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43106 %T Canadian Older Adults’ Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey %A Fakhfakh,Maya %A Blanchette,Virginie %A Plourde,Karine V %A Gadio,Souleymane %A Elf,Marie %A Jones,C Allyson %A Meijering,Louise %A Giguère,Anik %A Légaré,France %+ Department of Family Medicine and Emergency Medicine, Université Laval, Ferdinand-Vandry Pavilion, 1050 Av. de la Médecine, Quebec City, QC, G1V 0A6, Canada, 1 4186563678, France.Legare@mfa.ulaval.ca %K aged %K intention %K decision aid %K decision support techniques %K housing %K unified theory of acceptance and use of technology %K UTAUT %K information technology %K internet %K shared decision-making %D 2023 %7 18.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision. Objective: We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention. Methods: We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents’ intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA. Results: Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=–.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001). Conclusions: Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA. %M 36566499 %R 10.2196/43106 %U https://aging.jmir.org/2023/1/e43106 %U https://doi.org/10.2196/43106 %U http://www.ncbi.nlm.nih.gov/pubmed/36566499 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e41212 %T Developing a Capsule Clinic—A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China %A Li,Dongliang %A Zhang,Rujia %A Chen,Chun %A Huang,Yunyun %A Wang,Xiaoyi %A Yang,Qingren %A Zhu,Xuebo %A Zhang,Xiangyang %A Hao,Mo %A Shui,Liming %+ Yinzhou District Health Bureau, No 1221, Bachelor Road, Shounan Street, Yinzhou District, Ningbo, 315199, China, 86 13967820698, 707761065@qq.com %K primary health care %K accessibility %K capsule clinic %K 24-hour clinic %K big-data %K China %K United Nations %K internet clinic %D 2023 %7 9.1.2023 %9 Viewpoint %J JMIR Med Inform %G English %X Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients’ usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process—from diagnosis to prescription services—can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations’ PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity. %M 36622737 %R 10.2196/41212 %U https://medinform.jmir.org/2023/1/e41212 %U https://doi.org/10.2196/41212 %U http://www.ncbi.nlm.nih.gov/pubmed/36622737 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39965 %T Implementation of Shared Decision-Making Within Internet Hospitals in China Based on Patients’ Needs: Feasibility Study and Content Analysis %A Yu,Tianzhi %A Jin,Chunjie %A Wu,Xiaodan %A Yue,Dianmin %+ School of Economics and Management, Hebei University of Technology, No. 5340 Siping Road Beichen District, Tianjin, 300401, China, 86 13920955339, dmingyue@hebut.edu.cn %K internet hospital %K shared decision-making between doctors and patients %K patient needs %K feasibility %D 2023 %7 6.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet hospitals are developing rapidly in China, and their convenient and efficient medical services are being increasingly recognized by patients. Many hospitals have set up their own internet hospitals to provide web-based medical services. Tianjin Medical University General Hospital has established a multidisciplinary and comprehensive internet hospital to provide diversified medical services according to the needs of patients. A way to further improve web-based medical services is by examining how shared decision-making (SDM) can be carried out in internet hospital diagnosis and treatment services, thereby improving patients’ medical experience. Objective: The aim of this study was to analyze the feasibility of implementing doctor-patient SDM in internet hospital diagnosis and treatment services based on patients’ needs in China. Methods: In this study, the medical data of 10 representative departments in the internet hospital of Tianjin Medical University General Hospital from January 1 to January 31, 2022, were extracted as a whole; 25,266 cases were selected. After excluding 2056 cases with incomplete information, 23,210 cases were finally included in this study. A chi-square test was performed to analyze the characteristics and medical service needs of internet hospital patients in order to identify the strengths of SDM in internet hospitals. Results: The internet hospital patients from 10 clinical departments were significantly different in terms of gender (χ29=3425.6; P<.001), age (χ236=27,375.8; P<.001), mode of payment (χ29=3501.1; P<.001), geographic distribution (χ29=347.2; P<.001), and duration of illness (χ236=2863.3; P<.001). Patient medical needs included drug prescriptions, examination prescriptions, medical record explanations, drug use instructions, prehospitalization preparations, further consultations with doctors (unspecified purpose), treatment plan consultations, initial diagnoses based on symptoms, and follow-up consultations after discharge. The medical needs of the patients in different clinical departments were significantly different (χ272=8465.5; P<.001). Conclusions: Our study provides a practical and theoretical basis for the feasibility of doctor-patient SDM in internet hospitals and offers some implementation strategies. We focus on the application of SDM in web-based diagnosis and treatment in internet hospitals rather than on a disease or a disease management software. The medical service needs of different patient groups can be effectively obtained from an internet hospital, which provides the practical conditions for the promotion of doctor-patient SDM. Our findings show that the internet hospital platform expands the scope of SDM and is a new way for the large-scale application of doctor-patient SDM. %M 36607710 %R 10.2196/39965 %U https://formative.jmir.org/2023/1/e39965 %U https://doi.org/10.2196/39965 %U http://www.ncbi.nlm.nih.gov/pubmed/36607710 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e38736 %T Characterizing the Gaps Between Best-Practice Implementation Strategies and Real-world Implementation: Qualitative Study Among Family Physicians Who Engaged With Audit and Feedback Reports %A Rouleau,Geneviève %A Reis,Catherine %A Ivers,Noah %A Desveaux,Laura %+ Institute for Health System Solutions and Virtual Care, Women’s College Hospital, 76, Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 4383921857, Genevieve.Rouleau@wchospital.ca %K audit and feedback %K family physicians %K primary care %K qualitative %D 2023 %7 6.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In Ontario, Canada, a government agency known as Ontario Health is responsible for making audit and feedback reports available to all family physicians to encourage ongoing quality improvement. The confidential report provides summary data on 3 key areas of practice: safe prescription, cancer screening, and diabetes management. Objective: This report was redesigned to improve its usability in line with evidence. The objective of this study was to explore how the redesign was perceived, with an emphasis on recipients’ understanding of the report and their engagement with it. Methods: We conducted qualitative semistructured interviews with family physicians who had experience with both versions of the report recruited through purposeful and snowball sampling. We analyzed the transcripts following an emergent and iterative approach. Results: Saturation was reached after 17 family physicians participated. In total, 2 key themes emerged as factors that affected the perceived usability of the report: alignment between the report and the recipients’ expectations and capacity to engage in quality improvement. Family physicians expected the report and its quality indicators to reflect best practices and to be valid and accurate. They also expected the report to offer feedback on the clinical activities they perceived to be within their control to change. Furthermore, family physicians expected the goal of the report to be aligned with their perspective on feasible quality improvement activities. Most of these expectations were not met, limiting the perceived usability of the report. The capacity to engage with audit and feedback was hindered by several organizational and physician-level barriers, including the lack of fit with the existing workflow, competing priorities, time constraints, and insufficient skills for bridging the gaps between their data and the corresponding desired actions. Conclusions: Despite recognized improvements in the design of the report to better align with best practices, it was not perceived as highly usable. Improvements in the presentation of the data could not overcome misalignment with family physicians’ expectations or the limited capacity to engage with the report. Integrating iterative evaluations informed by user-centered design can complement evidence-based guidance for implementation strategies. Creating a space for bringing together audit and feedback designers and recipients may help improve usability and effectiveness. %M 36607715 %R 10.2196/38736 %U https://humanfactors.jmir.org/2023/1/e38736 %U https://doi.org/10.2196/38736 %U http://www.ncbi.nlm.nih.gov/pubmed/36607715 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38818 %T Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff %A Schuetze,Leon %A Srivastava,Siddharth %A Missenye,Abdallah Mtiba %A Rwezaula,Elizeus Josephat %A Stoermer,Manfred %A De Allegri,Manuela %+ Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 0931 201 31141, leon.schuetze@uni-heidelberg.de %K health financing %K qualitative %K digital health intervention %K low-resource setting %K strategic purchasing %K scale %K mobile phone %D 2023 %7 6.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. Objective: This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. Methods: We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. Results: Respondents appreciated IMIS’s intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. Conclusions: Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage. %M 36607708 %R 10.2196/38818 %U https://www.jmir.org/2023/1/e38818 %U https://doi.org/10.2196/38818 %U http://www.ncbi.nlm.nih.gov/pubmed/36607708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43601 %T Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review %A Kruse,Clemens Scott %A Molina-Nava,Annamaria %A Kapoor,Yajur %A Anerobi,Courtney %A Maddukuri,Harshita %+ Texas State University, 601 University Dr, San Marcos, TX, 78666, United States, 1 512 245 4462, scottkruse@txstate.edu %K telemedicine %K telehealth %K mobile health %K mHealth %K eHealth %K quality %D 2023 %7 5.1.2023 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine has a long history; however, its efficacy has been reported with mixed reviews. Studies have reported a wide range of quality implications when using the telemedicine modality of care. Objective: This study aimed to analyze the effectiveness of telemedicine through 6 domains of quality through an analysis of randomized controlled trials (RCTs) published in the literature published, to date, in 2022. Methods: A total of 4 databases were searched using a standard Boolean string. The 882,420 results were reduced to 33 for analysis through filtering and randomization. The systematic literature review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; 2020). Results: The Cohen κ statistic was calculated to show agreement between the reviewers (Cohen κ=0.90, strong). Medical outcomes associated with the telemedicine modality were 100% effective with a weighted average effect size of 0.21 (small effect). Many medical outcomes were positive but not statistically better than treatment as usual. RCTs have reported positive outcomes for physical and mental health, medical engagement, behavior change, increased quality of life, increased self-efficacy, increased social support, and reduced costs. All 6 domains of quality were identified in the RCTs and 4 were identified in 100% of the studies. Telemedicine is highly patient-centered because it meets digital preferences, is convenient, avoids stigma, and enables education at one’s own pace. A few barriers exist to its wide adoption, such as staff training and cost, and it may not be the preferred modality for all. Conclusions: The effectiveness of telemedicine is equal to or greater than that of traditional care across a wide spectrum of services studied in this systematic literature review. Providers should feel comfortable offering this modality of care as a standard option to patients where it makes sense to do so. Although barriers exist for wide adoption, the facilitators are all patient facing. Trial Registration: PROSPERO CRD42022343478; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343478 %M 36602844 %R 10.2196/43601 %U https://www.jmir.org/2023/1/e43601 %U https://doi.org/10.2196/43601 %U http://www.ncbi.nlm.nih.gov/pubmed/36602844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40976 %T The Assessment of Medical Device Software Supporting Health Care Services for Chronic Patients in a Tertiary Hospital: Overarching Study %A Baltaxe,Erik %A Hsieh,Hsin Wen %A Roca,Josep %A Cano,Isaac %+ Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Villarroel 170, Barcelona, 08036, Spain, 34 932275540, iscano@recerca.clinic.cat %K chronic patients %K digital health %K health technology assessment %K implementation research %K integrated care %D 2023 %7 4.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative digital health tools are increasingly being evaluated and, in some instances, integrated at scale into health systems. However, the applicability of assessment methodologies in real-life scenarios to demonstrate value generation and consequently foster sustainable adoption of digitally enabled health interventions has some bottlenecks. Objective: We aimed to build on the process of premarket assessment of 4 digital health interventions piloted at the Hospital Clinic de Barcelona (HCB), as well as on the analysis of current medical device software regulations and postmarket surveillance in the European Union and United States in order to generate recommendations and lessons learnt for the sustainable adoption of digitally enabled health interventions. Methods: Four digital health interventions involving prototypes were piloted at the HCB (studies 1-4). Cocreation and quality improvement methodologies were used to consolidate a pragmatic evaluation method to assess the perceived usability and satisfaction of end users (both patients and health care professionals) by means of the System Usability Scale and the Net Promoter Score, including general questions about satisfaction. Analyses of both medical software device regulations and postmarket surveillance in the European Union and United States (2017-2021) were performed. Finally, an overarching analysis on lessons learnt was conducted considering 4 domains (technical, clinical, usability, and cost), as well as differentiating among 3 different eHealth strategies (telehealth, integrated care, and digital therapeutics). Results: Among the participant stakeholders, the System Usability Scale score was consistently higher in patients (studies 1, 2, 3, and 4: 78, 67, 56, and 76, respectively) than in health professionals (studies 2, 3, and 4: 52, 43, and 54, respectively). In general, use of the supporting digital health tools was recommended more by patients (studies 1, 2, 3, and 4: Net Promoter Scores of −3%, 31%, −21%, and 31%, respectively) than by professionals (studies 2, 3, and 4: Net Promoter Scores of −67%, 1%, and −80%, respectively). The overarching analysis resulted in pragmatic recommendations for the digital health evaluation domains and the eHealth strategies considered. Conclusions: Lessons learnt on the digitalization of health resulted in practical recommendations that could contribute to future deployment experiences. %M 36598817 %R 10.2196/40976 %U https://www.jmir.org/2023/1/e40976 %U https://doi.org/10.2196/40976 %U http://www.ncbi.nlm.nih.gov/pubmed/36598817 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40771 %T Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study %A Du,Yumeng %A Zhou,Qiru %A Cheng,Weibin %A Zhang,Zhang %A Hoelzer,Samantha %A Liang,Yizhi %A Xue,Hao %A Ma,Xiaochen %A Sylvia,Sean %A Tian,Junzhang %A Tang,Weiming %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No.466 Xingangzhong Road, Haizhu District, Guangzhou, 510317, China, 86 15920567132, weiming_tang@med.unc.edu %K telemedicine %K telehealth %K rural residents %K mixed methods %K China %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. Objective: We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. Methods: Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. Results: A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. Conclusions: This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support. %M 36563026 %R 10.2196/40771 %U https://publichealth.jmir.org/2022/12/e40771 %U https://doi.org/10.2196/40771 %U http://www.ncbi.nlm.nih.gov/pubmed/36563026 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40061 %T Perceptions of a Secure Cloud-Based Solution for Data Sharing During Acute Stroke Care: Qualitative Interview Study %A Tuler de Oliveira,Marcela %A Amorim Reis,Lúcio Henrik %A Marquering,Henk %A Zwinderman,Aeilko H %A Delgado Olabarriaga,Sílvia %+ Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 205663273, m.tuler@amsterdamumc.nl %K qualitative interview study %K electronic health records %K cloud-based applications %K acute stroke care %K cross-organization data sharing %K data privacy %K encryption %K data access control %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute stroke care demands fast procedures performed through the collaboration of multiple professionals across multiple organizations. Cloud computing and the wide adoption of electronic medical records (EMRs) enable health care systems to improve data availability and facilitate sharing among professionals. However, designing a secure and privacy-preserving EMR cloud-based application is challenging because it must dynamically control the access to the patient’s EMR according to the needs for data during treatment. Objective: We developed a prototype of a secure EMR cloud-based application. The application explores the security features offered by the eHealth cloud-based framework created by the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Horizon 2020 project. This study aimed to collect impressions, challenges, and improvements for the prototype when applied to the use case of secure data sharing among acute care teams during emergency treatment in the Netherlands. Methods: We conducted 14 semistructured interviews with medical professionals with 4 prominent roles in acute care: emergency call centers, ambulance services, emergency hospitals, and general practitioner clinics. We used in-depth interviews to capture their perspectives about the application’s design and functions and its use in a simulated acute care event. We used thematic analysis of interview transcripts. Participants were recruited until the collected data reached thematic saturation. Results: The participants’ perceptions and feedback are presented as 5 themes identified from the interviews: current challenges (theme 1), quality of the shared EMR data (theme 2), integrity and auditability of the EMR data (theme 3), usefulness and functionality of the application (theme 4), and trust and acceptance of the technology (theme 5). The results reinforced the current challenges in patient data sharing during acute stroke care. Moreover, from the user point of view, we expressed the challenges of adopting the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Acute Stroke Care application in a real scenario and provided suggestions for improving the proposed technology’s acceptability. Conclusions: This study has endorsed a system that supports data sharing among acute care professionals with efficiency, but without compromising the security and privacy of the patient. This explorative study identified several significant barriers to and improvement opportunities for the future acceptance and adoption of the proposed system. Moreover, the study results highlight that the desired digital transformation should consider integrating the already existing systems instead of requesting migration to a new centralized system. %M 36563043 %R 10.2196/40061 %U https://formative.jmir.org/2022/12/e40061 %U https://doi.org/10.2196/40061 %U http://www.ncbi.nlm.nih.gov/pubmed/36563043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36265 %T Navigating the Systemic Conditions of a Digital Health Ecosystem in Alberta, Canada: Embedded Case Study %A Saunders,Chad %A Currie,Devon %A Virani,Shane %A De Grood,Jill %+ Entrepreneurship & Innovation, Haskayne School of Business, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 6075, wsaunder@ucalgary.ca %K digital health %K entrepreneurial ecosystem %K systemic conditions %K policy %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health promises numerous value-creating outcomes. These include improved health, reduced costs, and the creation of lucrative markets, which, in turn, provide high-quality employment, productivity growth, and a climate that attracts investment. For this value creation and capture, the activities of a diverse set of stakeholders within a digital health ecosystem require coordination. However, the antecedents of the coordination needed for an effective digital health ecosystem are not well understood. Objective: The purpose of this study was to investigate the systemic conditions of the digital health ecosystem in Alberta, Canada, as critical antecedents to ecosystem coordination from the perspective of the authors as applicants to an innovative digital health funding program embedded within the larger digital health ecosystem of innovators or entrepreneurs, health system leaders, support partners, and funders. Methods: We employed a qualitative embedded case study of the systemic conditions within the digital health ecosystem in Alberta, Canada (main case) using semistructured interviews with 36 stakeholders representing innovators or entrepreneurs, health system leaders, support partners, and funders (subcases). The interviews were conducted over a 2-month period between May 26 and July 22, 2021. Data were coded for key themes and synthesized around 5 propositions developed from academic publications and policy reports. Results: The findings indicated varying levels of support for each proposition, with moderate support for accessing real problems, data, training, and space for evaluations. However, the most fundamental gap appears to be in ecosystem navigation, in particular, the absence of intermediaries (eg, individuals, organizations, and technology) to provide guidance on the available support services and dependencies among the various ecosystem actors and programs. Conclusions: Navigating the systemic conditions of the digital health ecosystem is extremely challenging for entrepreneurs, especially those without prior health care experience, and this remains an issue even for those with such experience. Policy interventions aimed at increasing collaboration among ecosystem support providers, along with tools and incentives to ensure coordination, are essential as the ecosystem and those dependent on it grow. %M 36542428 %R 10.2196/36265 %U https://formative.jmir.org/2022/12/e36265 %U https://doi.org/10.2196/36265 %U http://www.ncbi.nlm.nih.gov/pubmed/36542428 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 12 %P e42664 %T Telehealth System Based on the Ontology Design of a Diabetes Management Pathway Model in China: Development and Usability Study %A Fan,ZhiYuan %A Cui,LiYuan %A Ye,Ying %A Li,ShouCheng %A Deng,Ning %+ College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Zhouyiqing Bldg 512, 38 Zheda Rd, Hangzhou, 310000, China, 86 571 2295 2693, zju.dengning@gmail.com %K diabetes %K chronic disease management %K Chronic Disease Management Pathway %K ontology %K Semantic Web Rule Language rules %K SWRL rules %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Diabetes needs to be under control through management and intervention. Management of diabetes through mobile health is a practical approach; however, most diabetes mobile health management systems do not meet expectations, which may be because of the lack of standardized management processes in the systems and the lack of intervention implementation recommendations in the management knowledge base. Objective: In this study, we aimed to construct a diabetes management care pathway suitable for the actual situation in China to express the diabetes management care pathway using ontology and develop a diabetes closed-loop system based on the construction results of the diabetes management pathway and apply it practically. Methods: This study proposes a diabetes management care pathway model in which the management process of diabetes is divided into 9 management tasks, and the Diabetes Care Pathway Ontology (DCPO) is constructed to represent the knowledge contained in this pathway model. A telehealth system, which can support the comprehensive management of patients with diabetes while providing active intervention by physicians, was designed and developed based on the DCPO. A retrospective study was performed based on the data records extracted from the system to analyze the usability and treatment effects of the DCPO. Results: The diabetes management pathway ontology constructed in this study contains 119 newly added classes, 28 object properties, 58 data properties, 81 individuals, 426 axioms, and 192 Semantic Web Rule Language rules. The developed mobile medical system was applied to 272 patients with diabetes. Within 3 months, the average fasting blood glucose of the patients decreased by 1.34 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.63 mmol/L (P=.003); the average systolic and diastolic blood pressures decreased by 11.84 mmHg (P=.02) and 8.8 mmHg (P=.02), respectively. In patients who received physician interventions owing to abnormal attention or low-compliance warnings, the average fasting blood glucose decreased by 2.45 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.89 mmol/L (P=.003) in all patients with diabetes; the average systolic and diastolic blood pressure decreased by 20.06 mmHg (P=.02) and 17.37 mmHg (P=.02), respectively, in patients with both hypertension and diabetes during the 3-month management period. Conclusions: This study helps guide the timing and content of interactive interventions between physicians and patients and regulates physicians’ medical service behavior. Different management plans are formulated for physicians and patients according to different characteristics to comprehensively manage various cardiovascular risk factors. The application of the DCPO in the diabetes management system can provide effective and adequate management support for patients with diabetes and those with both diabetes and hypertension. %M 36534448 %R 10.2196/42664 %U https://medinform.jmir.org/2022/12/e42664 %U https://doi.org/10.2196/42664 %U http://www.ncbi.nlm.nih.gov/pubmed/36534448 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40370 %T Factors Associated With the Acceptance of an eHealth App for Electronic Health Record Sharing System: Population-Based Study %A Huang,Junjie %A Pang,Wing Sze %A Wong,Yuet Yan %A Mak,Fung Yu %A Chan,Florence S W %A Cheung,Clement S K %A Wong,Wing Nam %A Cheung,Ngai Tseung %A Wong,Martin C S %+ The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Room 407, 4/F, School of Public Health Building, Prince of Wales Hospital, Sha Tin, 999077, Hong Kong, 852 2252 8782, wong_martin@cuhk.edu.hk %K digital health %K eHealth %K electronic health record %K system %K mobile app %K app %K public %K private %K community %K caregiver %K awareness %K perception %K improvement %K utility %K technology %K model %K health information %D 2022 %7 12.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In the second stage of the Electronic Health Record Sharing System (eHRSS) development, a mobile app (eHealth app) was launched to further enhance collaborative care among the public sector, the private sector, the community, and the caregivers. Objective: This study aims to investigate the factors associated with the downloading and utilization of the app, as well as the awareness, perception, and future improvement of the app. Methods: We collected 2110 surveys; respondents were stratified into 3 groups according to their status of enrollment in the eHRSS. The primary outcome measure was the downloading and acceptance of the eHealth app. We collected the data on social economics factors, variables of the Technology Acceptance Model and Theory of Planned Behavior. Any factors identified as significant in the univariate analysis (P<.20) will be included in a subsequent multivariable regression analysis model. All P values ≤.05 will be considered statistically significant in multiple logistic regression analysis. The structural equation modeling was performed to identify interactions among the variables. Results: The respondents had an overall high satisfaction rate and a positive attitude toward continuing to adopt and recommend the app. However, the satisfaction rate among respondents who have downloaded but not adopted the app was relatively lower, and few of them perceived that the downloading and acceptance processes are difficult. A high proportion of current users expressed a positive attitude about continuing to adopt and recommend the app to friends, colleagues, and family members. The behavioral intention strongly predicted the acceptance of the eHealth app (β=.89; P<.001). Attitude (β=.30; P<.001) and perceived norm; β=.37; P<.001) played important roles in determining behavioral intention, which could predict the downloading and acceptance of the eHealth app (β=.14; P<.001). Conclusions: Despite the high satisfaction rate among the respondents, privacy concerns and perceived difficulties in adopting the app were the major challenges of promoting eHealth. Further promotion could be made through doctors and publicity. For future improvement, comprehensive health records and tailored health information should be included. %M 36382349 %R 10.2196/40370 %U https://www.jmir.org/2022/12/e40370 %U https://doi.org/10.2196/40370 %U http://www.ncbi.nlm.nih.gov/pubmed/36382349 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39647 %T Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey %A Patel,Sharvil Piyush %A Sun,Elizabeth %A Reinhardt,Alec %A Geevarghese,Sanjaly %A He,Simon %A Gazmararian,Julie A %+ Omnimed Inc, 5363 Veterans Parkway, Suite C, Columbus, GA, 31904, United States, 1 706 905 2971, spatel@omnimedinc.org %K digital health %K health accessibility %K utilization %K mobile health %K mHealth %K telemedicine %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities’ knowledge of equity along digital health use patterns. Objective: This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions. %M 36472905 %R 10.2196/39647 %U https://formative.jmir.org/2022/12/e39647 %U https://doi.org/10.2196/39647 %U http://www.ncbi.nlm.nih.gov/pubmed/36472905 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e37954 %T Digital Phenotyping Data to Predict Symptom Improvement and App Personalization: Protocol for a Prospective Study %A Currey,Danielle %A Torous,John %+ School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, United States, 1 617 667 6700, jtorous@gmail.com %K digital phenotyping %K digital phenotype %K mental health %K depression %K anxiety %K smartphone %K app %K college student %K university student %K young adult %K engagement %K digital health %K mobile health %K mHealth %K health app %K Technology Acceptance Model %K adoption %D 2022 %7 29.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphone apps that capture surveys and sensors are increasingly being leveraged to collect data on clinical conditions. In mental health, this data could be used to personalize psychiatric support offered by apps so that they are more effective and engaging. Yet today, few mental health apps offer this type of support, often because of challenges associated with accurately predicting users’ actual future mental health. Objective: In this protocol, we present a study design to explore engagement with mental health apps in college students, using the Technology Acceptance Model as a theoretical framework, and assess the accuracy of predicting mental health changes using digital phenotyping data. Methods: There are two main goals of this study. First, we present a logistic regression model fit on data from a prior study on college students and prospectively test this model on a new student cohort to assess its accuracy. Second, we will provide users with data-driven activity suggestions every 4 days to determine whether this type of personalization will increase engagement or attitudes toward the app compared to those receiving no personalized recommendations. Results: The study was completed in the spring of 2022, and the manuscript is currently in review at JMIR Publications. Conclusions: This is one of the first digital phenotyping algorithms to be prospectively validated. Overall, our results will inform the potential of digital phenotyping data to serve as tailoring data in adaptive interventions and to increase rates of engagement. International Registered Report Identifier (IRRID): PRR1-10.2196/37954 %M 36445745 %R 10.2196/37954 %U https://www.researchprotocols.org/2022/11/e37954 %U https://doi.org/10.2196/37954 %U http://www.ncbi.nlm.nih.gov/pubmed/36445745 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e39890 %T The Factors Influencing Older Adults’ Decisions Surrounding Adoption of Technology: Quantitative Experimental Study %A Moxley,Jerad %A Sharit,Joseph %A Czaja,Sara J %+ Division of Geriatrics and Palliative Medicine, Center on Aging and Behavioral Research, Weill Cornell Medicine, 420 70th St, New York, NY, 10021, United States, 1 6469627148, sjc7004@med.cornell.edu %K aging %K technology %K design %K older adult %K technology %K application %K independence %K relationship %K adopt %K transportation %K leisure %K health %K learning %K adoption %K cognition %K cognitive %K willingness %K design %K marketing %K consumer %K mobile phone %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid diffusion of technology apps may support older adults’ independence and improve the quality of their lives. Models for predicting technology acceptance in older adults are sparse, based on broad questions related to general technology acceptance, and largely not grounded in theories of aging. Objective: This study aimed to use a mixed methods approach involving 5 technologies to comprehensively assess the causal relationships among factors that influence older adults’ willingness to adopt the technologies. Methods: In total, 187 men and women aged 65 to 92 years participated in the study. Participants were given presentations on 5 different technologies spanning domains that included transportation, leisure, health, and new learning and provided ratings of each technology on various measures hypothesized to influence adoption. They were also administered other instruments to collect data on their actual and self-assessed cognitive abilities, rates of discounting of the technologies with respect to willingness to invest time to attain higher skills in the technologies, general technology experience, and attitudes toward technology. We used the machine learning technique of k-fold cross-validated regressions to select variables that predicted participants’ willingness to adopt the technologies. Results: Willingness to adopt technologies was most impacted by 3 variables: perceived value of the technologies (β=.54), perceived improvement in quality of life attainable from the technologies (β=.24), and confidence in being able to use the technologies (β=.15). These variables, in turn, were mostly facilitated or inhibited by the perceived effort required to learn to use the technologies, a positive attitude toward technology as reflected in the optimism component of the technology readiness scale, the degree to which technologies were discounted, and the perceived help needed to learn to use the technologies. Conclusions: Our findings demonstrate that participants’ willingness to adopt technologies is mainly determined by perceptions of 3 aspects of the technologies; these aspects possibly mediate many relationships with willingness to adopt. We discuss the implications of these findings for the design and marketing of technology products for older consumers. %M 36416885 %R 10.2196/39890 %U https://aging.jmir.org/2022/4/e39890 %U https://doi.org/10.2196/39890 %U http://www.ncbi.nlm.nih.gov/pubmed/36416885 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e40039 %T Perspective Toward Machine Learning Implementation in Pediatric Medicine: Mixed Methods Study %A Alexander,Natasha %A Aftandilian,Catherine %A Guo,Lin Lawrence %A Plenert,Erin %A Posada,Jose %A Fries,Jason %A Fleming,Scott %A Johnson,Alistair %A Shah,Nigam %A Sung,Lillian %+ Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada, 1 416 813 5287, lillian.sung@sickkids.ca %K machine learning %K clinical utilization %K preferences %K qualitative interviews %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Given the costs of machine learning implementation, a systematic approach to prioritizing which models to implement into clinical practice may be valuable. Objective: The primary objective was to determine the health care attributes respondents at 2 pediatric institutions rate as important when prioritizing machine learning model implementation. The secondary objective was to describe their perspectives on implementation using a qualitative approach. Methods: In this mixed methods study, we distributed a survey to health system leaders, physicians, and data scientists at 2 pediatric institutions. We asked respondents to rank the following 5 attributes in terms of implementation usefulness: the clinical problem was common, the clinical problem caused substantial morbidity and mortality, risk stratification led to different actions that could reasonably improve patient outcomes, reducing physician workload, and saving money. Important attributes were those ranked as first or second most important. Individual qualitative interviews were conducted with a subsample of respondents. Results: Among 613 eligible respondents, 275 (44.9%) responded. Qualitative interviews were conducted with 17 respondents. The most common important attributes were risk stratification leading to different actions (205/275, 74.5%) and clinical problem causing substantial morbidity or mortality (177/275, 64.4%). The attributes considered least important were reducing physician workload and saving money. Qualitative interviews consistently prioritized implementations that improved patient outcomes. Conclusions: Respondents prioritized machine learning model implementation where risk stratification would lead to different actions and clinical problems that caused substantial morbidity and mortality. Implementations that improved patient outcomes were prioritized. These results can help provide a framework for machine learning model implementation. %M 36394938 %R 10.2196/40039 %U https://medinform.jmir.org/2022/11/e40039 %U https://doi.org/10.2196/40039 %U http://www.ncbi.nlm.nih.gov/pubmed/36394938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e41463 %T Omnichannel Communication to Boost Patient Engagement and Behavioral Change With Digital Health Interventions %A Blasiak,Agata %A Sapanel,Yoann %A Leitman,Dana %A Ng,Wei Ying %A De Nicola,Raffaele %A Lee,V Vien %A Todorov,Atanas %A Ho,Dean %+ The Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, #05-COR Centre for Life Sciences, Singapore, 117456, Singapore, 65 6601 7766, agata.blasiak@nus.edu.sg %K digital health intervention %K omnichannel engagement %K behavioral change %K communication channels %K personalized engagement %K health care %K patient care %K health care outcome %K patient engagement %K digital twin %K DHI %K digital health %K eHealth %K framework %K development %D 2022 %7 16.11.2022 %9 Viewpoint %J J Med Internet Res %G English %X Digital health interventions are being increasingly incorporated into health care workflows to improve the efficiency of patient care. In turn, sustained patient engagement with digital health interventions can maximize their benefits toward health care outcomes. In this viewpoint, we outline a dynamic patient engagement by using various communication channels and the potential use of omnichannel engagement to integrate these channels. We conceptualize a novel patient care journey where multiple web-based and offline communication channels are integrated through a “digital twin.” The principles of implementing omnichannel engagement for digital health interventions and digital twins are also broadly covered. Omnichannel engagement in digital health interventions implies a flexibility for personalization, which can enhance and sustain patient engagement with digital health interventions, and ultimately, patient quality of care and outcomes. We believe that the novel concept of omnichannel engagement in health care can be greatly beneficial to patients and the system once it is successfully realized to its full potential. %M 36383427 %R 10.2196/41463 %U https://www.jmir.org/2022/11/e41463 %U https://doi.org/10.2196/41463 %U http://www.ncbi.nlm.nih.gov/pubmed/36383427 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e37478 %T Considering Clinician Competencies for the Implementation of Artificial Intelligence–Based Tools in Health Care: Findings From a Scoping Review %A Garvey,Kim V %A Thomas Craig,Kelly Jean %A Russell,Regina %A Novak,Laurie L %A Moore,Don %A Miller,Bonnie M %+ Clinical Evidence Development, Aetna Medical Affairs, CVS Health, 151 Farmington Avenue, RC31, Hartford, CT, 06156, United States, 1 970 261 3366, craigk@aetna.com %K artificial intelligence %K competency %K clinical education %K patient %K digital health %K digital tool %K clinical tool %K health technology %K health care %K educational framework %K decision-making %K clinical decision %K health information %K physician %D 2022 %7 16.11.2022 %9 Review %J JMIR Med Inform %G English %X Background: The use of artificial intelligence (AI)–based tools in the care of individual patients and patient populations is rapidly expanding. Objective: The aim of this paper is to systematically identify research on provider competencies needed for the use of AI in clinical settings. Methods: A scoping review was conducted to identify articles published between January 1, 2009, and May 1, 2020, from MEDLINE, CINAHL, and the Cochrane Library databases, using search queries for terms related to health care professionals (eg, medical, nursing, and pharmacy) and their professional development in all phases of clinical education, AI-based tools in all settings of clinical practice, and professional education domains of competencies and performance. Limits were provided for English language, studies on humans with abstracts, and settings in the United States. Results: The searches identified 3476 records, of which 4 met the inclusion criteria. These studies described the use of AI in clinical practice and measured at least one aspect of clinician competence. While many studies measured the performance of the AI-based tool, only 4 measured clinician performance in terms of the knowledge, skills, or attitudes needed to understand and effectively use the new tools being tested. These 4 articles primarily focused on the ability of AI to enhance patient care and clinical decision-making by improving information flow and display, specifically for physicians. Conclusions: While many research studies were identified that investigate the potential effectiveness of using AI technologies in health care, very few address specific competencies that are needed by clinicians to use them effectively. This highlights a critical gap. %M 36318697 %R 10.2196/37478 %U https://medinform.jmir.org/2022/11/e37478 %U https://doi.org/10.2196/37478 %U http://www.ncbi.nlm.nih.gov/pubmed/36318697 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40124 %T Effects of Hospital Digitization on Clinical Outcomes and Patient Satisfaction: Nationwide Multiple Regression Analysis Across German Hospitals %A von Wedel,Philip %A Hagist,Christian %A Liebe,Jan-David %A Esdar,Moritz %A Hübner,Ursula %A Pross,Christoph %+ Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Burgplatz 2, Vallendar, 56179, Germany, 49 02616509 ext 255, philip.wedel@whu.edu %K health care information technology %K electronic health records %K hospital digitization %K quality of care %K clinical outcomes %K patient satisfaction %K user-perceived value %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of health information technology (HIT) by health care providers is commonly believed to improve the quality of care. Policy makers in the United States and Germany follow this logic and deploy nationwide HIT adoption programs to fund hospital investments in digital technologies. However, scientific evidence for the beneficial effects of HIT on care quality at a national level remains mostly US based, is focused on electronic health records (EHRs), and rarely accounts for the quality of digitization from a hospital user perspective. Objective: This study aimed to examine the effects of digitization on clinical outcomes and patient experience in German hospitals. Hence, this study adds to the small stream of literature in this field outside the United States. It goes beyond assessing the effects of mere HIT adoption and also considers user-perceived HIT value. In addition, the impact of a variety of technologies beyond EHRs was examined. Methods: Multiple linear regression models were estimated using emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. The adoption and user-perceived value of HIT represented key independent variables, and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted, observed-to-expected outcome ratios for patients who had stroke, myocardial infarction, or hip replacement. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 subdomains of HIT and EHRs was derived from the German 2020 Healthcare IT Report. Results: Statistical analysis was based on an overall sample of 383 German hospitals. The analyzed data set suggested no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction. However, a higher user-perceived value or quality of the installed tools did improve outcomes. Emergency care outcomes benefited from user-friendly overall digitization (β=−.032; P=.04), which was especially driven by the user-friendliness of admission HIT (β=−.023; P=.07). Elective care outcomes were positively impacted by user-friendly EHR installations (β=−.138; P=.008). Similarly, the results suggested user-friendly, overall digitization to have a moderate positive effect on patient satisfaction (β=−.009; P=.01). Conclusions: The results of this study suggest that hospital digitization is not an end in itself. Policy makers and hospitals are well advised to not only focus on the mere adoption of digital technologies but also continuously work toward digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that the assumed benefits of single technologies are not realized across all care domains. %M 36355423 %R 10.2196/40124 %U https://www.jmir.org/2022/11/e40124 %U https://doi.org/10.2196/40124 %U http://www.ncbi.nlm.nih.gov/pubmed/36355423 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e40338 %T Shared Interoperable Clinical Decision Support Service for Drug-Allergy Interaction Checks: Implementation Study %A Jung,Sungwon %A Bae,Sungchul %A Seong,Donghyeong %A Oh,Ock Hee %A Kim,Yoomi %A Yi,Byoung-Kee %+ Department of Artificial Intelligent Convergence, Kangwon National University, 1 Ganwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea, 82 33 250 7672, byoungkeeyi@gmail.com %K clinical decision support %K drug-allergy interaction %K Health Level 7 %K Fast Healthcare Interoperability Resources %K interoperability %K CDS Hooks %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Clinical decision support (CDS) can improve health care with respect to the quality of care, patient safety, efficiency, and effectiveness. Establishing a CDS system in a health care setting remains a challenge. A few hospitals have used self-developed in-house CDS systems or commercial CDS solutions. Since these in-house CDS systems tend to be tightly coupled with a specific electronic health record system, the functionality and knowledge base are not easily shareable. A shared interoperable CDS system facilitates the sharing of the knowledge base and extension of CDS services. Objective: The study focuses on developing and deploying the national CDS service for the drug-allergy interaction (DAI) check for health care providers in Korea that need to introduce the service but lack the budget and expertise. Methods: To provide the shared interoperable CDS service, we designed and implemented the system based on the CDS Hooks specification and Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The study describes the CDS development process. The system development went through requirement analysis, design, implementation, and deployment. In particular, the concept architecture was designed based on the CDS Hooks structure. The MedicationRequest and AllergyIntolerance resources were profiled to exchange data using the FHIR standard. The discovery and DAI check application programming interfaces and rule engine were developed. Results: The CDS service was deployed on G-Cloud, a government cloud service. In March 2021, the CDS service was launched, and 67 health care providers participated in the CDS service. The health care providers participated in the service with 1,008,357 DAI checks for 114,694 patients, of which 33,054 (3.32%) cases resulted in a “warning.” Conclusions: Korea’s Ministry of Health and Welfare has been trying to build an HL7 FHIR-based ecosystem in Korea. As one of these efforts, the CDS service initiative has been conducted. To promote the rapid adoption of the HL7 FHIR standard, it is necessary to accelerate practical service development and to appeal to policy makers regarding the benefits of FHIR standardization. With the development of various case-specific implementation guides using the Korea Core implementation guide, the FHIR standards will be distributed nationwide, and more shared interoperable health care services will be introduced in Korea. %M 36355401 %R 10.2196/40338 %U https://medinform.jmir.org/2022/11/e40338 %U https://doi.org/10.2196/40338 %U http://www.ncbi.nlm.nih.gov/pubmed/36355401 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40681 %T Investigating Patients' Continuance Intention Toward Conversational Agents in Outpatient Departments: Cross-sectional Field Survey %A Li,Xingyi %A Xie,Shirong %A Ye,Zhengqiang %A Ma,Shishi %A Yu,Guangjun %+ Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, No 355 Luding Road, Shanghai, 200062, China, 86 18917762998, gjyu@shchildren.com.cn %K conversational agent %K continuance intention %K expectation-confirmation model %K partial least squares %K structural equation modeling %K chatbot %K virtual assistant %K cross-sectional %K field study %K optimization %K outpatient %K interview %K qualitative %K questionnaire %K satisfaction %K perceived usefulness %K intention %K adoption %K attitude %K perception %D 2022 %7 7.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Conversational agents (CAs) have been developed in outpatient departments to improve physician-patient communication efficiency. As end users, patients’ continuance intention is essential for the sustainable development of CAs. Objective: The aim of this study was to facilitate the successful usage of CAs by identifying key factors influencing patients’ continuance intention and proposing corresponding managerial implications. Methods: This study proposed an extended expectation-confirmation model and empirically tested the model via a cross-sectional field survey. The questionnaire included demographic characteristics, multiple-item scales, and an optional open-ended question on patients’ specific expectations for CAs. Partial least squares structural equation modeling was applied to assess the model and hypotheses. The qualitative data were analyzed via thematic analysis. Results: A total of 172 completed questionaries were received, with a 100% (172/172) response rate. The proposed model explained 75.5% of the variance in continuance intention. Both satisfaction (β=.68; P<.001) and perceived usefulness (β=.221; P=.004) were significant predictors of continuance intention. Patients' extent of confirmation significantly and positively affected both perceived usefulness (β=.817; P<.001) and satisfaction (β=.61; P<.001). Contrary to expectations, perceived ease of use had no significant impact on perceived usefulness (β=.048; P=.37), satisfaction (β=−.004; P=.63), and continuance intention (β=.026; P=.91). The following three themes were extracted from the 74 answers to the open-ended question: personalized interaction, effective utilization, and clear illustrations. Conclusions: This study identified key factors influencing patients’ continuance intention toward CAs. Satisfaction and perceived usefulness were significant predictors of continuance intention (P<.001 and P<.004, respectively) and were significantly affected by patients’ extent of confirmation (P<.001 and P<.001, respectively). Developing a better understanding of patients’ continuance intention can help administrators figure out how to facilitate the effective implementation of CAs. Efforts should be made toward improving the aspects that patients reasonably expect CAs to have, which include personalized interactions, effective utilization, and clear illustrations. %M 36342768 %R 10.2196/40681 %U https://www.jmir.org/2022/11/e40681 %U https://doi.org/10.2196/40681 %U http://www.ncbi.nlm.nih.gov/pubmed/36342768 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e38483 %T Managing Critical Patient-Reported Outcome Measures in Oncology Settings: System Development and Retrospective Study %A Strachna,Olga %A Asan,Onur %A Stetson,Peter D %+ School of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Terrace, Hoboken, NJ, 07030, United States, 1 201 216 5514, oasan@stevens.edu %K patient-reported outcome measures %K delivery of health care %K self-report %K quality of care %K neoplasms %K surveys and questionnaires %K clinical decision support systems %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Remote monitoring programs based on the collection of patient-reported outcome (PRO) data are being increasingly adopted in oncology practices. Although PROs are a great source of patient data, the management of critical PRO data is not discussed in detail in the literature. Objective: This first-of-its-kind study aimed to design, describe, and evaluate a closed-loop alerting and communication system focused on managing PRO-related alerts in cancer care. Methods: We designed and developed a novel solution using an agile software development methodology by incrementally building new capabilities. We evaluated these new features using participatory design and the Fit between Individuals, Task, and Technology framework. Results: A total of 8 questionnaires were implemented using alerting features, resulting in an alert rate of 7.82% (36,838/470,841) with 13.28% (10,965/82,544) of the patients triggering at least one alert. Alerts were reviewed by 501 staff members spanning across 191 care teams. All the alerts were reviewed with a median response time of 1 hour (SD 185 hours) during standard business hours. The most severe (red) alerts were documented 56.83% (2592/4561) of the time, whereas unlabeled alerts were documented 27.68% (1298/4689) of the time, signaling clinician concordance with the alert thresholds. Conclusions: A PRO-based alert and communication system has some initial benefits in reviewing clinically meaningful PRO data in a reasonable amount of time. We have discussed key system design considerations, workflow integration, and the mitigation of potential impact on the burden of care teams. The introduction of a PRO-based alert and communication system provides a reliable mechanism for care teams to review and respond to patient symptoms quickly. The system was standardized across many different oncology settings, demonstrating system flexibility. Future studies should focus on formally evaluating system usability through qualitative methods. %M 36326801 %R 10.2196/38483 %U https://medinform.jmir.org/2022/11/e38483 %U https://doi.org/10.2196/38483 %U http://www.ncbi.nlm.nih.gov/pubmed/36326801 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40597 %T Barriers and Facilitators Influencing Real-time and Digital-Based Reporting of Adverse Drug Reactions by Community Pharmacists: Qualitative Study Using the Task-Technology Fit Framework %A Fossouo Tagne,Joel %A Yakob,Reginald Amin %A Mcdonald,Rachael %A Wickramasinghe,Nilmini %+ Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, John St, Hawthorn VIC, Melbourne, 3122, Australia, 61 412478610, jfossouo@gmail.com %K pharmacovigilance %K adverse drug reaction %K pharmacist %K Task-Technology Fit %K digital health %D 2022 %7 11.10.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Medication use can result in adverse drug reactions (ADRs) that cause increased morbidity and health care consumption for patients and could potentially be fatal. Timely reporting of ADRs to regulators may contribute to patient safety by facilitating information gathering on drug safety data. Currently, little is known about how community pharmacists (CPs) monitor, handle, and report ADRs in Australia. Objective: This study aimed to identify perceived barriers to and facilitators of ADR reporting by CPs in Australia and suggest digital interventions. Methods: A qualitative study with individual interviews was conducted with CPs working across Victoria, Australia, between April 2022 and May 2022. A semistructured interview guide was used to identify perceived barriers to and facilitators of ADR reporting among CPs. The data were analyzed using thematic analysis. We constructed themes from the CP-reported barriers and facilitators. The themes were subsequently aligned with the Task-Technology Fit framework. Results: A total of 12 CPs were interviewed. Identified barriers were lack of knowledge of both the ADR reporting process and ADR reporting systems, time constraints, lack of financial incentives, lack of organizational support for ADR reporting, inadequate IT systems, and preference to refer consumers to physicians. The proposed facilitators of ADR reporting included enhancing CPs knowledge and awareness of ADRs, financial incentives for ADR reporting, workflow-integrated ADR reporting technology systems, feedback provision to CPs on the reported ADRs, and promoting consumer ADR reporting. Conclusions: Barriers to and facilitators of ADR reporting spanned both the task and technology aspects of the Task-Technology Fit model. Addressing the identified barriers to ADR reporting and providing workplace technologies that support ADR reporting may improve ADR reporting by CPs. Further investigations to observe ADR handling and reporting within community pharmacies can enhance patient safety by increasing ADR reporting by CPs. %M 36222800 %R 10.2196/40597 %U https://www.i-jmr.org/2022/2/e40597 %U https://doi.org/10.2196/40597 %U http://www.ncbi.nlm.nih.gov/pubmed/36222800 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e32666 %T Bolstering the Business Case for Adoption of Shared Decision-Making Systems in Primary Care: Randomized Controlled Trial %A Sperl-Hillen,JoAnn M %A Anderson,Jeffrey P %A Margolis,Karen L %A Rossom,Rebecca C %A Kopski,Kristen M %A Averbeck,Beth M %A Rosner,Jeanine A %A Ekstrom,Heidi L %A Dehmer,Steven P %A O’Connor,Patrick J %+ Research Department, HealthPartners Center for Chronic Care Innovation, 8170 33rd Ave S, Bloomington, MN, 55425, United States, 1 952 967 5009, JoAnn.M.SperlHillen@HealthPartners.Com %K clinical decision support %K primary care %K ICD-10 diagnostic coding %K CPT levels of service %K shared decision-making %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited budgets may often constrain the ability of health care delivery systems to adopt shared decision-making (SDM) systems designed to improve clinical encounters with patients and quality of care. Objective: This study aimed to assess the impact of an SDM system shown to improve diabetes and cardiovascular patient outcomes on factors affecting revenue generation in primary care clinics. Methods: As part of a large multisite clinic randomized controlled trial (RCT), we explored the differences in 1 care system between clinics randomized to use an SDM intervention (n=8) versus control clinics (n=9) regarding the (1) likelihood of diagnostic coding for cardiometabolic conditions using the 10th Revision of the International Classification of Diseases (ICD-10) and (2) current procedural terminology (CPT) billing codes. Results: At all 24,138 encounters with care gaps targeted by the SDM system, the proportion assigned high-complexity CPT codes for level of service 5 was significantly higher at the intervention clinics (6.1%) compared to that in the control clinics (2.9%), with P<.001 and adjusted odds ratio (OR) 1.64 (95% CI 1.02-2.61). This was consistently observed across the following specific care gaps: diabetes with glycated hemoglobin A1c (HbA1c)>8% (n=8463), 7.2% vs 3.4%, P<.001, and adjusted OR 1.93 (95% CI 1.01-3.67); blood pressure above goal (n=8515), 6.5% vs 3.7%, P<.001, and adjusted OR 1.42 (95% CI 0.72-2.79); suboptimal statin management (n=17,765), 5.8% vs 3%, P<.001, and adjusted OR 1.41 (95% CI 0.76-2.61); tobacco dependency (n=7449), 7.5% vs. 3.4%, P<.001, and adjusted OR 2.14 (95% CI 1.31-3.51); BMI >30 kg/m2 (n=19,838), 6.2% vs 2.9%, P<.001, and adjusted OR 1.45 (95% CI 0.75-2.8). Compared to control clinics, intervention clinics assigned ICD-10 diagnosis codes more often for observed cardiometabolic conditions with care gaps, although the difference did not reach statistical significance. Conclusions: In this randomized study, use of a clinically effective SDM system at encounters with care gaps significantly increased the proportion of encounters assigned high-complexity (level 5) CPT codes, and it was associated with a nonsignificant increase in assigning ICD-10 codes for observed cardiometabolic conditions. Trial Registration: ClinicalTrials.gov NCT 02451670; https://clinicaltrials.gov/ct2/show/NCT 02451670 %M 36201392 %R 10.2196/32666 %U https://formative.jmir.org/2022/10/e32666 %U https://doi.org/10.2196/32666 %U http://www.ncbi.nlm.nih.gov/pubmed/36201392 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40238 %T Artificial Intelligence Applications in Health Care Practice: Scoping Review %A Sharma,Malvika %A Savage,Carl %A Nair,Monika %A Larsson,Ingrid %A Svedberg,Petra %A Nygren,Jens M %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K artificial intelligence %K health care %K implementation %K scoping review %K technology adoption %D 2022 %7 5.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) is often heralded as a potential disruptor that will transform the practice of medicine. The amount of data collected and available in health care, coupled with advances in computational power, has contributed to advances in AI and an exponential growth of publications. However, the development of AI applications does not guarantee their adoption into routine practice. There is a risk that despite the resources invested, benefits for patients, staff, and society will not be realized if AI implementation is not better understood. Objective: The aim of this study was to explore how the implementation of AI in health care practice has been described and researched in the literature by answering 3 questions: What are the characteristics of research on implementation of AI in practice? What types and applications of AI systems are described? What characteristics of the implementation process for AI systems are discernible? Methods: A scoping review was conducted of MEDLINE (PubMed), Scopus, Web of Science, CINAHL, and PsycINFO databases to identify empirical studies of AI implementation in health care since 2011, in addition to snowball sampling of selected reference lists. Using Rayyan software, we screened titles and abstracts and selected full-text articles. Data from the included articles were charted and summarized. Results: Of the 9218 records retrieved, 45 (0.49%) articles were included. The articles cover diverse clinical settings and disciplines; most (32/45, 71%) were published recently, were from high-income countries (33/45, 73%), and were intended for care providers (25/45, 56%). AI systems are predominantly intended for clinical care, particularly clinical care pertaining to patient-provider encounters. More than half (24/45, 53%) possess no action autonomy but rather support human decision-making. The focus of most research was on establishing the effectiveness of interventions (16/45, 35%) or related to technical and computational aspects of AI systems (11/45, 24%). Focus on the specifics of implementation processes does not yet seem to be a priority in research, and the use of frameworks to guide implementation is rare. Conclusions: Our current empirical knowledge derives from implementations of AI systems with low action autonomy and approaches common to implementations of other types of information systems. To develop a specific and empirically based implementation framework, further research is needed on the more disruptive types of AI systems being implemented in routine care and on aspects unique to AI implementation in health care, such as building trust, addressing transparency issues, developing explainable and interpretable solutions, and addressing ethical concerns around privacy and data protection. %M 36197712 %R 10.2196/40238 %U https://www.jmir.org/2022/10/e40238 %U https://doi.org/10.2196/40238 %U http://www.ncbi.nlm.nih.gov/pubmed/36197712 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 9 %P e37283 %T The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review %A Modi,Shikha %A Feldman,Sue S %+ Department of Political Science, Auburn University, 7074 Haley Center, Auburn, AL, 36849, United States, 1 2563355796, szs0308@auburn.edu %K electronic health records %K EHRs %K value %K financial outcomes %K clinical outcomes %K health informatics %K clinical informatics %D 2022 %7 27.9.2022 %9 Review %J JMIR Med Inform %G English %X 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. %M 36166286 %R 10.2196/37283 %U https://medinform.jmir.org/2022/9/e37283 %U https://doi.org/10.2196/37283 %U http://www.ncbi.nlm.nih.gov/pubmed/36166286 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e38926 %T COVID-19’s Impact on Digital Health Adoption: The Growing Gap Between a Technological and a Cultural Transformation %A Meskó,Bertalan %+ The Medical Futurist Institute, Povl Bang-Jensen u 2/B1 4/1, Budapest, 1118, Hungary, 36 36703807260, berci@medicalfuturist.com %K COVID-19 %K digital health %K future %K cultural transformation %K medical information %K technology adoption %K health care %K physician burnout %K burnout %D 2022 %7 19.9.2022 %9 Viewpoint %J JMIR Hum Factors %G English %X Health care in the 21st century has started undergoing major changes due to the rising number of patients with chronic conditions; increased access to new technologies, medical information, and peer support via the internet; and the ivory tower of medicine breaking down. This marks the beginning of a cultural transformation called digital health. This has also led to a shift in the roles of patients and medical professionals, resulting in a new, equal partnership. When COVID-19 hit, the adoption of digital health technologies skyrocketed. The technological revolution we had been aiming for in health care took place in just months due to the pandemic, but the cultural transition is lagging. This creates a dangerous gap between what is possible technologically through remote care, at-home lab tests, or health sensors and what patients and physicians are actually longing for. If we do it well enough now, we can spare a decade of technological transformations and bring that long-term vision of patients becoming the point of care to the practical reality of today. This is a historic opportunity we might not want to waste. %M 36121692 %R 10.2196/38926 %U https://humanfactors.jmir.org/2022/3/e38926 %U https://doi.org/10.2196/38926 %U http://www.ncbi.nlm.nih.gov/pubmed/36121692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39787 %T Waiting Lists for Psychotherapy and Provider Attitudes Toward Low-Intensity Treatments as Potential Interventions: Survey Study %A Peipert,Allison %A Krendl,Anne C %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 812 855 2012, lolorenz@indiana.edu %K psychotherapy %K CBT %K cognitive behavioral therapy %K behavior therapy %K digital mental health %K self-help %K support group %K mental health %K digital health %K eHealth %K low-intensity intervention %K survey %K waiting list %K health system %K health care delivery %K health care professional %K care provider %K bibliotherapy %K attitude %K perception %K digital intervention %K web-based intervention %K depression %K anxiety %K mental disorder %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Common mental disorders, including depression and anxiety, are leading causes of disability worldwide. Digital mental health interventions, such as web-based self-help and other low-intensity treatments (LITs) that are not digital (eg, bibliotherapy), have the potential to reach many individuals by circumventing common barriers present in traditional mental health care. It is unclear how often LITs are used in clinical practice, or whether providers would be interested in their use for treatment waiting lists. Objective: The aims of this study were to (1) describe current practices for treatment waiting lists, (2) describe providers’ attitudes toward digital and nondigital LITs for patients on a waiting list, and (3) explore providers’ willingness to use digital and nondigital LITs and their decisions to learn about them. Methods: We surveyed 141 practicing mental health care providers (eg, therapists and psychologists) and provided an opportunity for them to learn about LITs. Results: Most participants reported keeping a waiting list. Few participants reported currently recommending digital or nondigital LITs, though most were willing to use at least one for patients on their waiting list. Attitudes toward digital and nondigital LITs were neutral to positive. Guided digital and nondigital LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Most participants selected to access additional information on LITs, with the most popular being web-based self-help. Conclusions: Results suggest providers are currently not recommending LITs for patients on treatment waiting lists but would be willing to recommend them. Future work should explore barriers and facilitators to implementing digital and nondigital LITs for patients on treatment waiting lists. %M 36112400 %R 10.2196/39787 %U https://formative.jmir.org/2022/9/e39787 %U https://doi.org/10.2196/39787 %U http://www.ncbi.nlm.nih.gov/pubmed/36112400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e29927 %T Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis %A Iglesias,Natalia %A Juarez,Jose M %A Campos,Manuel %+ Instituto de Investigación de Tecnologías de la Información y las Comunicaciones Orientadas, University of Murcia, Faculty of Computer Science, Campus Espinardo, University of Murcia, Murcia, 30100, Spain, 34 868887864, natalia.iglesias@um.es %K openEHR task planning %K business process model and notation %K BPMN %K clinical pathways %K catheter-related bloodstream infection %K CR-BSI %K clinical guidelines %D 2022 %7 15.9.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36107480 %R 10.2196/29927 %U https://www.jmir.org/2022/9/e29927 %U https://doi.org/10.2196/29927 %U http://www.ncbi.nlm.nih.gov/pubmed/36107480 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e34905 %T Practices, Perceived Benefits, and Barriers Among Medical Students and Health Care Professionals Regarding the Adoption of eHealth in Clinical Settings: Cross-sectional Survey Study %A Nguyen,Long Hoang %A Nguyen,Lien Thi Khanh %A Nguyen,Tham Thi %A Trong Dam,Vu Anh %A Vu,Thuc Minh Thi %A Nguyen,Hao Anh Si %A Vu,Giang Thu %A Latkin,Carl A %A Ho,Roger C M %A Ho,Cyrus S H %+ Institute for Global Health Innovations, Duy Tan University, 254 Nguyen Van Linh, Da Nang, 550000, Vietnam, 84 941890199, damtanhvu@duytan.edu.vn %K eHealth %K literacy %K perception %K practices %K health care professional %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: eHealth is increasingly becoming an indispensable part of health practice and policy-making strategies. However, the use of eHealth tools in clinical practice and the perceptions of eHealth among medical students and health care professionals in Vietnam are not well understood. Objective: This study aims to investigate perceptions and practices regarding eHealth and their associated factors among medical students and health care professionals. Methods: A web-based cross-sectional study was conducted on 523 medical students and health care professionals. Information about the practices for, perceived barriers to, and benefits of eHealth application in clinical practices was collected. Multivariate Tobit and logistic regression models were used to determine factors associated with perceptions and practices. Results: In total, 61.6% (322/523) of participants used eHealth tools in clinical practices, with moderate levels of eHealth literacy. The score for the perceived benefits of eHealth tools was low. The most common barrier for eHealth utilization was human resources for IT (240/523, 45.9%), followed by security and risk control capacity (226/523, 43.2%) and no training in eHealth application (223/523, 42.6%). Age, eHealth literacy, and the use of the internet for updating medical knowledge were positively associated with using eHealth tools in clinical practices. Conclusions: eHealth tools were moderately used in clinical practices, and the benefits of eHealth were underestimated among health care professionals and medical students in Vietnam. Renovating the current medical education curriculum to integrate eHealth principles should be required to equip health care professionals and medical students with essential skills for rapid digital transformation. %M 36098992 %R 10.2196/34905 %U https://mededu.jmir.org/2022/3/e34905 %U https://doi.org/10.2196/34905 %U http://www.ncbi.nlm.nih.gov/pubmed/36098992 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e39782 %T The Reduction in Medical Errors on Implementing an Intensive Care Information System in a Setting Where a Hospital Electronic Medical Record System is Already in Use: Retrospective Analysis %A Seino,Yusuke %A Sato,Nobuo %A Idei,Masafumi %A Nomura,Takeshi %+ Department of Intensive Care Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 1628666, Japan, 81 3 3353 8111, yu-seino@ca2.so-net.ne.jp %K clinical information system %K electronic medical record %K intensive care unit %K medical error %D 2022 %7 31.8.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Although the various advantages of clinical information systems in intensive care units (ICUs), such as intensive care information systems (ICISs), have been reported, their role in preventing medical errors remains unclear. Objective: This study aimed to investigate the changes in the incidence and type of errors in the ICU before and after ICIS implementation in a setting where a hospital electronic medical record system is already in use. Methods: An ICIS was introduced to the general ICU of a university hospital. After a step-by-step implementation lasting 3 months, the ICIS was used for all patients starting from April 2019. We performed a retrospective analysis of the errors in the ICU during the 6-month period before and after ICIS implementation by using data from an incident reporting system, and the number, incidence rate, type, and patient outcome level of errors were determined. Results: From April 2018 to September 2018, 755 patients were admitted to the ICU, and 719 patients were admitted from April 2019 to September 2019. The number of errors was 153 in the 2018 study period and 71 in the 2019 study period. The error incidence rates in 2018 and 2019 were 54.1 (95% CI 45.9-63.4) and 27.3 (95% CI 21.3-34.4) events per 1000 patient-days, respectively (P<.001). During both periods, there were no significant changes in the composition of the types of errors (P=.16), and the most common type of error was medication error. Conclusions: ICIS implementation was temporally associated with a 50% reduction in the number and incidence rate of errors in the ICU. Although the most common type of error was medication error in both study periods, ICIS implementation significantly reduced the number and incidence rate of medication errors. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041471; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047345 %M 35964333 %R 10.2196/39782 %U https://periop.jmir.org/2022/1/e39782 %U https://doi.org/10.2196/39782 %U http://www.ncbi.nlm.nih.gov/pubmed/35964333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37223 %T The Technology Acceptance of Video Consultations for Type 2 Diabetes Care in General Practice: Cross-sectional Survey of Danish General Practitioners %A Torp,Daniel Cæsar %A Sandbæk,Annelli %A Prætorius,Thim %+ Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, Aarhus, 8200, Denmark, 45 20539002, thipra@rm.dk %K video consultations %K telemedicine %K diabetes %K chronic diseases %K general practice %K technology acceptance %K technology acceptance model %D 2022 %7 30.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, video consultations became a common method of delivering care in general practice. To date, research has mostly studied acute or subacute care, thereby leaving a knowledge gap regarding the potential of using video consultations to manage chronic diseases. Objective: This study aimed to examine general practitioners’ technology acceptance of video consultations for the purpose of managing type 2 diabetes in general practice. Methods: A web-based survey based on the technology acceptance model measuring 4 dimensions—perceived usefulness, perceived ease of use, attitude, and behavioral intention to use—was sent to all general practices (N=1678) in Denmark to elicit user perspectives. The data were analyzed using structural equation modeling. Results: The survey sample comprised 425 general practitioners who were representative of the population. Structural equation modeling showed that 4 of the 5 hypotheses in the final research model were statistically significant (P<.001). Perceived ease of use had a positive influence on perceived usefulness and attitude. Attitude was positively influenced by perceived usefulness. Attitude had a positive influence on behavioral intention to use, although perceived usefulness did not. Goodness-of-fit indices showed acceptable fits for the structural equation modeling estimation. Conclusions: Perceived usefulness was the primary driver of general practitioners’ positive attitude toward video consultations for type 2 diabetes care. The study suggests that to improve attitude and technology use, decision-makers should focus on improving usefulness, that is, how it can improve treatment and make it more effective and easier. %M 36040765 %R 10.2196/37223 %U https://www.jmir.org/2022/8/e37223 %U https://doi.org/10.2196/37223 %U http://www.ncbi.nlm.nih.gov/pubmed/36040765 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e37578 %T Predicting Readmission Charges Billed by Hospitals: Machine Learning Approach %A Gopukumar,Deepika %A Ghoshal,Abhijeet %A Zhao,Huimin %+ Department of Health and Clinical Outcomes Research, School of Medicine, Saint Louis University, SALUS Center, 3545 Lafayette Ave., 4th floor, Room 409 B, St.Louis, MO, 63110, United States, 1 3149779300, deepika.gopukumar@health.slu.edu %K readmission charges %K readmission analytics %K predictive models %K machine learning %K readmissions %K predictive analytics %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The Centers for Medicare and Medicaid Services projects that health care costs will continue to grow over the next few years. Rising readmission costs contribute significantly to increasing health care costs. Multiple areas of health care, including readmissions, have benefited from the application of various machine learning algorithms in several ways. Objective: We aimed to identify suitable models for predicting readmission charges billed by hospitals. Our literature review revealed that this application of machine learning is underexplored. We used various predictive methods, ranging from glass-box models (such as regularization techniques) to black-box models (such as deep learning–based models). Methods: We defined readmissions as readmission with the same major diagnostic category (RSDC) and all-cause readmission category (RADC). For these readmission categories, 576,701 and 1,091,580 individuals, respectively, were identified from the Nationwide Readmission Database of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality for 2013. Linear regression, lasso regression, elastic net, ridge regression, eXtreme gradient boosting (XGBoost), and a deep learning model based on multilayer perceptron (MLP) were the 6 machine learning algorithms we tested for RSDC and RADC through 10-fold cross-validation. Results: Our preliminary analysis using a data-driven approach revealed that within RADC, the subsequent readmission charge billed per patient was higher than the previous charge for 541,090 individuals, and this number was 319,233 for RSDC. The top 3 major diagnostic categories (MDCs) for such instances were the same for RADC and RSDC. The average readmission charge billed was higher than the previous charge for 21 of the MDCs in the case of RSDC, whereas it was only for 13 of the MDCs in RADC. We recommend XGBoost and the deep learning model based on MLP for predicting readmission charges. The following performance metrics were obtained for XGBoost: (1) RADC (mean absolute percentage error [MAPE]=3.121%; root mean squared error [RMSE]=0.414; mean absolute error [MAE]=0.317; root relative squared error [RRSE]=0.410; relative absolute error [RAE]=0.399; normalized RMSE [NRMSE]=0.040; mean absolute deviation [MAD]=0.031) and (2) RSDC (MAPE=3.171%; RMSE=0.421; MAE=0.321; RRSE=0.407; RAE=0.393; NRMSE=0.041; MAD=0.031). The performance obtained for MLP-based deep neural networks are as follows: (1) RADC (MAPE=3.103%; RMSE=0.413; MAE=0.316; RRSE=0.410; RAE=0.397; NRMSE=0.040; MAD=0.031) and (2) RSDC (MAPE=3.202%; RMSE=0.427; MAE=0.326; RRSE=0.413; RAE=0.399; NRMSE=0.041; MAD=0.032). Repeated measures ANOVA revealed that the mean RMSE differed significantly across models with P<.001. Post hoc tests using the Bonferroni correction method indicated that the mean RMSE of the deep learning/XGBoost models was statistically significantly (P<.001) lower than that of all other models, namely linear regression/elastic net/lasso/ridge regression. Conclusions: Models built using XGBoost and MLP are suitable for predicting readmission charges billed by hospitals. The MDCs allow models to accurately predict hospital readmission charges. %M 35896038 %R 10.2196/37578 %U https://medinform.jmir.org/2022/8/e37578 %U https://doi.org/10.2196/37578 %U http://www.ncbi.nlm.nih.gov/pubmed/35896038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37472 %T Investigating a Work System Approach to Implement an Emergency Department Surge Management System: Case Study %A Jewer,Jennifer %+ Faculty of Business Administration, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3X5, Canada, 1 7098643094, jenniferj@mun.ca %K emergency department %K surge management %K work system %K system implementation %K emergency department information system %K mobile phone %D 2022 %7 25.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Emergency department (ED) crowding is a global health care issue. eHealth systems have the potential to reduce crowding; however, the true benefits are seldom realized because the systems are not integrated into clinicians’ work. We sought a deep understanding of how an eHealth system implementation can be structured to truly integrate the system into the workflow. Objective: The specific objectives of this study were to examine whether work system theory (WST) is a good approach to structure the implementation of an eHealth system by incorporating the entire work system, and not just the eHealth system, in the implementation framework; identify the role that specific elements of WST’s static framework and dynamic work system life cycle model play in the implementation; and demonstrate how WST can be applied in the health care setting to guide the implementation of an eHealth system. Methods: Through a case study of an ED in a rural hospital, we used a mixed methods approach to examine the implementation of a surge management system through the lens of WST. We conducted 14 hours of observation in the ED; 20 interviews with clinicians, management, and members of the implementation team; and a survey of 23 clinicians; reviewed related documentation; and analyzed ED data to measure wait times. We used template analysis based on WST to structure our analysis of qualitative data and descriptive statistics for quantitative data. Results: The surge management system helped to reduce crowding in the ED, staff was satisfied with the implementation, and wait time improvements have been maintained for several years. Although study participants indicated changes to their workflow, 72% (13/18) of survey participants were satisfied with their use of the system, and 82% (14/17) indicated that it was integrated with their workflow. Examining the implementation through the lens of WST enabled us to identify the aspects of the implementation that made it so successful. By applying the WST static framework, we saw how the implementation team incorporated the elements of the ED work system, assessed their alignment, and designed interventions to address areas of misalignment. The dynamic work system life cycle model captured how planned and unplanned changes were managed throughout the iterative implementation cycle—83% (15/18) of participants indicated that there was sufficient management support for the changes and 80% (16/20) indicated the change served an important purpose. Conclusions: The broad scope and holistic approach of WST is well suited to guide eHealth system implementations as it focuses efforts on the entire work system and not just the IT artifact. We broaden the focus of WST by applying it to the implementation of an ED surge management system. These findings will guide further studies and implementations of eHealth systems using WST. %M 36006684 %R 10.2196/37472 %U https://www.jmir.org/2022/8/e37472 %U https://doi.org/10.2196/37472 %U http://www.ncbi.nlm.nih.gov/pubmed/36006684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e30902 %T Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study %A Lin,Jody L %A Huber,Bernd %A Amir,Ofra %A Gehrmann,Sebastian %A Ramirez,Kimberly S %A Ochoa,Kimberly M %A Asch,Steven M %A Gajos,Krzysztof Z %A Grosz,Barbara J %A Sanders,Lee M %+ Department of Pediatrics, University of Utah School of Medicine, 100 Mario Capecchi Drive, Salt Lake City, UT, 84114, United States, 1 801 662 3645, jody.lin@hsc.utah.edu %K care coordination %K implementation science %K chronic illness %K pediatric %K family medicine %K barrier %K complex care %K children %K families %K parents %K care providers %K chronic disease %K coordination %K implementation %K improvement %K technology %K feasibility %K acceptability %K monitoring %D 2022 %7 23.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC. Objective: The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation. Methods: We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children’s hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (–2 strong barrier to +2 strong facilitator). Results: Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo; providers: 30-minute tutorial and 5-minute video on use in a clinic visit; both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years; n=28, 80% female; n=17, 49% Caucasian; n=16, 46% Hispanic; and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK’s internet accessibility and email reminders (parents), and GK’s ability to set long-term goals and use at the end of visits (providers). A key barrier was GK’s lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers. Conclusions: Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records. Trial Registration: ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071 %M 35998021 %R 10.2196/30902 %U https://www.jmir.org/2022/8/e30902 %U https://doi.org/10.2196/30902 %U http://www.ncbi.nlm.nih.gov/pubmed/35998021 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e37482 %T Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity %A Alexander,Gregory L %A Liu,Jianfang %A Powell,Kimberly R %A Stone,Patricia W %+ School of Nursing, Columbia University, Room 628, 560 W 168th Street, New York, NY, 10032, United States, 1 573 301 3131, ga2545@cumc.columbia.edu %K nursing homes %K health information technology %K policy %K nursing informatics %K electronic health record %K electronic data %K data sharing %K care providers %K resident %K care %K quality of care %K structural disparity %K clinical support %K administration %D 2022 %7 23.8.2022 %9 Original Paper %J JMIR Aging %G English %X 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. %M 35998030 %R 10.2196/37482 %U https://aging.jmir.org/2022/3/e37482 %U https://doi.org/10.2196/37482 %U http://www.ncbi.nlm.nih.gov/pubmed/35998030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37611 %T The Adoption of Artificial Intelligence in Health Care and Social Services in Australia: Findings From a Methodologically Innovative National Survey of Values and Attitudes (the AVA-AI Study) %A Isbanner,Sebastian %A O’Shaughnessy,Pauline %A Steel,David %A Wilcock,Scarlet %A Carter,Stacy %+ Australian Centre for Health Engagement Evidence and Values, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 2 4221 3243, stacyc@uow.edu.au %K artificial intelligence %K surveys and questionnaires %K consumer health informatics %K social welfare %K bioethics %K social values %D 2022 %7 22.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) for use in health care and social services is rapidly developing, but this has significant ethical, legal, and social implications. Theoretical and conceptual research in AI ethics needs to be complemented with empirical research to understand the values and judgments of members of the public, who will be the ultimate recipients of AI-enabled services. Objective: The aim of the Australian Values and Attitudes on AI (AVA-AI) study was to assess and compare Australians’ general and particular judgments regarding the use of AI, compare Australians’ judgments regarding different health care and social service applications of AI, and determine the attributes of health care and social service AI systems that Australians consider most important. Methods: We conducted a survey of the Australian population using an innovative sampling and weighting methodology involving 2 sample components: one from an omnibus survey using a sample selected using scientific probability sampling methods and one from a nonprobability-sampled web-based panel. The web-based panel sample was calibrated to the omnibus survey sample using behavioral, lifestyle, and sociodemographic variables. Univariate and bivariate analyses were performed. Results: We included weighted responses from 1950 Australians in the web-based panel along with a further 2498 responses from the omnibus survey for a subset of questions. Both weighted samples were sociodemographically well spread. An estimated 60% of Australians support the development of AI in general but, in specific health care scenarios, this diminishes to between 27% and 43% and, for social service scenarios, between 31% and 39%. Although all ethical and social dimensions of AI presented were rated as important, accuracy was consistently the most important and reducing costs the least important. Speed was also consistently lower in importance. In total, 4 in 5 Australians valued continued human contact and discretion in service provision more than any speed, accuracy, or convenience that AI systems might provide. Conclusions: The ethical and social dimensions of AI systems matter to Australians. Most think AI systems should augment rather than replace humans in the provision of both health care and social services. Although expressing broad support for AI, people made finely tuned judgments about the acceptability of particular AI applications with different potential benefits and downsides. Further qualitative research is needed to understand the reasons underpinning these judgments. The participation of ethicists, social scientists, and the public can help guide AI development and implementation, particularly in sensitive and value-laden domains such as health care and social services. %M 35994331 %R 10.2196/37611 %U https://www.jmir.org/2022/8/e37611 %U https://doi.org/10.2196/37611 %U http://www.ncbi.nlm.nih.gov/pubmed/35994331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38714 %T The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians’ Work: Network Analysis Approach %A Saukkonen,Petra %A Elovainio,Marko %A Virtanen,Lotta %A Kaihlanen,Anu-Marja %A Nadav,Janna %A Lääveri,Tinja %A Vänskä,Jukka %A Viitanen,Johanna %A Reponen,Jarmo %A Heponiemi,Tarja %+ Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, PO Box 30, Finland, 358 29 524 8289, petra.saukkonen@thl.fi %K network analysis %K mixed graphical model %K physicians %K health care digitalization %K digitalization of work %K work in transformation %K digital health %D 2022 %7 17.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians’ work is needed. Objective: The aim of this study was to examine physicians’ perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. Methods: A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients’ active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Results: Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). Conclusions: The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians’ work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians’ work. The adoption of digital health is not just a technological project but a project that changes existing work practices. %M 35976692 %R 10.2196/38714 %U https://www.jmir.org/2022/8/e38714 %U https://doi.org/10.2196/38714 %U http://www.ncbi.nlm.nih.gov/pubmed/35976692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37682 %T Determining the Influencing Factors on Acceptance of eHealth Pain Management Interventions Among Patients With Chronic Pain Using the Unified Theory of Acceptance and Use of Technology: Cross-sectional Study %A Stoppok,Paula %A Teufel,Martin %A Jahre,Lisa %A Rometsch,Caroline %A Müßgens,Diana %A Bingel,Ulrike %A Skoda,Eva-Maria %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, Germany, 49 201 43 87 55 20, alexander.baeuerle@uni-due.de %K eHealth %K eHealth interventions %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K chronic pain %K pain management %K acceptance %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is a complex disease with high prevalence rates, and many individuals who are affected do not receive adequate treatment. As a complement to conventional therapies, eHealth interventions could provide many benefits to a multimodal treatment approach for patients with chronic pain, whereby future use is associated with the acceptance of these interventions. Objective: This study aims to assess the acceptance of eHealth pain management interventions among patients with chronic pain and identify the influencing factors on acceptance. A further objective of the study is to evaluate the viability of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and compare it with its extended version in terms of explained variance of acceptance. Methods: We performed a cross-sectional web-based study. In total, 307 participants with chronic pain, as defined according to the International Association for the Study of Pain criteria, were recruited through flyers, posters, and web-based inquiries between December 2020 and July 2021. In addition to sociodemographic and medical data, the assessment included validated psychometric instruments and an extended version of the well-established UTAUT model. For statistical analyses, group comparisons and multiple hierarchical regression analyses were performed. Results: The acceptance of eHealth pain management interventions among patients with chronic pain was overall moderate to high (mean 3.67, SD 0.89). There was significant difference in acceptance among age groups (W=9674.0; r=0.156; P=.04). Effort expectancy (β=.37; P<.001), performance expectancy (β=.33; P<.001), and social influence (β=.34; P<.001) proved to be the most important predictors of acceptance. The extended UTAUT (including the original UTAUT factors as well as sociodemographic, medical, and eHealth-related factors) model explained 66.4% of the variance in acceptance, thus supporting the viability of the model. Compared with the original UTAUT model (performance expectancy, effort expectancy, and social influence), the extended model explained significantly more variance (F25,278=1.74; P=.02). Conclusions: Given the association between acceptance and future use, the knowledge of the influencing factors on acceptance should be used in the development and promotion of eHealth pain management interventions. Overall, the acceptance of eHealth pain management interventions was moderate to high. In total, 8 predictors proved to be significant predictors of acceptance. The UTAUT model is a valuable instrument for determining acceptance as well as the factors that influence acceptance of eHealth pain management interventions among patients with chronic pain. The extended UTAUT model provided the greatest predictive value for acceptance. %M 35976199 %R 10.2196/37682 %U https://formative.jmir.org/2022/8/e37682 %U https://doi.org/10.2196/37682 %U http://www.ncbi.nlm.nih.gov/pubmed/35976199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37641 %T Digital Twins for Managing Health Care Systems: Rapid Literature Review %A Elkefi,Safa %A Asan,Onur %+ School of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 4145264330, oasan@stevens.edu %K health care %K digital twins %K safety %K information management %K supply chain management %K operational control %K well-being promotion %K human factors %K technology %K health informatics %K literature synthesis %K scheduling and optimization %K digital health %D 2022 %7 16.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Although most digital twin (DT) applications for health care have emerged in precision medicine, DTs can potentially support the overall health care process. DTs (twinned systems, processes, and products) can be used to optimize flows, improve performance, improve health outcomes, and improve the experiences of patients, doctors, and other stakeholders with minimal risk. Objective: This paper aims to review applications of DT systems, products, and processes as well as analyze the potential of these applications for improving health care management and the challenges associated with this emerging technology. Methods: We performed a rapid review of the literature and reported available studies on DTs and their applications in health care management. We searched 5 databases for studies published between January 2002 and January 2022 and included peer-reviewed studies written in English. We excluded studies reporting DT usage to support health care practice (organ transplant, precision medicine, etc). Studies were analyzed based on their contribution toward DT technology to improve user experience in health care from human factors and systems engineering perspectives, accounting for the type of impact (product, process, or performance/system level). Challenges related to the adoption of DTs were also summarized. Results: The DT-related studies aimed at managing health care systems have been growing over time from 0 studies in 2002 to 17 in 2022, with 7 published in 2021 (N=17 studies). The findings reported on applications categorized by DT type (system: n=8; process: n=5; product: n=4) and their contributions or functions. We identified 4 main functions of DTs in health care management including safety management (n=3), information management (n=2), health management and well-being promotion (n=3), and operational control (n=9). DTs used in health care systems management have the potential to avoid unintended or unexpected harm to people during the provision of health care processes. They also can help identify crisis-related threats to a system and control the impacts. In addition, DTs ensure privacy, security, and real-time information access to all stakeholders. Furthermore, they are beneficial in empowering self-care abilities by enabling health management practices and providing high system efficiency levels by ensuring that health care facilities run smoothly and offer high-quality care to every patient. Conclusions: The use of DTs for health care systems management is an emerging topic. This can be seen in the limited literature supporting this technology. However, DTs are increasingly being used to ensure patient safety and well-being in an organized system. Thus, further studies aiming to address the challenges of health care systems challenges and improve their performance should investigate the potential of DT technology. In addition, such technologies should embed human factors and ergonomics principles to ensure better design and more successful impact on patient and doctor experiences. %M 35972776 %R 10.2196/37641 %U https://www.jmir.org/2022/8/e37641 %U https://doi.org/10.2196/37641 %U http://www.ncbi.nlm.nih.gov/pubmed/35972776 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e35612 %T National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study %A Haverinen,Jari %A Keränen,Niina %A Tuovinen,Timo %A Ruotanen,Ronja %A Reponen,Jarmo %+ FinnTelemedicum, Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Aapistie 5 A, Oulu, 90220, Finland, 358 505680144, jari.haverinen@oulu.fi %K eHealth %K electronic health records %K picture archiving and communication systems %K health information exchange %K electronic prescribing %K referral and consultation %K videoconferencing %K clinical decision support systems %K health informatics %K clinical informatics %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 35969462 %R 10.2196/35612 %U https://medinform.jmir.org/2022/8/e35612 %U https://doi.org/10.2196/35612 %U http://www.ncbi.nlm.nih.gov/pubmed/35969462 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e33491 %T Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study %A Adedeji,Taiwo %A Fraser,Hamish %A Scott,Philip %+ School of Computing, University of Portsmouth, Buckingham Building, Lion Terrace, Portsmouth, PO1 3HE, United Kingdom, 44 2392846429, taiwo.adedeji@port.ac.uk %K theory of change %K electronic health records %K maternal and child health %K primary health center %K success criteria %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Digital health has been a tool of transformation for the delivery of health care services globally. An electronic health record (EHR) system can solve the bottleneck of paper documentation in health service delivery if it is successfully implemented, but poor implementation can lead to a waste of resources. The study of EHR system implementation in low- and middle-income countries (LMICs) is of particular interest to health stakeholders such as policy makers, funders, and care providers because of the efficiencies and evidence base that could result from the appropriate evaluation of such systems. Objective: We aimed to develop a theory of change (ToC) for the implementation of EHRs for maternal and child health care delivery in LMICs. The ToC is an outcomes-based approach that starts with the long-term goals and works backward to the inputs and mediating components required to achieve these goals for complex programs. Methods: We used the ToC approach for the whole implementation’s life cycle to guide the pilot study and identify the preconditions needed to realize the study’s long-term goal at Festac Primary Health Centre in Lagos, Nigeria. To evaluate the maturity of the implementation, we adapted previously defined success factors to supplement the ToC approach. Results: The initial ToC map showed that the long-term goal was an improved service delivery in primary care with the introduction of EHRs. The revised ToC revealed that the long-term change was the improved maternal and child health care delivery at Festac Primary Health Center using EHRs. We proposed a generic ToC map that implementers in LMICs can use to introduce an optimized EHR system, with assumptions about sustainability and other relevant factors. The outcomes from the critical success factors were sustainability: the sustained improvements included trained health care professionals, a change in mindset from using paper systems toward digital health transformation, and using the project’s laptops to collect aggregate data for the District Health Information System 2–based national health information management system; financial: we secured funding to procure IT equipment, including servers, laptops, and networking, but the initial cost of implementation was high, and funds mainly came from the funding partner; and organizational: the health professionals, especially the head of nursing and health information officers, showed significant commitment to adopting the EHR system, but certain physicians and midwives were unwilling to use the EHR system initially until they were persuaded or incentivized by the management. Conclusions: This study shows that the ToC is a rewarding approach to framing dialogue with stakeholders and serves as a framework for planning, evaluation, learning, and reflection. We hypothesized that any future health IT implementation in primary care could adapt our ToC approach to their contexts with necessary modifications based on inherent characteristics. %M 35969461 %R 10.2196/33491 %U https://medinform.jmir.org/2022/8/e33491 %U https://doi.org/10.2196/33491 %U http://www.ncbi.nlm.nih.gov/pubmed/35969461 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e35726 %T Harnessing the Electronic Health Care Record to Optimize Patient Safety in Primary Care: Framework for Evaluating e–Safety-Netting Tools %A Black,Georgia Bell %A Bhuiya,Afsana %A Friedemann Smith,Claire %A Hirst,Yasemin %A Nicholson,Brian David %+ Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2031083157, g.black@ucl.ac.uk %K primary care %K patient safety %K electronic health record %K safety %K optimize %K framework %K evaluation %K tool %K diagnostic %K uncertainty %K management %K netting %K software %K criteria %D 2022 %7 1.8.2022 %9 Viewpoint %J JMIR Med Inform %G English %X The management of diagnostic uncertainty is part of every primary care physician’s role. e–Safety-netting tools help health care professionals to manage diagnostic uncertainty. Using software in addition to verbal or paper based safety-netting methods could make diagnostic delays and errors less likely. There are an increasing number of software products that have been identified as e–safety-netting tools, particularly since the start of the COVID-19 pandemic. e–Safety-netting tools can have a variety of functions, such as sending clinician alerts, facilitating administrative tasking, providing decision support, and sending reminder text messages to patients. However, these tools have not been evaluated by using robust research designs for patient safety interventions. We present an emergent framework of criteria for effective e–safety-netting tools that can be used to support the development of software. The framework is based on validated frameworks for electronic health record development and patient safety. There are currently no tools available that meet all of the criteria in the framework. We hope that the framework will stimulate clinical and public conversations about e–safety-netting tools. In the future, a validated framework would drive audits and improvements. We outline key areas for future research both in primary care and within integrated care systems. %M 35916722 %R 10.2196/35726 %U https://medinform.jmir.org/2022/8/e35726 %U https://doi.org/10.2196/35726 %U http://www.ncbi.nlm.nih.gov/pubmed/35916722 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38437 %T Key Stakeholder Barriers and Facilitators to Implementing Remote Monitoring Technologies: Protocol for a Mixed Methods Analysis %A Iqbal,Fahad Mujtaba %A Joshi,Meera %A Khan,Sadia %A Wright,Mike %A Ashrafian,Hutan %A Darzi,Ara %+ Division of Surgery, Imperial College London, Praed Street, London, W2 1NY, United Kingdom, 44 2033126666, fahad.iqbal@doctors.org.uk %K implementation science %K health plan implementation %K mobile health %K health care industry %K stakeholder %K barriers %K remote monitoring %K implementation %K digitization %K digital solutions %D 2022 %7 21.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The implementation of novel digital solutions within the National Health Service has historically been challenging. Since the start of the COVID-19 pandemic, there has been a greater push for digitization and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation have been poorly studied. Objective: We aim to investigate key stakeholder barriers and facilitators to implementing remote monitoring solutions to identify factors that could affect successful adoption. Methods: A mixed methods approach will be implemented. Semistructured interviews will be conducted with high-level stakeholders from industry and academia and health care providers who have played an instrumental role in, and have prior experience with, implementing digital solutions, alongside the use of an adapted version of the Technology Acceptance Model questionnaire. Results: Enrollment is currently underway, having started in February 2022. It is anticipated to end in July 2022, with data analysis scheduled to commence in August 2022. Conclusions: The results of our study may highlight key barriers and facilitators to implementing digital remote monitoring solutions, thereby allowing for improved widespread adoption within the National Health Service in the future. Trial Registration: ClinicalTrials.gov NCT05321004; https://clinicaltrials.gov/ct2/show/NCT05321004 %M 35862185 %R 10.2196/38437 %U https://www.researchprotocols.org/2022/7/e38437 %U https://doi.org/10.2196/38437 %U http://www.ncbi.nlm.nih.gov/pubmed/35862185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37338 %T Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review %A Sung,Meekang %A He,Jinyu %A Zhou,Qi %A Chen,Yaolong %A Ji,John S %A Chen,Haotian %A Li,Zhihui %+ Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 10084, China, 86 13718264652, zhihuili@mail.tsinghua.edu.cn %K health information technology %K noncommunicable disease management %K chronic disease management %K systematic review %K implementation science %D 2022 %7 20.7.2022 %9 Review %J J Med Internet Res %G English %X Background: Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. Objective: We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. Methods: We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. Results: We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians’ suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. Conclusions: Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries. %M 35857364 %R 10.2196/37338 %U https://www.jmir.org/2022/7/e37338 %U https://doi.org/10.2196/37338 %U http://www.ncbi.nlm.nih.gov/pubmed/35857364 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e37346 %T A Rapid-Learning Health System to Support Implementation of Early Intervention Services for Psychosis in Quebec, Canada: Protocol %A Ferrari,Manuela %A Iyer,Srividya %A LeBlanc,Annie %A Roy,Marc-André %A Abdel-Baki,Amal %+ Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), 900 Rue St Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8242, amal.abdel-baki@umontreal.ca %K rapid-learning health system %K early intervention for psychosis %K measurement-based care %K real-time electronic data capturing %K patient-oriented research %K knowledge translation %K mobile phone %D 2022 %7 19.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given the strong evidence of their effectiveness, early intervention services (EIS) for psychosis are being widely implemented. However, heterogeneity in the implementation of essential components remains an ongoing challenge. Rapid-learning health systems (RLHSs) that embed data collection in clinical settings for real-time learning and continuous quality improvement can address this challenge. Therefore, we implemented an RLHS in 11 EIS in Quebec, Canada. Objective: This project aims to determine the feasibility and acceptability of implementing an RLHS in EIS and assess its impact on compliance with standards for essential EIS components. Methods: Funding for this project was secured in July 2019, and ethics approval was received in December 2019. The implementation of this RLHS involves 6 iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, and provincial EIS associations) are involved in all phases. Meaningful EIS quality indicators (eg, satisfaction and timeliness of response to referrals) were selected based on a literature review, provincial guidelines, and stakeholder consensus on prioritization of indicators. A digital infrastructure was designed and deployed comprising a user-friendly interface for routinely collecting data from programs; a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life; and data analytic, visualization, and reporting functionalities to provide participating programs with real-time feedback on their ongoing performance in relation to standards and to other programs, including tailored recommendations. Our community of practice conducts activities, leveraging insights from data to build program capacity while continuously aligning their practices with standards and best practices. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, we are collecting quantitative and qualitative data on the reach, effectiveness, adoption, implementation, and maintenance of our RLHS for evaluating its impacts. Results: Phase 1 (identifying RLHS indicators for EIS based on a literature synthesis, a survey, and consensus meetings with all stakeholder groups) and phase 2 (developing and implementing the RLHS digital infrastructure) are completed (September 2019 to May 2020). Phases 3 to 5 have been ongoing (June 2020 to June 2022). Continuous data collection through the RLHS data capture platforms and real-time feedback to all stakeholders are deployed. Phase 6 will be implemented in 2022 to assess the impact of the RLHS using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework with quantitative and qualitative data. Conclusions: This project will yield valuable insights into the implementation of RLHS in EIS, offering preliminary evidence of its acceptability, feasibility, and impacts on program-level outcomes. The findings will refine our RLHS further and advance approaches that use data, stakeholder voices, and collaborative learning to improve outcomes and quality in services for psychosis. International Registered Report Identifier (IRRID): DERR1-10.2196/37346 %M 35852849 %R 10.2196/37346 %U https://www.researchprotocols.org/2022/7/e37346 %U https://doi.org/10.2196/37346 %U http://www.ncbi.nlm.nih.gov/pubmed/35852849 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e36102 %T Recommendations for Better Adoption of Medical Photography as a Clinical Tool %A Wongvibulsin,Shannon %A Feterik,Kristian %+ Division of Dermatology, Department of Medicine, University of California, Los Angeles, 200 Medical Plaza Suite 450, Los Angeles, CA, 90095, United States, 1 (310) 794 5659, swongvibulsin@mednet.ucla.edu %K medical photography %K photo documentation %K EMR %K electronic medical record %K electronic health record %K EHR %K interoperability %K interoperable %K photography %K photograph %K imaging %K image capture %K image %K image storage %K clinical instrument %K clinical tool %D 2022 %7 18.7.2022 %9 Viewpoint %J Interact J Med Res %G English %X The use of photography in routine clinical practice has the potential to increase the efficiency of overall patient care as well as improve clinical documentation and provider-to-provider communication. This is particularly important in the setting of provider burnout in the electronic health record era and during the COVID-19 pandemic. Despite the potential of photographs to enhance workflows and patient care, challenges remain that hinder the successful incorporation of medical photography into clinical practice, often because of inconsistent structure and implementation. Our proposed consolidated framework for clinical photography consists of five key aspects: appropriate informed consent; proper preparation and positioning; image acquisition with consideration of the field of view, orientation, focus, resolution, scale, and color calibration; streamlined and secure image storage and documentation; and interoperable file exchange. Overall, this viewpoint is a forward-looking paper on leveraging medical photography as an electronic health record tool for clinical care, research, and education. %M 35849427 %R 10.2196/36102 %U https://www.i-jmr.org/2022/2/e36102 %U https://doi.org/10.2196/36102 %U http://www.ncbi.nlm.nih.gov/pubmed/35849427 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 7 %P e39145 %T The Power of Patient Engagement With Electronic Health Records as Research Participants %A Pawelek,Jeff %A Baca-Motes,Katie %A Pandit,Jay A %A Berk,Benjamin B %A Ramos,Edward %+ Digital Trials Center, Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, United States, 1 858 784 2028, eramos@scripps.edu %K electronic health record %K EHR %K digital health technology %K digital clinical trial %K underrepresentation %K underrepresented in biomedical research %K biomedical research %D 2022 %7 8.7.2022 %9 Viewpoint %J JMIR Med Inform %G English %X Electronic health record (EHR) technology has become a central digital health tool throughout health care. EHR systems are responsible for a growing number of vital functions for hospitals and providers. More recently, patient-facing EHR tools are allowing patients to interact with their EHR and connect external sources of health data, such as wearable fitness trackers, personal genomics, and outside health services, to it. As patients become more engaged with their EHR, the volume and variety of digital health information will serve an increasingly useful role in health care and health research. Particularly due to the COVID-19 pandemic, the ability for the biomedical research community to pivot to fully remote research, driven largely by EHR data capture and other digital health tools, is an exciting development that can significantly reduce burden on study participants, improve diversity in clinical research, and equip researchers with more robust clinical data. In this viewpoint, we describe how patient engagement with EHR technology is poised to advance the digital clinical trial space, an innovative research model that is uniquely accessible and inclusive for study participants. %M 35802410 %R 10.2196/39145 %U https://medinform.jmir.org/2022/7/e39145 %U https://doi.org/10.2196/39145 %U http://www.ncbi.nlm.nih.gov/pubmed/35802410 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35403 %T Automated Decision Support For Community Mental Health Services Using National Electronic Health Records: Qualitative Implementation Case Study %A van Kasteren,Yasmin %A Strobel,Jörg %A Bastiampillai,Tarun %A Linedale,Ecushla %A Bidargaddi,Niranjan %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, 5001, Australia, 61 8 82018840, niranjan.bidargaddi@flinders.edu.au %K implementation %K computerised clinical decision system %K decision system %K decision support %K participatory action framework %K psychotropic medication %K psychotropic %K nonadherence %K monitoring %K medication adherence %K algorithms %K algorithm %K electronic health records %K EHR %K health record %K normalization process theory %K automated alerts %K automated alert %K mental health %K mental illness %K adherence %K medication %K eHealth %K web-based %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A high proportion of patients with severe mental illness relapse due to nonadherence to psychotropic medication. In this paper, we use the normalization process theory (NPT) to describe the implementation of a web-based clinical decision support system (CDSS) for Community Mental Health Services (CMHS) called Actionable Intime Insights or AI2. AI2 has two distinct functions: (1) it provides an overview of medication and treatment history to assist in reviewing patient adherence and (2) gives alerts indicating nonadherence to support early intervention. Objective: Our objective is to evaluate the pilot implementation of the AI2 application to better understand the challenges of implementing a web-based CDSS to support medication adherence and early intervention in CMHS. Methods: The NPT and participatory action framework were used to both explore and support implementation. Qualitative data were collected over the course of the 14-month implementation, in which researchers were active participants. Data were analyzed and coded using the NPT framework. Qualitative data included discussions, meetings, and work products, including emails and documents. Results: This study explores the barriers and enablers of implementing a CDSS to support early intervention within CMHS using Medicare data from Australia’s national electronic record system, My Health Record (MyHR). The implementation was a series of ongoing negotiations, which resulted in a staged implementation with compromises on both sides. Clinicians were initially hesitant about using a CDSS based on MyHR data and expressed concerns about the changes to their work practice required to support early intervention. Substantial workarounds were required to move the implementation forward. This pilot implementation allowed us to better understand the challenges of implementation and the resources and support required to implement and sustain a model of care based on automated alerts to support early intervention. Conclusions: The use of decision support based on electronic health records is growing, and while implementation is challenging, the potential benefits of early intervention to prevent relapse and hospitalization and ensure increased efficiency of the health care system are worth pursuing. %M 35788103 %R 10.2196/35403 %U https://humanfactors.jmir.org/2022/3/e35403 %U https://doi.org/10.2196/35403 %U http://www.ncbi.nlm.nih.gov/pubmed/35788103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32577 %T Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study %A Reid,Hadley Woodruff %A Proeschold-Bell,Rae Jean %A Makarushka,Christina %A Melgar Vega,Katherine Dayllan %A Huchko,Megan %A Jeronimo,Jose %A Vasudevan,Lavanya %+ Department of Family Medicine and Community Health, Duke University, Suite 600, 2200 West Main Street, Durham, NC, 27705, United States, 1 919 613 1423, lavanya.vasudevan@duke.edu %K cervical cancer %K mobile health %K Peru %K colposcopy %K implementation science %K Consolidated Framework for Implementation Research %K CFIR %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective: We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru. Methods: We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results: In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions: The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting. %M 35737455 %R 10.2196/32577 %U https://formative.jmir.org/2022/6/e32577 %U https://doi.org/10.2196/32577 %U http://www.ncbi.nlm.nih.gov/pubmed/35737455 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 6 %P e34753 %T A Clinical Decision Support System for Assessing the Risk of Cervical Cancer: Development and Evaluation Study %A Chekin,Nasrin %A Ayatollahi,Haleh %A Karimi Zarchi,Mojgan %+ Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, No 4, Yasemi St, Vali-e-Asr St, Tehran, 1996713883, Iran, 98 2188794301, ayatollahi.h@iums.ac.ir %K cervical cancer %K clinical decision support system %K risk assessment %K medical informatics %K cancer %K oncology %K decision support %K risk %K CDSS %K cervical %K prototype %K evaluation %K testing %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Cervical cancer has been recognized as a preventable type of cancer. As the assessment of all the risk factors of a disease is challenging for physicians, information technology and risk assessment models have been used to estimate the degree of risk. Objective: The aim of this study was to develop a clinical decision support system to assess the risk of cervical cancer. Methods: This study was conducted in 2 phases in 2021. In the first phase of the study, 20 gynecologists completed a questionnaire to determine the essential parameters for assessing the risk of cervical cancer, and the data were analyzed using descriptive statistics. In the second phase of the study, the prototype of the clinical decision support system was developed and evaluated. Results: The findings revealed that the most important parameters for assessing the risk of cervical cancer consisted of general and specific parameters. In total, the 8 parameters that had the greatest impact on the risk of cervical cancer were selected. After developing the clinical decision support system, it was evaluated and the mean values of sensitivity, specificity, and accuracy were 85.81%, 93.82%, and 91.39%, respectively. Conclusions: The clinical decision support system developed in this study can facilitate the process of identifying people who are at risk of developing cervical cancer. In addition, it can help to increase the quality of health care and reduce the costs associated with the treatment of cervical cancer. %M 35731549 %R 10.2196/34753 %U https://medinform.jmir.org/2022/6/e34753 %U https://doi.org/10.2196/34753 %U http://www.ncbi.nlm.nih.gov/pubmed/35731549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33368 %T The Drivers of Acceptance of Artificial Intelligence–Powered Care Pathways Among Medical Professionals: Web-Based Survey Study %A Cornelissen,Lisa %A Egher,Claudia %A van Beek,Vincent %A Williamson,Latoya %A Hommes,Daniel %+ Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 655320046, lisa.cornelissen@dearhealth.com %K technology acceptance %K artificial intelligence %K health care providers %K machine learning %K technology adoption %K health innovation %K user adoption %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The emergence of Artificial Intelligence (AI) has been proven beneficial in several health care areas. Nevertheless, the uptake of AI in health care delivery remains poor. Despite the fact that the acceptance of AI-based technologies among medical professionals is a key barrier to their implementation, knowledge about what informs such attitudes is scarce. Objective: The aim of this study was to identify and examine factors that influence the acceptability of AI-based technologies among medical professionals. Methods: A survey was developed based on the Unified Theory of Acceptance and Use of Technology model, which was extended by adding the predictor variables perceived trust, anxiety and innovativeness, and the moderator profession. The web-based survey was completed by 67 medical professionals in the Netherlands. The data were analyzed by performing a multiple linear regression analysis followed by a moderating analysis using the Hayes PROCESS macro (SPSS; version 26.0, IBM Corp). Results: Multiple linear regression showed that the model explained 75.4% of the variance in the acceptance of AI-powered care pathways (adjusted R2=0.754; F9,0=22.548; P<.001). The variables medical performance expectancy (β=.465; P<.001), effort expectancy (β=–.215; P=.005), perceived trust (β=.221; P=.007), nonmedical performance expectancy (β=.172; P=.08), facilitating conditions (β=–.160; P=.005), and professional identity (β=.156; P=.06) were identified as significant predictors of acceptance. Social influence of patients (β=.042; P=.63), anxiety (β=.021; P=.84), and innovativeness (β=.078; P=.30) were not identified as significant predictors. A moderating effect by gender was found between the relationship of facilitating conditions and acceptance (β=–.406; P=.09). Conclusions: Medical performance expectancy was the most significant predictor of AI-powered care pathway acceptance among medical professionals. Nonmedical performance expectancy, effort expectancy, perceived trust, and professional identity were also found to significantly influence the acceptance of AI-powered care pathways. These factors should be addressed for successful implementation of AI-powered care pathways in health care delivery. The study was limited to medical professionals in the Netherlands, where uptake of AI technologies is still in an early stage. Follow-up multinational studies should further explore the predictors of acceptance of AI-powered care pathways over time, in different geographies, and with bigger samples. %M 35727614 %R 10.2196/33368 %U https://formative.jmir.org/2022/6/e33368 %U https://doi.org/10.2196/33368 %U http://www.ncbi.nlm.nih.gov/pubmed/35727614 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e31029 %T A Reference Architecture for Data-Driven and Adaptive Internet-Delivered Psychological Treatment Systems: Software Architecture Development and Validation Study %A Mukhiya,Suresh Kumar %A Lamo,Yngve %A Rabbi,Fazle %+ Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Bergen, 5063, Norway, 47 55 58 58 00, itsmeskm99@gmail.com %K software architecture %K adaptive system %K IDPT system %K health care systems %K ICBT %K adaptive strategies %K personalized therapies %K reference architecture %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Internet-delivered psychological treatment (IDPT) systems are software applications that offer psychological treatments via the internet. Such IDPT systems have become one of the most commonly practiced and widely researched forms of psychotherapy. Evidence shows that psychological treatments delivered by IDPT systems can be an effective way of treating mental health morbidities. However, current IDPT systems have high dropout rates and low user adherence. The primary reason is that the current IDPT systems are not flexible, adaptable, and personalized as they follow a fixed tunnel-based treatment architecture. A fixed tunnel-based architecture follows predefined, sequential treatment content for every patient, irrespective of their context, preferences, and needs. Moreover, current IDPT systems have poor interoperability, making it difficult to reuse and share treatment materials. There is a lack of development and documentation standards, conceptual frameworks, and established (clinical) guidelines for such IDPT systems. As a result, several ad hoc forms of IDPT models exist. Consequently, developers and researchers have tended to reinvent new versions of IDPT systems, making them more complex and less interoperable. Objective: This study aimed to design, develop, and evaluate a reference architecture (RA) for adaptive systems that can facilitate the design and development of adaptive, interoperable, and reusable IDPT systems. Methods: This study was conducted in collaboration with a large interdisciplinary project entitled INTROMAT (Introducing Mental Health through Adaptive Technology), which brings together information and communications technology researchers, information and communications technology industries, health researchers, patients, clinicians, and patients’ next of kin to reach its vision. First, we investigated previous studies and state-of-the-art works based on the project’s problem domain and goals. On the basis of the findings from these investigations, we identified 2 primary gaps in current IDPT systems: lack of adaptiveness and limited interoperability. Second, we used model-driven engineering and Domain-Driven Design techniques to design, develop, and validate the RA for building adaptive, interoperable, and reusable IDPT systems to address these gaps. Third, based on the proposed RA, we implemented a prototype as the open-source software. Finally, we evaluated the RA and open-source implementation using empirical (case study) and nonempirical approaches (software architecture analysis method, expert evaluation, and software quality attributes). Results: This paper outlines an RA that supports flexible user modeling and the adaptive delivery of treatments. To evaluate the proposed RA, we developed an open-source software based on the proposed RA. The open-source framework aims to improve development productivity, facilitate interoperability, increase reusability, and expedite communication with domain experts. Conclusions: Our results showed that the proposed RA is flexible and capable of adapting interventions based on patients’ needs, preferences, and context. Furthermore, developers and researchers can extend the proposed RA to various health care interventions. %M 35723905 %R 10.2196/31029 %U https://humanfactors.jmir.org/2022/2/e31029 %U https://doi.org/10.2196/31029 %U http://www.ncbi.nlm.nih.gov/pubmed/35723905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33709 %T Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion %A Engeltjes,Bernice %A Rosman,Ageeth %A Scheele,Fedde %A Vis,Christiaan %A Wouters,Eveline %+ Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015AK, Netherlands, 31 641804881, engeltjesbernice@gmail.com %K obstetric triage %K Normalization Process Theory %K implementation strategy %K hierarchy %K medical staff %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff. Objective: The primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals. Methods: An evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group. Results: Overall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement. Conclusions: The DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital. %M 35616176 %R 10.2196/33709 %U https://formative.jmir.org/2022/6/e33709 %U https://doi.org/10.2196/33709 %U http://www.ncbi.nlm.nih.gov/pubmed/35616176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35317 %T Integration vs Collaborative Redesign Strategies of Health Systems’ Supply Chains in the Post-COVID-19 New Normal: Cross-sectional Survey Across the United States %A Khuntia,Jiban %A Mejia,Frances J %A Ning,Xue %A Helton,Jeff %A Stacey,Rulon %+ Health Administration Research Consortium, University of Colorado Denver, 1475 Lawrence St., Denver, CO, 80202, United States, 1 303 315 8424, jiban.khuntia@ucdenver.edu %K COVID-19 %K post-COVID-19 %K health systems %K supply chain integration %K supply chain collaboration %K supply chain resilience %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, questions such as how health systems are shaping strategies to restore the supply chain disruptions are essential to have confidence in health systems’ supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. Objective: This study focuses on teasing out the nuance of supply chain integration versus collaborative redesign strategies for health systems in the post-COVID-19 new normal. We focus on 2 research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems’ supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 health system CEOs contacted, 135 (21.6%) responded to our survey. We considered supply chain–relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set from the 124 health systems. Next, we used ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. Results: Health systems with higher disruptions would choose integration (positive, P<.001) over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes (P<.01), while collaborations are perceived to lead to greater growth opportunities (P<.05); however, the role of integration in growth is not entirely ruled out (combined model, P<.001). Plausibly, some health systems would choose integration and collaborative redesign models, which have a significant relationship with both services (combined model, P<.01) and growth, establishing the importance of mixed strategies for health systems. Conclusions: The cost of health care continues to rise, and supply-related costs constitute a large portion of a hospital’s expenditure. Understanding supply chain strategic choices are essential for a health system’s success. Although collaboration is an option, focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems. %M 35452405 %R 10.2196/35317 %U https://formative.jmir.org/2022/6/e35317 %U https://doi.org/10.2196/35317 %U http://www.ncbi.nlm.nih.gov/pubmed/35452405 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 6 %P e34678 %T Perspective of Information Technology Decision Makers on Factors Influencing Adoption and Implementation of Artificial Intelligence Technologies in 40 German Hospitals: Descriptive Analysis %A Weinert,Lina %A Müller,Julia %A Svensson,Laura %A Heinze,Oliver %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34367, lina.weinert@med.uni-heidelberg.de %K artificial intelligence %K AI readiness %K implementation %K decision-making %K descriptive analysis %K quantitative study %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: New artificial intelligence (AI) tools are being developed at a high speed. However, strategies and practical experiences surrounding the adoption and implementation of AI in health care are lacking. This is likely because of the high implementation complexity of AI, legacy IT infrastructure, and unclear business cases, thus complicating AI adoption. Research has recently started to identify the factors influencing AI readiness of organizations. Objective: This study aimed to investigate the factors influencing AI readiness as well as possible barriers to AI adoption and implementation in German hospitals. We also assessed the status quo regarding the dissemination of AI tools in hospitals. We focused on IT decision makers, a seldom studied but highly relevant group. Methods: We created a web-based survey based on recent AI readiness and implementation literature. Participants were identified through a publicly accessible database and contacted via email or invitational leaflets sent by mail, in some cases accompanied by a telephonic prenotification. The survey responses were analyzed using descriptive statistics. Results: We contacted 609 possible participants, and our database recorded 40 completed surveys. Most participants agreed or rather agreed with the statement that AI would be relevant in the future, both in Germany (37/40, 93%) and in their own hospital (36/40, 90%). Participants were asked whether their hospitals used or planned to use AI technologies. Of the 40 participants, 26 (65%) answered “yes.” Most AI technologies were used or planned for patient care, followed by biomedical research, administration, and logistics and central purchasing. The most important barriers to AI were lack of resources (staff, knowledge, and financial). Relevant possible opportunities for using AI were increase in efficiency owing to time-saving effects, competitive advantages, and increase in quality of care. Most AI tools in use or in planning have been developed with external partners. Conclusions: Few tools have been implemented in routine care, and many hospitals do not use or plan to use AI in the future. This can likely be explained by missing or unclear business cases or the need for a modern IT infrastructure to integrate AI tools in a usable manner. These shortcomings complicate decision-making and resource attribution. As most AI technologies already in use were developed in cooperation with external partners, these relationships should be fostered. IT decision makers should assess their hospitals’ readiness for AI individually with a focus on resources. Further research should continue to monitor the dissemination of AI tools and readiness factors to determine whether improvements can be made over time. This monitoring is especially important with regard to government-supported investments in AI technologies that could alleviate financial burdens. Qualitative studies with hospital IT decision makers should be conducted to further explore the reasons for slow AI. %M 35704378 %R 10.2196/34678 %U https://medinform.jmir.org/2022/6/e34678 %U https://doi.org/10.2196/34678 %U http://www.ncbi.nlm.nih.gov/pubmed/35704378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36501 %T Acceptance, Barriers, and Facilitators to Implementing Artificial Intelligence–Based Decision Support Systems in Emergency Departments: Quantitative and Qualitative Evaluation %A Fujimori,Ryo %A Liu,Keibun %A Soeno,Shoko %A Naraba,Hiromu %A Ogura,Kentaro %A Hara,Konan %A Sonoo,Tomohiro %A Ogura,Takayuki %A Nakamura,Kensuke %A Goto,Tadahiro %+ Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 1138655, Japan, 81 08095261328, fujimori0203@gmail.com %K clinical decision support system %K preimplementation %K qualitative %K mixed methods %K artificial intelligence %K emergency medicine %K CDSS %K computerized decision %K computerized decision support system %K AI %K AI-based %K CFIR %K quantitative analysis %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increasing availability of clinical decision support systems (CDSSs) and rising expectation for CDSSs based on artificial intelligence (AI), little is known about the acceptance of AI-based CDSS by physicians and its barriers and facilitators in emergency care settings. Objective: We aimed to evaluate the acceptance, barriers, and facilitators to implementing AI-based CDSSs in the emergency care setting through the opinions of physicians on our newly developed, real-time AI-based CDSS, which alerts ED physicians by predicting aortic dissection based on numeric and text information from medical charts, by using the Unified Theory of Acceptance and Use of Technology (UTAUT; for quantitative evaluation) and the Consolidated Framework for Implementation Research (CFIR; for qualitative evaluation) frameworks. Methods: This mixed methods study was performed from March to April 2021. Transitional year residents (n=6), emergency medicine residents (n=5), and emergency physicians (n=3) from two community, tertiary care hospitals in Japan were included. We first developed a real-time CDSS for predicting aortic dissection based on numeric and text information from medical charts (eg, chief complaints, medical history, vital signs) with natural language processing. This system was deployed on the internet, and the participants used the system with clinical vignettes of model cases. Participants were then involved in a mixed methods evaluation consisting of a UTAUT-based questionnaire with a 5-point Likert scale (quantitative) and a CFIR-based semistructured interview (qualitative). Cronbach α was calculated as a reliability estimate for UTAUT subconstructs. Interviews were sampled, transcribed, and analyzed using the MaxQDA software. The framework analysis approach was used during the study to determine the relevance of the CFIR constructs. Results: All 14 participants completed the questionnaires and interviews. Quantitative analysis revealed generally positive responses for user acceptance with all scores above the neutral score of 3.0. In addition, the mixed methods analysis identified two significant barriers (System Performance, Compatibility) and two major facilitators (Evidence Strength, Design Quality) for implementation of AI-based CDSSs in emergency care settings. Conclusions: Our mixed methods evaluation based on theoretically grounded frameworks revealed the acceptance, barriers, and facilitators of implementation of AI-based CDSS. Although the concern of system failure and overtrusting of the system could be barriers to implementation, the locality of the system and designing an intuitive user interface could likely facilitate the use of optimal AI-based CDSS. Alleviating and resolving these factors should be key to achieving good user acceptance of AI-based CDSS. %M 35699995 %R 10.2196/36501 %U https://formative.jmir.org/2022/6/e36501 %U https://doi.org/10.2196/36501 %U http://www.ncbi.nlm.nih.gov/pubmed/35699995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34479 %T Strategies for Implementing Occupational eMental Health Interventions: Scoping Review %A Bernard,Renaldo M %A Toppo,Claudia %A Raggi,Alberto %A de Mul,Marleen %A de Miquel,Carlota %A Pugliese,Maria Teresa %A van der Feltz-Cornelis,Christina M %A Ortiz-Tallo,Ana %A Salvador-Carulla,Luis %A Lukersmith,Sue %A Hakkaart-van Roijen,Leona %A Merecz-Kot,Dorota %A Staszewska,Kaja %A Sabariego,Carla %+ Swiss Paraplegic Research, Guido A. Zäch-Strasse 4, Nottwil, 6207, Switzerland, 41 419396654, renaldo.bernard@paraplegie.ch %K implementation %K mobile health %K mHealth %K mental health %K eMental health %K occupational health %K barriers %K facilitators %K scoping review %K mobile phone %D 2022 %7 1.6.2022 %9 Review %J J Med Internet Res %G English %X Background: The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. Objective: The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. Methods: A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. Results: A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. Conclusions: This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review’s findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions. %M 35648457 %R 10.2196/34479 %U https://www.jmir.org/2022/6/e34479 %U https://doi.org/10.2196/34479 %U http://www.ncbi.nlm.nih.gov/pubmed/35648457 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35380 %T Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review %A Silva,Cícera Renata Diniz Vieira %A Lopes,Rayssa Horácio %A de Goes Bay Jr,Osvaldo %A Martiniano,Claudia Santos %A Fuentealba-Torres,Miguel %A Arcêncio,Ricardo Alexandre %A Lapão,Luís Velez %A Dias,Sonia %A Uchoa,Severina Alice da Costa %+ Faculty of Health Sciences, Federal University of Rio Grande do Norte, 601 General Gustavo Cordeiro de Faria Street, Natal, 59012-570, Brazil, 55 84 3221 0862, renatadiniz_enf@yahoo.com.br %K digital health %K telehealth %K telemedicine %K primary health care %K quality of care %K COVID-19 %K pandemic %K science database %K gray literature %D 2022 %7 31.5.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service. %M 35319466 %R 10.2196/35380 %U https://humanfactors.jmir.org/2022/2/e35380 %U https://doi.org/10.2196/35380 %U http://www.ncbi.nlm.nih.gov/pubmed/35319466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33742 %T Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals %A Zhu,Xiao %A Tao,Youyou %A Zhu,Ruilin %A Wu,Dezhi %A Ming,Wai-kit %+ Management Science Department, Lancaster University Management School, Lancaster University, Bailrigg, Lancaster, LA1 4YX, United Kingdom, 44 1524592938, ruilin.zhu@lancaster.ac.uk %K radio frequency identification %K bar coding %K tracking technology adoption %K smart hospital %K hospital affiliation %K governance structure %K location %K clinical use %K supply chain use %D 2022 %7 26.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. Objective: This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. Methods: This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. Results: From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system—1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). Conclusions: As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures. %M 35617002 %R 10.2196/33742 %U https://www.jmir.org/2022/5/e33742 %U https://doi.org/10.2196/33742 %U http://www.ncbi.nlm.nih.gov/pubmed/35617002 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34026 %T Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study %A Wetzel,Anna-Jasmin %A Koch,Roland %A Preiser,Christine %A Müller,Regina %A Klemmt,Malte %A Ranisch,Robert %A Ehni,Hans-Jörg %A Wiesing,Urban %A Rieger,Monika A %A Henking,Tanja %A Joos,Stefanie %+ Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr. 5, Tübingen, 72076, Germany, 49 7071 29 85226, jasmin.wetzel@med.uni-tuebingen.de %K symptom checker apps %K self-diagnosis, self-triage, digitalization in primary care, general practitioners %K symptom checker %K app %K mobile app %K primary care %D 2022 %7 16.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. Objective: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. Methods: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. Results: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. Conclusions: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67 International Registered Report Identifier (IRRID): DERR1-10.2196/34026 %M 35576570 %R 10.2196/34026 %U https://www.researchprotocols.org/2022/5/e34026 %U https://doi.org/10.2196/34026 %U http://www.ncbi.nlm.nih.gov/pubmed/35576570 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33505 %T Health Care Professionals’ Experiences of Web-Based Symptom Checkers for Triage: Cross-sectional Survey Study %A Kujala,Sari %A Hörhammer,Iiris %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo, FI-00076, Finland, 358 503862768, sari.kujala@aalto.fi %K adoption %K symptom checker %K triage %K health care professional %K survey %K online health %K digital health %K health organizations %K health care %D 2022 %7 5.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based symptom checkers are promising tools that provide help to patients seeking guidance on health problems. Many health organizations have started using them to enhance triage. Patients use the symptom checker to report their symptoms online and submit the report to the health care center through the system. Health care professionals (registered nurse, practical nurse, general physician, physiotherapist, etc) receive patient inquiries with urgency rating, decide on actions to be taken, and communicate these to the patients. The success of the adoption, however, depends on whether the tools can efficiently support health care professionals’ workflow and achieve their support. Objective: This study explores the factors influencing health care professionals’ support for a web-based symptom checker for triage. Methods: Data were collected through a web-based survey of 639 health care professionals using either of the two most used web-based symptom checkers in the Finnish public primary care. Linear regression models were fitted to study the associations between the study variables and health care professionals’ support for the symptom checkers. In addition, the health care professionals’ comments collected via survey were qualitatively analyzed to elicit additional insights about the benefits and challenges of the clinical use of symptom checkers. Results: Results show that the perceived beneficial influence of the symptom checkers on health care professionals’ work and the perceived usability of the tools were positively associated with professionals’ support. The perceived benefits to patients and organizational support for use were positively associated, and threat to professionals’ autonomy was negatively associated with health care professionals’ support. These associations were, however, not independent of other factors included in the models. The influences on professionals’ work were both positive and negative; the tools streamlined work by providing preliminary information on patients and reduced the number of phone calls, but they also created extra work as the professionals needed to call patients and ask clarifying questions. Managing time between the use of symptom checkers and other tasks was also challenging. Meanwhile, according to health care professionals’ experience, the symptom checkers benefited patients as they received help quickly with a lower threshold for care. Conclusions: The efficient use of symptom checkers for triage requires usable solutions that support health care professionals’ work. High-quality information about the patients’ conditions and an efficient way of communicating with patients are needed. Using a new eHealth tool also requires that health organizations and teams reorganize their workflows and work distributions to support clinical processes. %M 35511254 %R 10.2196/33505 %U https://www.jmir.org/2022/5/e33505 %U https://doi.org/10.2196/33505 %U http://www.ncbi.nlm.nih.gov/pubmed/35511254 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34628 %T Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity %A Wolff,Jennifer L %A Dukhanin,Vadim %A Burgdorf,Julia G %A DesRoches,Catherine M %+ Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Room 692, 624 North Broadway, Baltimore, MD, 21205-1996, United States, 1 410 502 0458, jwolff2@jhu.edu %K patient portal %K electronic health record %K care partners %K proxy %K health equity %K health informatics %K health services %K elderly %K older adults %K aging %K cognition %K health system %K care delivery %K elderly care %D 2022 %7 4.5.2022 %9 Viewpoint %J JMIR Aging %G English %X Growing reliance on the patient portal as a mainstream modality in health system interactions necessitates prioritizing digital health equity through systems-level strategies that acknowledge and support all persons. Older adults with physical, cognitive, sensory, and socioeconomic vulnerabilities often rely on the involvement of family and friends in managing their health, but the role of these care partners in health information technology is largely undefined and poorly understood. This viewpoint article discusses challenges and opportunities of systematic engagement of care partners through shared access to the patient portal that have been amplified in the context of the COVID-19 outbreak and recent implementation of federal information blocking rules to promote information transparency alongside broader shifts toward care delivery innovation and population aging. We describe implementation considerations and the promise of granular, role-based privacy controls in addressing the nuanced and dynamic nature of individual information sharing preferences and fostering person- and family-centered care delivery. %M 35507405 %R 10.2196/34628 %U https://aging.jmir.org/2022/2/e34628 %U https://doi.org/10.2196/34628 %U http://www.ncbi.nlm.nih.gov/pubmed/35507405 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35094 %T Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help? %A Pit,Sabrina %A Ramsden,Robyn %A Tan,Aaron JH %A Payne,Kristy %A Barr,James %A Eames,Benjamin %A Edwards,Mike %A Colbran,Richard %+ New South Wales Rural Doctors Network, 1/53 Cleary Street, Hamilton, 2308, Australia, 61 429455720, sabrina.pit@sydney.edu.au %K health %K wellness %K mobile apps %K persuasive strategies %K behavior change %K review %K health workforce %K capability %K career %K employment %K rural %K workforce planning %K mHealth %K mobile health %K digital health %K health professional %K user experience %K health application %K task support %K social support %K dialog support %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health professionals’ perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals’ perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini’s Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific–based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals’ perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. %M 35499866 %R 10.2196/35094 %U https://humanfactors.jmir.org/2022/2/e35094 %U https://doi.org/10.2196/35094 %U http://www.ncbi.nlm.nih.gov/pubmed/35499866 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33706 %T Adoption of a Postoperative Pain Self-Report Tool: Qualitative Study %A Thiel,Bram %A Iao,Inez %A Smid,Joris %A de Wit,Emmy %A Koopman,Seppe %A Geerts,Bart %A Godfried,Marc %A Kalkman,Cor %+ Department of Anesthesiology, OLVG Hospital, Oosterpark 9, Amsterdam, 1091AC, Netherlands, 31 0205994773, b.thiel@olvg.nl %K innovation %K eHealth adoption model, mobile health %K pain %K self-report %K perioperative medicine %K postoperative pain %K surgery %D 2022 %7 26.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 35471472 %R 10.2196/33706 %U https://humanfactors.jmir.org/2022/2/e33706 %U https://doi.org/10.2196/33706 %U http://www.ncbi.nlm.nih.gov/pubmed/35471472 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e25688 %T Bugs in the Virtual Clinic: Confronting Telemedicine’s Challenges Through Empathy and Support %A Crotty,Bradley H %A Somai,Melek %+ Inception Labs, Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53122, United States, 1 4149558807, bcrotty@mcw.edu %K telemedicine %K virtual care %K patient experience %K consumer informatics %K telehealth %K access %K challenge %K electronic health record %K digital health %D 2022 %7 22.4.2022 %9 Viewpoint %J J Particip Med %G English %X Although telemedicine has been an important conduit for clinical care during the COVID-19 pandemic, not all patients have been able to meaningfully participate in this mode of health care provision. Challenges with accessing telemedicine using consumer technology can interfere with the ability of patients and clinicians to meaningfully connect and lead to significant investments in time by clinicians and their staff. In this narrative case, we identify issues related to patients’ use of technology, make comparisons between telehealth adoption and the deployment of electronic health records, and propose that building intuitive and supported digital care experiences for patients is required to make virtual care sustainable. %M 35452399 %R 10.2196/25688 %U https://jopm.jmir.org/2022/1/e25688 %U https://doi.org/10.2196/25688 %U http://www.ncbi.nlm.nih.gov/pubmed/35452399 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e30518 %T The Effectiveness of the Capacity Building and Mentorship Program in Improving Evidence-Based Decision-making in the Amhara Region, Northwest Ethiopia: Difference-in-Differences Study %A Chanyalew,Moges Asressie %A Yitayal,Mezgebu %A Atnafu,Asmamaw %A Mengiste,Shegaw Anagaw %A Tilahun,Binyam %+ Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 251 911617734, mogesabu@gmail.com %K capacity building %K mentorship %K mentoring %K mentor %K training %K data use %K information use %K facility head %K department head %K quasi-experiment %K difference-in-differences %K Ethiopia %K Amhara %K weak health information system %K HIS %K health information system %K CBMP %K DID %K decision-making %K Africa %K evidence based %K effectiveness %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Weak health information systems (HISs) hobble countries’ abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager. Objective: This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia. Methods: The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was calculated using the double population formula, and we recruited 172 participants from each group. We applied a difference-in-differences analysis approach to determine the effectiveness of the intervention. Heterogeneity of program effect among subgroups was assessed using a triple differences method (ie, difference-in-difference-in-differences [DIDID] method). Thus, the β coefficients, 95% CIs, and P values were calculated for each parameter, and we determined that the program was effective if the interaction term was significant at P<.05. Results: Data were collected using the endpoint survey from 155 out of 172 (90.1%) participants in the intervention group and 166 out of 172 (96.5%) participants in the comparison group. The average level of information use for the comparison group was 37.3% (95% CI 31.1%-43.6%) at baseline and 43.7% (95% CI 37.9%-49.5%) at study endpoint. The average level of information use for the intervention group was 52.2% (95% CI 46.2%-58.3%) at baseline and 75.8% (95% CI 71.6%-80.0%) at study endpoint. The study indicated that the net program change over time was 17% (95% CI 5%-28%; P=.003). The subgroup analysis also indicated that location showed significant program effect heterogeneity, with a DIDID estimate equal to 0.16 (95% CI 0.026-0.29; P=.02). However, sex, age, educational level, salary, and experience did not show significant heterogeneity in program effect, with DIDID estimates of 0.046 (95% CI –0.089 to 0.182), –0.002 (95% CI –0.015 to 0.009), –0.055 (95% CI –0.190 to 0.079), –1.63 (95% CI –5.22 to 1.95), and –0.006 (95% CI –0.017 to 0.005), respectively. Conclusions: The CBMP was effective at enhancing the capacity of study participants in using the routine HIS for decision-making. We noted that urban facilities had benefited more than their counterparts. The intervention has been shown to produce positive outcomes and should be scaled up to be used in other districts. Moreover, the mentorship modalities for rural facilities should be redesigned to maximize the benefits. Trial Registration: Pan African Clinical Trials Registry PACTR202001559723931; https://tinyurl.com/3j7e5ka5 %M 35451990 %R 10.2196/30518 %U https://medinform.jmir.org/2022/4/e30518 %U https://doi.org/10.2196/30518 %U http://www.ncbi.nlm.nih.gov/pubmed/35451990 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e37500 %T The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey %A Kainiemi,Emma %A Vehko,Tuulikki %A Kyytsönen,Maiju %A Hörhammer,Iiris %A Kujala,Sari %A Jormanainen,Vesa %A Heponiemi,Tarja %+ Finnish Institute for Health and Welfare, PO Box 30, Mannerheimintie 166, Helsinki, 00271, Finland, 358 295248292, emma.kainiemi@thl.fi %K patient portal %K digital technology %K eHealth %K nonuse %K dissatisfaction %K COVID-19 %K digital health %K patient empowerment %K epidemiology %K population survey %K national survey %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public’s confidence in the protection of their confidential data. %M 35404831 %R 10.2196/37500 %U https://medinform.jmir.org/2022/4/e37500 %U https://doi.org/10.2196/37500 %U http://www.ncbi.nlm.nih.gov/pubmed/35404831 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e34954 %T Cluster Analysis of Primary Care Physician Phenotypes for Electronic Health Record Use: Retrospective Cohort Study %A Fong,Allan %A Iscoe,Mark %A Sinsky,Christine A %A Haimovich,Adrian D %A Williams,Brian %A O'Connell,Ryan T %A Goldstein,Richard %A Melnick,Edward %+ National Center for Human Factors in Healthcare, MedStar Health, 3007 Tilden St NW, Washington, DC, 20008, United States, 1 2022449807, allan.fong@medstar.net %K electronic health record %K phenotypes %K cluster analysis %K unsupervised machine learning %K machine learning %K EHR %K primary care %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic health records (EHRs) have become ubiquitous in US office-based physician practices. However, the different ways in which users engage with EHRs remain poorly characterized. Objective: The aim of this study is to explore EHR use phenotypes among ambulatory care physicians. Methods: In this retrospective cohort analysis, we applied affinity propagation, an unsupervised clustering machine learning technique, to identify EHR user types among primary care physicians. Results: We identified 4 distinct phenotype clusters generalized across internal medicine, family medicine, and pediatrics specialties. Total EHR use varied for physicians in 2 clusters with above-average ratios of work outside of scheduled hours. This finding suggested that one cluster of physicians may have worked outside of scheduled hours out of necessity, whereas the other preferred ad hoc work hours. The two remaining clusters represented physicians with below-average EHR time and physicians who spend the largest proportion of their EHR time on documentation. Conclusions: These findings demonstrate the utility of cluster analysis for exploring EHR use phenotypes and may offer opportunities for interventions to improve interface design to better support users’ needs. %M 35275070 %R 10.2196/34954 %U https://medinform.jmir.org/2022/4/e34954 %U https://doi.org/10.2196/34954 %U http://www.ncbi.nlm.nih.gov/pubmed/35275070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e35130 %T Using the Technology Acceptance Model to Characterize Barriers and Opportunities of Telemedicine in Rural Populations: Survey and Interview Study %A Holtz,Bree %A Mitchell,Katharine %A Hirko,Kelly %A Ford,Sabrina %+ Department of Advertising and Public Relations, College of Communication Arts & Sciences, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K telehealth %K technology acceptance model %K pilot study %K rural %K Michigan %K health care access %K telemedicine %K phone interviews %K paper surveys %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care access issues have long plagued rural Americans. One approach to alleviating the challenges and poor health outcomes for rural individuals is through the use of telemedicine, sometimes called telehealth. It is important to understand factors that may be related to telemedicine adoption or nonadoption, particularly in underserved rural settings. Objective: This pilot study examines telemedicine perceptions among rural, underserved populations using the Technology Acceptance Model, which serves as a framework to explore the adoption of telemedicine services by those who have used it. This study also explores the differences between user and nonuser perceptions of telemedicine. Methods: Paper surveys and phone interviews were conducted in rural Northern Lower Michigan. Results: Perceived usefulness and perceived ease of use explained 91% of the variability in attitude toward telemedicine (R2=0.91; F1,15=73.406; P<.001). Ease of use was a significant predictor (mean 2.36, SD 1.20; P<.001), but usefulness (mean 3.16, SD 0.81; P=.20) was not. Furthermore, there were significant differences in individual perception of telemedicine between users and nonusers. For example, nonusers believed they would receive better care in person (users: mean 3.30, SD 1.22; nonusers: mean 1.91, SD 1.14; F1,32=10.126; P=.003). The quantitative findings were reinforced by the qualitative results from the phone interviews. Conclusions: Overall, the Technology Acceptance Model is an appropriate model to understand the attitudes toward telemedicine that may lead to its adoption by rural Americans. %M 35436207 %R 10.2196/35130 %U https://formative.jmir.org/2022/4/e35130 %U https://doi.org/10.2196/35130 %U http://www.ncbi.nlm.nih.gov/pubmed/35436207 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e34973 %T Readiness to Embrace Artificial Intelligence Among Medical Doctors and Students: Questionnaire-Based Study %A Boillat,Thomas %A Nawaz,Faisal A %A Rivas,Homero %+ Design Lab, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Healthcare City 14, Dubai, United Arab Emirates, 971 43838759, Thomas.boillat@mbru.ac.ae %K artificial intelligence in medicine %K health care %K questionnaire %K medical doctors %K medical students %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Similar to understanding how blood pressure is measured by a sphygmomanometer, physicians will soon have to understand how an artificial intelligence–based application has come to the conclusion that a patient has hypertension, diabetes, or cancer. Although there are an increasing number of use cases where artificial intelligence is or can be applied to improve medical outcomes, the extent to which medical doctors and students are ready to work and leverage this paradigm is unclear. Objective: This research aims to capture medical students’ and doctors’ level of familiarity toward artificial intelligence in medicine as well as their challenges, barriers, and potential risks linked to the democratization of this new paradigm. Methods: A web-based questionnaire comprising five dimensions—demographics, concepts and definitions, training and education, implementation, and risks—was systematically designed from a literature search. It was completed by 207 participants in total, of which 105 (50.7%) medical doctors and 102 (49.3%) medical students trained in all continents, with most of them in Europe, the Middle East, Asia, and North America. Results: The results revealed no significant difference in the familiarity of artificial intelligence between medical doctors and students (P=.91), except that medical students perceived artificial intelligence in medicine to lead to higher risks for patients and the field of medicine in general (P<.001). We also identified a rather low level of familiarity with artificial intelligence (medical students=2.11/5; medical doctors=2.06/5) as well as a low attendance to education or training. Only 2.9% (3/105) of medical doctors attended a course on artificial intelligence within the previous year, compared with 9.8% (10/102) of medical students. The complexity of the field of medicine was considered one of the biggest challenges (medical doctors=3.5/5; medical students=3.8/5), whereas the reduction of physicians’ skills was the most important risk (medical doctors=3.3; medical students=3.6; P=.03). Conclusions: The question is not whether artificial intelligence will be used in medicine, but when it will become a standard practice for optimizing health care. The low level of familiarity with artificial intelligence identified in this study calls for the implementation of specific education and training in medical schools and hospitals to ensure that medical professionals can leverage this new paradigm and improve health outcomes. %M 35412463 %R 10.2196/34973 %U https://mededu.jmir.org/2022/2/e34973 %U https://doi.org/10.2196/34973 %U http://www.ncbi.nlm.nih.gov/pubmed/35412463 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e29813 %T The Effect of an Additional Structured Methods Presentation on Decision-Makers’ Reading Time and Opinions on the Helpfulness of the Methods in a Quantitative Report: Nonrandomized Trial %A Koetsenruijter,Jan %A Wronski,Pamela %A Ghosh,Sucheta %A Müller,Wolfgang %A Wensing,Michel %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 4743, jankoetsenruyter@hotmail.com %K decision-making %K health care reports %K reading behavior %K research methods %K eye-tracking %K perceived importance %K electronic health records %K feasibility %K quantitative methods %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although decision-makers in health care settings need to read and understand the validity of quantitative reports, they do not always carefully read information on research methods. Presenting the methods in a more structured way could improve the time spent reading the methods and increase the perceived relevance of this important report section. Objective: To test the effect of a structured summary of the methods used in a quantitative data report on reading behavior with eye-tracking and measure the effect on the perceived importance of this section. Methods: A nonrandomized pilot trial was performed in a computer laboratory setting with advanced medical students. All participants were asked to read a quantitative data report; an intervention arm was also shown a textbox summarizing key features of the methods used in the report. Three data-collection methods were used to document reading behavior and the views of participants: eye-tracking (during reading), a written questionnaire, and a face-to-face interview. Results: We included 35 participants, 22 in the control arm and 13 in the intervention arm. The overall time spent reading the methods did not differ between the 2 arms. The intervention arm considered the information in the methods section to be less helpful for decision-making than did the control arm (scores for perceived helpfulness were 4.1 and 2.9, respectively, range 1-10). Participants who read the box more intensively tended to spend more time on the methods as a whole (Pearson correlation 0.81, P=.001). Conclusions: Adding a structured summary of information on research methods attracted attention from most participants, but did not increase the time spent on reading the methods or lead to increased perceptions that the methods section was helpful for decision-making. Participants made use of the summary to quickly judge the methods, but this did not increase the perceived relevance of this section. %M 35412464 %R 10.2196/29813 %U https://medinform.jmir.org/2022/4/e29813 %U https://doi.org/10.2196/29813 %U http://www.ncbi.nlm.nih.gov/pubmed/35412464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e35418 %T A Sense of Coherence Approach to Improving Patient Experience Using Information Infrastructure Modeling: Design Science Research %A Williams,Patricia A H %A Lovelock,Brendan %A Cabarrus,Javier Antonio %+ Flinders-Cisco Digital Health Design Lab, Flinders Digital Health Research Centre, College of Science and Engineering, Flinders University, Tonsley Campus, GPO Box 2100, Adelaide, 5001, Australia, 61 882012023, trish.williams@flinders.edu.au %K medical informatics %K information infrastructure %K digital hospitals %K patient experience %K implementation %K eHealth %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care provider organizations are complex and dynamic environments. Consequently, how the physical and social environment of such organizations interact with an individual is a primary driver of an individual’s experience. Increasingly, the capabilities required for them to successfully interact with those within their care are critically dependent on the information infrastructure they have in place, which enables people, both patients and staff, to work optimally together to deliver their clinical and operational objectives. Objective: This study aims to design a framework to address the challenge of how to assemble information systems in health care to support an improved sense of coherence for patients, as well as potentially innovate patients’ experiences, by connecting and orchestrating the synergy among people, processes, and systems. Methods: It is necessary to understand the needs of health care providers and patients to address this challenge at a level relevant to information process design and technology development. This paper describes the design science research method used to combine the sense of coherence, which is a core concept within the Antonosky salutogenic approach to health and well-being, with an established information infrastructure maturity framework, demonstrating the coalescence of 2 distinct conceptual perspectives on care delivery. This paper provides an approach to defining a positive and supportive health care experience and linking this to the capabilities of an information- and technology-enabled environment. Results: This research delivers a methodology for describing the patient experience in a form relevant to information infrastructure design, articulating a pathway from information infrastructure to patient experience. It proposes that patient experience can be viewed pragmatically in terms of the established sense of coherence concept, with its ability to identify and guide resources to modulate a patient’s environmental stressors. This research establishes a framework for determining and optimizing the capability of a facility’s information infrastructure to support the sense of coherence defined by the experiences of its patients. Conclusions: This groundbreaking research provides a framework for health care provider organizations to understand and assess the ability of their information infrastructure to support and improve the patient experience. The tool assists providers in defining their technology-dependent operational goals around patient experience and, consequently, in identifying the information capabilities needed to support these goals. The results demonstrate how a fundamental shift in thinking about the use of information infrastructure can transform the patient experience. This study details an approach to describing information infrastructure within an experience-oriented framework that enables the impact of technology on experience to be designed explicitly. The contribution to knowledge is a new perspective on modeling how information infrastructure can contribute to supportive health-promoting environments. Furthermore, it may significantly affect the design and deployment of future digital infrastructures in health care. %M 35307641 %R 10.2196/35418 %U https://formative.jmir.org/2022/4/e35418 %U https://doi.org/10.2196/35418 %U http://www.ncbi.nlm.nih.gov/pubmed/35307641 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e29385 %T Automating Large-scale Health Care Service Feedback Analysis: Sentiment Analysis and Topic Modeling Study %A Alexander,George %A Bahja,Mohammed %A Butt,Gibran Farook %+ The School of Computer Science, University of Birmingham, The School of Computer Science, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0121 414 3344, gxa548@alumni.bham.ac.uk %K natural language processing %K topic modeling %K National Health Service %K latent Dirichlet allocation %K reviews %K patient feedback %K automated solutions %K large-scale health service %K free-text %K unstructured data %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Obtaining patient feedback is an essential mechanism for health care service providers to assess their quality and effectiveness. Unlike assessments of clinical outcomes, feedback from patients offers insights into their lived experiences. The Department of Health and Social Care in England via National Health Service Digital operates a patient feedback web service through which patients can leave feedback of their experiences in structured and free-text report forms. Free-text feedback, compared with structured questionnaires, may be less biased by the feedback collector and, thus, more representative; however, it is harder to analyze in large quantities and challenging to derive meaningful, quantitative outcomes. Objective: The aim of this study is to build a novel data analysis and interactive visualization pipeline accessible through an interactive web application to facilitate the interrogation of and provide unique insights into National Health Service patient feedback. Methods: This study details the development of a text analysis tool that uses contemporary natural language processing and machine learning models to analyze free-text clinical service reviews to develop a robust classification model and interactive visualization web application. The methodology is based on the design science research paradigm and was conducted in three iterations: a sentiment analysis of the patient feedback corpus in the first iteration, topic modeling (unigram and bigram)–based analysis for topic identification in the second iteration, and nested topic modeling in the third iteration that combines sentiment analysis and topic modeling methods. An interactive data visualization web application for use by the general public was then created, presenting the data on a geographic representation of the country, making it easily accessible. Results: Of the 11,103 possible clinical services that could be reviewed across England, 2030 (18.28%) different services received a combined total of 51,845 reviews between October 1, 2017, and September 30, 2019. Dominant topics were identified for the entire corpus followed by negative- and positive-sentiment topics in turn. Reviews containing high- and low-sentiment topics occurred more frequently than reviews containing less polarized topics. Time-series analysis identified trends in topic and sentiment occurrence frequency across the study period. Conclusions: Using contemporary natural language processing techniques, unstructured text data were effectively characterized for further analysis and visualization. An efficient pipeline was successfully combined with a web application, making automated analysis and dissemination of large volumes of information accessible. This study represents a significant step in efforts to generate and visualize useful, actionable, and unique information from free-text patient reviews. %M 35404254 %R 10.2196/29385 %U https://medinform.jmir.org/2022/4/e29385 %U https://doi.org/10.2196/29385 %U http://www.ncbi.nlm.nih.gov/pubmed/35404254 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e22866 %T Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study %A Mosch,Lina Katharina %A Poncette,Akira-Sebastian %A Spies,Claudia %A Weber-Carstens,Steffen %A Schieler,Monique %A Krampe,Henning %A Balzer,Felix %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450651 ext 767, lina.mosch@charite.de %K digital health %K patient monitoring %K intensive care medicine %K intensive care unit %K technological innovation %K user-centered %K usability %K implementation %K implementation science %K qualitative research %K interview %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective: This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods: This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results: This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions: Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 %M 35394445 %R 10.2196/22866 %U https://formative.jmir.org/2022/4/e22866 %U https://doi.org/10.2196/22866 %U http://www.ncbi.nlm.nih.gov/pubmed/35394445 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e27924 %T Chinese Americans’ Use of Patient Portal Systems: Scoping Review %A Lawrence,Katharine %A Chong,Stella %A Krelle,Holly %A Roberts,Timothy %A Thorpe,Lorna %A Trinh-Shevrin,Chau %A Yi,Stella %A Kwon,Simona %+ Healthcare Innovation Bridging Research, Informatics, and Design (HiBRID) Lab, Department of Population Health, New York University Grossman School of Medicine, 227 E 30th St, 6th Floor, New York, NY, 10016, United States, 1 6465013488, katharine.lawrence@nyulangone.org %K patient portal %K electronic health records %K personal health records %K ehealth %K health equity %K digital divide %K Chinese Americans %K Asian Americans %D 2022 %7 1.4.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. Objective: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. Methods: The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. Results: In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record–based data over qualitative or other methodologies; and a pattern of aggregating Chinese American–related data into a larger Asian or Asian American designation. Conclusions: There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools. %M 35363153 %R 10.2196/27924 %U https://humanfactors.jmir.org/2022/2/e27924 %U https://doi.org/10.2196/27924 %U http://www.ncbi.nlm.nih.gov/pubmed/35363153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32994 %T Synthesizing Dimensions of Digital Maturity in Hospitals: Systematic Review %A Duncan,Rhona %A Eden,Rebekah %A Woods,Leanna %A Wong,Ides %A Sullivan,Clair %+ School of Information Systems, Queensland University of Technology, 2 George Street, Brisbane, 4000, Australia, 61 434237975, rg.eden@qut.edu.au %K digital maturity %K digital capability %K eHealth %K digital hospitals %K capability model %K maturity model %K literature review %K electronic medical records %D 2022 %7 30.3.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35353050 %R 10.2196/32994 %U https://www.jmir.org/2022/3/e32994 %U https://doi.org/10.2196/32994 %U http://www.ncbi.nlm.nih.gov/pubmed/35353050 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34090 %T Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study %A Liang,Su-Ying %A Stults,Cheryl D %A Jones,Veena G %A Huang,Qiwen %A Sutton,Jeremy %A Tennyson,Guy %A Chan,Albert S %+ Sutter Health Center for Health Systems Research, 795 El Camino Real, Ames Building, Palo Alto, CA, , United States, 1 650 691 6432, liangs2@sutterhealth.org %K access to care %K behavioral economics %K online %K web-based appointment scheduling %K health service %K behavior %K health care %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 35353051 %R 10.2196/34090 %U https://humanfactors.jmir.org/2022/1/e34090 %U https://doi.org/10.2196/34090 %U http://www.ncbi.nlm.nih.gov/pubmed/35353051 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33128 %T Telehealth Business Models and Their Components: Systematic Review %A Velayati,Farnia %A Ayatollahi,Haleh %A Hemmat,Morteza %A Dehghan,Reza %+ Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, No. 4 Rashid Yasemi St, Vali-Asr St, Tehran, 1996713883, Iran, 98 21 88794302, ayatollahi.h@iums.ac.ir %K telehealth %K telemedicine %K mobile health %K business model %K value %K commerce %K revenue %K market %K systematic review %K health care %D 2022 %7 29.3.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35348471 %R 10.2196/33128 %U https://www.jmir.org/2022/3/e33128 %U https://doi.org/10.2196/33128 %U http://www.ncbi.nlm.nih.gov/pubmed/35348471 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e35216 %T Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study %A Cimini,Christiane Correa Rodrigues %A Maia,Junia Xavier %A Pires,Magda Carvalho %A Ribeiro,Leonardo Bonisson %A Pinto,Vânia Soares de Oliveira e Almeida %A Batchelor,James %A Ribeiro,Antonio Luiz Pinho %A Marcolino,Milena Soriano %+ Medical School and Telehealth Center, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua do Cruzeiro, 01, Bairro Jardim São Paulo, Teófilo Otoni-MG, 38803-371, Brazil, 55 33988900906, christiane.cimini@gmail.com %K hypertension %K diabetes mellitus %K COVID-19 %K pandemic %K primary health care %K telemedicine %K clinical decision support systems %K patient care management %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions. Objective: This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home. Methods: This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software. Results: Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment. Conclusions: The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines. %M 35191842 %R 10.2196/35216 %U https://medinform.jmir.org/2022/3/e35216 %U https://doi.org/10.2196/35216 %U http://www.ncbi.nlm.nih.gov/pubmed/35191842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34144 %T Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review %A Yao,Rui %A Zhang,Wenli %A Evans,Richard %A Cao,Guang %A Rui,Tianqi %A Shen,Lining %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No 13 Hangkong Road, Wuhan, 430030, China, 86 (027)83692730, sln2008@hust.edu.cn %K health inequities %K digital health technologies %K health care services %K socially disadvantaged groups %K scoping review %K mobile phone %D 2022 %7 21.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective: This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods: Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics’ Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results: A total of 2325 studies were collected during the search process, of which 41 (1.76%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions: The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance. %M 35311682 %R 10.2196/34144 %U https://www.jmir.org/2022/3/e34144 %U https://doi.org/10.2196/34144 %U http://www.ncbi.nlm.nih.gov/pubmed/35311682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33046 %T Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review %A Blijleven,Vincent %A Hoxha,Florian %A Jaspers,Monique %+ Center for Marketing & Supply Chain Management, Nyenrode Business Universiteit, Straatweg 25, Breukelen, 3621 BG, Netherlands, 31 630023248, vincentblijleven@gmail.com %K electronic health records %K electronic medical records %K framework %K patient safety %K unintended consequences %K usability %K workarounds %K workflow %D 2022 %7 15.3.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35289752 %R 10.2196/33046 %U https://www.jmir.org/2022/3/e33046 %U https://doi.org/10.2196/33046 %U http://www.ncbi.nlm.nih.gov/pubmed/35289752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32722 %T Acceptance of the District Health Information System Version 2 Platform for Malaria Case-Based Surveillance By Health Care Workers in Botswana: Web-Based Survey %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Keetile,Mpho %A Kadimo,Khutsafalo %A Senyatso,Refilwe Yvonne %A Ntebela,Davies %A Valela,Buthugwashe %A Murambi,Clement %+ Department of Computer Science, Faculty of Science, University of Botswana, Private Bag UB 0022, Plot 4775 Notwane Rd, Gaborone, 00267, Botswana, 267 3555700 ext 5700, ndlovuk@ub.ac.bw %K malaria case-based surveillance %K district health information system %K eHealth %K technology acceptance model %K Botswana %K DHIS2 %K malaria %K surveillance %K public health %K technology adoption %K user acceptance %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform. Objective: We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful. Methods: The study’s design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020. Results: Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants’ survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform. Conclusions: Participants’ responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana. %M 35289760 %R 10.2196/32722 %U https://formative.jmir.org/2022/3/e32722 %U https://doi.org/10.2196/32722 %U http://www.ncbi.nlm.nih.gov/pubmed/35289760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33531 %T Improving the Development and Implementation of Audit and Feedback Systems to Support Health Care Workers in Limiting Antimicrobial Resistance in the Hospital: Scoping Review %A Keizer,Julia %A Bente,Britt E %A Al Naiemi,Nashwan %A Van Gemert-Pijnen,Lisette JEWC %A Beerlage-De Jong,Nienke %+ Centre for eHealth and Wellbeing Research, Section of Psychology, Health and Technology, University of Twente, PO Box 217, Enschede, 7500 AE, Netherlands, 31 53 489 1289, j.keizer@utwente.nl %K scoping review %K audit and feedback %K eHealth %K development %K implementation %K antimicrobial resistance %K antibiotic stewardship %K infection control %D 2022 %7 11.3.2022 %9 Review %J J Med Internet Res %G English %X Background: For eHealth technologies in general and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential, as it increases the likelihood of achieving desired outcomes by ensuring a fit among eHealth technology, stakeholders, and their context. In addition, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies but is often not elaborated on in publications. Objective: This scoping review aims to provide insights into the development and implementation strategies for AF systems for a real-world problem that threatens modern health care—antimicrobial resistance—and provide an interdisciplinary conceptual framework that can serve as a checklist and guidance for making informed choices in the development and implementation of future AF systems. Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, IEEE Xplore Digital Library, and Embase (≥2010) for studies describing either the development or implementation process, or both, of an AF system for antimicrobial resistance or infections in hospitals. Studies reporting only on effectiveness or impact were excluded. A total of 3 independent reviewers performed the study selection, and 2 reviewers constructed the conceptual framework through the axial and selective coding of often-used theories, models, and frameworks (TMFs) from the literature on AF and eHealth development and implementation. Subsequently, the conceptual framework was used for the systematic extraction and interpretation of the studies’ descriptions of AF systems and their development and implementation. Results: The search resulted in 2125 studies that were screened for eligibility, of which 12 (0.56%); 2012-2020) were included. These studies described the development and implementation processes heterogeneously in terms of study aims, study targets, target groups, methods, and theoretical underpinnings. Few studies have explicitly explained how choices for the development and implementation of AF systems were substantiated by the TMFs. The conceptual framework provided insights into what is reported on the development and implementation process and revealed underreported AF system constructs (eg, AF system design; engagement with the AF system; and comparison, goal setting, and action planning) and development and implementation (eg, champions) constructs. Conclusions: This scoping review showed the current heterogeneous reporting of AF systems and their development and implementation processes and exemplified how interdisciplinary TMFs can (and should) be balanced in a conceptual framework to capture relevant AF systems and development and implementation constructs. Thereby, it provides a concrete checklist and overall guidance that supports the professionalization and harmonization of AF system development and implementation. For the development and implementation of future AF systems and other eHealth technologies, researchers and health care workers should be supported in selecting and integrating TMFs into their development and implementation process and encouraged to explicitly report on theoretical underpinnings and the substantiation of choices. %M 35275082 %R 10.2196/33531 %U https://www.jmir.org/2022/3/e33531 %U https://doi.org/10.2196/33531 %U http://www.ncbi.nlm.nih.gov/pubmed/35275082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e24582 %T Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers %A Schlieter,Hannes %A Marsch,Lisa A %A Whitehouse,Diane %A Otto,Lena %A Londral,Ana Rita %A Teepe,Gisbert Wilhelm %A Benedict,Martin %A Ollier,Joseph %A Ulmer,Tom %A Gasser,Nathalie %A Ultsch,Sabine %A Wollschlaeger,Bastian %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 632 94 8, tobias.kowatsch@unisg.ch %K digital health %K health care delivery %K health interventions %K digital health services %K enablers %K barriers %D 2022 %7 11.3.2022 %9 Viewpoint %J J Med Internet Res %G English %X Health care delivery is undergoing a rapid change from traditional processes toward the use of digital health interventions and personalized medicine. This movement has been accelerated by the COVID-19 crisis as a response to the need to guarantee access to health care services while reducing the risk of contagion. Digital health scale-up is now also vital to achieve population-wide impact: it will only accomplish sustainable effects if and when deployed into regular health care delivery services. The question of how sustainable digital health scale-up can be successfully achieved has, however, not yet been sufficiently resolved. This paper identifies and discusses enablers and barriers for scaling up digital health innovations. The results discussed in this paper were gathered by scientists and representatives of public bodies as well as patient organizations at an international workshop on scaling up digital health innovations. Results are explored in the context of prior research and implications for future work in achieving large-scale implementations that will benefit the population as a whole. %M 35275065 %R 10.2196/24582 %U https://www.jmir.org/2022/3/e24582 %U https://doi.org/10.2196/24582 %U http://www.ncbi.nlm.nih.gov/pubmed/35275065 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34918 %T Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study %A Schretzlmaier,Patrik %A Hecker,Achim %A Ammenwerth,Elske %+ Institute of Medical Informatics, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tirol, 6060, Austria, 49 17657875980, patrik.schretzlmaier@edu.umit-tirol.at %K mHealth %K mobile health %K mobile apps %K diabetes mellitus %K technology acceptance %K UTAUT2 %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective: This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods: In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results: This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions: This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context. %M 35262493 %R 10.2196/34918 %U https://humanfactors.jmir.org/2022/1/e34918 %U https://doi.org/10.2196/34918 %U http://www.ncbi.nlm.nih.gov/pubmed/35262493 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34920 %T Toward Successful Implementation of Artificial Intelligence in Health Care Practice: Protocol for a Research Program %A Svedberg,Petra %A Reed,Julie %A Nilsen,Per %A Barlow,James %A Macrae,Carl %A Nygren,Jens %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K process evaluation %K complex intervention %K implementation %K knowledge exchange %K health policy %K organizational change %K capacity building %K qualitative methods %K framework analysis %D 2022 %7 9.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 35262500 %R 10.2196/34920 %U https://www.researchprotocols.org/2022/3/e34920 %U https://doi.org/10.2196/34920 %U http://www.ncbi.nlm.nih.gov/pubmed/35262500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32800 %T Tackling the Burden of Electronic Health Record Use Among Physicians in a Mental Health Setting: Physician Engagement Strategy %A Tajirian,Tania %A Jankowicz,Damian %A Lo,Brian %A Sequeira,Lydia %A Strudwick,Gillian %A Almilaji,Khaled %A Stergiopoulos,Vicky %+ Information Management Group, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 30515, Tania.Tajirian@camh.ca %K burnout %K organizational strategy %K electronic health record use %K clinical informatics %K medical informatics %D 2022 %7 8.3.2022 %9 Viewpoint %J J Med Internet Res %G English %X The burden associated with using the electronic health record system continues to be a critical issue for physicians and is potentially contributing to physician burnout. At a large academic mental health hospital in Canada, we recently implemented a Physician Engagement Strategy focused on reducing the burden of electronic health record use through close collaboration with clinical leadership, information technology leadership, and physicians. Built on extensive stakeholder consultation, this strategy highlights initiatives that we have implemented (or will be implementing in the near future) under four components: engage, inspire, change, and measure. In this viewpoint paper, we share our process of developing and implementing the Physician Engagement Strategy and discuss the lessons learned and implications of this work. %M 35258473 %R 10.2196/32800 %U https://www.jmir.org/2022/3/e32800 %U https://doi.org/10.2196/32800 %U http://www.ncbi.nlm.nih.gov/pubmed/35258473 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e27691 %T Primary Care: The Actual Intelligence Required for Artificial Intelligence to Advance Health Care and Improve Health %A Liaw,Winston R %A Westfall,John M %A Williamson,Tyler S %A Jabbarpour,Yalda %A Bazemore,Andrew %+ Department of Health Systems and Population Health Sciences, University of Houston, 4349 Martin Luther King Blvd, Houston, TX, 77204, United States, 1 7137439862, winstonrliaw@gmail.com %K artificial intelligence %K primary care %D 2022 %7 8.3.2022 %9 Viewpoint %J JMIR Med Inform %G English %X With conversational agents triaging symptoms, cameras aiding diagnoses, and remote sensors monitoring vital signs, the use of artificial intelligence (AI) outside of hospitals has the potential to improve health, according to a recently released report from the National Academy of Medicine. Despite this promise, the success of AI is not guaranteed, and stakeholders need to be involved with its development to ensure that the resulting tools can be easily used by clinicians, protect patient privacy, and enhance the value of the care delivered. A crucial stakeholder group missing from the conversation is primary care. As the nation’s largest delivery platform, primary care will have a powerful impact on whether AI is adopted and subsequently exacerbates health disparities. To leverage these benefits, primary care needs to serve as a medical home for AI, broaden its teams and training, and build on government initiatives and funding. %M 35258464 %R 10.2196/27691 %U https://medinform.jmir.org/2022/3/e27691 %U https://doi.org/10.2196/27691 %U http://www.ncbi.nlm.nih.gov/pubmed/35258464 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34452 %T Understanding Patients’ Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study %A Chen,Jinying %A Wijesundara,Jessica G %A Enyim,Gabrielle E %A Lombardini,Lisa M %A Gerber,Ben S %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, United States, 1 508 856 6063, jinying.chen@umassmed.edu %K coronary %K monitor %K elder %K health app %K symptom %K eHealth %K mobile health %K intention %K barrier %K facilitator %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients’ intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as “If this app were available to me, I would use it.” Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1%), 45 (45%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90% (90/100) White, 39% (39/100) women, and 88% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65%) agreed or strongly agreed that they would use the app, among which 53 (82%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75% among those aged 65-74 years and dropped to 44% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. %M 35254269 %R 10.2196/34452 %U https://humanfactors.jmir.org/2022/1/e34452 %U https://doi.org/10.2196/34452 %U http://www.ncbi.nlm.nih.gov/pubmed/35254269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e37419 %T 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” %A Stausberg,Jürgen %A Uslu,Aykut %+ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, 45122, Germany, 49 201 723 77201, stausberg@ekmed.de %K cost analysis %K costs and cost analyses %K economic advantage %K electronic medical records %K electronic records %K health care %K hospitals %K computerized medical records systems %K quality of health care %K secondary data %D 2022 %7 4.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35254272 %R 10.2196/37419 %U https://www.jmir.org/2022/3/e37419 %U https://doi.org/10.2196/37419 %U http://www.ncbi.nlm.nih.gov/pubmed/35254272 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e37208 %T 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” %A Shakibaei Bonakdeh,Erfan %+ Department of Management, Monash Business School, Monash University, 900 Dandenong Rd, Caulfield East, Melbourne, VIC, 3145, Australia, 61 1399032000, erfan.shakibaeibonakdeh@monash.edu %K cost analysis %K costs and cost analyses %K economic advantage %K electronic medical records %K electronic records %K health care %K hospitals %K computerized medical records system %K quality of health care %K secondary data %D 2022 %7 4.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35254276 %R 10.2196/37208 %U https://www.jmir.org/2022/3/e37208 %U https://doi.org/10.2196/37208 %U http://www.ncbi.nlm.nih.gov/pubmed/35254276 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34894 %T Dashboards in Health Care Settings: Protocol for a Scoping Review %A Helminski,Danielle %A Kurlander,Jacob E %A Renji,Anjana Deep %A Sussman,Jeremy B %A Pfeiffer,Paul N %A Conte,Marisa L %A Gadabu,Oliver J %A Kokaly,Alex N %A Goldberg,Rebecca %A Ranusch,Allison %A Damschroder,Laura J %A Landis-Lewis,Zach %+ Department of Internal Medicine, University of Michigan, NCRC Building 14, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 7346153952, dhelmins@umich.edu %K dashboard %K mHealth %K medical informatics %K quality improvement %K scoping review %K health care %K Cochrane library %K Cochrane %K stakeholder %K health care sector %K digital health %K design %K end user %K development %K implementation %K evaluation %K user need %D 2022 %7 2.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care organizations increasingly depend on business intelligence tools, including “dashboards,” to capture, analyze, and present data on performance metrics. Ideally, dashboards allow users to quickly visualize actionable data to inform and optimize clinical and organizational performance. In reality, dashboards are typically embedded in complex health care organizations with massive data streams and end users with distinct needs. Thus, designing effective dashboards is a challenging task and theoretical underpinnings of health care dashboards are poorly characterized; even the concept of the dashboard remains ill-defined. Researchers, informaticists, clinical managers, and health care administrators will benefit from a clearer understanding of how dashboards have been developed, implemented, and evaluated, and how the design, end user, and context influence their uptake and effectiveness. Objective: This scoping review first aims to survey the vast published literature of “dashboards” to describe where, why, and for whom they are used in health care settings, as well as how they are developed, implemented, and evaluated. Further, we will examine how dashboard design and content is informed by intended purpose and end users. Methods: In July 2020, we searched MEDLINE, Embase, Web of Science, and the Cochrane Library for peer-reviewed literature using a targeted strategy developed with a research librarian and retrieved 5188 results. Following deduplication, 3306 studies were screened in duplicate for title and abstract. Any abstracts mentioning a health care dashboard were retrieved in full text and are undergoing duplicate review for eligibility. Articles will be included for data extraction and analysis if they describe the development, implementation, or evaluation of a dashboard that was successfully used in routine workflow. Articles will be excluded if they were published before 2015, the full text is unavailable, they are in a non-English language, or they describe dashboards used for public health tracking, in settings where direct patient care is not provided, or in undergraduate medical education. Any discrepancies in eligibility determination will be adjudicated by a third reviewer. We chose to focus on articles published after 2015 and those that describe dashboards that were successfully used in routine practice to identify the most recent and relevant literature to support future dashboard development in the rapidly evolving field of health care informatics. Results: All articles have undergone dual review for title and abstract, with a total of 2019 articles mentioning use of a health care dashboard retrieved in full text for further review. We are currently reviewing all full-text articles in duplicate. We aim to publish findings by mid-2022. Findings will be reported following guidance from the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Conclusions: This scoping review will provide stakeholders with an overview of existing dashboard tools, highlighting the ways in which dashboards have been developed, implemented, and evaluated in different settings and for different end user groups, and identify potential research gaps. Findings will guide efforts to design and use dashboards in the health care sector more effectively. International Registered Report Identifier (IRRID): DERR1-10.2196/34894 %M 35234650 %R 10.2196/34894 %U https://www.researchprotocols.org/2022/3/e34894 %U https://doi.org/10.2196/34894 %U http://www.ncbi.nlm.nih.gov/pubmed/35234650 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e33044 %T A Roadmap for Boosting Model Generalizability for Predicting Hospital Encounters for Asthma %A Luo,Gang %+ Department of Biomedical Informatics and Medical Education, University of Washington, UW Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K clinical decision support %K forecasting %K machine learning %K patient care management %K medical informatics %K asthma %K health care %K health care systems %K health care costs %K prediction models %K risk prediction %D 2022 %7 1.3.2022 %9 Viewpoint %J JMIR Med Inform %G English %X In the United States, ~9% of people have asthma. Each year, asthma incurs high health care cost and many hospital encounters covering 1.8 million emergency room visits and 439,000 hospitalizations. A small percentage of patients with asthma use most health care resources. To improve outcomes and cut resource use, many health care systems use predictive models to prospectively find high-risk patients and enroll them in care management for preventive care. For maximal benefit from costly care management with limited service capacity, only patients at the highest risk should be enrolled. However, prior models built by others miss >50% of true highest-risk patients and mislabel many low-risk patients as high risk, leading to suboptimal care and wasted resources. To address this issue, 3 site-specific models were recently built to predict hospital encounters for asthma, gaining up to >11% better performance. However, these models do not generalize well across sites and patient subgroups, creating 2 gaps before translating these models into clinical use. This paper points out these 2 gaps and outlines 2 corresponding solutions: (1) a new machine learning technique to create cross-site generalizable predictive models to accurately find high-risk patients and (2) a new machine learning technique to automatically raise model performance for poorly performing subgroups while maintaining model performance on other subgroups. This gives a roadmap for future research. %M 35230246 %R 10.2196/33044 %U https://medinform.jmir.org/2022/3/e33044 %U https://doi.org/10.2196/33044 %U http://www.ncbi.nlm.nih.gov/pubmed/35230246 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e32738 %T The Case for the Anesthesiologist-Informaticist %A Lee,Robert %A Hitt,James %A Hobika,Geoffrey G %A Nader,Nader D %+ Department of Anesthesiology, VA Western New York Healthcare System, 3495 Bailey Ave, Buffalo, NY, 14215, United States, 1 716 834 9200, rlee32@buffalo.edu %K anesthesia %K anesthesiology %K AIMS %K anesthesia information management systems %K clinical informatics %K anesthesia informatics %K perioperative informatics %K health information %K perioperative medicine %K health technology %D 2022 %7 28.2.2022 %9 Viewpoint %J JMIR Perioper Med %G English %X Health care has been transformed by computerization, and the use of electronic health record systems has become widespread. Anesthesia information management systems are commonly used in the operating room to maintain records of anesthetic care delivery. The perioperative environment and the practice of anesthesia generate a large volume of data that may be reused to support clinical decision-making, research, and process improvement. Anesthesiologists trained in clinical informatics, referred to as informaticists or informaticians, may help implement and optimize anesthesia information management systems. They may also participate in clinical research, management of information systems, and quality improvement in the operating room or throughout a health care system. Here, we describe the specialty of clinical informatics, how anesthesiologists may obtain training in clinical informatics, and the considerations particular to the subspecialty of anesthesia informatics. Management of perioperative information systems, implementation of computerized clinical decision support systems in the perioperative environment, the role of virtual visits and remote monitoring, perioperative informatics research, perioperative process improvement, leadership, and change management are described from the perspective of the anesthesiologist-informaticist. %M 35225822 %R 10.2196/32738 %U https://periop.jmir.org/2022/1/e32738 %U https://doi.org/10.2196/32738 %U http://www.ncbi.nlm.nih.gov/pubmed/35225822 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32230 %T Automated Pulmonary Embolism Risk Assessment Using the Wells Criteria: Validation Study %A Zhang,Nasen Jonathan %A Rameau,Philippe %A Julemis,Marsophia %A Liu,Yan %A Solomon,Jeffrey %A Khan,Sundas %A McGinn,Thomas %A Richardson,Safiya %+ Northwell Health, 600 Community Dr, Manhasset, NY, 11020, United States, 1 (516) 470 3377, nasenz@gmail.com %K health informatics %K pulmonary embolism %K electronic health record %K quality improvement %K clinical decision support systems %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Computed tomography pulmonary angiography (CTPA) is frequently used in the emergency department (ED) for the diagnosis of pulmonary embolism (PE), while posing risk for contrast-induced nephropathy and radiation-induced malignancy. Objective: We aimed to create an automated process to calculate the Wells score for pulmonary embolism for patients in the ED, which could potentially reduce unnecessary CTPA testing. Methods: We designed an automated process using electronic health records data elements, including using a combinatorial keyword search method to query free-text fields, and calculated automated Wells scores for a sample of all adult ED encounters that resulted in a CTPA study for PE at 2 tertiary care hospitals in New York, over a 2-month period. To validate the automated process, the scores were compared to those derived from a 2-clinician chart review. Results: A total of 202 ED encounters resulted in a completed CTPA to form the retrospective study cohort. Patients classified as “PE likely” by the automated process (126/202, 62%) had a PE prevalence of 15.9%, whereas those classified as “PE unlikely” (76/202, 38%; Wells score >4) had a PE prevalence of 7.9%. With respect to classification of the patient as “PE likely,” the automated process achieved an accuracy of 92.1% when compared with the chart review, with sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 90.5%, 94.4%, and 88.2%, respectively. Conclusions: This was a successful development and validation of an automated process using electronic health records data elements, including free-text fields, to classify risk for PE in ED visits. %M 35225812 %R 10.2196/32230 %U https://formative.jmir.org/2022/2/e32230 %U https://doi.org/10.2196/32230 %U http://www.ncbi.nlm.nih.gov/pubmed/35225812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32664 %T Patient Digital Health Technologies to Support Primary Care Across Clinical Contexts: Survey of Primary Care Providers, Behavioral Health Consultants, and Nurses %A Zaslavsky,Oleg %A Chu,Frances %A Renn,Brenna N %+ School of Nursing, University of Washington, 1959 Pacific Ave, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K survey %K primary care %K acceptance %K nurses %K primary care providers %K behavioral health consultants %K mobile health %K technology %K health promotion %K attitudes %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The acceptance of digital health technologies to support patient care for various clinical conditions among primary care providers and staff has not been explored. Objective: The purpose of this study was to explore the extent of potential differences between major groups of providers and staff in primary care, including behavioral health consultants (BHCs; eg, psychologists, social workers, and counselors), primary care providers (PCPs; eg, physicians and nurse practitioners), and nurses (registered nurses and licensed practical nurses) in the acceptance of various health technologies (ie, mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals) to support patient care across a variety of clinical situations. Methods: We surveyed 151 providers (51 BHCs, 52 PCPs, and 48 nurses) embedded in primary care clinics across the United States who volunteered to respond to a web-based survey distributed in December 2020 by a large health care market research company. Respondents indicated the technologies they consider appropriate to support patients’ health care needs across the following clinical contexts: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. We used descriptive statistics to summarize the distribution of demographic characteristics by provider type. We used contingency tables to compile summaries of the proportion of provider types endorsing each technology within and across clinical contexts. This study was exploratory in nature, with the intent to inform future research. Results: Most of the respondents were from urban and suburban settings (125/151, 82.8%), with 12.6% (n=19) practicing in rural or frontier settings and 4.6% (n=7) practicing in rural-serving clinics. Respondents were dispersed across the United States, including the Northeast (31/151, 20.5%), Midwest (n=32, 21.2%), South (n=49, 32.5%), and West (n=39, 25.8%). The highest acceptance for technologies across clinical contexts was among BHCs (32/51, 63%) and PCPs (30/52, 58%) for live video and among nurses for mobile apps (30/48, 63%). A higher percentage of nurses accepted all other technologies relative to BHCs and PCPs. Similarly, relative to other groups, PCPs indicated lower levels of acceptance. Within clinical contexts, the highest acceptance rates were reported among 80% (41/51) of BHCs and 69% (36/52) of PCPs endorsing live video for common mental health conditions and 75% (36/48) of nurses endorsing mobile apps for health-promoting behaviors. The lowest acceptance across providers was for social media in the context of medication management (9.3% [14/151] endorsement across provider type). Conclusions: The survey suggests potential differences in the way primary care clinicians and staff envision using technologies to support patient care. Future work must attend to reasons for differences in the acceptance of various technologies across providers and clinical contexts. Such an understanding will help inform appropriate implementation strategies to increase acceptability and gain greater adoption of appropriate technologies across conditions and patient populations. %M 35212642 %R 10.2196/32664 %U https://formative.jmir.org/2022/2/e32664 %U https://doi.org/10.2196/32664 %U http://www.ncbi.nlm.nih.gov/pubmed/35212642 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 2 %P e34907 %T The Science of Learning Health Systems: Scoping Review of Empirical Research %A Ellis,Louise A %A Sarkies,Mitchell %A Churruca,Kate %A Dammery,Genevieve %A Meulenbroeks,Isabelle %A Smith,Carolynn L %A Pomare,Chiara %A Mahmoud,Zeyad %A Zurynski,Yvonne %A Braithwaite,Jeffrey %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, 2113, Australia, 61 298502484, louise.ellis@mq.edu.au %K learning health systems %K learning health care systems %K implementation science %K evaluation %K health system %K health care system %K empirical research %K medical informatics %K review %D 2022 %7 23.2.2022 %9 Review %J JMIR Med Inform %G English %X Background: The development and adoption of a learning health system (LHS) has been proposed as a means to address key challenges facing current and future health care systems. The first review of the LHS literature was conducted 5 years ago, identifying only a small number of published papers that had empirically examined the implementation or testing of an LHS. It is timely to look more closely at the published empirical research and to ask the question, Where are we now? 5 years on from that early LHS review. Objective: This study performed a scoping review of empirical research within the LHS domain. Taking an “implementation science” lens, the review aims to map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. Methods: Two academic databases (PubMed and Scopus) were searched using the terms “learning health* system*” for papers published between January 1, 2016, to January 31, 2021, that had an explicit empirical focus on LHSs. Study information was extracted relevant to the review objective, including each study’s publication details; primary concern or focus; context; design; data type; implementation framework, model, or theory used; and implementation determinants or outcomes examined. Results: A total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (53/76, 69.7%) designed to contribute to achieving an LHS. Most of these studies focused on a particular clinical context or patient population (37/53, 69.8%), with far fewer studies focusing on whole hospital systems (4/53, 7.5%) or on other broad health care systems encompassing multiple facilities (12/53, 22.6%). Over two-thirds of the program-specific studies utilized quantitative methods (37/53, 69.8%), with a smaller number utilizing qualitative methods (10/53, 18.9%) or mixed-methods designs (6/53, 11.3%). The remaining 23 studies were classified into 1 of 3 key areas: ethics, policies, and governance (10/76, 13.2%); stakeholder perspectives of LHSs (5/76, 6.6%); or LHS-specific research strategies and tools (8/76, 10.5%). Overall, relatively few studies were identified that incorporated an implementation science framework. Conclusions: Although there has been considerable growth in empirical applications of LHSs within the past 5 years, paralleling the recent emergence of LHS-specific research strategies and tools, there are few high-quality studies. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers, and implementation outcomes in this field and will enable comparison and identification of trends across studies. %M 35195529 %R 10.2196/34907 %U https://medinform.jmir.org/2022/2/e34907 %U https://doi.org/10.2196/34907 %U http://www.ncbi.nlm.nih.gov/pubmed/35195529 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33819 %T Digital Health Paradox: International Policy Perspectives to Address Increased Health Inequalities for People Living With Disabilities %A van Kessel,Robin %A Hrzic,Rok %A O'Nuallain,Ella %A Weir,Elizabeth %A Wong,Brian Li Han %A Anderson,Michael %A Baron-Cohen,Simon %A Mossialos,Elias %+ Department of International Health, Care and Public Health Research Institute, Maastricht University, Minderbroedersberg 4-6, Maastricht, 6211LK, Netherlands, 31 43 388 2222, r.vankessel@maastrichtuniversity.nl %K digital health %K eHealth %K health policy %K health systems %K disability %K inclusion %K digital technologies %K people living with disabilities %D 2022 %7 22.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic accelerated the uptake of digital health worldwide and highlighted many benefits of these innovations. However, it also stressed the magnitude of inequalities regarding accessing digital health. Using a scoping review, this article explores the potential benefits of digital technologies for the global population, with particular reference to people living with disabilities, using the autism community as a case study. We ultimately explore policies in Sweden, Australia, Canada, Estonia, the United Kingdom, and the United States to learn how policies can lay an inclusive foundation for digital health systems. We conclude that digital health ecosystems should be designed with health equity at the forefront to avoid deepening existing health inequalities. We call for a more sophisticated understanding of digital health literacy to better assess the readiness to adopt digital health innovations. Finally, people living with disabilities should be positioned at the center of digital health policy and innovations to ensure they are not left behind. %M 35191848 %R 10.2196/33819 %U https://www.jmir.org/2022/2/e33819 %U https://doi.org/10.2196/33819 %U http://www.ncbi.nlm.nih.gov/pubmed/35191848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30527 %T Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines: Qualitative Case Study %A Frennert,Susanne %A Erlingsdóttir,Gudbjörg %A Muhic,Mirella %A Rydenfält,Christofer %A Milos Nymberg,Veronica %A Ekman,Björn %+ Department of Design Sciences, Lund University, Ingvar Kamprad Designcentrum, Sölvegatan 26, Lund, 223 62, Sweden, 46 2220195, susanne.frennert@design.lth.se %K digital patient management platform %K primary care %K normalization process theory coherence %K cognitive participation %K collective action %K reflexive monitoring %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input. Objective: This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice. Methods: HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis. Results: The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures. Conclusions: Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice. %M 35191845 %R 10.2196/30527 %U https://formative.jmir.org/2022/2/e30527 %U https://doi.org/10.2196/30527 %U http://www.ncbi.nlm.nih.gov/pubmed/35191845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28979 %T Telehealth Adoption and Discontinuation by US Hospitals: Results From 2 Quasi-Natural Experiments %A Baird,Aaron %A Cheng,Yichen %A Xia,Yusen %+ Institute of Health Administration, Georgia State University, 35 Broad Street, Suite 805, Atlanta, GA, 30303-3083, United States, 1 4044137639, abaird@gsu.edu %K telehealth %K hospitals %K adoption %K discontinuation %K health information system %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior US hospital telehealth (video visit) studies have focused on describing factors that influence telehealth adoption or performance effects for specific patient segments, hospital systems, or geographic regions. To our knowledge, a larger-scale, national-level (US) study has yet to be conducted on the causal impacts of hospital telehealth adoption as well as discontinuation. Objective: The aim of this study is to understand the causal impact of US hospital telehealth adoption or discontinuation on hospital performance from 2016 to 2018. Methods: We analyzed impacts of telehealth adoption or discontinuation by US hospitals on emergency department visits, total ambulatory visits (minus emergency department visits), outpatient services revenue, total facility expenses, and total hospital revenue for the 2016-2018 period. We specifically focused on performance effects for hospitals that switched from not having telehealth to adopting telehealth, or vice versa, during the 2016-2018 period, thus exploiting 2 quasi-natural experiments. We applied a difference-in-differences research design to each of the 2 main analyses. We compared hospitals that have made a telehealth change to groups of hospitals with similar characteristics that did not make a telehealth change, which established a counterfactual. To appropriately match hospitals between treatment and control groups, we applied propensity score matching. Our primary data were from the American Hospital Association Annual Survey and the Healthcare Cost Report Information System data. Several control variables were obtained from additional sources, including the Area Health Resource File and the Federal Communications Commission. Results: We found that telehealth adoption by US hospitals during the 2016-2018 period resulted in, on average, an increased number of total ambulatory visits (P=.008), increased total facility expenses (P<.001), and increased hospital revenue (P=.004) compared with the control group. We found that telehealth discontinuation during the same period resulted in, on average, decreased outpatient services revenue (P=.02) compared with the control group. Conclusions: Our findings suggest that telehealth adoption increases use but has mixed impacts on performance, given that cost and revenue increase. However, once telehealth is offered, removing it can have a negative impact on performance, implying that returning to prior performance levels, if telehealth is removed, may be challenging. %M 35179503 %R 10.2196/28979 %U https://formative.jmir.org/2022/2/e28979 %U https://doi.org/10.2196/28979 %U http://www.ncbi.nlm.nih.gov/pubmed/35179503 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32392 %T Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review %A Tran,Duc Minh %A Thwaites,C Louise %A Van Nuil,Jennifer Ilo %A McKnight,Jacob %A Luu,An Phuoc %A Paton,Chris %A , %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, 700000, Vietnam, 84 356574593, ductm@oucru.org %K digital health %K eHealth %K policy %K Vietnam %K hospital care %K data %K health %K electronic medical records %K standards %K compulsory %K patient ID %K administrative information %K health insurance ID %K mobile phone %D 2022 %7 9.2.2022 %9 Review %J J Med Internet Res %G English %X 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 Thư Viện Pháp Luật, 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. %M 35138264 %R 10.2196/32392 %U https://www.jmir.org/2022/2/e32392 %U https://doi.org/10.2196/32392 %U http://www.ncbi.nlm.nih.gov/pubmed/35138264 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e30755 %T Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union %A John,Oommen %A Sarbadhikari,Suptendra Nath %A Prabhu,Thanga %A Goel,Ashvini %A Thomas,Alexander %A Shroff,Sunil %A Allaudin,Fazilah %A Weerabaddana,Chaminda %A Alhuwail,Dari %A Koirala,Udaya %A Johnrose,Jayalal %A Codyre,Patricia %A Bleaden,Andy %A Singh,Shubnum %A Bajaj,Shuchin %+ The George Institute for Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, 110025, India, 91 9717669574, supten@gmail.com %K telehealth policy and practice %K implementation lessons %K challenges in scaling up %K capacity building of human resources %K data privacy %K telehealth %K health policy %K telemedicine %K implementation %K challenges %K human resources %K digital health %K data security %D 2022 %7 8.2.2022 %9 Viewpoint %J Interact J Med Res %G English %X This viewpoint summarizes the discussion that occurred during the “Translating Policy to Practice in Telehealth–Lessons from Global Implementation Experiences” panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth. %M 35133279 %R 10.2196/30755 %U https://www.i-jmr.org/2022/1/e30755 %U https://doi.org/10.2196/30755 %U http://www.ncbi.nlm.nih.gov/pubmed/35133279 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32714 %T Understanding Decision-Making in the Adoption of Digital Health Technology: The Role of Behavioral Economics’ Prospect Theory %A Khan,Waqas Ullah %A Shachak,Aviv %A Seto,Emily %+ Department of Health Informatics, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T3M6, Canada, 1 9059037401, waqas.khan@alum.utoronto.ca %K decision-making %K digital health technology adoption %K prospect theory %D 2022 %7 7.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X The decision to accept or reject new digital health technologies remains an ongoing challenge among health care patients, providers, technology companies, and policymakers. Over the past few decades, interest in understanding the choice to adopt technology has led to the development of numerous theories and models. In 1979, however, psychologists Kahneman and Tversky published their seminal research article that has pioneered the field of behavioral economics. They named their model the prospect theory and used it to explain decision-making behaviors under conditions of risk and uncertainty as well as to provide an understanding of why individuals may make irrational or inconsistent choices. Although the prospect theory has been used to explain decision-making in economics, law, political science, and clinically, at the individual level, its application to understanding choice in the adoption of digital health technology has not been explored. Herein, we discuss how the main components of the prospect theory’s editing phase (framing effect) and evaluation phase (value function and weighting function) can provide valuable insight on why health care patients, providers, technology companies, and policymakers may decide to accept or reject digital health technologies. %M 35129459 %R 10.2196/32714 %U https://www.jmir.org/2022/2/e32714 %U https://doi.org/10.2196/32714 %U http://www.ncbi.nlm.nih.gov/pubmed/35129459 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31167 %T Boundary Objects as Dialogical Learning Accelerators for Social Change in Design for Health: Systematic Review %A Terlouw,Gijs %A Kuipers,Derek %A Veldmeijer,Lars %A van 't Veer,Job %A Prins,Jelle %A Pierie,Jean-Pierre %+ NHL Stenden University of Applied Sciences, Rengerslaan 10, Leeuwarden, 8919 DD, Netherlands, 31 628317457, gijs.terlouw@nhlstenden.com %K boundary objects %K health %K innovation %K design %K systematic review %D 2022 %7 3.2.2022 %9 Review %J JMIR Hum Factors %G English %X 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. %M 35113023 %R 10.2196/31167 %U https://humanfactors.jmir.org/2022/1/e31167 %U https://doi.org/10.2196/31167 %U http://www.ncbi.nlm.nih.gov/pubmed/35113023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28870 %T Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study %A Neher,Margit %A Nygårdh,Annette %A Broström,Anders %A Lundgren,Johan %A Johansson,Peter %+ Department of Rehabilitation, School of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, 551 11, Sweden, 46 70 7892336, margit.neher@ju.se %K clients %K computer-assisted therapy %K consultation telehealth %K decision-makers %K implementation %K patients %K politicians %K qualitative methods %K remote %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35089139 %R 10.2196/28870 %U https://www.jmir.org/2022/1/e28870 %U https://doi.org/10.2196/28870 %U http://www.ncbi.nlm.nih.gov/pubmed/35089139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31920 %T Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis %A Yu,Jiyeon %A de Antonio,Angelica %A Villalba-Mora,Elena %+ Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, 28223, Spain, 34 910679250, elena.villalba@upm.es %K eHealth %K older people %K older user %K health technology %K acceptance factors %K adoption %K acceptance framework %K systematic review %K thematic analysis %K influential factor analysis %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults’ lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users’ acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants’ health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user–technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. %M 35089155 %R 10.2196/31920 %U https://www.jmir.org/2022/1/e31920 %U https://doi.org/10.2196/31920 %U http://www.ncbi.nlm.nih.gov/pubmed/35089155 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e34038 %T Technology-Enabled, Evidence-Driven, and Patient-Centered: The Way Forward for Regulating Software as a Medical Device %A Carolan,Jane Elizabeth %A McGonigle,John %A Dennis,Andrea %A Lorgelly,Paula %A Banerjee,Amitava %+ Institute of Health Informatics, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 07464345635, j.carolan@ucl.ac.uk %K Artificial intelligence %K machine learning %K algorithm %K software %K risk assessment %K informatics %D 2022 %7 27.1.2022 %9 Viewpoint %J JMIR Med Inform %G English %X Artificial intelligence (AI) is a broad discipline that aims to understand and design systems that display properties of intelligence. Machine learning (ML) is a subset of AI that describes how algorithms and models can assist computer systems in progressively improving their performance. In health care, an increasingly common application of AI/ML is software as a medical device (SaMD), which has the intention to diagnose, treat, cure, mitigate, or prevent disease. AI/ML includes either “locked” or “continuous learning” algorithms. Locked algorithms consistently provide the same output for a particular input. Conversely, continuous learning algorithms, in their infancy in terms of SaMD, modify in real-time based on incoming real-world data, without controlled software version releases. This continuous learning has the potential to better handle local population characteristics, but with the risk of reinforcing existing structural biases. Continuous learning algorithms pose the greatest regulatory complexity, requiring seemingly continuous oversight in the form of special controls to ensure ongoing safety and effectiveness. We describe the challenges of continuous learning algorithms, then highlight the new evidence standards and frameworks under development, and discuss the need for stakeholder engagement. The paper concludes with 2 key steps that regulators need to address in order to optimize and realize the benefits of SaMD: first, international standards and guiding principles addressing the uniqueness of SaMD with a continuous learning algorithm are required and second, throughout the product life cycle and appropriate to the SaMD risk classification, there needs to be continuous communication between regulators, developers, and SaMD end users to ensure vigilance and an accurate understanding of the technology. %M 35084352 %R 10.2196/34038 %U https://medinform.jmir.org/2022/1/e34038 %U https://doi.org/10.2196/34038 %U http://www.ncbi.nlm.nih.gov/pubmed/35084352 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e15413 %T Understanding Current Needs and Future Expectations of Informal Caregivers for Technology to Support Health and Well-being: National Survey Study %A Egan,Kieren J %A Clark,Patricia %A Deen,Zahid %A Paputa Dutu,Carmen %A Wilson,Graham %A McCann,Lisa %A Lennon,Marilyn %A Maguire,Roma %+ Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 141 548 3589, roma.maguire@strath.ac.uk %K caregiving %K technology %K health %K well-being %K digital health %K co-design %K mobile phone %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: There are approximately 6.5 million informal (unpaid) caregivers in the United Kingdom. Each caregiver plays a critical role in the society, supporting the health and well-being of those who are ill, disabled, or older and who need frequent support. Digital technologies are becoming a ubiquitous part of everyday life for many, but little is known about the real-world impact of technology for those in a caring role, including the abilities of technologies to address the mental and physical impacts of caregiving. Objective: This study aims to understand the current and future technology use of caregivers, including digital technologies used to care for themselves and the person they look after. Methods: We codeveloped a wide range of questions with caregivers and care professionals and delivered this survey both on the web and in paper format (eg, using social networks such as Twitter alongside in-person events). Questions were focused on providing care and looking after caregiver health and well-being. Analyses focused on both quantitative outcomes (frequency counts and Likert questions) and explored free text entries (thematic analysis). Results: From 356 respondents, we identified that caregivers were receptive to, and largely positive about current and future use of technology both for their own care and their caring role (eg, checking in from distance). There were notable concerns, including the risk that technology could replace human contact. We identified several key areas for future work, including communication with health and social care professionals, and the potential for technology to help caregivers with their own health. We also identified several stakeholders (eg, care workers, pharmacy staff, and general practitioners) who could act as suitable points for technology signposting and support. Conclusions: Caregivers are a transient, often difficult to reach population, and this work has collated a large body of knowledge across a diverse group of individuals. Many caregivers, like the rest of society, are realizing the benefits of using everyday technology to help deliver care. It is clear that there is already a high level of dependency on technologies, where future expectations will grow. However, many barriers to digital technology use remain, including a lack of ongoing technology support. Preventive measures linked to technology that can help look after a caregiver’s own health appear acceptable, particularly for communicative tools. This collated caregiver knowledge is a call for all stakeholders—academics, policy makers, and practitioners—to take note of these specific challenges, and to ensure that caregiver voices are both heard and fully integrated within the emerging digital health agenda. %M 35084339 %R 10.2196/15413 %U https://aging.jmir.org/2022/1/e15413 %U https://doi.org/10.2196/15413 %U http://www.ncbi.nlm.nih.gov/pubmed/35084339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29367 %T Early Adopters of Apple Health Records at a Large Academic Medical Center: Cross-sectional Survey of Users %A Rolnick,Joshua %A Ward,Robin %A Tait,Gordon %A Patel,Neha %+ United States Department of Veterans Affairs, 3900 Woodland Avenue, Philadelphia, PA, 19104, United States, 1 6175385191, rolnick@pennmedicine.upenn.edu %K Apple Health Records %K personal health record %K electronic health record %K patient satisfaction %K early adopters %K cross-sectional survey %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile applications offer a new approach to personal health records, which are internet-based tools for patients to consolidate and manage their health information. The University of Pennsylvania Health System (UPHS) was one of the first health systems to participate in Apple Health Records (AHR), a prominent example of this new generation of personal health records. Objective: This study aimed to characterize early adoption of AHR among UPHS patients and understand user perspectives. Methods: An email-based survey with fixed answer, Likert scale, and open-ended questions was administered to all UPHS patients using AHR in the first 10 months of enrollment. Survey data linked to the UPHS electronic health record system were used to analyze responses. Multivariable logistic regression modeled the association of patient characteristics with user ratings. Content analysis was used to analyze open-ended questions. Results: At the time of the survey, a total of 1458 patients had used AHR at least once. Mean age of AHR users was 47.5 years, 66.3% (967/1458) were male, 70.9% (1033/1458) were white, and 80.8% (1178/1458) had private insurance. Response rate was 26.8% (391/1458); 46.3% (180/389) were very satisfied with AHR, and 67.7% (264/390) described it as very easy to use. The most commonly utilized features were lab results (324/391, 82.9%), clinical vitals (264/391, 67.5%), and medications (253/391, 64.7%). No patient characteristics were associated with reporting high satisfaction or ease of use. The most common reason for using AHR was convenience/ease of use, and 58.2% (160/275) of users reported allowing no other apps to access their health information, citing privacy as one consideration. Conclusions: Early adopters of AHR were demographically white, male, and privately insured. Convenience was an important facilitator, and users were selective in which apps they allowed to access their health information. %M 35076397 %R 10.2196/29367 %U https://www.jmir.org/2022/1/e29367 %U https://doi.org/10.2196/29367 %U http://www.ncbi.nlm.nih.gov/pubmed/35076397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e19448 %T Stakeholder Power Analysis of the Facilitators and Barriers for Telehealth Solution Implementation in China: A Qualitative Study of Individual Users in Beijing and Interviews With Institutional Stakeholders %A Chen,Nuoya %+ Faculty of Global Studies, Justice and Rights, University of Macerata, Crescimbeni 30-32, Macerata, 62100, Italy, 39 3913385558, cny0824@gmail.com %K aging %K telehealth implementation %K stakeholder mapping and power analysis %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Facing COVID 19, the use of telehealth solutions grows exponentially. However, despite the large investments made into telehealth solutions, the implementation process remains slow and sluggish. Moreover, during COVID-19, older people experienced difficulties and had the highest mortality rates, and those lucky enough to survive faced tremendous pressure to use QR code-based health monitoring systems. Objective: This paper aims to determine the barriers and incentives for the implementation of telehealth solutions via a case study about telehealth implementation in China. Methods: We conducted 8 semi-structured interviews following the design of the interactive learning framework (research question defining, participant recruitment, exploratory stage, consultation stage, integration stage, and follow-up interview). One interview with a government official from the National Health Commission and another interview with a government official from the China Center for Disease Control and Prevention was conducted in the exploratory stage. The consultation stage comprised one interview with a business manager from the Huawei Wearable Unit, one interview with a business manager from Alibaba Health Brain Unit, and one interview with a business manager from Xiaomi. Two interviews with doctors from Fudan University-affiliated Huashan Hospital and Fudan University-affiliated Zhongshan hospital were conducted in the integration stage. In addition, 8 focus group studies with 64 participants from rural and urban Beijing were conducted. Finally, another telephone interview with a business manager of the Xiaomi Wearable Unit was conducted in the follow-up stage. Results: Telehealth solutions are designed to assist health care providers in realizing the quadruple aim of better health outcomes, lowering health care costs, improved health care quality, and improved doctor and patient experiences. Governments have high incentives to improve health care efficiency via telehealth solutions. However, they have limited resources to make the necessary infrastructure transformation. Conclusions: To fully realize the potential of telehealth devices, heavy infrastructure investment in the telecommunication network is required beforehand to resolve the interoperability issue occurring during the data collection process for telehealth solutions. The industry also demands a mature business model incorporating collaboration between various stakeholders and industrial partners to invest in infrastructure. Governments have high interest and significant influence on building the necessary infrastructure for telehealth solution implementation in China. Industrial actors have a high interest and a medium level of power for telehealth solution implementation. Users have high interest but a lower level of power for the usage of telehealth solutions, and doctors have low interest and a medium level of power for telehealth solutions implementation. %M 35044321 %R 10.2196/19448 %U https://formative.jmir.org/2022/1/e19448 %U https://doi.org/10.2196/19448 %U http://www.ncbi.nlm.nih.gov/pubmed/35044321 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e27431 %T Implementation of E-prescription for Multidose Dispensed Drugs: Qualitative Study of General Practitioners’ Experiences %A Gullslett,Monika Knudsen %A Strand Bergmo,Trine %+ Norwegian Centre for E-Health Research, University Hospital of North Norway, Postboks 35, Tromsø, 9038, Norway, 47 90784208, monika.knudsen.gullslett@ehealthresearch.no %K e-prescribing of multidose drug dispensing (eMDD) %K pharmacy %K start-up %K general practitioner (GP) %K Norway %K digital health %K digital tools %K e-prescriptions %K physicians %K qualitative study %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased use of pharmaceuticals challenges both capacity and safety related to medication management for patients and changes in how general practitioners (GPs) and other health personnel interact with and follow up with patients. E-prescribing of multidose drug dispensing (eMDD) is 1 of the national measures being tested in Norway. Objective: The objective of this study is to explore GPs’ experiences with the challenges and benefits of implementing eMDD in Norway. Methods: Qualitative in-depth and group interviews were conducted with a total of 25 GPs between 2018 and 2020. Transcribed files were saved in NVivo to conduct a step-by-step content analysis. NVivo is a software tool for organizing, managing, and analyzing qualitative data. Results: The study revealed that eMDD offers many benefits. At the same time, there are several challenges related to information, training, and initiation, as well as to the responsibility for the medication, interactions, and the risk of incorrect medication. An important activity in the start-up phase was an information meeting with pharmacies and technology suppliers, as well as exchanging information and instructions with pharmacies on how to get started. Four analytic themes emerged through the extraction of data: (1) start-up with eMDD (“Be patient”); (2) the need for training; (3) interaction, safety, and efficiency; and (4) the working day with eMDD. Conclusions: There is a variation in different GPs’ needs regarding training and information, and considerable variation in competence and motivation related to the use of digital tools. There are also different degrees of understanding the everyday work of the other actors in the medication chain. In particular, the harmonization of medication lists related to the use of time, expenditures, and challenges with technological solutions in the introduction phase was emphasized as a challenge. Overall, GPs who have started using the system report great benefits; these are largely related to an increased overview of patients’ total medication lists, less time spent on prescribing prescriptions, and increased collaboration with pharmacies and nurses, both in service from providers in homes and in nursing homes. %M 35037881 %R 10.2196/27431 %U https://humanfactors.jmir.org/2022/1/e27431 %U https://doi.org/10.2196/27431 %U http://www.ncbi.nlm.nih.gov/pubmed/35037881 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e17568 %T A Self-help Tool to Facilitate Implementation of eHealth Initiatives in Health Care (E-Ready): Formative Evaluation %A Dannapfel,Petra %A Thomas,Kristin %A Chakhunashvili,Alexander %A Melin,Jeanette %A Trolle Lagerros,Ylva %+ Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Building 511-001, 14th Floor, Linköping, 58183, Sweden, 46 727 174370, petra.dannapfel@regionostergotland.se %K implementation science %K health care sector %K telemedicine %K organizational readiness for change %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions have the potential to increase the efficiency and effectiveness of health care. However, research has shown that implementing eHealth in routine health care practice is difficult. Organizational readiness to change has been shown to be central to successful implementation. This paper describes the development and formative evaluation of a generic self-help tool, E-Ready, designed to be used by managers, project leaders, or others responsible for implementation in a broad range of health care settings. Objective: The aim of this study is to develop and evaluate a tool that could facilitate eHealth implementation in, for example, health care. Methods: A first version of the tool was generated based on implementation theory (E-Ready 1.0). A formative evaluation was undertaken through expert panels (n=15), cognitive interviews (n=17), and assessment of measurement properties on E-Ready items from 3 different workplaces (n=165) using Rasch analyses. E-Ready 1.0 was also field tested among the target population (n=29). Iterative revisions were conducted during the formative evaluation process, and E-Ready 2.0 was generated. Results: The E-Ready Tool consists of a readiness assessment survey and a hands-on manual. The survey measures perceived readiness for change (willingness and capability) at individual and collective levels: perceived conditions for change at the workplace, perceived individual conditions for change, perceived support and engagement among management, perceived readiness among colleagues, perceived consequences on status quo, and perceived workplace attitudes. The manual contains a brief introduction, instructions on how to use the tool, information on the themes of E-Ready, instructions on how to create an implementation plan, brief advice for success, and tips for further reading on implementation theory. Rasch analyses showed overall acceptable measurement properties in terms of fit validity. The subscale Individual conditions for change (3 items) had the lowest person reliability (0.56), whereas Perceived consequences on status quo (5 items) had the highest person reliability (0.87). Conclusions: E-Ready 2.0 is a new self-help tool to guide implementation targeting health care provider readiness and engagement readiness ahead of eHealth initiatives in, for example, health care settings. E-Ready can be improved further to capture additional aspects of implementation; improvements can also be made by evaluating the tool in a larger sample. %M 35037884 %R 10.2196/17568 %U https://formative.jmir.org/2022/1/e17568 %U https://doi.org/10.2196/17568 %U http://www.ncbi.nlm.nih.gov/pubmed/35037884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32939 %T Perceptions and Needs of Artificial Intelligence in Health Care to Increase Adoption: Scoping Review %A Chew,Han Shi Jocelyn %A Achananuparp,Palakorn %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65168687, jocelyn.chew.hs@nus.edu.sg %K artificial intelligence %K health care %K service delivery %K perceptions %K needs %K scoping %K review %D 2022 %7 14.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) has the potential to improve the efficiency and effectiveness of health care service delivery. However, the perceptions and needs of such systems remain elusive, hindering efforts to promote AI adoption in health care. Objective: This study aims to provide an overview of the perceptions and needs of AI to increase its adoption in health care. Methods: A systematic scoping review was conducted according to the 5-stage framework by Arksey and O’Malley. Articles that described the perceptions and needs of AI in health care were searched across nine databases: ACM Library, CINAHL, Cochrane Central, Embase, IEEE Xplore, PsycINFO, PubMed, Scopus, and Web of Science for studies that were published from inception until June 21, 2021. Articles that were not specific to AI, not research studies, and not written in English were omitted. Results: Of the 3666 articles retrieved, 26 (0.71%) were eligible and included in this review. The mean age of the participants ranged from 30 to 72.6 years, the proportion of men ranged from 0% to 73.4%, and the sample sizes for primary studies ranged from 11 to 2780. The perceptions and needs of various populations in the use of AI were identified for general, primary, and community health care; chronic diseases self-management and self-diagnosis; mental health; and diagnostic procedures. The use of AI was perceived to be positive because of its availability, ease of use, and potential to improve efficiency and reduce the cost of health care service delivery. However, concerns were raised regarding the lack of trust in data privacy, patient safety, technological maturity, and the possibility of full automation. Suggestions for improving the adoption of AI in health care were highlighted: enhancing personalization and customizability; enhancing empathy and personification of AI-enabled chatbots and avatars; enhancing user experience, design, and interconnectedness with other devices; and educating the public on AI capabilities. Several corresponding mitigation strategies were also identified in this study. Conclusions: The perceptions and needs of AI in its use in health care are crucial in improving its adoption by various stakeholders. Future studies and implementations should consider the points highlighted in this study to enhance the acceptability and adoption of AI in health care. This would facilitate an increase in the effectiveness and efficiency of health care service delivery to improve patient outcomes and satisfaction. %M 35029538 %R 10.2196/32939 %U https://www.jmir.org/2022/1/e32939 %U https://doi.org/10.2196/32939 %U http://www.ncbi.nlm.nih.gov/pubmed/35029538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28323 %T Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review %A Woodcock,Elizabeth W %+ Department of Health Policy & Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30307, United States, 1 404 272 2274, elizabeth@elizabethwoodcock.com %K appointment %K scheduling %K outpatient %K ambulatory %K online %K self-serve %K e-book %K web-based %K automation %K patient satisfaction %K self-scheduling %K eHealth %K digital health %K mobile phone %D 2022 %7 11.1.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35014968 %R 10.2196/28323 %U https://www.jmir.org/2022/1/e28323 %U https://doi.org/10.2196/28323 %U http://www.ncbi.nlm.nih.gov/pubmed/35014968 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e31837 %T Impact of Electronic Health Record Interoperability on Telehealth Service Outcomes %A Zhang,Xinyue %A Saltman,Richard %+ Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 6th Floor, Atlanta, GA, 30322, United States, 1 2068494755, xinyue.zhang2@emory.edu %K Electronic Health Records %K Telehealth %K Telemental health %K Pandemic %K Health outcomes %K Health Policy %D 2022 %7 11.1.2022 %9 Viewpoint %J JMIR Med Inform %G English %X This paper aims to develop a telehealth success model and discusses three critical components: (1) health information quality, (2) electronic health record system quality, and (3) telehealth service quality to ensure effective telehealth service delivery, reduce professional burnout, and enhance access to care. The paper applied a policy analysis method and discussed telehealth applications in rural health, mental health, and veterans health services. The results pointed out the fact that, although telehealth paired with semantic/organizational interoperability facilitates value-based and team-based care, challenges remain to enhance user (both patients and clinicians) experience and satisfaction. The conclusion indicates that approaches at systemic and physician levels are needed to reduce disparities in health technology adoption and improve access to telehealth care. %M 34890347 %R 10.2196/31837 %U https://medinform.jmir.org/2022/1/e31837 %U https://doi.org/10.2196/31837 %U http://www.ncbi.nlm.nih.gov/pubmed/34890347 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e33600 %T Current Status of the Health Information Technology Industry in China from the China Hospital Information Network Conference: Cross-sectional Study of Participating Companies %A Zhang,Zhongan %A Zheng,Xu %A An,Kai %A He,Yunfan %A Wang,Tong %A Zhou,Ruizhu %A Zheng,Qilin %A Nuo,Mingfu %A Liang,Jun %A Lei,Jianbo %+ Center for Medical Informatics, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China, 86 15201230935, jblei@hsc.pku.edu.cn %K medical informatics %K China Hospital Information Network Conference %K industry analysis %K county medical community %K smart hospital %K cross-sectional study %K digital therapeutic %K information network %K health care %K hospital information %K medical information %K tertiary hospital %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 35014959 %R 10.2196/33600 %U https://medinform.jmir.org/2022/1/e33600 %U https://doi.org/10.2196/33600 %U http://www.ncbi.nlm.nih.gov/pubmed/35014959 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28762 %T Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study %A Garcia,Gracie %A Crenner,Christopher %+ Department of History and Philosophy of Medicine, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 6209514171, grace.c.garcia1@gmail.com %K electronic health records %K electronic medical records %K health information technology %K health information exchange %K health policy %K international %K emergency medicine %K medical informatics %K meaningful use %K burnout %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 34994702 %R 10.2196/28762 %U https://humanfactors.jmir.org/2022/1/e28762 %U https://doi.org/10.2196/28762 %U http://www.ncbi.nlm.nih.gov/pubmed/34994702 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28981 %T Patient Perspectives on the Digitization of Personal Health Information in the Emergency Department: Mixed Methods Study During the COVID-19 Pandemic %A Ly,Sophia %A Tsang,Ricky %A Ho,Kendall %+ Faculty of Medicine, University of British Columbia, 3312-818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048220327, sophia.ly@alumni.ubc.ca %K emergency medicine %K digital health %K health informatics %K electronic health record %K patient portal %K patient-physician relationship %K COVID-19 %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although the digitization of personal health information (PHI) has been shown to improve patient engagement in the primary care setting, patient perspectives on its impact in the emergency department (ED) are unknown. Objective: The primary objective was to characterize the views of ED users in British Columbia, Canada, on the impacts of PHI digitization on ED care. Methods: This was a mixed methods study consisting of an online survey followed by key informant interviews with a subset of survey respondents. ED users in British Columbia were asked about their ED experiences and attitudes toward PHI digitization in the ED. Results: A total of 108 participants submitted survey responses between January and April 2020. Most survey respondents were interested in the use of electronic health records (79/105, 75%) and patient portals (91/107, 85%) in the ED and were amenable to sharing their ED PHI with ED staff (up to 90% in emergencies), family physicians (up to 91%), and family caregivers (up to 75%). In addition, 16 survey respondents provided key informant interviews in August 2020. Interviewees expected PHI digitization in the ED to enhance PHI access by health providers, patient-provider relationships, patient self-advocacy, and postdischarge care management, although some voiced concerns about patient privacy risk and limited access to digital technologies (eg, smart devices, internet connection). Many participants thought the COVID-19 pandemic could provide momentum for the digitization of health care. Conclusions: Patients overwhelmingly support PHI digitization in the form of electronic health records and patient portals in the ED. The COVID-19 pandemic may represent a critical moment for the development and implementation of these tools. %M 34818211 %R 10.2196/28981 %U https://medinform.jmir.org/2022/1/e28981 %U https://doi.org/10.2196/28981 %U http://www.ncbi.nlm.nih.gov/pubmed/34818211 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31246 %T Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study %A Cresswell,Kathrin %A Domínguez Hernández,Andrés %A Williams,Robin %A Sheikh,Aziz %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 131 651 4151, Kathrin.Cresswell@ed.ac.uk %K cloud technology %K qualitative %K adoption %K implementation %K digital health %K data processing %K health care %K risk assessment %K user engagement %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 34989688 %R 10.2196/31246 %U https://humanfactors.jmir.org/2022/1/e31246 %U https://doi.org/10.2196/31246 %U http://www.ncbi.nlm.nih.gov/pubmed/34989688 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31617 %T Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey %A Breil,Bernhard %A Salewski,Christel %A Apolinário-Hagen,Jennifer %+ Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, Reinarzstraße 49, Krefeld, 47805, Germany, 49 21518226710, bernhard.breil@hs-niederrhein.de %K patient acceptance of health care %K mobile apps %K blood pressure %K mobile health %K health applications %K technology acceptance %K patients %K physicians %K digital health %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. %M 34989683 %R 10.2196/31617 %U https://cardio.jmir.org/2022/1/e31617 %U https://doi.org/10.2196/31617 %U http://www.ncbi.nlm.nih.gov/pubmed/34989683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31752 %T Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review %A Kruse,Clemens %A Heinemann,Katharine %+ School of Health Administration, Texas State University, Encino Hall, Room 250, 601 University Dr, San Marcos, TX, 78666, United States, 1 5122454462, scottkruse@txstate.edu %K telemedicine %K pandemic %K technology acceptance %K COVID-19 %K digital health %K telehealth %K health policy %K health care %D 2022 %7 4.1.2022 %9 Review %J J Med Internet Res %G English %X Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective: The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods: The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted. %M 34854815 %R 10.2196/31752 %U https://www.jmir.org/2022/1/e31752 %U https://doi.org/10.2196/31752 %U http://www.ncbi.nlm.nih.gov/pubmed/34854815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28086 %T The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study %A Ahadzadeh,Ashraf Sadat %A Wu,Shin Ling %A Ong,Fon Sim %A Deng,Ruolan %+ Department of Journalism, Xiamen University Malaysia, Bandar Sunsuria, Sepang, Selangor, 43900, Malaysia, 60 147393423, ahadzadeh1980@gmail.com %K mobile health %K mHealth %K internal health locus of control %K performance expectancy %K effort expectancy %K social influence %K mediation %D 2021 %7 29.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective: The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods: A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results: The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions: This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption. %M 34964718 %R 10.2196/28086 %U https://www.jmir.org/2021/12/e28086 %U https://doi.org/10.2196/28086 %U http://www.ncbi.nlm.nih.gov/pubmed/34964718 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e31633 %T Breaking the Data Value-Privacy Paradox in Mobile Mental Health Systems Through User-Centered Privacy Protection: A Web-Based Survey Study %A Zhang,Dongsong %A Lim,Jaewan %A Zhou,Lina %A Dahl,Alicia A %+ The University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223-0001, United States, 1 7046871893, dzhang15@uncc.edu %K mobile apps %K mental health %K privacy concerns %K privacy protection %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile mental health systems (MMHS) have been increasingly developed and deployed in support of monitoring, management, and intervention with regard to patients with mental disorders. However, many of these systems rely on patient data collected by smartphones or other wearable devices to infer patients’ mental status, which raises privacy concerns. Such a value-privacy paradox poses significant challenges to patients’ adoption and use of MMHS; yet, there has been limited understanding of it. Objective: To address the significant literature gap, this research aims to investigate both the antecedents of patients’ privacy concerns and the effects of privacy concerns on their continuous usage intention with regard to MMHS. Methods: Using a web-based survey, this research collected data from 170 participants with MMHS experience recruited from online mental health communities and a university community. The data analyses used both repeated analysis of variance and partial least squares regression. Results: The results showed that data type (P=.003), data stage (P<.001), privacy victimization experience (P=.01), and privacy awareness (P=.08) have positive effects on privacy concerns. Specifically, users report higher privacy concerns for social interaction data (P=.007) and self-reported data (P=.001) than for biometrics data; privacy concerns are higher for data transmission (P=.01) and data sharing (P<.001) than for data collection. Our results also reveal that privacy concerns have an effect on attitude toward privacy protection (P=.001), which in turn affects continuous usage intention with regard to MMHS. Conclusions: This study contributes to the literature by deepening our understanding of the data value-privacy paradox in MMHS research. The findings offer practical guidelines for breaking the paradox through the design of user-centered and privacy-preserving MMHS. %M 34951604 %R 10.2196/31633 %U https://mental.jmir.org/2021/12/e31633 %U https://doi.org/10.2196/31633 %U http://www.ncbi.nlm.nih.gov/pubmed/34951604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27096 %T Electronic Health Record Implementations and Insufficient Training Endanger Nurses’ Well-being: Cross-sectional Survey Study %A Heponiemi,Tarja %A Gluschkoff,Kia %A Vehko,Tuulikki %A Kaihlanen,Anu-Marja %A Saranto,Kaija %A Nissinen,Sari %A Nadav,Janna %A Kujala,Sari %+ Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K electronic health records %K implementation %K information systems %K training %K stress %K cognitive failures %K time pressure %K registered nurses %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34941546 %R 10.2196/27096 %U https://www.jmir.org/2021/12/e27096 %U https://doi.org/10.2196/27096 %U http://www.ncbi.nlm.nih.gov/pubmed/34941546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26323 %T Value of the Electronic Medical Record for Hospital Care: Update From the Literature %A Uslu,Aykut %A Stausberg,Jürgen %+ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, 45122, Germany, 49 201 72377201, stausberg@ekmed.de %K cost analysis %K costs and cost analyses %K economic advantage %K electronic medical records %K electronic records %K health care %K hospitals %K medical records systems computerized %K quality of health care %K secondary data %D 2021 %7 23.12.2021 %9 Review %J J Med Internet Res %G English %X 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. %M 34941544 %R 10.2196/26323 %U https://www.jmir.org/2021/12/e26323 %U https://doi.org/10.2196/26323 %U http://www.ncbi.nlm.nih.gov/pubmed/34941544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28610 %T Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary–Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study %A Bele,Sumedh %A Cassidy,Christine %A Curran,Janet %A Johnson,David W %A Bailey,J A Michelle %+ Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Dr NW, Calgary, AB, T3B 6A8, Canada, 1 403 955 3015, jamichelle.bailey@albertahealthservices.ca %K telemedicine %K eHealth %K pediatric care %K inpatient %K regional %K rural %K Canada %K Theoretical Domains Framework %K qualitative %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children’s Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. Objective: The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. Methods: This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. Results: Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary–regional relationships. Conclusions: This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers’ and family members’ perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. International Registered Report Identifier (IRRID): RR2-10.1186/s12913-018-3859-2 %M 34941561 %R 10.2196/28610 %U https://www.jmir.org/2021/12/e28610 %U https://doi.org/10.2196/28610 %U http://www.ncbi.nlm.nih.gov/pubmed/34941561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31321 %T An Integrated Model to Improve Medication Reconciliation in Oncology: Prospective Interventional Study %A Passardi,Alessandro %A Serra,Patrizia %A Donati,Caterina %A Fiori,Federica %A Prati,Sabrina %A Vespignani,Roberto %A Taglioni,Gabriele %A Farfaneti Ghetti,Patrizia %A Martinelli,Giovanni %A Nanni,Oriana %A Altini,Mattia %A Frassineti,Giovanni Luca %A Minguzzi,Martina Vittoria %+ IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Via P. Maroncelli 40, Meldola, 47014, Italy, 39 0543 739992, roberto.vespignani@irst.emr.it %K medication recognition %K medication reconciliation %K IT platform %K community pharmacies %K healthcare transitions %K pharmacy %K oncology %K drug incompatibility %K information technology %K drug interactions %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate medication reconciliation reduces the risk of drug incompatibilities and adverse events that can occur during transitions in care. Community pharmacies (CPs) are a crucial part of the health care system and could be involved in collecting essential information on conventional and supplementary drugs used at home. Objective: The aim of this paper was to establish an alliance between our cancer institute, Istituto Romagnolo per lo Studio dei Tumori (IRST), and CPs, the latter entrusted with the completion of a pharmacological recognition survey. We also aimed to integrate the national information technology (IT) platform of CPs with the electronic medical records of IRST. Methods: Cancer patients undergoing antiblastic treatments were invited to select a CP taking part in the study and to complete the pharmacological recognition step. The information collected by the pharmacist was sent to the electronic medical records of IRST through the new IT platform, after which the oncologist performed the reconciliation process. Results: A total of 66 CPs completed surveys for 134 patients. An average of 5.9 drugs per patient was used at home, with 12 or more used in the most advanced age groups. Moreover, 60% (80/134) of the patients used nonconventional products or critical foods. Some potential interactions between nonconventional medications and cancer treatments were reported. Conclusions: In the PROF-1 (Progetto di Rete in Oncologia con le Farmacie di comunità della Romagna) study, an alliance was created between our cancer center and CPs to improve medication reconciliation, and a new integrated IT platform was validated. Trial Registration: ClinicalTrials.gov NCT04796142; https://clinicaltrials.gov/ct2/show/NCT04796142 %M 34932001 %R 10.2196/31321 %U https://www.jmir.org/2021/12/e31321 %U https://doi.org/10.2196/31321 %U http://www.ncbi.nlm.nih.gov/pubmed/34932001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e22672 %T A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial %A Doyle,Julie %A Murphy,Emma %A Gavin,Shane %A Pascale,Alessandra %A Deparis,Stéphane %A Tommasi,Pierpaolo %A Smith,Suzanne %A Hannigan,Caoimhe %A Sillevis Smitt,Myriam %A van Leeuwen,Cora %A Lastra,Julia %A Galvin,Mary %A McAleer,Patricia %A Tompkins,Lorraine %A Jacobs,An %A M Marques,Marta %A Medina Maestro,Jaime %A Boyle,Gordon %A Dinsmore,John %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91 K584, Ireland, 353 429370497, julie.doyle@dkit.ie %K digital health %K aging %K multimorbidity %K chronic disease %K self-management %K integrated care %K longitudinal study %K engagement %K usability %K mobile phone %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 %M 34914612 %R 10.2196/22672 %U https://www.jmir.org/2021/12/e22672 %U https://doi.org/10.2196/22672 %U http://www.ncbi.nlm.nih.gov/pubmed/34914612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e22125 %T A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial %A Dinsmore,John %A Hannigan,Caoimhe %A Smith,Suzanne %A Murphy,Emma %A Kuiper,Janneke M L %A O'Byrne,Emma %A Galvin,Mary %A Jacobs,An %A Sillevis Smitt,Myriam %A van Leeuwen,Cora %A McAleer,Patricia %A Tompkins,Lorraine %A Brady,Anne-Marie %A McCarron,Mary %A Doyle,Julie %+ Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, GAS Building, 24 D'Olier Street, Dublin, D02 T283, Ireland, 353 18964155 ext 4155, dinsmorj@tcd.ie %K multimorbidity %K digital health %K chronic disease %K self-management %K older adults %K integrated care %K behaviour change %K mobile phone %K smart phone %K smart device %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ≥65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 %M 34914613 %R 10.2196/22125 %U https://www.researchprotocols.org/2021/12/e22125 %U https://doi.org/10.2196/22125 %U http://www.ncbi.nlm.nih.gov/pubmed/34914613 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30092 %T Assessing Patient Engagement in Health Care: Proposal for a Modeling and Simulation Framework for Behavioral Analysis %A Alwasel,Athary %A Stergioulas,Lampros %A Fakhimi,Masoud %A Garn,Wolfgang %+ Surrey Business School, University of Surrey, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 1483 683048, a.alwasel@surrey.ac.uk %K modeling and simulation %K behavioral analysis %K patient engagement %K behavioral factors, health care %K human factors %K outcomes %K patient health %K health policy %K chronic diseases %K behavioral model %D 2021 %7 8.12.2021 %9 Proposal %J JMIR Res Protoc %G English %X Human behavior plays a vital role in health care effectiveness and system performance. Therefore, it is necessary to look carefully at the interactions within a system and how a system is affected by the behavioral responses and activities of its various components, particularly human components and actions. Modeling patients’ engagement behaviors can be valuable in many ways; for example, models can evaluate the effects of therapeutic interventions on health improvement, health care effectiveness, and desired outcomes of changing health lifestyles. Modeling and simulation (M&S) help us to understand the interactions within a whole system under defined conditions. M&S in patient behavior analysis involve models that attempt to identify certain human behaviors that most likely have an impact on health care operations and services. Our study’s overall aims are (1) to investigate the impacts of patients’ engagement and various human behavior patterns on health care effectiveness and the achievement of desired outcomes and (2) to construct and validate a framework for modeling patient engagement and implementing and supporting patient management best practices, health policy-making processes, and innovative interventions in health care. We intend to extract routinely collected data of different parameters from general patients diagnosed with chronic diseases, such as diabetes. Our plan is to design data sets and extract health data from a pool of >4 million patient records from different general practices in England. We will focus on the primary electronic medical records of patients with at least 1 chronic disease (>200,000 records). Simulation techniques will be used to study patient engagement and its impact on health care effectiveness and outcome measures. The study will integrate available approaches to develop a framework for modeling how patients’ behaviors affect health care activities and outcomes and to underline the characteristics and salient factors that operational management needs to be aware of when developing a behavioral model for assessing patient engagement. The M&S framework, which is under development, will consider patient behavior in context and the underlying factors of human behavior with the help of simulation techniques. The proposed framework will be validated and evaluated through a health care case study. We expect to identify leading factors that influence and affect patient engagement and associated behavioral activities and to illustrate the challenges and complexities of developing simulation models for conducting behavioral analyses within health care settings. Additionally, we will assess patients’ engagement behaviors in terms of achieving health care effectiveness and desired outcomes, and we will specifically evaluate the impacts of patient engagement activities on health care services, patient management styles, and the effectiveness of health interventions in terms of achieving the intended outcomes—improved health and patient satisfaction.International Registered Report Identifier (IRRID): PRR1-10.2196/30092 %M 34889774 %R 10.2196/30092 %U https://www.researchprotocols.org/2021/12/e30092 %U https://doi.org/10.2196/30092 %U http://www.ncbi.nlm.nih.gov/pubmed/34889774 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30278 %T Acceptance, Use, and Barriers of Telemedicine in Transgender Health Care in Times of SARS-CoV-2: Nationwide Cross-sectional Survey %A Hertling,Stefan %A Hertling,Doreen %A Martin,David %A Graul,Isabel %+ Department of Obstetrics and Gynaecology, University Hospital Jena, Am Klinikum 1, Jena, 07743, Germany, 49 17632251161, stefan.hertling@yahoo.de %K telemedicine %K health services research %K COVID-19 %K transgender health care %K acceptance %K usage %K barrier %K telehealth %K gender %K identity %K transgender %K cross-sectional %K survey %K Germany %K framework %K implementation %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global incidence in the treatment of transgender people is increasing. During the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in the management of transgender health care could support physicians. Objective: The aim of this study was to analyze the acceptance, use, and barriers of telemedicine in transgender health care in times of SARS-CoV-2 in Germany. Methods: This prospective cross-sectional study was based on a survey of gynecological endocrinologists and transgender patients undergoing gender-affirming hormone treatment in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations. Results: We analyzed responses of 269 transgender patients and 202 gynecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they did not currently use telemedicine, although they would like to do so. Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19. The majority in both groups agreed on the implementation of virtual visits in the context of stable disease conditions. In the treatment phases, 74.3% (150/202) of the physicians said they would use telemedicine during follow-ups. Half of the physicians said they would choose tele-counseling as a specific approach to improving care (128/202, 63.4%). Obstacles to the introduction of telemedicine among physicians included the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.4%), and poor reimbursement (106/202, 52.5%). Conclusions: Telemedicine in transgender health care found limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge of physicians in the use of telemedicine. More research in tele-endogynecology is needed. Future studies should include large-scale randomized controlled trials, economic analyses, and the exploration of user preferences. %M 34591783 %R 10.2196/30278 %U https://publichealth.jmir.org/2021/12/e30278 %U https://doi.org/10.2196/30278 %U http://www.ncbi.nlm.nih.gov/pubmed/34591783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31668 %T How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals %A Nadav,Janna %A Kaihlanen,Anu-Marja %A Kujala,Sari %A Laukka,Elina %A Hilama,Pirjo %A Koivisto,Juha %A Keskimäki,Ilmo %A Heponiemi,Tarja %+ Finnish Institution for Health and Welfare, PO Box 30, Mannerheimintie 166, Helsinki, FI-00271, Finland, 358 2952480, janna.nadav@thl.fi %K digital services %K implementation %K health and social care professionals %K integration %K normalization process theory %K interview %K social work %K health care %K focus groups %D 2021 %7 1.12.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34855610 %R 10.2196/31668 %U https://www.jmir.org/2021/12/e31668 %U https://doi.org/10.2196/31668 %U http://www.ncbi.nlm.nih.gov/pubmed/34855610 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e32180 %T Health Professionals’ Perspectives on Electronic Medical Record Infusion and Individual Performance: Model Development and Questionnaire Survey Study %A Chen,Rai-Fu %A Hsiao,Ju-Ling %+ Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Number 60, Sec 1, Erren Road, Rende District, Tainan City, 71710, Taiwan, 886 6 2664911 ext 5106, mayo5012@gmail.com %K health care professional %K electronic medical records %K IS infusion %K individual performance %K EHR %K electronic health record %K performance %K perspective %K information system %K integration %K decision-making %K health information exchange %K questionnaire %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X 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 (β=.411), portability (β=.217), personal innovativeness (β=.198), technostress (β=.169), and time criticality (β=.168), and individual performance (R2=0.541) was affected by EMR infusion (β=.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. %M 34851297 %R 10.2196/32180 %U https://medinform.jmir.org/2021/11/e32180 %U https://doi.org/10.2196/32180 %U http://www.ncbi.nlm.nih.gov/pubmed/34851297 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e31214 %T Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study %A Mathioudakis,Nestoras %A Aboabdo,Moeen %A Abusamaan,Mohammed S %A Yuan,Christina %A Lewis Boyer,LaPricia %A Pilla,Scott J %A Johnson,Erica %A Desai,Sanjay %A Knight,Amy %A Greene,Peter %A Golden,Sherita H %+ Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, United States, 1 410 502 8089, nmathio1@jhmi.edu %K informatics alert %K clinical decision support %K hypoglycemia %K hospital %K inpatient %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Iatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems can be used to reduce the incidence of this potentially avoidable adverse event. Objective: This study aims to determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in a hospital setting. Methods: Using the Agency for Healthcare Research and Quality Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform the future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (ie, the Five Rights). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. Results: A 21-item electronic survey was completed by 102 inpatient-based providers, followed by 2 focus group sessions (6 providers per session). Respondents universally agreed or strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that can be addressed with an informatics alert. Stakeholders expressed a preference for an alert that is nonintrusive, accurate, communicated in near real time to the ordering provider, and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section, were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. Conclusions: The design preferences identified in this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at a high risk of treatment-related hypoglycemia. %M 34842544 %R 10.2196/31214 %U https://humanfactors.jmir.org/2021/4/e31214 %U https://doi.org/10.2196/31214 %U http://www.ncbi.nlm.nih.gov/pubmed/34842544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25170 %T Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study %A Rauwerdink,Anneloek %A Kasteleyn,Marise J %A Chavannes,Niels H %A Schijven,Marlies P %+ Department of Radiology and Nuclear Medicine, Amsterdam UMC, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 566 9111, anneloek@hotmail.com %K CSIRO framework %K evaluation strategy %K eHealth %K telemedicine %K qualitative research %K formative evaluation %K digital health %D 2021 %7 25.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. Objective: The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. Methods: To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. Results: The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects’ progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. Conclusions: The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects’ progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. International Registered Report Identifier (IRRID): RR2-10.1016/j.ceh.2020.12.002 %M 34842536 %R 10.2196/25170 %U https://www.jmir.org/2021/11/e25170 %U https://doi.org/10.2196/25170 %U http://www.ncbi.nlm.nih.gov/pubmed/34842536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28854 %T Analysis of a Web-Based Dashboard to Support the Use of National Audit Data in Quality Improvement: Realist Evaluation %A Alvarado,Natasha %A McVey,Lynn %A Elshehaly,Mai %A Greenhalgh,Joanne %A Dowding,Dawn %A Ruddle,Roy %A Gale,Chris P %A Mamas,Mamas %A Doherty,Patrick %A West,Robert %A Feltbower,Richard %A Randell,Rebecca %+ Faculty of Health Studies, University of Bradford, Great Horton Road, Bradford, BD7 1DP, United Kingdom, 44 07715433565, n.alvarado@bradford.ac.uk %K data %K QualDash %K audit %K dashboards %K support %K quality %D 2021 %7 23.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Dashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices needs further investigation. Objective: This paper reports the findings of a realist evaluation of a web-based quality dashboard (QualDash) developed to support the use of national audit data in quality improvement. Methods: QualDash was co-designed with data users and installed in 8 clinical services (3 pediatric intensive care units and 5 cardiology services) across 5 health care organizations (sites A-E) in England between July and December 2019. Champions were identified to support adoption. Data to evaluate QualDash were collected between July 2019 and August 2021 and consisted of 148.5 hours of observations including hospital wards and clinical governance meetings, log files that captured the extent of use of QualDash over 12 months, and a questionnaire designed to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analyzed to understand how, why, and in what circumstances QualDash supported the use of national audit data in quality improvement. Results: The observations revealed that variation across sites in the amount and type of resources available to support data use, alongside staff interactions with QualDash, shaped its use and impact. Sites resourced with skilled audit support staff and established reporting systems (sites A and C) continued to use existing processes to report data. A number of constraints influenced use of QualDash in these sites including that some dashboard metrics were not configured in line with user expectations and staff were not fully aware how QualDash could be used to facilitate their work. In less well-resourced services, QualDash automated parts of their reporting process, streamlining the work of audit support staff (site B), and, in some cases, highlighted issues with data completeness that the service worked to address (site E). Questionnaire responses received from 23 participants indicated that QualDash was perceived as useful and easy to use despite its variable use in practice. Conclusions: Web-based dashboards have the potential to support data-driven improvement, providing access to visualizations that can help users address key questions about care quality. Findings from this study point to ways in which dashboard design might be improved to optimize use and impact in different contexts; this includes using data meaningful to stakeholders in the co-design process and actively engaging staff knowledgeable about current data use and routines in the scrutiny of the dashboard metrics and functions. In addition, consideration should be given to the processes of data collection and upload that underpin the quality of the data visualized and consequently its potential to stimulate quality improvement. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033208 %M 34817384 %R 10.2196/28854 %U https://www.jmir.org/2021/11/e28854 %U https://doi.org/10.2196/28854 %U http://www.ncbi.nlm.nih.gov/pubmed/34817384 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e24332 %T Implementation Outcome Scales for Digital Mental Health (iOSDMH): Scale Development and Cross-sectional Study %A Sasaki,Natsu %A Obikane,Erika %A Vedanthan,Rajesh %A Imamura,Kotaro %A Cuijpers,Pim %A Shimazu,Taichi %A Kamada,Masamitsu %A Kawakami,Norito %A Nishi,Daisuke %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3521, d-nishi@m.u-tokyo.ac.jp %K implementation outcomes %K acceptability %K appropriateness %K feasibility %K harm %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions are being used more than ever for the prevention and treatment of psychological problems. Optimizing the implementation aspects of digital mental health is essential to deliver the program to populations in need, but there is a lack of validated implementation outcome measures for digital mental health interventions. Objective: The primary aim of this study is to develop implementation outcome scales of digital mental health for different levels of stakeholders involved in the implementation process: users, providers, and managers or policy makers. The secondary aim is to validate the developed scale for users. Methods: We developed English and Japanese versions of the implementation outcome scales for digital mental health (iOSDMH) based on the literature review and panel discussions with experts in implementation research and web-based psychotherapy. The study developed acceptability, appropriateness, feasibility, satisfaction, and harm as the outcome measures for users, providers, and managers or policy makers. We conducted evidence-based interventions via the internet using UTSMeD, a website for mental health information (N=200). Exploratory factor analysis (EFA) was conducted to assess the structural validity of the iOSDMH for users. Satisfaction, which consisted of a single item, was not included in the EFA. Results: The iOSDMH was developed for users, providers, and managers or policy makers. The iOSDMH contains 19 items for users, 11 items for providers, and 14 items for managers or policy makers. Cronbach α coefficients indicated intermediate internal consistency for acceptability (α=.665) but high consistency for appropriateness (α=.776), feasibility (α=.832), and harm (α=.777) of the iOSDMH for users. EFA revealed 3-factor structures, indicating acceptability and appropriateness as close concepts. Despite the similarity between these 2 concepts, we inferred that acceptability and appropriateness should be used as different factors, following previous studies. Conclusions: We developed iOSDMH for users, providers, and managers. Psychometric assessment of the scales for users demonstrated acceptable reliability and validity. Evaluating the components of digital mental health implementation is a major step forward in implementation science. %M 34817391 %R 10.2196/24332 %U https://formative.jmir.org/2021/11/e24332 %U https://doi.org/10.2196/24332 %U http://www.ncbi.nlm.nih.gov/pubmed/34817391 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30485 %T Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study %A Paré,Guy %A Raymond,Louis %A Castonguay,Alexandre %A Grenier Ouimet,Antoine %A Trudel,Marie-Claude %+ Department of Information Technologies, HEC Montréal, 3000, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 2A7, Canada, 1 514 340 6812, alexandre.castonguay@hec.ca %K medical appointment scheduling system %K electronic booking %K e-booking %K primary care %K accessibility of care %K availability of care %K advance access %K electronic medical record %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 34783670 %R 10.2196/30485 %U https://medinform.jmir.org/2021/11/e30485 %U https://doi.org/10.2196/30485 %U http://www.ncbi.nlm.nih.gov/pubmed/34783670 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e31037 %T Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework %A Yakovchenko,Vera %A McInnes,D Keith %A Petrakis,Beth Ann %A Gillespie,Chris %A Lipschitz,Jessica M %A McCullough,Megan B %A Richardson,Lorilei %A Vetter,Brian %A Hogan,Timothy P %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 3374, vera.yakovchenko@va.gov %K implementation science %K implementation facilitation %K texting %K veterans %K eHealth %K self-management %K digital health %K digital medicine %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective: We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods: Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results: We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions: VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration: ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 %M 34779779 %R 10.2196/31037 %U https://mhealth.jmir.org/2021/11/e31037 %U https://doi.org/10.2196/31037 %U http://www.ncbi.nlm.nih.gov/pubmed/34779779 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e31527 %T The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study %A Burmann,Anja %A Tischler,Max %A Faßbach,Mira %A Schneitler,Sophie %A Meister,Sven %+ Fraunhofer Institute for Software and Systems Engineering, Emil-Figge-Str 91, Dortmund, 44227, Germany, 49 2319 7677435, anja.burmann@isst.fraunhofer.de %K digitalization %K digital transformation %K health care %K human factor %K physicians %K digital natives %K web-based survey %K digital health %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Digitalization affects all areas of society, including the health care sector. However, the digitalization of health care provision is progressing slowly compared to other sectors. In the professional and political literature, physicians are partially portrayed as digitalization sceptics. Thus, the role of physicians in this process requires further investigation. The theory of “digital natives” suggests a lower hurdle for younger generations to engage with digital technologies. Objective: The objective of this study was to investigate the role of physicians in the process of digitalizing health care provision in Germany and to assess the age factor. Methods: We conducted a large-scale study to assess the role of this professional group in the progress of the digital transformation of the German health care sector. Therefore, in an anonymous online survey, we inquired about the current digital penetration of the personal working environment, expectations, attitude toward, and concerns regarding digitalization. Based on these data, we studied associations with the nominal variable age and variations across 2 age groups. Results: The 1274 participants included in the study generally showed a high affinity towards digitalization with a mean of 3.88 on a 5-point Likert scale; 723 respondents (56.75%) stated they personally use mobile apps in their everyday working life, with a weak tendency to be associated with the respondents’ age (η=0.26). Participants saw the most noticeable existing benefits through digitalization in data quality and readability (882/1274, 69.23%) and the least in patient engagement (213/1274, 16.72%). Medical practitioners preponderantly expect further improvements through increased digitalization across almost all queried areas but the most in access to medical knowledge (1136/1274, 89.17%), treatment of orphan diseases (1016/1274, 79.75%), and medical research (1023/1274, 80.30%). Conclusions: Respondents defined their role in the digitalization of health care provision as ambivalent: “scrutinizing” on the one hand but “active” and “open” on the other. A gap between willingness to participate and digital sovereignty was indicated. Thus, education on digitalization as a means to support health care provision should not only be included in the course of study but also in the continuing process of further and advanced training. %M 34545813 %R 10.2196/31527 %U https://medinform.jmir.org/2021/11/e31527 %U https://doi.org/10.2196/31527 %U http://www.ncbi.nlm.nih.gov/pubmed/34545813 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30356 %T Health Information Needs of Young Chinese People Based on an Online Health Community: Topic and Statistical Analysis %A Wang,Jie %A Wang,Xin %A Wang,Lei %A Peng,Yan %+ School of Management, Capital Normal University, No. 56 Xisanhuan North Rd, Haidian District, Beijing, 100089, China, 86 01068901018, wangjie@cnu.edu.cn %K information needs %K young people %K online health community %K topic analysis %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The internet has been widely accessible and well accepted by young people; however, there is a limited understanding of the internet usage patterns and characteristics on issues related to health problems. The contents posted on online health communities (OHCs) are valuable resources to learn about youth's health information needs. Objective: In this study, we concurrently exploited statistical analysis and topic analysis of online health information needs to explore the distribution, impact factors, and topics of interest relevant to Chinese young people. Methods: We collected 60,478 health-related data sets posted by young people from a well-known Chinese OHC named xywy.com. Descriptive statistical analysis and correlation analysis were applied to find the distribution and influence factors of the information needs of Chinese young people. Furthermore, a general 4-step topic mining strategy was presented for sparse short texts, which included sentence vectorization, dimension reduction, clustering, and keyword generation. Results: In the Chinese OHC, Chinese young people had a high demand for information in the areas of gynecology and obstetrics, internal medicine, dermatology, plastic surgery, and surgery, and they focused on topics such as treatment, symptoms, causes, pathology, and diet. Females accounted for 69.67% (42,136/60,478) and young adults accounted for 87.44% (52,882/60,478) of all data. Gender, age, and disease type all had a significant effect on young people's information needs and topic preferences (P<.001). Conclusions: We conducted comprehensive analyses to discover the online health information needs of Chinese young people. The research findings are of great practical value to carry out health education and health knowledge dissemination inside and outside of schools according to the interests of youth, enable the innovation of information services in OHCs, and improve the health literacy of young people. %M 34747707 %R 10.2196/30356 %U https://medinform.jmir.org/2021/11/e30356 %U https://doi.org/10.2196/30356 %U http://www.ncbi.nlm.nih.gov/pubmed/34747707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25159 %T The Sociological Perspective of Users’ Invisible Work: A Qualitative Research Framework for Studying Digital Health Innovations Integration %A Trupia,Dilara Vanessa %A Mathieu-Fritz,Alexandre %A Duong,Tu Anh %+ LATTS, Univ Gustave Eiffel, CNRS, Ecole des Ponts, 5 boulevard Descartes, Cité Descartes, Bâtiment Bois de l’Etang, Marne-la-Vallée, F-77454, France, 33 618635423, dilaratrupia@gmail.com %K digital health innovations %K qualitative analysis %K sociological framework %K invisible work %K patient work %K user work %K participatory health care %K chronic illness %K self-quantification %D 2021 %7 4.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: When new technology is integrated into a care pathway, it faces resistance due to the changes it introduces into the existing context. To understand the success or failure of digital health innovations, it is necessary to pay attention to the adjustments that users must perform to make them work, by reshaping the context and sometimes by altering the ways in which they perform activities. This adaptation work, most of which remains invisible, constitutes an important factor in the success of innovations and the ways in which they transform care practices. Objective: This work aims to present a sociological framework for studying new health technology uses through a qualitative analysis of the different types of tasks and activities that users, both health professionals and patients, must perform to integrate these technologies and make them work in their daily routine. Methods: This paper uses a three-part method to structure a theoretical model to study users’ invisible work. The first part of the method includes a thematic literature review, previously published by one of the coauthors, of major sociological studies conducted on digital health innovations integration into existing care organizations and practices. The second part extends this review to introduce definitions and applications of the users’ invisible work concept. The third part consists of producing a theoretical framework to study the concept according to the different contexts and practices of the users. Results: The paper proposes four dimensions (organizational, interactional, practical, and experiential), each composed of a set of criteria that allow a comparative analysis of different users’ work according to different health technologies. Conclusions: This framework can be applied both as an analytical tool in a research protocol and as an agenda to identify less visible adoption criteria for digital health technologies. %M 34734832 %R 10.2196/25159 %U https://www.jmir.org/2021/11/e25159 %U https://doi.org/10.2196/25159 %U http://www.ncbi.nlm.nih.gov/pubmed/34734832 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31408 %T Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study %A Golz,Christoph %A Peter,Karin Anne %A Müller,Thomas Jörg %A Mutschler,Jochen %A Zwakhalen,Sandra M G %A Hahn,Sabine %+ Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, Bern, 3008, Switzerland, 41 0318484591, christoph.golz@bfh.ch %K technostress %K digital competence %K psychiatry %K health professionals %K multiple regression %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Psychiatric hospitals are becoming increasingly digitized because of the disruptive rise in technical possibilities. This digitization leads to new tasks and demands for health professionals, which can have an impact on technostress. It is unclear whether digital competence reduces technostress and how technostress affects health professionals’ mental and physical health. Objective: This study aims to assess the association between digital competence and technostress, considering individual characteristics and the association between technostress and long-term consequences for health professionals. Methods: Cross-sectional data from 3 Swiss psychiatric hospitals were analyzed using multiple linear regression. The dependent variables for the models were digital competence, technostress, and long-term consequences (intention to leave the organization or the profession, burnout symptoms, job satisfaction, general health status, quality of sleep, headaches, and work ability). One model was calculated for each long-term consequence. The mean scores for technostress and digital competence could range between 0 (fully disagree) and 4 (fully agree), where a high value for technostress indicated high technostress and a high value for digital competence indicated high digital competence. Results: The sample comprised 493 health professionals in psychiatric hospitals. They rated their technostress as moderate (mean 1.30, SD 0.55) and their digital competence as high (mean 2.89, SD 0.73). Digital competence was found to be significantly associated with technostress (β=−.20; P<.001). Among the individual characteristics, age (β=.004; P=.03) and profession were significantly associated with both digital competence and technostress. Technostress is a relevant predictor of burnout symptoms (β=10.32; P<.001), job satisfaction (β=−6.08; P<.001), intention to leave the profession (β=4.53; P=.002), organization (β=7.68; P<.001), general health status (β=−4.47; P<.001), quality of sleep (β=−5.87; P<.001), headaches (β=6.58; P<.001), and work ability (β=−1.40; P<.001). Conclusions: Physicians and nurses who have more interaction with digital technologies rate their technostress higher and their digital competence lower than those in other professions. Health professionals with low interaction with digital technologies appear to overestimate their digital competence. With increasing digitization in psychiatric hospitals, an increase in the relevance of this topic is expected. Educational organizations and psychiatric hospitals should proactively promote the digital competence of health professionals to manage expected disruptive changes. %M 34734840 %R 10.2196/31408 %U https://mental.jmir.org/2021/11/e31408 %U https://doi.org/10.2196/31408 %U http://www.ncbi.nlm.nih.gov/pubmed/34734840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30637 %T Factors Affecting the Extent of Patients’ Electronic Medical Record Use: An Empirical Study Focusing on System and Patient Characteristics %A Agrawal,Lavlin %A Ndabu,Theophile %A Mulgund,Pavankumar %A Sharman,Raj %+ The State University of New York at Buffalo, School of Management, 160 Jacobs Management Center, Buffalo, NY, 14260-4000, United States, 1 (716) 645 3204, lavlinag@buffalo.edu %K electronic medical record %K patient safety %K caregiver %K chronic conditions %K HINTS dataset %K patient technology acceptance model %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ access to and use of electronic medical records (EMRs) places greater information in their hands, which helps them better comanage their health, leading to better clinical outcomes. Despite numerous benefits that promote health and well-being, patients’ acceptance and use of EMRs remains low. We study the impact of predictors that affect the use of EMR by patients to understand better the underlying causal factors for the lower use of EMR. Objective: This study aims to examine the critical system (eg, performance expectancy and effort expectancy) and patient characteristics (eg, health condition, issue involvement, preventive health behaviors, and caregiving status) that influence the extent of patients’ EMR use. Methods: We used secondary data collected by Health Information National Trends Survey 5 cycle 3 and performed survey data analysis using structural equation modeling technique to test our hypotheses. Structural equation modeling is a technique commonly used to measure and analyze the relationships of observed and latent variables. We also addressed common method bias to understand if there was any systematic effect on the observed correlation between the measures for the predictor and predicted variables. Results: The statistically significant drivers of the extent of EMR use were performance expectancy (β=.253; P<.001), perceived behavior control (β=.236; P<.001), health knowledge (β=–.071; P=.007), caregiving status (β=.059; P=.013), issue involvement (β=.356; P<.001), chronic conditions (β=.071; P=.016), and preventive health behavior (β=.076; P=.005). The model accounted for 32.9% of the variance in the extent of EMR use. Conclusions: The study found that health characteristics, such as chronic conditions and patient disposition (eg, preventive health behavior and issue involvement), directly affect the extent of EMR use. The study also revealed that issue involvement mediates the impact of preventive health behaviors and the presence of chronic conditions on the extent of patients’ EMR use. %M 34709181 %R 10.2196/30637 %U https://www.jmir.org/2021/10/e30637 %U https://doi.org/10.2196/30637 %U http://www.ncbi.nlm.nih.gov/pubmed/34709181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28924 %T Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study %A Fujioka,Jamie Keiko %A Bickford,Julia %A Gritke,Jennifer %A Stamenova,Vess %A Jamieson,Trevor %A Bhatia,R Sacha %A Desveaux,Laura %+ Women's College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville St, Room 6319, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, laura.desveaux@wchospital.ca %K patient portal %K electronic health record %K patient health record %K digital health %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. Objective: This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. Methods: This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. Results: Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. Conclusions: Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement. %M 34709195 %R 10.2196/28924 %U https://www.jmir.org/2021/10/e28924 %U https://doi.org/10.2196/28924 %U http://www.ncbi.nlm.nih.gov/pubmed/34709195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28096 %T The Transition to an Entirely Digital Immunization Registry in Ha Noi Province and Son La Province, Vietnam: Readiness Assessment Study %A Duong,Hong %A Dao,Sang %A Dang,Huyen %A Nguyen,Linh %A Ngo,Tuan %A Nguyen,Trung %A Tran,Lan Anh %A Nguyen,Doan %A Rivera,Maya %A Nguyen,Nga %+ PATH Vietnam, #1101, 11th floor, Hanoi Towers, 49 Hai Ba Trung Street, Hoan Kiem District, Hanoi, 100000, Vietnam, 84 024 3936 2215 ext 130, ntnguyen@path.org %K immunizations %K immunization registry %K readiness assessment %K electronic immunization records %K Vietnam %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Vietnam is one of the first low- to middle-income countries to develop and implement a national-scale electronic immunization registry. This system was finalized into the National Immunization Information System (NIIS) and scaled up to a national-level system in 2017. As a result, immunization coverage and the timeliness of vaccinations have drastically improved. The time spent on planning and reporting vaccinations has drastically reduced; as a result, vaccination planning and reporting has become more accurate and effective. However, to date, end users have been tasked with managing both the NIIS and paper-based systems in parallel until a formal assessment of the readiness to fully transition to the NIIS is conducted. Objective: This study aims to evaluate the readiness to move to an entirely digital NIIS in 2 provinces of Vietnam—Ha Noi and Son La. Methods: All health facilities were surveyed to assess their infrastructure, capacity, and need for human resources. NIIS end users were observed and interviewed to evaluate their NIIS knowledge and skill sets. Data from immunization cards and facility paper-based logbooks were compared with data from the NIIS, and vaccine stocks at selected facilities were tallied and compared with data from the NIIS. Results: Of the 990 health facilities evaluated, most used the NIIS to enter and track immunizations (987/990, 99.7%) and vaccine stocks (889/990, 90.8%). Most had stable electricity (971/990, 98.1%), at least 1 computer (986/990, 99.6%), and ≥2 trained NIIS end users (825/990, 83.3%). End users reported that the NIIS supported them in managing and reporting immunization data and saving them time (725/767, 94.5%). Although many end users were able to perform basic skills, almost half struggled with performing more complex tasks. Immunization data were compiled from the NIIS and immunization cards (338/378, 89.4%) and paper-based logbooks (254/269, 94.4%). However, only 54.5% (206/378) of immunization IDs matched, 57% (13/23) of Bacillus Calmette-Guérin vaccination records were accurate, and 70% (21/30) of the facilities had consistent physical vaccine stock balances. The feedback received from NIIS end users suggests that more supportive supervision, frequent refresher training for strengthening their skill sets, and detailed standardized guides for improving data quality are needed. Conclusions: The readiness to transition to a digital system is promising; however, additional resources are required to address the timeliness, completeness, and accuracy of the data. %M 34694232 %R 10.2196/28096 %U https://formative.jmir.org/2021/10/e28096 %U https://doi.org/10.2196/28096 %U http://www.ncbi.nlm.nih.gov/pubmed/34694232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e33113 %T Medical Students’ Perceptions of a Blockchain-Based Decentralized Work History and Credentials Portfolio: Qualitative Feasibility Study %A Hasselgren,Anton %A Kralevska,Katina %A Gligoroski,Danilo %A Faxvaag,Arild %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Mellomila 71, Trondheim, 7018, Norway, 47 46948498, anton.hasselgren@ntnu.no %K blockchain %K eHealth %K qualitative research %K VerifyMed %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Increased digitization of health care might challenge some of the trust functions that are established in a traditional health care system. We have, with the concept of VerifyMed, developed a decentralized service for work history and competence verification, as a means to increase trust in the virtual interaction between a patient and a caregiver, mitigate administrative burden, and provide patient-reported outcomes seamlessly for health professionals. Objective: This research aimed to validate the use case of a decentralized credentials service for health care professionals in Norway. We also aimed to evaluate the proof-of-concept of VerifyMed, a blockchain-based credential service for health care professionals. Methods: A qualitative approach was applied with data collection through 9 semistructured interviews and 2 focus groups (one with 4 participants and the other with 5 participants). The System Usability Scale (SUS) was used as a part of the interviews. Data were analyzed through the principles of systematic text condensation. The recruitment of participants ended when it was concluded that the data had reached saturation. Results: The following 5 themes were identified from the interviews and focus groups: (1) the need for aggregated storage of work- and study-related verification, (2) trust in a virtual health care environment, (3) the potential use of patient feedback, (4) trust in blockchain technology, and (5) improvements of the VerifyMed concept. The SUS questionnaire gave a score of 69.7. Conclusions: This study has validated the need for a decentralized system where health care professionals can control their credentials and, potentially, their reputation. Future work should update the VerifyMed system according to this input. We concluded that a decentralized system for the storage of work-related verifiable credentials could increase trust in a virtualized health care system. %M 34677137 %R 10.2196/33113 %U https://formative.jmir.org/2021/10/e33113 %U https://doi.org/10.2196/33113 %U http://www.ncbi.nlm.nih.gov/pubmed/34677137 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31582 %T Health Care Providers’ Acceptance of a Personal Health Record: Cross-sectional Study %A Yousef,Consuela Cheriece %A Salgado,Teresa M %A Farooq,Ali %A Burnett,Keisha %A McClelland,Laura E %A Abu Esba,Laila Carolina %A Alhamdan,Hani Solaiman %A Khoshhal,Sahal %A Aldossary,Ibrahim Fahad %A Alyas,Omar Anwar %A DeShazo,Jonathan P %+ Pharmaceutical Care Department, Ministry of National Guard Health Affairs, P.O. Box 4616, Dammam, 31412, Saudi Arabia, 966 8532555, consuela_73@hotmail.com %K personal health records %K patient portals %K Ministry of National Guard Health Affairs %K UTAUT %K eHealth %K Middle East %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs’ acceptance of PHRs in the Kingdom of Saudi Arabia. Objective: The aim of this study was to identify predictors of HCPs’ acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. Methods: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. Results: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (β=.17, P=.03) and attitude (β=.61, P<.01). No moderating effects were present. Conclusions: This study identified performance expectancy and attitude as predictors of HCPs’ behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors. %M 34569943 %R 10.2196/31582 %U https://www.jmir.org/2021/10/e31582 %U https://doi.org/10.2196/31582 %U http://www.ncbi.nlm.nih.gov/pubmed/34569943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29301 %T Adoption of Machine Learning Systems for Medical Diagnostics in Clinics: Qualitative Interview Study %A Pumplun,Luisa %A Fecho,Mariska %A Wahl,Nihal %A Peters,Felix %A Buxmann,Peter %+ Software & Digital Business Group, Technical University of Darmstadt, Hochschulstraße 1, Darmstadt, 64289, Germany, 49 6151 16 24221, luisa.pumplun@tu-darmstadt.de %K machine learning %K clinics %K diagnostics %K adoption %K maturity model %D 2021 %7 15.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Recently, machine learning (ML) has been transforming our daily lives by enabling intelligent voice assistants, personalized support for purchase decisions, and efficient credit card fraud detection. In addition to its everyday applications, ML holds the potential to improve medicine as well, especially with regard to diagnostics in clinics. In a world characterized by population growth, demographic change, and the global COVID-19 pandemic, ML systems offer the opportunity to make diagnostics more effective and efficient, leading to a high interest of clinics in such systems. However, despite the high potential of ML, only a few ML systems have been deployed in clinics yet, as their adoption process differs significantly from the integration of prior health information technologies given the specific characteristics of ML. Objective: This study aims to explore the factors that influence the adoption process of ML systems for medical diagnostics in clinics to foster the adoption of these systems in clinics. Furthermore, this study provides insight into how these factors can be used to determine the ML maturity score of clinics, which can be applied by practitioners to measure the clinic status quo in the adoption process of ML systems. Methods: To gain more insight into the adoption process of ML systems for medical diagnostics in clinics, we conducted a qualitative study by interviewing 22 selected medical experts from clinics and their suppliers with profound knowledge in the field of ML. We used a semistructured interview guideline, asked open-ended questions, and transcribed the interviews verbatim. To analyze the transcripts, we first used a content analysis approach based on the health care–specific framework of nonadoption, abandonment, scale-up, spread, and sustainability. Then, we drew on the results of the content analysis to create a maturity model for ML adoption in clinics according to an established development process. Results: With the help of the interviews, we were able to identify 13 ML-specific factors that influence the adoption process of ML systems in clinics. We categorized these factors according to 7 domains that form a holistic ML adoption framework for clinics. In addition, we created an applicable maturity model that could help practitioners assess their current state in the ML adoption process. Conclusions: Many clinics still face major problems in adopting ML systems for medical diagnostics; thus, they do not benefit from the potential of these systems. Therefore, both the ML adoption framework and the maturity model for ML systems in clinics can not only guide future research that seeks to explore the promises and challenges associated with ML systems in a medical setting but also be a practical reference point for clinicians. %M 34652275 %R 10.2196/29301 %U https://www.jmir.org/2021/10/e29301 %U https://doi.org/10.2196/29301 %U http://www.ncbi.nlm.nih.gov/pubmed/34652275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25646 %T Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care %A Cohen Rodrigues,Talia R %A de Buisonjé,David R %A Keesman,Mike %A Reijnders,Thomas %A van der Geer,Jessica E %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Atsma,Douwe E %A Evers,Andrea W M %+ Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 71 527 3627, t.r.cohen.rodrigues@fsw.leidenuniv.nl %K eHealth %K digital health %K cardiovascular disease %K cardiac care %K lifestyle change %K lifestyle support %K intervention %K health care professionals %K implementation %K interview %K facilitators %K barriers %D 2021 %7 15.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people’s life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers. Objective: This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD. Methods: In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care. Results: We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth. Conclusions: HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care. %M 34652280 %R 10.2196/25646 %U https://www.jmir.org/2021/10/e25646 %U https://doi.org/10.2196/25646 %U http://www.ncbi.nlm.nih.gov/pubmed/34652280 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30940 %T Accelerating the Appropriate Adoption of Artificial Intelligence in Health Care: Protocol for a Multistepped Approach %A Wiljer,David %A Salhia,Mohammad %A Dolatabadi,Elham %A Dhalla,Azra %A Gillan,Caitlin %A Al-Mouaswas,Dalia %A Jackson,Ethan %A Waldorf,Jacqueline %A Mattson,Jane %A Clare,Megan %A Lalani,Nadim %A Charow,Rebecca %A Balakumar,Sarmini %A Younus,Sarah %A Jeyakumar,Tharshini %A Peteanu,Wanda %A Tavares,Walter %+ University Health Network, 190 Elizabeth Street, R Fraser Elliot Building RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.wiljer@uhn.ca %K artificial intelligence %K health care providers %K education %K learning %K patient care %K adoption %K mHealth %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Significant investments and advances in health care technologies and practices have created a need for digital and data-literate health care providers. Artificial intelligence (AI) algorithms transform the analysis, diagnosis, and treatment of medical conditions. Complex and massive data sets are informing significant health care decisions and clinical practices. The ability to read, manage, and interpret large data sets to provide data-driven care and to protect patient privacy are increasingly critical skills for today’s health care providers. Objective: The aim of this study is to accelerate the appropriate adoption of data-driven and AI-enhanced care by focusing on the mindsets, skillsets, and toolsets of point-of-care health providers and their leaders in the health system. Methods: To accelerate the adoption of AI and the need for organizational change at a national level, our multistepped approach includes creating awareness and capacity building, learning through innovation and adoption, developing appropriate and strategic partnerships, and building effective knowledge exchange initiatives. Education interventions designed to adapt knowledge to the local context and address any challenges to knowledge use include engagement activities to increase awareness, educational curricula for health care providers and leaders, and the development of a coaching and practice-based innovation hub. Framed by the Knowledge-to-Action framework, we are currently in the knowledge creation stage to inform the curricula for each deliverable. An environmental scan and scoping review were conducted to understand the current state of AI education programs as reported in the academic literature. Results: The environmental scan identified 24 AI-accredited programs specific to health providers, of which 11 were from the United States, 6 from Canada, 4 from the United Kingdom, and 3 from Asian countries. The most common curriculum topics across the environmental scan and scoping review included AI fundamentals, applications of AI, applied machine learning in health care, ethics, data science, and challenges to and opportunities for using AI. Conclusions: Technologies are advancing more rapidly than organizations, and professionals can adopt and adapt to them. To help shape AI practices, health care providers must have the skills and abilities to initiate change and shape the future of their discipline and practices for advancing high-quality care within the digital ecosystem. International Registered Report Identifier (IRRID): PRR1-10.2196/30940 %M 34612839 %R 10.2196/30940 %U https://www.researchprotocols.org/2021/10/e30940 %U https://doi.org/10.2196/30940 %U http://www.ncbi.nlm.nih.gov/pubmed/34612839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24200 %T Sharing Government Health Data With the Private Sector: Community Attitudes Survey %A Braunack-Mayer,Annette %A Fabrianesi,Belinda %A Street,Jackie %A O'Shaughnessy,Pauline %A Carter,Stacy M %A Engelen,Lina %A Carolan,Lucy %A Bosward,Rebecca %A Roder,David %A Sproston,Kylie %+ Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4298 1228, abmayer@uow.edu.au %K big data %K health information systems %K health data %K private sector %K data linkage %K public opinion %K consent %K trust %K public interest %K social license %D 2021 %7 1.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of government health data for secondary purposes, such as monitoring the quality of hospital services, researching the health needs of populations, and testing how well new treatments work, is increasing. This increase in the secondary uses of health data has led to increased interest in what the public thinks about data sharing, in particular, the possibilities of sharing with the private sector for research and development. Although international evidence demonstrates broad public support for the secondary use of health data, this support does not extend to sharing health data with the private sector. If governments intend to share health data with the private sector, knowing what the public thinks will be important. This paper reports a national survey to explore public attitudes in Australia toward sharing health data with private companies for research on and development of therapeutic drugs and medical devices. Objective: This study aims to explore public attitudes in Australia toward sharing government health data with the private sector. Methods: A web-based survey tool was developed to assess attitudes about sharing government health data with the private sector. A market research company was employed to administer the web-based survey in June 2019. Results: The survey was completed by 2537 individuals residing in Australia. Between 51.8% and 57.98% of all participants were willing to share their data, with slightly fewer in favor of sharing to improve health services (51.99%) and a slightly higher proportion in favor of sharing for research and development (57.98%). There was a preference for opt-in consent (53.44%) and broad support for placing conditions on sharing health information with private companies (62% to 91.99%). Wide variability was also observed in participants’ views about the extent to which the private sector could be trusted and how well they would behave if entrusted with people’s health information. In their qualitative responses, the participants noted concerns about private sector corporate interests, corruption, and profit making and expressed doubt about the Australian government’s capacity to manage data sharing safely. The percentages presented are adjusted against the Australian population. Conclusions: This nationally representative survey provides preliminary evidence that Australians are uncertain about sharing their health data with the private sector. Although just over half of all the respondents supported sharing health data with the private sector, there was also strong support for strict conditions on sharing data and for opt-in consent and significant concerns about how well the private sector would manage government health data. Addressing public concern about sharing government health data with the private sector will require more and better engagement to build community understanding about how agencies can collect, share, protect, and use their personal data. %M 34596573 %R 10.2196/24200 %U https://www.jmir.org/2021/10/e24200 %U https://doi.org/10.2196/24200 %U http://www.ncbi.nlm.nih.gov/pubmed/34596573 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27122 %T Radiation Oncologists’ Perceptions of Adopting an Artificial Intelligence–Assisted Contouring Technology: Model Development and Questionnaire Study %A Zhai,Huiwen %A Yang,Xin %A Xue,Jiaolong %A Lavender,Christopher %A Ye,Tiantian %A Li,Ji-Bin %A Xu,Lanyang %A Lin,Li %A Cao,Weiwei %A Sun,Ying %+ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, Guangzhou, 510060, China, 86 02087343066, sunying@sysucc.org.cn %K artificial intelligence %K technology acceptance model %K intension %K resistance %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: An artificial intelligence (AI)–assisted contouring system benefits radiation oncologists by saving time and improving treatment accuracy. Yet, there is much hope and fear surrounding such technologies, and this fear can manifest as resistance from health care professionals, which can lead to the failure of AI projects. Objective: The objective of this study was to develop and test a model for investigating the factors that drive radiation oncologists’ acceptance of AI contouring technology in a Chinese context. Methods: A model of AI-assisted contouring technology acceptance was developed based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model by adding the variables of perceived risk and resistance that were proposed in this study. The model included 8 constructs with 29 questionnaire items. A total of 307 respondents completed the questionnaires. Structural equation modeling was conducted to evaluate the model’s path effects, significance, and fitness. Results: The overall fitness indices for the model were evaluated and showed that the model was a good fit to the data. Behavioral intention was significantly affected by performance expectancy (β=.155; P=.01), social influence (β=.365; P<.001), and facilitating conditions (β=.459; P<.001). Effort expectancy (β=.055; P=.45), perceived risk (β=−.048; P=.35), and resistance bias (β=−.020; P=.63) did not significantly affect behavioral intention. Conclusions: The physicians’ overall perceptions of an AI-assisted technology for radiation contouring were high. Technology resistance among Chinese radiation oncologists was low and not related to behavioral intention. Not all of the factors in the Venkatesh UTAUT model applied to AI technology adoption among physicians in a Chinese context. %M 34591029 %R 10.2196/27122 %U https://www.jmir.org/2021/9/e27122 %U https://doi.org/10.2196/27122 %U http://www.ncbi.nlm.nih.gov/pubmed/34591029 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 9 %P e18471 %T Defining Patient-Oriented Natural Language Processing: A New Paradigm for Research and Development to Facilitate Adoption and Use by Medical Experts %A Sarker,Abeed %A Al-Garadi,Mohammed Ali %A Yang,Yuan-Chi %A Choi,Jinho %A Quyyumi,Arshed A %A Martin,Greg S %+ Department of Biomedical Informatics, School of Medicine, Emory University, 101 Woodruff Circle, Office 4101, Atlanta, GA, 30322, United States, 1 404 712 0055, abeed@dbmi.emory.edu %K natural language processing %K text mining %K patient-centered care %K evidence-based medicine %K medical informatics %D 2021 %7 28.9.2021 %9 Viewpoint %J JMIR Med Inform %G English %X The capabilities of natural language processing (NLP) methods have expanded significantly in recent years, and progress has been particularly driven by advances in data science and machine learning. However, NLP is still largely underused in patient-oriented clinical research and care (POCRC). A key reason behind this is that clinical NLP methods are typically developed, optimized, and evaluated with narrowly focused data sets and tasks (eg, those for the detection of specific symptoms in free texts). Such research and development (R&D) approaches may be described as problem oriented, and the developed systems perform specialized tasks well. As standalone systems, however, they generally do not comprehensively meet the needs of POCRC. Thus, there is often a gap between the capabilities of clinical NLP methods and the needs of patient-facing medical experts. We believe that to increase the practical use of biomedical NLP, future R&D efforts need to be broadened to a new research paradigm—one that explicitly incorporates characteristics that are crucial for POCRC. We present our viewpoint about 4 such interrelated characteristics that can increase NLP systems’ suitability for POCRC (3 that represent NLP system properties and 1 associated with the R&D process)—(1) interpretability (the ability to explain system decisions), (2) patient centeredness (the capability to characterize diverse patients), (3) customizability (the flexibility for adapting to distinct settings, problems, and cohorts), and (4) multitask evaluation (the validation of system performance based on multiple tasks involving heterogeneous data sets). By using the NLP task of clinical concept detection as an example, we detail these characteristics and discuss how they may result in the increased uptake of NLP systems for POCRC. %M 34581670 %R 10.2196/18471 %U https://medinform.jmir.org/2021/9/e18471 %U https://doi.org/10.2196/18471 %U http://www.ncbi.nlm.nih.gov/pubmed/34581670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27285 %T Assessment of the Quality Management System for Clinical Nutrition in Jiangsu: Survey Study %A Wang,Jin %A Pan,Chen %A Ma,Xianghua %+ First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China, 86 17625989728, yixingpanchen@163.com %K quality management system %K human resource management %K artificial intelligence %K online health %K health science %K clinical nutrition %K online platform %K health platform %K nutrition %K patient education %K dietitian %D 2021 %7 27.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions. Objective: This study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control. Methods: The participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information. Results: A total of 330 questionnaires were collected, with a response rate of 96.77% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8% from 2018 to 2020) and the significant growth of dietitians (t93.4=–0.42; P=.02) both show the advancements of the QMSNJ. Conclusions: As the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future. %M 34569942 %R 10.2196/27285 %U https://formative.jmir.org/2021/9/e27285 %U https://doi.org/10.2196/27285 %U http://www.ncbi.nlm.nih.gov/pubmed/34569942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28869 %T Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review %A Hopstaken,Jana S %A Verweij,Lynn %A van Laarhoven,Cees J H M %A Blijlevens,Nicole M A %A Stommel,Martijn W J %A Hermens,Rosella P M G %+ Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, 6525 GA, Netherlands, 31 024 36 680 86, jana.hopstaken@radboudumc.nl %K digital care platforms %K cancer care %K eHealth %K telemedicine %K health care services %K fragmentation of care %K health care fragmentation %K oncology %K quality of care %K barriers %K facilitators %K patient experience %D 2021 %7 24.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider–reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. Objective: The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider–reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. Methods: The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. Results: Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. Conclusions: The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels. %M 34559057 %R 10.2196/28869 %U https://www.jmir.org/2021/9/e28869 %U https://doi.org/10.2196/28869 %U http://www.ncbi.nlm.nih.gov/pubmed/34559057 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 9 %P e30322 %T Sociotechnical Drivers and Barriers in the Consumer Adoption of Personal Health Records: Empirical Investigation %A Ruhi,Umar %A Majedi,Armin %A Chugh,Ritesh %+ Business Analytics & Information Systems, Telfer School of Management, University of Ottawa, 55 Laurier East, Ottawa, ON, K1N 6N5, Canada, 1 6135625800 ext 1990, umar.ruhi@uottawa.ca %K electronic personal health records %K PHR %K patient facing information systems %K technology adoption %K technology acceptance %K consumer health informatics %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Increasingly popular in the health care domain, electronic personal health records (PHRs) have the potential to foster engagement toward improving health outcomes, achieving efficiencies in care, and reducing costs. Despite the touted benefits of PHRs, their uptake is lackluster, with low adoption rates. Objective: This paper reports findings from an empirical investigation of the sociotechnical factors affecting the adoption of PHRs. Methods: A research model comprising personal and technological determinants of PHR adoption was developed and validated in this study. Demographic, technographic, and psychographic data pertaining to the use of PHRs were collected through a web-based questionnaire for past, current, and potential users. Partial least squares-based structural equation modeling was used to estimate a structural model of cognitive and affective factors impacting intentions to use PHRs. Results: The analysis revealed that in addition to the expected positive impact of a PHR system’s usefulness and usability, system integration also positively affects consumers’ intention to adopt. The results also suggest that higher levels of perceived usability and integration do not translate into higher levels of perceived usefulness. The study also highlights the importance of subjective norms, technology awareness, and technology anxiety as direct antecedents of the intention to adopt PHRs. The differential effects of the adoption factors are also discussed. Conclusions: We hope that our study will contribute to the understanding of consumer adoption of PHRs and help improve the design and delivery of consumer-centric health care technologies. After discussing the implications for research, we provide suggestions and guidelines for PHR technology developers and constituents in the health care delivery chain. %M 34343106 %R 10.2196/30322 %U https://medinform.jmir.org/2021/9/e30322 %U https://doi.org/10.2196/30322 %U http://www.ncbi.nlm.nih.gov/pubmed/34343106 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28976 %T Building Primary Health Care Personnel’s Support for a Patient Portal While Alleviating eHealth-Related Stress: Survey Study %A Hörhammer,Iiris %A Kujala,Sari %A Hilama,Pirjo %A Heponiemi,Tarja %+ Department of Industrial Engineering and Management, Aalto University, Otaniementie 1, Espoo, 02150, Finland, 358 503430063, iiris.riippa@aalto.fi %K patient portal %K implementation %K adoption %K health care personnel %K eHealth-related stress %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care personnel’s (HCP) engagement in patient portal implementation is necessary in embedding the use of the portal in everyday practices of a health care organization. While portal implementation may raise personnel’s positive expectations of the benefits in patient care, it is often also stressful for them due to increased workloads and disruptions in clinical workflows. An understanding of social and technical factors that build personnel’s support for patient portal implementation and alleviate their eHealth-related stress is therefore needed to realize the full potential of portals. Objective: The aim of this study was to explore the influence of managerial implementation practices, information technology (IT) usability, and personnel’s eHealth competences on support for patient portal implementation and eHealth-related stress among primary HCP. Methods: The data were collected through a survey of 919 members at 2 health organizations in Finland. Linear and logistic regression models were fitted to study the associations between the variables. Results: Professionals’ eHealth competence (β=.15, P<.001), usability (β=.11, P<.001), and implementation practices (β=.07, P<.001) were positively associated with professionals’ support and negatively associated with professionals eHealth-related stress (β=−.07, P=.010; β=−.27, P<.001; and β=−.14, P<.001, respectively). Professionals’ support was associated with their promotion of the portal to the patients (odds ratio 1.22, 95% CI 1.07-1.40). Conclusions: The adoption of appropriate implementation practices and the usability of the technology can build personnel’s support for a patient portal and alleviate their stress related to eHealth. Personnel’s support is manifested in their promotion of the portal to patients. Health care managers are encouraged to consider the usability of the technology and the good implementation practices, such as proper informing, engagement of the personnel in planning the services, and allocation of resources to improve eHealth competence, as prerequisites for meaningful and sustainable use of patient portals. %M 34550087 %R 10.2196/28976 %U https://www.jmir.org/2021/9/e28976 %U https://doi.org/10.2196/28976 %U http://www.ncbi.nlm.nih.gov/pubmed/34550087 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28766 %T A Road Map for Remote Digital Health Technology for Motor Neuron Disease %A van Eijk,Ruben P A %A Beelen,Anita %A Kruitwagen,Esther T %A Murray,Deirdre %A Radakovic,Ratko %A Hobson,Esther %A Knox,Liam %A Helleman,Jochem %A Burke,Tom %A Rubio Pérez,Miguel Ángel %A Reviers,Evy %A Genge,Angela %A Steyn,Frederik J %A Ngo,Shyuan %A Eaglesham,John %A Roes,Kit C B %A van den Berg,Leonard H %A Hardiman,Orla %A McDermott,Christopher J %+ UMC Utrecht Brain Centre, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 88 75 579 39, r.p.a.vaneijk-2@umcutrecht.nl %K amyotrophic lateral sclerosis %K digital health care technology %K e-health %D 2021 %7 22.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X Despite recent and potent technological advances, the real-world implementation of remote digital health technology in the care and monitoring of patients with motor neuron disease has not yet been realized. Digital health technology may increase the accessibility to and personalization of care, whereas remote biosensors could optimize the collection of vital clinical parameters, irrespective of patients’ ability to visit the clinic. To facilitate the wide-scale adoption of digital health care technology and to align current initiatives, we outline a road map that will identify clinically relevant digital parameters; mediate the development of benefit-to-burden criteria for innovative technology; and direct the validation, harmonization, and adoption of digital health care technology in real-world settings. We define two key end products of the road map: (1) a set of reliable digital parameters to capture data collected under free-living conditions that reflect patient-centric measures and facilitate clinical decision making and (2) an integrated, open-source system that provides personalized feedback to patients, health care providers, clinical researchers, and caregivers and is linked to a flexible and adaptable platform that integrates patient data in real time. Given the ever-changing care needs of patients and the relentless progression rate of motor neuron disease, the adoption of digital health care technology will significantly benefit the delivery of care and accelerate the development of effective treatments. %M 34550089 %R 10.2196/28766 %U https://www.jmir.org/2021/9/e28766 %U https://doi.org/10.2196/28766 %U http://www.ncbi.nlm.nih.gov/pubmed/34550089 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26623 %T Barriers and Facilitators to the Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: Qualitative Analysis %A Sarkar,Urmimala %A Lee,Jane E %A Nguyen,Kim H %A Lisker,Sarah %A Lyles,Courtney R %+ Department of Medicine, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, United States, 1 6282064273, urmimala.sarkar@ucsf.edu %K virtual reality %K medical informatics %K information technology %K implementation science %K qualitative research %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior studies have shown that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. However, the majority of these studies were conducted among primarily White, relatively advantaged populations and in well-resourced settings. Objective: We conducted a qualitative, theory-informed implementation science study to assess the readiness for VR in safety-net settings. Methods: Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semistructured interviews with current VR users and nonusers based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform AppliedVR (Los Angeles, CA, USA). We used deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. Results: Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and nonusers identified a lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute, given resource and staffing constraints in safety-net settings. Conclusions: VR for pain management holds interest for frontline pain management clinicians and leadership in safety-net health settings but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and scaling of VR use. %M 34550074 %R 10.2196/26623 %U https://www.jmir.org/2021/9/e26623 %U https://doi.org/10.2196/26623 %U http://www.ncbi.nlm.nih.gov/pubmed/34550074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e17913 %T Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers %A Nowaskie,Dustin Z %+ Department of Psychiatry, Indiana University School of Medicine, 355 W 16th Street, #2364, Indianapolis, IN, 46202, United States, 1 317 963 7307, dznowaskie@gmail.com %K cultural competency %K disparities %K e-health %K healthcare %K internet %K LGBTQ+ %K online platform %K providers %K resources %K eHealth %K health care %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health—a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform—was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. %M 34550083 %R 10.2196/17913 %U https://formative.jmir.org/2021/9/e17913 %U https://doi.org/10.2196/17913 %U http://www.ncbi.nlm.nih.gov/pubmed/34550083 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 9 %P e29374 %T Using a New Model of Electronic Health Record Training to Reduce Physician Burnout: A Plan for Action %A Mohan,Vishnu %A Garrison,Cort %A Gold,Jeffrey A %+ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code BICC, Portland, OR, 97239-3098, United States, 1 5034944469, mohanv@ohsu.edu %K electronic health records %K clinician burnout %K EHR training %K clinician wellness %K after-hours EHR use %K EHR %K patient data %K burnout %K simulation %K efficiency %K optimization %K well-being %D 2021 %7 20.9.2021 %9 Viewpoint %J JMIR Med Inform %G English %X Physician burnout in the United States has been growing at an alarming rate, and health care organizations are beginning to invest significant resources in combating this phenomenon. Although the causes for burnout are multifactorial, a key issue that affects physicians is that they spend a significant proportion of their time interacting with their electronic health record (EHR) system, primarily because of the need to sift through increasing amounts of patient data, coupled with a significant documentation burden. This has led to physicians spending increasing amounts of time with the EHR outside working hours trying to catch up on paperwork (“pajama time”), which is a factor linked to burnout. In this paper, we propose an innovative model of EHR training using high-fidelity EHR simulations designed to facilitate efficient optimization of EHR use by clinicians and emphasize the importance of both lifelong learning and physician well-being. %M 34325400 %R 10.2196/29374 %U https://medinform.jmir.org/2021/9/e29374 %U https://doi.org/10.2196/29374 %U http://www.ncbi.nlm.nih.gov/pubmed/34325400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29085 %T Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study %A Dowthwaite,Liz %A Fischer,Joel %A Perez Vallejos,Elvira %A Portillo,Virginia %A Nichele,Elena %A Goulden,Murray %A McAuley,Derek %+ Horizon Digital Economy Research, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07943583035, liz.dowthwaite@gmail.com %K trust %K technology adoption %K COVID-19 %K digital contact tracing %K coronavirus %K vulnerable populations %K attitudes %K SARS-CoV-2 %K digital proximity tracing %K compliance %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps. %M 34406960 %R 10.2196/29085 %U https://www.jmir.org/2021/9/e29085 %U https://doi.org/10.2196/29085 %U http://www.ncbi.nlm.nih.gov/pubmed/34406960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28518 %T Assessing Professionals’ Adoption Readiness for eMental Health: Development and Validation of the eMental Health Adoption Readiness Scale %A Feijt,Milou A %A de Kort,Yvonne A W %A Westerink,Joyce H D M %A Bierbooms,Joyce J P A %A Bongers,Inge M B %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction Group, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, De Rondom 70, Eindhoven, 5612 AP, Netherlands, 31 40 247 2889, m.a.feijt@tue.nl %K eMental health %K adoption of innovation %K mental health care %K scale development %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals’ readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. Objective: The aim of this study is to develop and validate an instrument for assessing mental health care professionals’ readiness to adopt EMH. Methods: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. Results: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs. Conclusions: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals. %M 34533469 %R 10.2196/28518 %U https://www.jmir.org/2021/9/e28518 %U https://doi.org/10.2196/28518 %U http://www.ncbi.nlm.nih.gov/pubmed/34533469 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e26580 %T Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting %A Aminoff,Hedvig %A Meijer,Sebastiaan %+ Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11 C, Huddinge, Stockholm, 14152, Sweden, 46 8 790 97 64, hedvigam@kth.se %K telemedicine %K telemedicine evaluation %K ERCP %K work domain analysis %K abstraction hierarchy %K complexity %K context %K cognitive systems engineering %D 2021 %7 16.9.2021 %9 Commentary %J JMIR Perioper Med %G English %X Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about how to best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growing interest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation. This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key to understanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where a telemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modeling can provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings. %M 34528894 %R 10.2196/26580 %U https://periop.jmir.org/2021/2/e26580 %U https://doi.org/10.2196/26580 %U http://www.ncbi.nlm.nih.gov/pubmed/34528894 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e27021 %T Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study %A Palos-Sanchez,Pedro R %A Saura,Jose Ramon %A Rios Martin,Miguel Ángel %A Aguayo-Camacho,Mariano %+ Department of Financial Economy and Operations Management, Faculty of Economic and Business Sciences, University of Seville, Av. Ramon y Cajal, 1, Seville, 41017, Spain, 34 954557515, ppalos@us.es %K mHealth apps %K mobile apps %K eHealth %K promotion of health %K TAM %K PLS–SEM %K COVID-19 %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps. Objective: The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications. Methods: The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS–SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant. Results: The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%). Conclusions: mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users’ symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender. %M 34499044 %R 10.2196/27021 %U https://mhealth.jmir.org/2021/9/e27021 %U https://doi.org/10.2196/27021 %U http://www.ncbi.nlm.nih.gov/pubmed/34499044 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25797 %T Closing the Virtual Gap in Health Care: A Series of Case Studies Illustrating the Impact of Embedding Evaluation Alongside System Initiatives %A Desveaux,Laura %A Budhwani,Suman %A Stamenova,Vess %A Bhattacharyya,Onil %A Shaw,James %A Bhatia,R Sacha %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 4302, laura.desveaux@thp.ca %K virtual care %K primary care %K embedded research %K implementation %K knowledge exchange %K health policy %D 2021 %7 3.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X Early decisions relating to the implementation of virtual care relied on necessity and clinical judgement, but there is a growing need for the generation of evidence to inform policy and practice designs. The need for stronger partnerships between researchers and decision-makers is well recognized, but how these partnerships can be structured and how research can be embedded alongside existing virtual care initiatives remain unclear. We present a series of case studies that illustrate how embedded research can inform policy decisions related to the implementation of virtual care, where decisions are either to (1) discontinue (red light), (2) redesign (yellow light), or (3) scale up existing initiatives (green light). Data were collected through document review and informal interviews with key study personnel. Case 1 involved an evaluation of a mobile diabetes platform that demonstrated a mismatch between the setting and the technology (decision outcome: discontinue). Case 2 involved an evaluation of a mental health support platform that suggested evidence-based modifications to the delivery model (decision outcome: redesign). Case 3 involved an evaluation of video visits that generated evidence to inform the ideal model of implementation at scale (decision outcome: scale up). In this paper, we highlight the characteristics of the partnership and the process that enabled success and use the cases to illustrate how these characteristics were operationalized. Structured communication included monthly check-ins and iterative report development. We also outline key characteristics of the partnership (ie, trust and shared purpose) and the process (ie, timeliness, tailored reporting, and adaptability) that drove the uptake of evidence in decision-making. Across each case, the evaluation was designed to address policy questions articulated by our partners. Furthermore, structured communication provided opportunities for knowledge mobilization. Structured communication was operationalized through monthly meetings as well as the delivery of interim and final reports. These case studies demonstrate the importance of partnering with health system decision-makers to generate and mobilize scientific evidence. Embedded research partnerships founded on a shared purpose of system service provided an effective strategy to bridge the oft-cited gap between science and policy. Structured communication provided a mechanism for collaborative problem-solving and real-time feedback, and it helped contextualize emerging insights. %M 34477560 %R 10.2196/25797 %U https://www.jmir.org/2021/9/e25797 %U https://doi.org/10.2196/25797 %U http://www.ncbi.nlm.nih.gov/pubmed/34477560 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28391 %T Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study %A Skovlund,Søren Eik %A Nicolucci,Antonio %A Balk-Møller,Nina %A Berthelsen,Dorthe B %A Glümer,Charlotte %A Perrild,Hans %A Kjær,Pernille %A Nørgaard,Lise Mellergaard %A Troelsen,Lise Havbæk %A Pietraszek,Anna %A Hessler,Danielle %A Kaplan,Sherrie %A Ejskjær,Niels %+ Department of Clinical Medicine, Aalborg University, Soendre Skovvej 15, Aalborg, Denmark, 45 40228835, soren@sorenskovlund.com %K diabetes %K type 1 diabetes %K type 2 diabetes %K multisector care %K digital health %K patient-reported outcomes %K patient-centered care %K internet-administered %K feasibility %K mixed-method research %K mobile phone %D 2021 %7 3.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is growing evidence that digital patient-reported outcome (PRO) questionnaires and PRO-based decision support tools may help improve the active engagement of people with diabetes in self-care, thereby improving the quality of care. However, many barriers still exist for the real-world effectiveness and implementation of such PRO tools in routine care. Furthermore, limited research has evaluated the acceptability, feasibility, and benefits of such tools across different health care settings. Objective: This study aims to evaluate the acceptability, feasibility, and perceived benefits of the Danish digital PRO diabetes tool in different health care settings in Denmark and to determine the factors affecting its implementation. Furthermore, the study evaluates the psychometric characteristics of the Danish PRO Diabetes Questionnaire and the validity of the scoring algorithms for dialogue support. The objective of this study is to guide the ongoing optimization of the PRO diabetes tool, its implementation, and the design of future randomized controlled effectiveness studies. Methods: We designed a multicenter, mixed methods, single-arm acceptability-feasibility implementation study protocol to contribute to the real-world pilot test of a new digital PRO diabetes tool in routine diabetes care. The use of the tool involves two main steps. First, the people with diabetes will complete a digital PRO Diabetes Questionnaire in the days before a routine diabetes visit. Second, the health care professional (HCP) will use a digital PRO tool to review the PRO results together with the people with diabetes during the visit. The PRO diabetes tool is designed to encourage and support people to take an active role for the people with diabetes in their own care and to expedite the delivery of person-centered, collaborative, and coordinated care. Results: A multicenter pilot study protocol and psychometrically designed digital data collection tools for evaluation were developed and deployed as part of a national evaluation of a new digital PRO diabetes intervention. A total of 598 people with diabetes and 34 HCPs completed the study protocol by April 1, 2021. Conclusions: A large-scale, mixed methods, multicenter study for evaluating the use of the nationally developed PRO Diabetes Questionnaire in routine care across all health care sectors in Denmark by using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model as a framework has been designed and is ongoing. This study is expected to provide new important and detailed information about the real-world acceptability, perceived relevance, and benefits of the PRO diabetes tool among a large heterogeneous population of people with diabetes in Denmark and HCPs in different care settings. The results will be used to further improve the PRO tool, design implementation facilitation support strategies, and design future controlled effectiveness studies. International Registered Report Identifier (IRRID): DERR1-10.2196/28391 %M 34477563 %R 10.2196/28391 %U https://www.researchprotocols.org/2021/9/e28391 %U https://doi.org/10.2196/28391 %U http://www.ncbi.nlm.nih.gov/pubmed/34477563 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e28381 %T Robotic Pharmacy Implementation and Outcomes in Saudi Arabia: A 21-Month Usability Study %A Momattin,Hisham %A Arafa,Shokry %A Momattin,Shahad %A Rahal,Rayan %A Waterson,James %+ Mouwasat Medical Services, Mouwasat Hospital, 16 D Street, Dammam, 32263, Saudi Arabia, 966 9200 04477, Hisham.Momattin@mouwasat.com %K patient satisfaction %K automation %K integration %K medication error %K outpatient %K medication management %K usability %K medication dispensing %K robotics %K pharmacy %K medication records %K error %K record %K implementation %K outcome %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: We describe the introduction, use, and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was specifically undertaken to increase throughput, reduce medication dispensing error rates, improve patient satisfaction, and free up pharmacists’ time to allow for increased face-to-face consultations with patients. Objective: We forecasted growth of our outpatient service at 25% per annum over 5- and 10-year horizons and set out to prepare our outpatient pharmacy service to meet this demand. Initial project goals were set as a 50% reduction in the average patient wait time, a 15% increase in patient satisfaction regarding pharmacy wait time and pharmacy services, a 25% increase in pharmacist productivity, and zero dispensing errors. This was expected to be achieved within 10 months of go-live. Realignment of pharmacist activity toward counseling and medication review with patients was a secondary goal, along with the rapid development of a reputation in the served community for patient-centered care. Methods: Preimplementation data for patient wait time for dispensing of prescribed medications as a specific measure of patient satisfaction was gathered as part of wider ongoing data collection in this field. Pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1000 prescriptions were also aggregated. All preimplementation data was gathered over an 11-month period. Results: From go-live, data were gathered on the above metrics in 1-month increments. At the 10-month point, there had been a 53% reduction in the average wait time, a 20% increase in patient satisfaction regarding pharmacy wait time, with a 22% increase in overall patient satisfaction regarding pharmacy services, and a 33% increase in pharmacist productivity. A zero dispensing error rate was reported. Conclusions: The robotic pharmacy solution studied was highly effective, but a robust upstream supply chain is vital to ensure stock levels, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility’s software systems for appointments, medication records, and prescription generation in order to garner its full benefits. Overall patient satisfaction with pharmacy services is strongly influenced by wait time and follow-up studies are required to identify how to use this positive effect and make optimal use of freed-up pharmacist time. The extra time spent by pharmacists with patients and the opportunity for complete overview of the patient’s medication history, which full integration provides, may allow us to address challenging issues such as medication nonadherence. Reduced wait times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing patients to have increased contact time with pharmacists. %M 34304149 %R 10.2196/28381 %U https://humanfactors.jmir.org/2021/3/e28381 %U https://doi.org/10.2196/28381 %U http://www.ncbi.nlm.nih.gov/pubmed/34304149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27926 %T Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study %A Mendez,Kyra Jennifer Waligora %A Budhathoki,Chakra %A Labrique,Alain Bernard %A Sadak,Tatiana %A Tanner,Elizabeth K %A Han,Hae Ra %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 929 4327, kwaligo1@jhu.edu %K mHealth applications %K mobile health %K intention to adopt mHealth applications %K dementia caregivers %K family caregiving %K chronic disease self-management %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. Objective: The purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management. Methods: We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. Results: Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. Conclusions: When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management. %M 34463637 %R 10.2196/27926 %U https://mhealth.jmir.org/2021/8/e27926 %U https://doi.org/10.2196/27926 %U http://www.ncbi.nlm.nih.gov/pubmed/34463637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24890 %T Alignment of Key Stakeholders’ Priorities for Patient-Facing Tools in Digital Health: Mixed Methods Study %A Lyles,Courtney Rees %A Adler-Milstein,Julia %A Thao,Crishyashi %A Lisker,Sarah %A Nouri,Sarah %A Sarkar,Urmimala %+ Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, United States, 1 628 206 6483, courtney.lyles@ucsf.edu %K medical informatics %K medical informatics apps %K information technology %K implementation science %K mixed methods %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is widespread agreement on the promise of patient-facing digital health tools to transform health care. Yet, few tools are in widespread use or have documented clinical effectiveness. Objective: The aim of this study was to gain insight into the gap between the potential of patient-facing digital health tools and real-world uptake. Methods: We interviewed and surveyed experts (in total, n=24) across key digital health stakeholder groups—venture capitalists, digital health companies, payers, and health care system providers or leaders—guided by the Consolidated Framework for Implementation Research. Results: Our findings revealed that external policy, regulatory demands, internal organizational workflow, and integration needs often take priority over patient needs and patient preferences for digital health tools, which lowers patient acceptance rates. We discovered alignment, across all 4 stakeholder groups, in the desire to engage both patients and frontline health care providers in broader dissemination and evaluation of digital health tools. However, major areas of misalignment between stakeholder groups have stymied the progress of digital health tool uptake—venture capitalists and companies focused on external policy and regulatory demands, while payers and providers focused on internal organizational workflow and integration needs. Conclusions: Misalignment of the priorities of digital health companies and their funders with those of providers and payers requires direct attention to improve uptake of patient-facing digital health tools and platforms. %M 34435966 %R 10.2196/24890 %U https://www.jmir.org/2021/8/e24890 %U https://doi.org/10.2196/24890 %U http://www.ncbi.nlm.nih.gov/pubmed/34435966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e23372 %T Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England %A Cresswell,Kathrin %A Sheikh,Aziz %A Franklin,Bryony Dean %A Krasuska,Marta %A The Nguyen,Hung %A Hinder,Susan %A Lane,Wendy %A Mozaffar,Hajar %A Mason,Kathy %A Eason,Sally %A Potts,Henry %A Williams,Robin %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 (0)131 651 4151, kathrin.cresswell@ed.ac.uk %K digital transformation %K health system %K learning ecosystem %D 2021 %7 19.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service. Objective: This study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge. Methods: We conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding. Results: We conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas. Conclusions: Knowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals. Policy interventions need to enhance incentives and reduce barriers to sharing across the ecosystem, be flexible in tailoring formal interventions to emerging needs, and promote informal knowledge sharing. %M 34420927 %R 10.2196/23372 %U https://www.jmir.org/2021/8/e23372 %U https://doi.org/10.2196/23372 %U http://www.ncbi.nlm.nih.gov/pubmed/34420927 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e30214 %T Predicting Patients’ Intention to Use a Personal Health Record Using an Adapted Unified Theory of Acceptance and Use of Technology Model: Secondary Data Analysis %A Yousef,Consuela Cheriece %A Salgado,Teresa M %A Farooq,Ali %A Burnett,Keisha %A McClelland,Laura E %A Thomas,Abin %A Alenazi,Ahmed O %A Abu Esba,Laila Carolina %A AlAzmi,Aeshah %A Alhameed,Abrar Fahad %A Hattan,Ahmed %A Elgadi,Sumaya %A Almekhloof,Saleh %A AlShammary,Mohammed A %A Alanezi,Nazzal Abdullah %A Alhamdan,Hani Solaiman %A Khoshhal,Sahal %A DeShazo,Jonathan P %+ Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, PO Box 4616, Dammam, Saudi Arabia, 966 138532555 ext 1680, consuela_73@hotmail.com %K personal health record %K patient portal %K eHealth %K Middle East %K Saudi Arabia %K Unified Theory of Acceptance and Use of Technology %K prediction %K intention %K electronic health record %K acceptance %K model %K framework %K secondary analysis %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia’s Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the 3-fold aim for health care—increased access, reduced cost, and improved quality of care—and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country. Objective: Using the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs PHR (MNGHA Care) app. Methods: Using secondary data from a cross-sectional survey, data measuring the intention to use the MNGHA Care app, along with its predictors, were collected from among adults (n=324) visiting Ministry of National Guard-Health Affairs facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, and experience with health apps) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression. Results: Of the eligible population, a total of 261 adult patients were included in the analysis. They had a mean age of 35.07 (SD 9.61) years, 50.6 % were male (n=132), 45.2% had university-level education (n=118), and 53.3% had at least 1 chronic medical condition (n=139). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.38). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (P<.05). Prior experience with health apps moderated the relationship between social influence and behavioral intention to use the PHR (P=.04). Conclusions: This study contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country’s aim of transforming the health care system. Similar to previous studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given to support these areas. %M 34304150 %R 10.2196/30214 %U https://medinform.jmir.org/2021/8/e30214 %U https://doi.org/10.2196/30214 %U http://www.ncbi.nlm.nih.gov/pubmed/34304150 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30453 %T Digital Orientation of Health Systems in the Post–COVID-19 “New Normal” in the United States: Cross-sectional Survey %A Khuntia,Jiban %A Ning,Xue %A Stacey,Rulon %+ CU Business School, University of Colorado Denver, 1475 Lawrence Street, Denver, CO, 80202, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K post–COVID-19 %K digital orientation %K health systems %K digital transformation %K digital health %K telehealth %K telemedicine %K COVID-19 %K impact %K insight %K cross-sectional %K survey %K United States %K electronic health record %K EHR %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems’ abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post–COVID-19 “new normal” in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation–oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems’ digital orientation, whereas the latter two will prepare for future disruptions. Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption. Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations. Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern. %M 34254947 %R 10.2196/30453 %U https://www.jmir.org/2021/8/e30453 %U https://doi.org/10.2196/30453 %U http://www.ncbi.nlm.nih.gov/pubmed/34254947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e22316 %T Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study %A Rostad,Hanne Marie %A Stokke,Randi %+ Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivegen 22, Gjøvik, 2815, Norway, 47 61 13 54 00, hanne.m.rostad@ntnu.no %K ambient assisted living %K cross-sectional survey %K home care services %K innovation %K long-term care %K nursing homes %K telecare %K welfare technology %K mobile phone %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care. Objective: We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care. Methods: Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis. Results: A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach. Conclusions: Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources. %M 34398791 %R 10.2196/22316 %U https://www.jmir.org/2021/8/e22316 %U https://doi.org/10.2196/22316 %U http://www.ncbi.nlm.nih.gov/pubmed/34398791 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e25046 %T Barriers to the Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Qualitative Interview Study %A Richardson,Safiya %A Dauber-Decker,Katherine L %A McGinn,Thomas %A Barnaby,Douglas P %A Cattamanchi,Adithya %A Pekmezaris,Renee %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 600 Community Drive, Suite 403, Manhasset, NY, 11030, United States, 1 5166001411, srichard12@northwell.edu %K medical informatics %K pulmonary embolism %K electronic health records %K quality improvement %K clinical decision support systems %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Clinicians often disregard potentially beneficial clinical decision support (CDS). Objective: In this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool. Methods: We conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells’ criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging. Results: Interviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells’ criteria, (5) missed risk factors, and (6) social pressure. Conclusions: Clinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care. %M 34346901 %R 10.2196/25046 %U https://humanfactors.jmir.org/2021/3/e25046 %U https://doi.org/10.2196/25046 %U http://www.ncbi.nlm.nih.gov/pubmed/34346901 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e24405 %T Using Electronic Medical Record Data for Research in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 Hospital in Beijing: Cross-sectional Study %A Li,Rui %A Niu,Yue %A Scott,Sarah Robbins %A Zhou,Chu %A Lan,Lan %A Liang,Zhigang %A Li,Jia %+ Information Center, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China, 86 10 83929211, lij@xwhosp.org %K electronic medical records %K data utilization %K medical research %K China %D 2021 %7 3.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the proliferation of electronic medical record (EMR) systems, there is an increasing interest in utilizing EMR data for medical research; yet, there is no quantitative research on EMR data utilization for medical research purposes in China. Objective: This study aimed to understand how and to what extent EMR data are utilized for medical research purposes in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 hospital in Beijing, China. Obstacles and issues in the utilization of EMR data were also explored to provide a foundation for the improved utilization of such data. Methods: For this descriptive cross-sectional study, cluster sampling from Xuanwu Hospital, one of two Stage 7 hospitals in Beijing, was conducted from 2016 to 2019. The utilization of EMR data was described as the number of requests, the proportion of requesters, and the frequency of requests per capita. Comparisons by year, professional title, and age were conducted by double-sided chi-square tests. Results: From 2016 to 2019, EMR data utilization was poor, as the proportion of requesters was 5.8% and the frequency was 0.1 times per person per year. The frequency per capita gradually slowed and older senior-level staff more frequently used EMR data compared with younger staff. Conclusions: The value of using EMR data for research purposes is not well studied in China. More research is needed to quantify to what extent EMR data are utilized across all hospitals in Beijing and how these systems can enhance future studies. The results of this study also suggest that young doctors may be less exposed or have less reason to access such research methods. %M 34342589 %R 10.2196/24405 %U https://medinform.jmir.org/2021/8/e24405 %U https://doi.org/10.2196/24405 %U http://www.ncbi.nlm.nih.gov/pubmed/34342589 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e29126 %T Examining the Mental Workload Associated With Digital Health Technologies in Health Care: Protocol for a Systematic Review Focusing on Assessment Methods %A Kremer,Lisanne %A Lipprandt,Myriam %A Röhrig,Rainer %A Breil,Bernhard %+ Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstr. 49, Krefeld, 47805, Germany, 49 21518226678, lisanne.kremer@hs-niederrhein.de %K mental workload %K cognitive load %K assessment %K healthcare workers %K health information system %K digital health technology %K health care professionals %K stress %K eyetracking %D 2021 %7 3.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The workload in health care is high; physicians and nurses report high stress levels due to a demanding environment where they often have to perform multiple tasks simultaneously. As a result, mental health issues among health care professionals (HCPs) are on the rise and the prevalence of errors in their daily tasks could increase. Processes of demographic change are partly responsible for even higher stress levels among HCPs. The digitization of patient care is intended to counteract these processes. However, it remains unclear whether these health information systems (HIS) and digital health technologies (DHT) support the HCPs and relieve stress, or if they represent a further burden. The mental construct that describes this burden of technologies is mental workload (MWL). Work in the clinic can be viewed as working in safety-critical environments. Particularly in this sensitive setting, the measurement methods of MWL are relevant, mainly due to their strongly differing levels of intrusiveness and sensitivity. The method of eye tracking could be a useful way to measure MWL directly in the field. Objective: The systematic review aims to address the following questions: (1) In which manner do DHT contribute to the overall MWL of HCPs? (2) Can we observe a direct or indirect effect of DHT on MWL? (3) Which aspects or factors of DHT contribute to an increase in MWL? (4) Which methods/assessments are applied to measure MWL related to HIS/DHT? (5) What role does eye tracking/pupillometry play in the context of measuring MWL? (6) Which outcomes are being assessed via eye tracking? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, we will conduct a systematic review. Based on the research questions, we define keywords that we then combine in search terms. The review follows the following steps: literature search, article selection, data extraction, risk of bias assessment, data analysis, and data synthesis. Results: We expect results as well as a finalization of the review in the summer of 2021. Conclusions: This review will evaluate the impact of DHT on the MWL of HCPs. In addition, assessment methods of MWL in the context of digital technologies will be systematically analyzed. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271 International Registered Report Identifier (IRRID): DERR1-10.2196/29126 %M 34342590 %R 10.2196/29126 %U https://www.researchprotocols.org/2021/8/e29126 %U https://doi.org/10.2196/29126 %U http://www.ncbi.nlm.nih.gov/pubmed/34342590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e22330 %T Policy Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study %A Lai,Yunfeng %A Chen,Shengqi %A Li,Meng %A Ung,Carolina Oi Lam %A Hu,Hao %+ State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Room 2057, Research Building N22, Avenida da Universidade, Taipa, Macau, Macau, 999078, China, 853 88228538, haohu@um.edu.mo %K internet hospital %K health policy %K medical service %K public hospital %K digital health %K China %D 2021 %7 20.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals have been encouraged by the Chinese government to develop an innovative medical service model that mainly uses new internet-based technologies to increase access to health care and improve the quality and efficiency of health care delivery. However, the academic exploration of the institutional and sectoral development of internet hospitals in China is scarce in the existing literature. Objective: This study aimed to investigate the policy interventions, development trends, and service innovations of internet hospitals in China. It is expected that the findings from this study will contribute to the further innovation of internet hospitals in China and provide references for the international development of internet hospitals for personalized digital health and patient-centric services. Methods: This study analyzed official policies related to internet hospitals that were implemented by the government in China since 2005. The data of formally approved internet hospitals were collected from official websites to analyze development trends. In-depth semistructured interviews were conducted with 58 key stakeholders who represented comprehensive viewpoints about the service innovations of internet hospitals between March and November 2019. Results: In total, 25 policies that promoted the development of internet hospitals in China were identified. These policies encompassed informatization infrastructure construction, medical resource integration, development model design, service model design, and payment model design. Of the 268 internet hospitals that had received an official license from the government, 153 public internet hospitals had been built mainly by medical institutions. Public tertiary hospitals were the main actors in founding internet hospitals that were created to provide services that targeted patients with common diseases or chronic diseases or patients living in remote and rural areas. Promoting convenient access to high-quality medical resources and saving patients’ and their families’ time were the key values of internet hospitals. Conclusions: The policy interventions strongly promoted the development of internet hospitals in China. Public tertiary hospitals led the development of internet hospitals. However, internet hospitals in China have mainly played roles that are complementary to those of physical medical institutions. The service model of internet hospitals needs more distinguished innovations to provide personalized digital health and patient-centric services. %M 34283025 %R 10.2196/22330 %U https://www.jmir.org/2021/7/e22330 %U https://doi.org/10.2196/22330 %U http://www.ncbi.nlm.nih.gov/pubmed/34283025 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e27449 %T Contact Tracing Apps: Lessons Learned on Privacy, Autonomy, and the Need for Detailed and Thoughtful Implementation %A Hogan,Katie %A Macedo,Briana %A Macha,Venkata %A Barman,Arko %A Jiang,Xiaoqian %+ School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St #600, Houston, TX, 77030, United States, 1 7135003930, xiaoqian.jiang@uth.tmc.edu %K contact tracing %K COVID-19 %K privacy %K smartphone apps %K mobile phone apps %K health information %K electronic health %K eHealth %K pandemic %K app %K mobile health %K mHealth %D 2021 %7 19.7.2021 %9 Viewpoint %J JMIR Med Inform %G English %X The global and national response to the COVID-19 pandemic has been inadequate due to a collective lack of preparation and a shortage of available tools for responding to a large-scale pandemic. By applying lessons learned to create better preventative methods and speedier interventions, the harm of a future pandemic may be dramatically reduced. One potential measure is the widespread use of contact tracing apps. While such apps were designed to combat the COVID-19 pandemic, the time scale in which these apps were deployed proved a significant barrier to efficacy. Many companies and governments sprinted to deploy contact tracing apps that were not properly vetted for performance, privacy, or security issues. The hasty development of incomplete contact tracing apps undermined public trust and negatively influenced perceptions of app efficacy. As a result, many of these apps had poor voluntary public uptake, which greatly decreased the apps’ efficacy. Now, with lessons learned from this pandemic, groups can better design and test apps in preparation for the future. In this viewpoint, we outline common strategies employed for contact tracing apps, detail the successes and shortcomings of several prominent apps, and describe lessons learned that may be used to shape effective contact tracing apps for the present and future. Future app designers can keep these lessons in mind to create a version that is suitable for their local culture, especially with regard to local attitudes toward privacy-utility tradeoffs during public health crises. %M 34254937 %R 10.2196/27449 %U https://medinform.jmir.org/2021/7/e27449 %U https://doi.org/10.2196/27449 %U http://www.ncbi.nlm.nih.gov/pubmed/34254937 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e24022 %T A Tool for Evaluating Medication Alerting Systems: Development and Initial Assessment %A Zheng,Wu Yi %A Van Dort,Bethany %A Marcilly,Romaric %A Day,Richard %A Burke,Rosemary %A Shakib,Sepehr %A Ku,Young %A Reid-Anderson,Hannah %A Baysari,Melissa %+ Black Dog Institute, Hospital Rd, Prince of Wales Hospital, Randwick, NSW, 2031, Australia, 61 422510718, wuyi.zheng@unsw.edu.au %K medication alerts %K decision support %K human factors %K assessment tool %K usability flaws %D 2021 %7 16.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: It is well known that recommendations from electronic medication alerts are seldom accepted or acted on by users. Key factors affecting the effectiveness of medication alerts include system usability and alert design. Thus, human factors principles that apply knowledge of human capabilities and limitations are increasingly used in the design of health technology to improve the usability of systems. Objective: This study aims to evaluate a newly developed evidence-based self-assessment tool that allows the valid and reliable evaluation of computerized medication alerting systems. This tool was developed to be used by hospital staff with detailed knowledge of their hospital’s computerized provider order entry system and alerts to identify and address potential system deficiencies. In this initial assessment, we aim to determine whether the items in the tool can measure compliance of medication alerting systems with human factors principles of design, the tool can be consistently used by multiple users to assess the same system, and the items are easy to understand and perceived to be useful for assessing medication alerting systems. Methods: The Tool for Evaluating Medication Alerting Systems (TEMAS) was developed based on human factors design principles and consisted of 66 items. In total, 18 staff members recruited across 6 hospitals used the TEMAS to assess their medication alerting systems. Data collected from participant assessments were used to evaluate the validity, reliability, and usability of the TEMAS. Validity was assessed by comparing the results of the TEMAS with those of prior in-house evaluations. Reliability was measured using Krippendorff α to determine agreement among assessors. A 7-item survey was used to determine usability. Results: The participants reported mostly negative (n=8) and neutral (n=7) perceptions of alerts in their medication alerting system. However, the validity of the TEMAS could not be directly tested, as participants were unaware of any results from prior in-house evaluations. The reliability of the TEMAS, as measured by Krippendorff α, was low to moderate (range 0.26-0.46); however, participant feedback suggests that individuals’ knowledge of the system varied according to their professional background. In terms of usability, 61% (11/18) of participants reported that the TEMAS items were generally easy to understand; however, participants suggested the revision of 22 items to improve clarity. Conclusions: This initial assessment of the TEMAS allowed the identification of its components that required modification to improve usability and usefulness. It also revealed that for the TEMAS to be effective in facilitating a comprehensive assessment of a medication alerting system, it should be completed by a multidisciplinary team of hospital staff from both clinical and technical backgrounds to maximize their knowledge of systems. %M 34269680 %R 10.2196/24022 %U https://medinform.jmir.org/2021/7/e24022 %U https://doi.org/10.2196/24022 %U http://www.ncbi.nlm.nih.gov/pubmed/34269680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22110 %T Evaluating Simplified Web Interfaces of Risk Models for Clinical Use: Pilot Survey Study %A Beaubien,Louis %A Conrad,Colin %A Music,Janet %A Toze,Sandra %+ Rowe School of Business, Faculty of Management, Dalhousie University, Kenneth C Rowe Management Building, 6100 University Ave, Halifax, NS, B3H 4R2, Canada, 1 902 494 7080, louis.beaubien@dal.ca %K risk model %K electronic records %K user interface %K technology acceptance %D 2021 %7 16.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In this pilot study, we investigated sociotechnical factors that affect intention to use a simplified web model to support clinical decision making. Objective: We investigated factors that are known to affect technology adoption using the unified theory of acceptance and use of technology (UTAUT2) model. The goal was to pilot and test a tool to better support complex clinical assessments. Methods: Based on the results of a previously published work, we developed a web-based mobile user interface, WebModel, to allow users to work with regression equations and their predictions to evaluate the impact of various characteristics or treatments on key outcomes (eg, survival time) for chronic obstructive pulmonary disease. The WebModel provides a way to combat information overload and more easily compare treatment options. It limits the number of web forms presented to a user to between 1 and 20, rather than the dozens of detailed calculations typically required. The WebModel uses responsive design and can be used on multiple devices. To test the WebModel, we designed a questionnaire to probe the efficacy of the WebModel and assess the usability and usefulness of the system. The study was live for one month, and participants had access to it over that time. The questionnaire was administered online, and data from 674 clinical users who had access to the WebModel were captured. SPSS and R were used for statistical analysis. Results: The regression model developed from UTAUT2 constructs was a fit. Specifically, five of the seven factors were significant positive coefficients in the regression: performance expectancy (β=.2730; t=7.994; P<.001), effort expectancy (β=.1473; t=3.870; P=.001), facilitating conditions (β=.1644; t=3.849; P<.001), hedonic motivation (β=.2321; t=3.991; P<.001), and habit (β=.2943; t=12.732). Social influence was not a significant factor, while price value had a significant negative influence on intention to use the WebModel. Conclusions: Our results indicate that multiple influences impact positive response to the system, many of which relate to the efficiency of the interface to provide clear information. Although we found that the price value was a negative factor, it is possible this was due to the removal of health workers from purchasing decisions. Given that this was a pilot test, and that the system was not used in a clinical setting, we could not examine factors related to actual workflow, patient safety, or social influence. This study shows that the concept of a simplified WebModel could be effective and efficient in reducing information overload in complex clinical decision making. We recommend further study to test this in a clinical setting and gather qualitative data from users regarding the value of the tool in practice. %M 34269692 %R 10.2196/22110 %U https://formative.jmir.org/2021/7/e22110 %U https://doi.org/10.2196/22110 %U http://www.ncbi.nlm.nih.gov/pubmed/34269692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26670 %T Measuring Success of Patients’ Continuous Use of Mobile Health Services for Self-management of Chronic Conditions: Model Development and Validation %A Song,Ting %A Deng,Ning %A Cui,Tingru %A Qian,Siyu %A Liu,Fang %A Guan,Yingping %A Yu,Ping %+ Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4221 5412, ping@uow.edu.au %K mobile health %K service %K smartphone %K mobile application %K continuous use %K high blood pressure %K chronic disease %K PLS %D 2021 %7 13.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health services are gradually being introduced to support patients’ self-management of chronic conditions. The success of these services is contingent upon patients’ continuous use of them. Objective: This study aims to develop a model to measure the success of patients’ continuous use of mobile health services for the self-management of chronic conditions. Methods: The proposed model was derived from the information systems continuance model and the information systems success model. This model contains 7 theoretical constructs: information quality, system quality, service quality, perceived usefulness, user satisfaction, perceived health status, and continuous use intention. A web-based questionnaire survey instrument was developed to test the model. The survey was conducted to collect data from 129 patients who used a mobile health app for hypertension management from 2017 to 2019. The questionnaire items were derived from validated instruments and were measured using a 5-point Likert scale. The partial least squares modelling method was used to test the theoretical model. Results: The model accounted for 58.5% of the variance in perceived usefulness (R2=0.585), 52.3% of the variance in user satisfaction (R2=0.523), and 41.4% of the variance in patients’ intention to make continuous use of mobile health services (R2=0.414). The continuous use intention was significantly influenced by their perceived health status (β=.195, P=.03), perceived usefulness (β=.307, P=.004), and user satisfaction (β=.254, P=.04) with the mobile health service. Information quality (β=.235, P=.005), system quality (β=.192, P=.02), and service quality (β=.494, P<.001) had a significantly positive influence on perceived usefulness but not on user satisfaction. Perceived usefulness had a significantly positive influence on user satisfaction (β=.664, P<.001). In a result opposite to the original hypothesis, perceived health status did not negatively influence patients’ intention to continue using the mobile health service but showed a significantly positive correlation. Conclusions: This study developed a theoretical model to predict and explain patients’ continuous use of mobile health services for self-management of chronic conditions and empirically tested the model. Perceived usefulness, user satisfaction, and health status contributed to patients’ intention to make continuous use of mobile health services for self-managing their chronic conditions. %M 34255685 %R 10.2196/26670 %U https://www.jmir.org/2021/7/e26670 %U https://doi.org/10.2196/26670 %U http://www.ncbi.nlm.nih.gov/pubmed/34255685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26817 %T Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study %A Tawfik,Daniel S %A Sinha,Amrita %A Bayati,Mohsen %A Adair,Kathryn C %A Shanafelt,Tait D %A Sexton,J Bryan %A Profit,Jochen %+ Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 435, Palo Alto, CA, 94304, United States, 1 650 723 9902, dtawfik@stanford.edu %K frustration with technology %K emotional exhaustion %K professional burnout %K work-life integration %K biomedical technology %K work-life balance %K user-centered design %K electronic health records %K medical informatics applications %K health information systems %D 2021 %7 6.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: New technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout. Objective: This study aimed to evaluate and quantify health care workers’ frustration with technology and its relationship with emotional exhaustion, after controlling for measures of work-life integration that may indicate excessive job demands. Methods: This was a cross-sectional, observational study of health care workers across 31 Michigan hospitals. We used the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey to measure work-life integration and emotional exhaustion among the survey respondents. We used mixed-effects hierarchical linear regression to evaluate the relationship among frustration with technology, other components of work-life integration, and emotional exhaustion, with adjustment for unit and health care worker characteristics. Results: Of 15,505 respondents, 5065 (32.7%) reported that they experienced frustration with technology on at least 3-5 days per week. Frustration with technology was associated with higher scores for the composite Emotional Exhaustion scale (r=0.35, P<.001) and each individual item on the Emotional Exhaustion scale (r=0.29-0.36, P<.001 for all). Each 10-point increase in the frustration with technology score was associated with a 1.2-point increase (95% CI 1.1-1.4) in emotional exhaustion (both measured on 100-point scales), after adjustment for other work-life integration items and unit and health care worker characteristics. Conclusions: This study found that frustration with technology and several other markers of work-life integration are independently associated with emotional exhaustion among health care workers. Frustration with technology is common but not ubiquitous among health care workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with health care technology may be an effective approach in reducing burnout among health care workers. %M 34255674 %R 10.2196/26817 %U https://www.jmir.org/2021/7/e26817 %U https://doi.org/10.2196/26817 %U http://www.ncbi.nlm.nih.gov/pubmed/34255674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26813 %T Stakeholder Perspectives on Barriers and Facilitators for the Adoption of Virtual Clinical Trials: Qualitative Study %A Coert,Romée Melanie Helena %A Timmis,James Kenneth %A Boorsma,André %A Pasman,Wilrike J %+ Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands, 31 652688579, romeecoert@hotmail.com %K virtual clinical trials %K decentralized clinical trials %K adoption %K do-it-yourself %K wearables %K diffusion of innovation theory %K clinical trials %K digital health %K virtual health %D 2021 %7 6.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional clinical trials are essential for generating high-quality evidence by measuring the efficacy of interventions in rigorously controlled clinical environments. However, their execution can be expensive and time-consuming. In addition, clinical trials face several logistical challenges regarding the identification, recruitment, and retention of participants; consistent data collection during trials; and adequate patient follow-up. This might lead to inefficient resource utilization. In order to partially address the current problems with conventional clinical trials, there exists the need for innovations. One such innovation is the virtual clinical trial (VCT). VCTs allow for the collection and integration of diverse data from multiple information sources, such as electronic health records, clinical and demographic data, patient-reported outcomes, anthropometric and activity measurements, and data collected by digital biomarkers or (small) samples that participants can collect themselves. Although VCTs have the potential to provide substantial value to clinical research and patients because they can lower clinical trial costs, increase the volume of data collected from patients’ daily environment, and reduce the burden of patient participation, so far VCT adoption is not commonplace. Objective: This paper aims to better understand the barriers and facilitators to VCT adoption by determining the factors that influence individuals’ considerations regarding VCTs from the perspective of various stakeholders. Methods: Based on online semistructured interviews, a qualitative study was conducted with pharmaceutical companies, food and health organizations, and an applied research organization in Europe. Data were thematically analyzed using Rogers’ diffusion of innovation theory. Results: A total of 16 individuals with interest and experience in VCTs were interviewed, including persons from pharmaceutical companies (n=6), food and health organizations (n=4), and a research organization (n=6). Key barriers included a potentially low degree of acceptance by regulatory authorities, technical issues (standardization, validation, and data storage), compliance and adherence, and lack of knowledge or comprehension regarding the opportunities VCTs have to offer. Involvement of regulators in development processes, stakeholder exposure to the results of pilot studies, and clear and simple instructions and assistance for patients were considered key facilitators. Conclusions: Collaboration among all stakeholders in VCT development is crucial to increase knowledge and awareness. Organizations should invest in accurate data collection technologies, and compliance of patients in VCTs needs to be ensured. Multicriteria decision analysis can help determine if a VCT is a preferred option by stakeholders. The findings of this study can be a good starting point to accelerate the development and widespread implementation of VCTs. %M 34255673 %R 10.2196/26813 %U https://www.jmir.org/2021/7/e26813 %U https://doi.org/10.2196/26813 %U http://www.ncbi.nlm.nih.gov/pubmed/34255673 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e28729 %T The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study %A Heponiemi,Tarja %A Kaihlanen,Anu-Marja %A Gluschkoff,Kia %A Saranto,Kaija %A Nissinen,Sari %A Laukka,Elina %A Vehko,Tuulikki %+ Department of Public Health and Welfare, Finnish Institute for Health and Welfare, PO Box 30, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K stress related to information systems %K time pressure %K usability %K stress %K health and social care %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses’ workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses’ well-being. Objective: This study aimed to examine the association between using a mobile version of the EHR and nurses’ perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators. Methods: This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other). Results: Nurses who used the mobile version of their EHR had higher levels of time pressure (F1,3537=14.96, P<.001) and stress related to information systems (F1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F1,3581=14.93, P<.001), ease of use (F1,3577=10.16, P=.001), and technical quality (F1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs. Conclusions: According to our results, it seems that at present mobile device use is not beneficial for the nurses’ well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses’ workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses. %M 34255704 %R 10.2196/28729 %U https://medinform.jmir.org/2021/7/e28729 %U https://doi.org/10.2196/28729 %U http://www.ncbi.nlm.nih.gov/pubmed/34255704 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e26393 %T Measuring the Interactions Between Health Demand, Informatics Supply, and Technological Applications in Digital Medical Innovation for China: Content Mapping and Analysis %A Du,Jian %A Chen,Ting %A Zhang,Luxia %+ National Institute of Health Data Science, Peking University, No.38 Xueyuan Road, Beijing, 100191, China, 86 82806538, zhanglx@bjmu.edu.cn %K medical informatics %K Medical Subject Headings (MeSH) %K health demand %K informatics supply %K technological applications %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: There were 2 major incentives introduced by the Chinese government to promote medical informatics in 2009 and 2016. As new drugs are the major source of medical innovation, informatics-related concepts and techniques are a major source of digital medical innovation. However, it is unclear whether the research efforts of medical informatics in China have met the health needs, such as disease management and population health. Objective: We proposed an approach to mapping the interplay between different knowledge entities by using the tree structure of Medical Subject Headings (MeSH) to gain insights into the interactions between informatics supply, health demand, and technological applications in digital medical innovation in China. Methods: All terms under the MeSH tree parent node “Diseases [C]” or node “Health [N01.400]” or “Public Health [N06.850]” were labelled as H. All terms under the node “Information Science [L]” were labelled as I, and all terms under node “Analytical, Diagnostic and Therapeutic Techniques, and Equipment [E]” were labelled as T. The H-I-T interactions can be measured by using their co-occurrences in a given publication. Results: The H-I-T interactions in China are showing significant growth and a more concentrated interplay were observed. Computing methodologies, informatics, and communications media (such as social media and the internet) constitute the majority of I-related concepts and techniques used for resolving the health promotion and diseases management problems in China. Generally there is a positive correlation between the burden and informatics research efforts for diseases in China. We think it is not contradictory that informatics research should be focused on the greatest burden of diseases or where it can have the most impact. Artificial intelligence is a competing field of medical informatics research in China, with a notable focus on diagnostic deep learning algorithms for medical imaging. Conclusions: It is suggested that technological transfers, namely the functionality to be realized by medical/health informatics (eg, diagnosis, therapeutics, surgical procedures, laboratory testing techniques, and equipment and supplies) should be strengthened. Research on natural language processing and electronic health records should also be strengthened to improve the real-world applications of health information technologies and big data in the future. %M 34255693 %R 10.2196/26393 %U https://medinform.jmir.org/2021/7/e26393 %U https://doi.org/10.2196/26393 %U http://www.ncbi.nlm.nih.gov/pubmed/34255693 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28944 %T Determinants of Catalan Public Primary Care Professionals’ Intention to Use Digital Clinical Consultations (eConsulta) in the Post–COVID-19 Context: Mixed Methods Study %A Saigí-Rubió,Francesc %A Vidal-Alaball,Josep %A Torrent-Sellens,Joan %A Jiménez-Zarco,Ana %A López Segui,Francesc %A Carrasco Hernandez,Marta %A Alzaga Reig,Xavier %A Bonet Simó,Josep Maria %A Abizanda González,Mercedes %A Piera-Jimenez,Jordi %A Solans,Oscar %+ Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Catala de la Salut, Carrer Pica d'Estats, 36, Sant Fruitos de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K teleconsultation %K eConsultation %K eHealth %K intention to use %K digital health %K Technology Acceptance Model %K TAM %K remote consultation %K telemedicine %K digital technology %K intention %K technology assessment %K telehealth %K pandemic %K digital tool %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care during lockdowns due to the COVID-19 pandemic. It has been used to support the health care needs of patients with COVID-19 and routine primary care patients alike. However, this change has not been fully consolidated. Objective: The objective of this study was to analyze the determinants of health care professionals’ intention to use the eConsulta digital clinical consultation tool in the post–COVID-19 context. Methods: A literature review of the Technology Acceptance Model allowed us to construct a theoretical model and establish a set of hypotheses on the influence of a variety of different factors relating to health care professionals, as well as the institutions where they work, on their intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data collection instrument. The data were analyzed using univariate and bivariate analysis techniques. To confirm the theoretical model, exploratory factor analysis and binary logistic regression were applied. Results: The most important variables were related to perceived benefits (B=2.408) and the type of use that individuals habitually made of eConsulta (B=0.715). Environmental pressure (B=0.678), experience with technology (B=0.542), gender (B=0.639), and the degree to which eConsulta had been implemented (B=0.266) were other variables influencing the intention to use the tool in the post–COVID-19 context. When replicating the previous analysis according to professional group, experience with technology and gender in the physician group, and experience with tool use and the center where a professional worked in the nurse group, were found to be of considerable importance. Conclusions: The implementation and use of eConsulta had increased significantly as a consequence of the COVID-19 pandemic, and the majority of health care professionals were satisfied with its use in practice and planned to incorporate it into their practices in the post–COVID-19 context. Perceived benefits and environmental pressure were determining factors in their attitude toward and intention to use eConsulta. %R 10.2196/28944 %U https://www.jmir.org/2021/6/e28944/ %U https://doi.org/10.2196/28944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26694 %T Why Are Digital Health Care Systems Still Poorly Designed, and Why Is Health Care Practice Not Asking for More? Three Paths Toward a Sustainable Digital Work Environment %A Persson,Johanna %A Rydenfält,Christofer %+ Department of Design Sciences, Lund University, Box 118, Lund, 22100, Sweden, 46 462224358, johanna.persson@design.lth.se %K digital systems %K electronic health records %K digital work environment %K ergonomics %K usability %K human-centered design %D 2021 %7 22.6.2021 %9 Viewpoint %J J Med Internet Res %G English %X Knowledge of how to design digital systems that are ergonomically sound, high in usability, and optimized for the user, context, and task has existed for some time. Despite this, there are still too many examples of new digital health care systems that are poorly designed and that could negatively affect both the work environment of health care staff and patient safety. This could be because of a gap between the theoretical knowledge of design and ergonomics and the practical implementation of this knowledge in procuring and developing digital health care systems. Furthermore, discussions of digitalization are often at a general level and risk neglecting the nature of direct interaction with the digital system. This is problematic since it is at this detailed level that work environment and patient safety issues materialize in practice. In this paper, we illustrate such issues with two scenarios concerned with contemporary electronic health care records, based on field studies in two health care settings. We argue that current methods and tools for designing and evaluating digital systems in health care must cater both to the holistic level and to the details of interaction and ergonomics. It must also be acknowledged that health care professionals are neither designers nor engineers, so expectations of them during the development of digital systems must be realistic. We suggest three paths toward a more sustainable digital work environment in health care: (1) better tools for evaluating the digital work environment in the field; (2) generic formulations of qualitative requirements related to usability and for adaptation to the user, context, and task, to be used in procurement; and (3) the introduction of digital ergonomics as an embracing concept capturing several of the ergonomic challenges (including physical, cognitive, and organizational aspects) involved in implementing and using digital systems. %M 34156336 %R 10.2196/26694 %U https://www.jmir.org/2021/6/e26694 %U https://doi.org/10.2196/26694 %U http://www.ncbi.nlm.nih.gov/pubmed/34156336 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23715 %T eHealth Implementation Issues in Low-Resource Countries: Model, Survey, and Analysis of User Experience %A Archer,Norman %A Lokker,Cynthia %A Ghasemaghaei,Maryam %A DiLiberto,Deborah %+ Information Systems, DeGroote School of Business, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada, 1 905 525 9140 ext 23944, archer@mcmaster.ca %K eHealth %K low-resource countries %K eHealth implementation effectiveness %K end user survey %K eHealth utilization %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The implementation of eHealth in low-resource countries (LRCs) is challenged by limited resources and infrastructure, lack of focus on eHealth agendas, ethical and legal considerations, lack of common system interoperability standards, unreliable power, and shortage of trained workers. Objective: The aim of this study is to describe and study the current situation of eHealth implementation in a small number of LRCs from the perspectives of their professional eHealth users. Methods: We developed a structural equation model that reflects the opinions of professional eHealth users who work on LRC health care front lines. We recruited country coordinators from 4 LRCs to help recruit survey participants: India, Egypt, Nigeria, and Kenya. Through a web-based survey that focused on barriers to eHealth implementation, we surveyed 114 participants. We analyzed the information using a structural equation model to determine the relationships among the constructs in the model, including the dependent variable, eHealth utilization. Results: Although all the model constructs were important to participants, some constructs, such as user characteristics, perceived privacy, and perceived security, did not play a significant role in eHealth utilization. However, the constructs related to technology infrastructure tended to reduce the impact of concerns and uncertainties (path coefficient=−0.32; P=.001), which had a negative impact on eHealth utilization (path coefficient=−0.24; P=.01). Constructs that were positively related to eHealth utilization were implementation effectiveness (path coefficient=0.45; P<.001), the countries where participants worked (path coefficient=0.29; P=.004), and whether they worked for privately or publicly funded institutions (path coefficient=0.18; P<.001). As exploratory research, the model had a moderately good fit for eHealth utilization (adjusted R2=0.42). Conclusions: eHealth success factors can be categorized into 5 groups; our study focused on frontline eHealth workers’ opinions concerning 2 of these groups: technology and its support infrastructure and user acceptance. We found significant disparities among the responses from different participant groups. Privately funded organizations tended to be further ahead with eHealth utilization than those that were publicly funded. Moreover, participant comments identified the need for more use of telemedicine in remote and rural regions in these countries. An understanding of these differences can help regions or countries that are lagging in the implementation and use of eHealth technologies. Our approach could also be applied to detailed studies of the other 3 categories of success factors: short- and long-term funding, organizational factors, and political or legislative aspects. %M 34142967 %R 10.2196/23715 %U https://www.jmir.org/2021/6/e23715 %U https://doi.org/10.2196/23715 %U http://www.ncbi.nlm.nih.gov/pubmed/34142967 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e24649 %T Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals %A Archambault,Patrick %A Turcotte,Stéphane %A Smith,Pascal Y %A Said Abasse,Kassim %A Paquet,Catherine %A Côté,André %A Gomez,Dario %A Khechine,Hager %A Gagnon,Marie-Pierre %A Tremblay,Melissa %A Elazhary,Nicolas %A Légaré,France %A , %+ Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V3Z1, Canada, 1 418 835 7121 ext 13907, patrick.archambault@fmed.ulaval.ca %K knowledge management %K knowledge translation %K implementation science %K collaborative writing applications %K wikis %K trauma care %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals’ use of wiki-based knowledge tools. Objective: This study aims to measure emergency physicians’ (EPs) and other acute care health professionals’ (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. Methods: In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. Results: Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs’ intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). Conclusions: The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care. %M 34142977 %R 10.2196/24649 %U https://medinform.jmir.org/2021/6/e24649 %U https://doi.org/10.2196/24649 %U http://www.ncbi.nlm.nih.gov/pubmed/34142977 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27345 %T Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations %A Huang,Mian %A Wang,Jian %A Nicholas,Stephen %A Maitland,Elizabeth %A Guo,Ziyue %+ Dong Fureng Institute of Economic and Social Development, Wuhan University, No 54 Dongsi Lishi Hutong, Dongcheng District, Beijing, 100010, China, 86 13864157135, wangjian993@whu.edu.cn %K health informatization %K COVID-19 %K health policy %K digital health %K health information technology %K China %D 2021 %7 17.6.2021 %9 Viewpoint %J J Med Internet Res %G English %X By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services. %M 34061761 %R 10.2196/27345 %U https://www.jmir.org/2021/6/e27345 %U https://doi.org/10.2196/27345 %U http://www.ncbi.nlm.nih.gov/pubmed/34061761 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e26681 %T Design and Implementation of an Informatics Infrastructure for Standardized Data Acquisition, Transfer, Storage, and Export in Psychiatric Clinical Routine: Feasibility Study %A Blitz,Rogério %A Storck,Michael %A Baune,Bernhard T %A Dugas,Martin %A Opel,Nils %+ Department of Psychiatry, University of Münster, Albert-Schweitzer-Str. 11, Münster, 48149, Germany, 49 2518358160, n_opel01@uni-muenster.de %K medical informatics %K digital mental health %K digital data collection %K psychiatry %K single-source metadata architecture transformation %K mental health %K design %K implementation %K feasibility %K informatics %K infrastructure %K data %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Empirically driven personalized diagnostic applications and treatment stratification is widely perceived as a major hallmark in psychiatry. However, databased personalized decision making requires standardized data acquisition and data access, which are currently absent in psychiatric clinical routine. Objective: Here, we describe the informatics infrastructure implemented at the psychiatric Münster University Hospital, which allows standardized acquisition, transfer, storage, and export of clinical data for future real-time predictive modelling in psychiatric routine. Methods: We designed and implemented a technical architecture that includes an extension of the electronic health record (EHR) via scalable standardized data collection and data transfer between EHRs and research databases, thus allowing the pooling of EHRs and research data in a unified database and technical solutions for the visual presentation of collected data and analyses results in the EHR. The Single-source Metadata ARchitecture Transformation (SMA:T) was used as the software architecture. SMA:T is an extension of the EHR system and uses module-driven engineering to generate standardized applications and interfaces. The operational data model was used as the standard. Standardized data were entered on iPads via the Mobile Patient Survey (MoPat) and the web application Mopat@home, and the standardized transmission, processing, display, and export of data were realized via SMA:T. Results: The technical feasibility of the informatics infrastructure was demonstrated in the course of this study. We created 19 standardized documentation forms with 241 items. For 317 patients, 6451 instances were automatically transferred to the EHR system without errors. Moreover, 96,323 instances were automatically transferred from the EHR system to the research database for further analyses. Conclusions: In this study, we present the successful implementation of the informatics infrastructure enabling standardized data acquisition and data access for future real-time predictive modelling in clinical routine in psychiatry. The technical solution presented here might guide similar initiatives at other sites and thus help to pave the way toward future application of predictive models in psychiatric clinical routine. %M 34106072 %R 10.2196/26681 %U https://mental.jmir.org/2021/6/e26681 %U https://doi.org/10.2196/26681 %U http://www.ncbi.nlm.nih.gov/pubmed/34106072 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e26598 %T Implementing Vertical Federated Learning Using Autoencoders: Practical Application, Generalizability, and Utility Study %A Cha,Dongchul %A Sung,MinDong %A Park,Yu-Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2363, yurangpark@yuhs.ac %K federated learning %K vertically incomplete data %K privacy %K machine learning %K coding %K data %K performance %K model %K security %K training %K dataset %K unsupervised learning %K data sharing %K protection %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Machine learning (ML) is now widely deployed in our everyday lives. Building robust ML models requires a massive amount of data for training. Traditional ML algorithms require training data centralization, which raises privacy and data governance issues. Federated learning (FL) is an approach to overcome this issue. We focused on applying FL on vertically partitioned data, in which an individual’s record is scattered among different sites. Objective: The aim of this study was to perform FL on vertically partitioned data to achieve performance comparable to that of centralized models without exposing the raw data. Methods: We used three different datasets (Adult income, Schwannoma, and eICU datasets) and vertically divided each dataset into different pieces. Following the vertical division of data, overcomplete autoencoder-based model training was performed for each site. Following training, each site’s data were transformed into latent data, which were aggregated for training. A tabular neural network model with categorical embedding was used for training. A centrally based model was used as a baseline model, which was compared to that of FL in terms of accuracy and area under the receiver operating characteristic curve (AUROC). Results: The autoencoder-based network successfully transformed the original data into latent representations with no domain knowledge applied. These altered data were different from the original data in terms of the feature space and data distributions, indicating appropriate data security. The loss of performance was minimal when using an overcomplete autoencoder; accuracy loss was 1.2%, 8.89%, and 1.23%, and AUROC loss was 1.1%, 0%, and 1.12% in the Adult income, Schwannoma, and eICU dataset, respectively. Conclusions: We proposed an autoencoder-based ML model for vertically incomplete data. Since our model is based on unsupervised learning, no domain-specific knowledge is required in individual sites. Under the circumstances where direct data sharing is not available, our approach may be a practical solution enabling both data protection and building a robust model. %M 34106083 %R 10.2196/26598 %U https://medinform.jmir.org/2021/6/e26598 %U https://doi.org/10.2196/26598 %U http://www.ncbi.nlm.nih.gov/pubmed/34106083 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24601 %T Patient-Centered Care: Transforming the Health Care System in Vietnam With Support of Digital Health Technology %A Dang,Thu Ha %A Nguyen,Tuan Anh %A Hoang Van,Minh %A Santin,Olinda %A Tran,Oanh Mai Thi %A Schofield,Penelope %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Melbourne, 3122, Australia, 61 422703347, thuhadang@swin.edu.au %K building blocks %K digital health %K eHealth %K patient-centered care %K telemedicine %K Vietnam %D 2021 %7 4.6.2021 %9 Viewpoint %J J Med Internet Res %G English %X Background: Over the recent decades, Vietnam has attained remarkable achievements in all areas of health care. However, shortcomings including health disparities persist particularly with a rapidly aging population. This has resulted in a shift in the disease burden from communicable to noncommunicable diseases such as dementia, cancer, and diabetes. These medical conditions require long-term care, which causes an accelerating crisis for the health sector and society. The current health care system in Vietnam is unlikely to cope with these challenges. Objective: The aim of this paper was to explore the opportunities, challenges, and necessary conditions for Vietnam in transforming toward a patient-centered care model to produce better health for people and reduce health care costs. Methods: We examine the applicability of a personalized and integrated Bespoke Health Care System (BHS) for Vietnam using a strength, weakness, opportunity, and threat analysis and examining the successes or failures of digital health care innovations in Vietnam. We then make suggestions for successful adoption of the BHS model in Vietnam. Results: The BHS model of patient-centered care empowers patients to become active participants in their own health care. Vietnam’s current policy, social, technological, and economic environment favors the transition of its health care system toward the BHS model. Nevertheless, the country is in an early stage of health care digitalization. The legal and regulatory system to protect patient privacy and information security is still lacking. The readiness to implement electronic medical records, a core element of the BHS, varies across health providers and clinical practices. The scarcity of empirical evidence and evaluation regarding the effectiveness and sustainability of digital health initiatives is an obstacle to the Vietnamese government in policymaking, development, and implementation of health care digitalization. Conclusions: Implementing a personalized and integrated health care system may help Vietnam to address health care needs, reduce pressure on the health care system and society, improve health care delivery, and promote health equity. However, in order to adopt the patient-centered care system and digitalized health care, a whole-system approach in transformation and operation with a co-design in the whole span of a digital health initiative developing process are necessary. %M 34085939 %R 10.2196/24601 %U https://www.jmir.org/2021/6/e24601 %U https://doi.org/10.2196/24601 %U http://www.ncbi.nlm.nih.gov/pubmed/34085939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27820 %T Optimization of Primary Care Among Black Americans Using Patient Portals: Qualitative Study %A Ordaz,Omar H %A Croff,Raina L %A Robinson,LaTroy D %A Shea,Steven A %A Bowles,Nicole P %+ Oregon Institute of Occupational Health Sciences, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd L606, Portland, OR, 97239, United States, 1 503 494 2541, bowlesn@ohsu.edu %K health promotion %K patient engagement %K telehealth %K telemedicine %K health disparities %K technology acceptance model %K health belief model %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Reduced patient portal use has previously been reported among Black Americans when compared with that of the general population. This statistic is concerning because portals have been shown to improve the control of chronic conditions that are more prevalent and severe in Black Americans. At their very simplest, portals allow patients to access their electronic health records and often provide tools for patients to interact with their own health information, treatment team members, and insurance companies. However, research suggests that Black American patients have greater concerns over a lack of support, loss of privacy, and reduced personalization of care compared with other Americans, which results in a disparity of portal use. Objective: This qualitative investigation of primary care experiences of Black Americans from across the United States who participated in remote focus groups in April and May 2020 aims to explore the use and perceived value of patient portals to better understand any barriers to optimized treatment in the primary care setting. Methods: We performed an inductive thematic analysis of 8 remote focus group interviews with 29 Black American patients aged 30-60 years to qualitatively assess the experiences of Black American patients with regular access to portals. Results: Thematic analysis uncovered the following interrelated themes regarding patient portals in primary care: the optimization of care, patient empowerment, patient-provider communication, and patient burden. Conclusions: In contrast to what has been described regarding the reluctance of Black Americans to engage with patient portals, our focus groups revealed the general acceptance of patient portals, which were described overwhelmingly as tools with the potential for providing exceptional, personalized care that may even work to mitigate the unfair burden of disease for Black Americans in primary care settings. Thus, opportunities for better health care will clearly arise with increased communication, experience, and adoption of remote health care practices among Black Americans. %M 34081016 %R 10.2196/27820 %U https://www.jmir.org/2021/6/e27820 %U https://doi.org/10.2196/27820 %U http://www.ncbi.nlm.nih.gov/pubmed/34081016 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e26463 %T Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study %A Liu,Jialin %A Liu,Siru %A Zheng,Tao %A Bi,Yongdong %+ Department of Medical Informatics, West China Hospital, Sichuan University, No.37 Guoxuexiang street, Chengdu, 610041, China, 86 2885422306, dljl8@163.com %K telemedicine %K COVID-19 %K survey %K physician %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non–COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. Objective: The purpose of this study was to understand physicians’ attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. Methods: We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. Results: Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents’ hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. Conclusions: Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome. %M 33945493 %R 10.2196/26463 %U https://medinform.jmir.org/2021/6/e26463 %U https://doi.org/10.2196/26463 %U http://www.ncbi.nlm.nih.gov/pubmed/33945493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e18500 %T Theories Informing eHealth Implementation: Systematic Review and Typology Classification %A Heinsch,Milena %A Wyllie,Jessica %A Carlson,Jamie %A Wells,Hannah %A Tickner,Campbell %A Kay-Lambkin,Frances %+ Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0249217035, Milena.Heinsch@newcastle.edu.au %K systematic review %K eHealth %K digital health %K mHealth %K mobile phone %K technology %K implementation %K adoption %K translation %K theory %D 2021 %7 31.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation. Objective: The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change. Methods: An electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building. Results: Of the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6). Conclusions: Theories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process. %M 34057427 %R 10.2196/18500 %U https://www.jmir.org/2021/5/e18500 %U https://doi.org/10.2196/18500 %U http://www.ncbi.nlm.nih.gov/pubmed/34057427 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24090 %T Patient Rationales Against the Use of Patient-Accessible Electronic Health Records: Qualitative Study %A Valeur,Hanne Støre %A Lie,Anne Kveim %A Moen,Kåre %+ Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, Oslo, 0318, Norway, 47 45248693, h.s.valeur@medisin.uio.no %K patient-accessible electronic health records %K open notes %K active patients %K patients’ perspective %K patient portal %K electronic health records %K participation %D 2021 %7 28.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-accessible electronic health records (PAEHRs) enable patients to access their health records through a secure connection over the internet. Although previous studies of patient experiences with this kind of service have shown that a majority of users are positive toward PAEHRs, little is known about why some patients occasionally or regularly choose not to use them. A better understanding of why patients may choose not to make use of digital health services such as PAEHRs is important for further development and implementation of services aimed at having patients participate in digital health services. Objective: The objective of the study was to explore patients’ rationales for not embracing online access to health records. Methods: Qualitative interviews were conducted with 40 patients in a department of internal medicine in a Norwegian hospital in 2018-2019. Interview transcripts were subjected to thematic content analysis. In this paper, we focus on the subject of nonuse of PAEHRs. Results: We identified 8 different rationales that study participants had for not embracing PAEHRs. When patients reflected on why they might not use PAEHRs, they variously explained that they found PAEHRs unnecessary (they did not feel they were useful), impersonal (they preferred oral dialogue with their doctor or nurse over written information), incomprehensible (the records contained medical terminology and explanations that were hard to understand), misery oriented (the records solely focused on disease), fear provoking (reading the records could cause unwanted emotional reactions), energy demanding (making sense of the records added to the work of being a patient), cumbersome (especially among patients who felt they did not have the necessary digital competence), and impoverishing (they were skeptical about the digital transformation of individual and social life). Conclusions: It is often assumed that the barriers to PAEHR use are mostly practical (such as lack of hardware and access to the internet). In this study, we showed that patients may have many other valid reasons for not wanting to adopt this kind of service. The results can help guide how PAEHRs and other digital health services are promoted and presented to patients, and they may suggest that the goal of a given new digital health service should not necessarily be full uptake by all patients. Rather, one should recognize that different patients might prefer and benefit from different kinds of “analog” and digital health services. %M 34047711 %R 10.2196/24090 %U https://www.jmir.org/2021/5/e24090 %U https://doi.org/10.2196/24090 %U http://www.ncbi.nlm.nih.gov/pubmed/34047711 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27811 %T Willingness to Adopt Health Information Among Social Question-and-Answer Community Users in China: Cross-sectional Survey Study %A Li,PengFei %A Xu,Lin %A Tang,Tingting %A Wu,Xiaoqian %A Huang,Cheng %+ Medical Informatics College, Chongqing Medical University, No 1 Yixueyuan Road, Yuzhong District, Chongqing, China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K health information adoption %K social question-and-answer community %K structural equation model %K Zhihu %D 2021 %7 21.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has spread around the world and has increased the public’s need for health information in the process. Meanwhile, in the context of lockdowns and other measures for preventing SARS-CoV-2 spread, the internet has surged as a web-based resource for health information. Under these conditions, social question-and-answer communities (SQACs) are playing an increasingly important role in improving public health literacy. There is great theoretical and practical significance in exploring the influencing factors of SQAC users’ willingness to adopt health information. Objective: The aim of this study was to establish an extended unified theory of acceptance and use of technology model that could analyze the influence factors of SQAC users’ willingness to adopt health information. Particularly, we tried to test the moderating effects that different demographic characteristics had on the variables’ influences. Methods: This study was conducted by administering a web-based questionnaire survey and analyzing the responses from a final total of 598 valid questionnaires after invalid data were cleaned. By using structural equation modelling, the influencing factors of SQAC users’ willingness to adopt health information were analyzed. The moderating effects of variables were verified via hierarchical regression. Results: Performance expectation (β=.282; P<.001), social influence (β=.238; P=.02), and facilitating conditions (β=.279; P=.002) positively affected users’ willingness to adopt health information, whereas effort expectancy (P=.79) and perceived risk (P=.41) had no significant effects. Gender had a significant moderating effect in the structural equation model (P<.001). Conclusions: SQAC users’ willingness to adopt health information was evidently affected by multiple factors, such as performance expectation, social influence, and facilitating conditions. The structural equation model proposed in this study has a good fitting degree and good explanatory power for users’ willingness to adopt health information. Suggestions were provided for SQAC operators and health management agencies based on our research results. %M 33970865 %R 10.2196/27811 %U https://www.jmir.org/2021/5/e27811 %U https://doi.org/10.2196/27811 %U http://www.ncbi.nlm.nih.gov/pubmed/33970865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25447 %T Utilizing Health Behavior Change and Technology Acceptance Models to Predict the Adoption of COVID-19 Contact Tracing Apps: Cross-sectional Survey Study %A Tomczyk,Samuel %A Barth,Simon %A Schmidt,Silke %A Muehlan,Holger %+ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, Greifswald, , Germany, 49 3834 420 3806, samuel.tomczyk@uni-greifswald.de %K mHealth %K COVID-19 %K UTAUT1 %K UTAUT2 %K health behavior change %K theory of planned behavior %K contact tracing %K app %K model %K technology acceptance %K cross-sectional studies %K social norms %K health communication %K privacy %K anxiety %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: To combat the global COVID-19 pandemic, contact tracing apps have been discussed as digital health solutions to track infection chains and provide appropriate information. However, observational studies point to low acceptance in most countries, and few studies have yet examined theory-based predictors of app use in the general population to guide health communication efforts. Objective: This study utilizes established health behavior change and technology acceptance models to predict adoption intentions and frequency of current app use. Methods: We conducted a cross-sectional online survey between May and July 2020 in a German convenience sample (N=349; mean age 35.62 years; n=226, 65.3% female). To inspect the incremental validity of model constructs as well as additional variables (privacy concerns, personalization), hierarchical regression models were applied, controlling for covariates. Results: The theory of planned behavior and the unified theory of acceptance and use of technology predicted adoption intentions (R2=56%-63%) and frequency of current app use (R2=33%-37%). A combined model only marginally increased the predictive value by about 5%, but lower privacy concerns and higher threat appraisals (ie, anticipatory anxiety) significantly predicted app use when included as additional variables. Moreover, the impact of perceived usefulness was positive for adoption intentions but negative for frequency of current app use. Conclusions: This study identified several theory-based predictors of contact tracing app use. However, few constructs, such as social norms, have a consistent positive effect across models and outcomes. Further research is required to replicate these observations, and to examine the interconnectedness of these constructs and their impact throughout the pandemic. Nevertheless, the findings suggest that promulgating affirmative social norms and positive emotional effects of app use, as well as addressing health concerns, might be promising strategies to foster adoption intentions and app use in the general population. %M 33882016 %R 10.2196/25447 %U https://www.jmir.org/2021/5/e25447 %U https://doi.org/10.2196/25447 %U http://www.ncbi.nlm.nih.gov/pubmed/33882016 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27340 %T Health Care Professional Association Agency in Preparing for Artificial Intelligence: Protocol for a Multi-Case Study %A Gillan,Caitlin %A Hodges,Brian %A Wiljer,David %A Dobrow,Mark %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 700 Bay St, 2nd Floor, Suite 201, Toronto, ON, M5G1Z6, Canada, 1 416 340 4800 ext 2916, caitlin.gillan@uhn.ca %K artificial intelligence %K health professions %K normalization process theory %K case study %D 2021 %7 19.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The emergence of artificial intelligence (AI) in health care has impacted health care systems, including employment, training, education, and professional regulation. It is incumbent on health professional associations to assist their membership in defining and preparing for AI-related change. Health professional associations, or the national groups convened to represent the interests of the members of a profession, play a unique role in establishing the sociocultural, normative, and regulative elements of health care professions. Objective: The aim of this paper is to present a protocol for a proposed study of how, when faced with AI as a disruptive technology, health professional associations engage in sensemaking and legitimization of change to support their membership in preparing for future practice. Methods: An exploratory multi-case study approach will be used. This study will be informed by the normalization process theory (NPT), which suggests behavioral constructs required for complex change, providing a novel lens through which to consider the agency of macrolevel actors in practice change. A total of 4 health professional associations will be studied, each representing an instrumental case and related fields selected for their early consideration of AI technologies. Data collection will consist of key informant interviews, observation of relevant meetings, and document review. Individual and collective sensemaking activities and action toward change will be identified using stakeholder network mapping. A hybrid inductive and deductive model will be used for a concurrent thematic analysis, mapping emergent themes against the NPT framework to assess fit and identify areas of discordance. Results: As of January 2021, we have conducted 17 interviews, with representation across the 4 health professional associations. Of these 17 interviews, 15 (88%) have been transcribed. Document review is underway and complete for one health professional association and nearly complete for another. Observation opportunities have been challenged by competing priorities during COVID-19 and may require revisiting. A linear cross-case analytic approach will be taken to present the data, highlighting both guidance for the implementation of AI and implications for the application of NPT at the macro level. The ability to inform consideration of AI will depend on the degree to which the engaged health professional associations have considered this topic at the time of the study and, hence, what priority it has been assigned within the health professional association and what actions have been taken to consider or prepare for it. The fact that this may differ between health professional associations and practice environments will require consideration throughout the analysis. Conclusions: Ultimately, this protocol outlines a case study approach to understand how, when faced with AI as a disruptive technology, health professional associations engage in sensemaking and legitimization of change to support their membership in preparing for future practice. International Registered Report Identifier (IRRID): DERR1-10.2196/27340 %M 34009136 %R 10.2196/27340 %U https://www.researchprotocols.org/2021/5/e27340 %U https://doi.org/10.2196/27340 %U http://www.ncbi.nlm.nih.gov/pubmed/34009136 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 5 %P e27228 %T Pathway-Driven Coordinated Telehealth System for Management of Patients With Single or Multiple Chronic Diseases in China: System Development and Retrospective Study %A Wang,Zheyu %A An,Jiye %A Lin,Hui %A Zhou,Jiaqiang %A Liu,Fang %A Chen,Juan %A Duan,Huilong %A Deng,Ning %+ Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Yuquan Campus, Hangzhou, 310027, China, 86 57122952693, zju.dengning@gmail.com %K chronic disease %K telehealth system %K integrated care %K pathway %K ontology %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Integrated care enhanced with information technology has emerged as a means to transform health services to meet the long-term care needs of patients with chronic diseases. However, the feasibility of applying integrated care to the emerging “three-manager” mode in China remains to be explored. Moreover, few studies have attempted to integrate multiple types of chronic diseases into a single system. Objective: The aim of this study was to develop a coordinated telehealth system that addresses the existing challenges of the “three-manager” mode in China while supporting the management of single or multiple chronic diseases. Methods: The system was designed based on a tailored integrated care model. The model was constructed at the individual scale, mainly focusing on specifying the involved roles and responsibilities through a universal care pathway. A custom ontology was developed to represent the knowledge contained in the model. The system consists of a service engine for data storage and decision support, as well as different forms of clients for care providers and patients. Currently, the system supports management of three single chronic diseases (hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease) and one type of multiple chronic conditions (hypertension with type 2 diabetes mellitus). A retrospective study was performed based on the long-term observational data extracted from the database to evaluate system usability, treatment effect, and quality of care. Results: The retrospective analysis involved 6964 patients with chronic diseases and 249 care providers who have registered in our system since its deployment in 2015. A total of 519,598 self-monitoring records have been submitted by the patients. The engine could generate different types of records regularly based on the specific care pathway. Results of the comparison tests and causal inference showed that a part of patient outcomes improved after receiving management through the system, especially the systolic blood pressure of patients with hypertension (P<.001 in all comparison tests and an approximately 5 mmHg decrease after intervention via causal inference). A regional case study showed that the work efficiency of care providers differed among individuals. Conclusions: Our system has potential to provide effective management support for single or multiple chronic conditions simultaneously. The tailored closed-loop care pathway was feasible and effective under the “three-manager” mode in China. One direction for future work is to introduce advanced artificial intelligence techniques to construct a more personalized care pathway. %M 33998999 %R 10.2196/27228 %U https://medinform.jmir.org/2021/5/e27228 %U https://doi.org/10.2196/27228 %U http://www.ncbi.nlm.nih.gov/pubmed/33998999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25577 %T Using a Multisectoral Approach to Advance Health Equity in Rural Arizona: Community-Engaged Survey Development and Implementation Study %A Remiker,Mark %A Sabo,Samantha %A Jiménez,Dulce %A Samarron Longorio,Alexandra %A Chief,Carmenlita %A Williamson,Heather %A Teufel-Shone,Nicolette %+ Center for Health Equity Research, Northern Arizona University, 1395 Knoles Dr., Flagstaff, AZ, 86011, United States, 1 2627487095, mark.remiker@nau.edu %K health equity %K community-engaged %K multisector %K survey development %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the past decade, public health research and practice sectors have shifted their focus away from identifying health disparities and toward addressing the social, environmental, and economic determinants of health equity. Given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. However, engaging various stakeholder groups, tapping into their unique knowledge systems, and identifying common objectives across sectors is difficult and time consuming and can impede collaborative efforts. Objective: The Southwest Health Equity Research Collaborative at Northern Arizona University, in partnership with an 11-member community advisory council, is addressing this need with a joint community-campus effort to develop and implement a Regional Health Equity Survey (RHES) designed to generate an interdisciplinary body of knowledge, which will be used to guide future multisectoral action for improving community health and well-being. Methods: Researchers and community partners used facilitated discussions and free listing techniques to generate survey items. The community partners pilot tested the survey instrument to evaluate its feasibility and duration before survey administration. Respondent-driven sampling was used to ensure that participants included leadership from across all sectors and regions of northern Arizona. Results: Over the course of 6 months, 206 participants representing 13 sectors across the 5 counties of northern Arizona were recruited to participate in an RHES. Survey response rates, completion percentage, and sector representation were used to assess the effectiveness and feasibility of using a community-engaged apporach for survey development and participant recruitment. The findings describe the current capacity to impact health equity by using a multisectoral approach in northern Arizona. Conclusions: The Southwest Health Equity Research Collaborative effectively engaged community members to assist with the development and implementation of an RHES aimed at understanding and promoting multisectoral action on the root causes of health inequity. The results will help to build research and evaluation capacity to address the social, economic, and environmental conditions of health inequity in the region. %M 33978596 %R 10.2196/25577 %U https://formative.jmir.org/2021/5/e25577 %U https://doi.org/10.2196/25577 %U http://www.ncbi.nlm.nih.gov/pubmed/33978596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27180 %T The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome %A Tossaint-Schoenmakers,Rosian %A Versluis,Anke %A Chavannes,Niels %A Talboom-Kamp,Esther %A Kasteleyn,Marise %+ Saltro Diagnostic Centre, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 6 55895361, rtossaint@saltro.nl %K eHealth %K digital health %K blended care %K quality %K integration %K health care organization %K structure %K process %K outcome %D 2021 %7 10.5.2021 %9 Review %J J Med Internet Res %G English %X 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. %M 33970123 %R 10.2196/27180 %U https://www.jmir.org/2021/5/e27180 %U https://doi.org/10.2196/27180 %U http://www.ncbi.nlm.nih.gov/pubmed/33970123 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22599 %T Smartphone Usage Among Doctors in the Clinical Setting in Two Culturally Distinct Countries: Cross-sectional Comparative Study %A Nair,Anjali Ajay %A Afroz,Samreen %A Ahmed,Bushra Urooj %A Ahmed,Uzma Urooj %A Foo,Chi Chung %A Zaidan,Hind %A Corbally,Martin %+ School of Medicine, RCSI Bahrain, Building No. 2441, Road 2835, Busaiteen, Bahrain, 852 6759 5753, 14034735@rcsi.com %K smartphone use %K mobile phone %K mobile technology %K smartphone technology %K medical apps %K mobile applications %K smartphone applications %K mHealth %K mobile health %K digital health %K medical informatics %K internet %K doctors %K patient care %K point of care %K Bahrain %K Hong Kong %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones and mobile applications have seen a surge in popularity in recent years, a pattern that has also been reflected in the health care system. Despite increased reliance among clinicians however, limited research has been conducted on the uptake and impact of smartphone usage in medical practice, especially outside the Western world. Objective: This study aimed to identify the usage of smartphones and medical apps by doctors in the clinical setting in 2 culturally distinct countries: King Hamad University Hospital (KHUH), Bahrain and Queen Mary Hospital (QMH), Hong Kong. Methods: A cross-sectional, comparative study was conducted where doctors in both hospitals were asked to take part in a 15-item online survey. The questions were categorized into the following groups: demographics of the study population, ownership and main use of smartphones, number and names of medical apps currently owned, rating usage of smartphones for medical purposes, time spent on a smartphone related to clinical use, clinical reliance on smartphones, and views on further integration of smartphones. The results were then tabulated and analyzed using SPSS Statistics 25 for Mac (IBM Corp Inc, Armonk, NY). Results: A total of 200 doctors were surveyed, with a total of 99.0% (99/100) of the doctors owning a smartphone in both KHUH and QMH; 58% (57/99) and 55% (54/99) of the doctors from KHUH and QMH, respectively, identified communication as their main use of smartphones in the clinical setting (P=.004). Doctors from KHUH were likely to spend more time on medical apps than doctors from QMH (P=.002). According to the overall results of both hospitals, 48% (32/67) of the junior doctors claimed high reliance on smartphones, whereas only 32.3% (41/127) of the senior doctors said the same (P=.03). Of doctors in KHUH and QMH, 78.0% (78/100) and 69.0% (69/100), respectively, either strongly agreed or agreed that smartphones need to be integrated into the clinical setting. In terms of preferences for future apps, 48% (48/100) and 56% (56/100) of the doctors in KHUH and QMH, respectively, agreed that more medical applications need to be created in order to support smartphone use in the clinical setting. Conclusions: These results suggest a substantial acceptance of smartphones by doctors in the clinical setting. It also elicits the need to establish policies to officially integrate smartphone technology into health care in accordance with ethical guidelines. More emphasis should be placed on creating medical applications that aid health care professionals in attaining their information from accurate sources and also regulate a system to monitor the usage of mobile devices within hospitals to prevent a breach of patient privacy and confidentiality. %M 33970119 %R 10.2196/22599 %U https://mhealth.jmir.org/2021/5/e22599 %U https://doi.org/10.2196/22599 %U http://www.ncbi.nlm.nih.gov/pubmed/33970119 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25547 %T Priority Given to Technology in Government-Based Mental Health and Addictions Vision and Strategy Documents: Systematic Policy Review %A Lal,Shalini %A Siafa,Lyna %A Lee,Hajin %A Adair,Carol E %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, PO Box 6128, Centre-ville station, Montréal, QC, H3C 3J7, Canada, 1 514 890 8000 ext 31581, shalini.lal@umontreal.ca %K e-mental health %K digital mental health %K virtual care %K technology %K mental health %K addictions %K review %K policy %K e-health %K mHealth %K digital health %K tele %D 2021 %7 5.5.2021 %9 Review %J J Med Internet Res %G English %X Background: The use of information and communication technologies (ICTs) to deliver mental health and addictions (MHA) services is a global priority, especially considering the urgent shift towards virtual delivery of care in response to the COVID-19 pandemic. It is important to monitor the evolving role of technology in MHA services. Given that MHA policy documents represent the highest level of priorities for a government’s vision and strategy for mental health care, one starting point is to measure the frequency with which technology is mentioned and the terms used to describe its use in MHA policy documents (before, during, and after COVID-19). Yet, to our knowledge, no such review of the extent to which ICTs are referred to in Canadian MHA policy documents exists to date. Objective: The objective of this systematic policy review was to examine the extent to which technology is addressed in Canadian government–based MHA policy documents prior to the COVID-19 pandemic to establish a baseline for documenting change. Methods: We reviewed 22 government-based MHA policy documents, published between 2011 and 2019 by 13 Canadian provinces and territories. We conducted content analysis to synthesize the policy priorities addressed in these documents into key themes, and then systematically searched for and tabulated the use of 39 technology-related keywords (in English and French) to describe and compare jurisdictions. Results: Technology was addressed in every document, however, to a varying degree. Of the 39 searched keywords, we identified 22 categories of keywords pertaining to the use of technology to deliver MHA services and information. The 6 most common categories were tele (n=16/22), phone (n=12/22), tech (n=11/22), online (n=10/22), line (n=10/22), and web (n=10/22), with n being the number of policy documents in which the category was mentioned out of 22 documents. The use of terms referring to advanced technologies, such as virtual (n=6/22) and app (n= 4/22), were less frequent. Additionally, policy documents from some provinces and territories (eg, Alberta and Newfoundland and Labrador) mentioned a diverse range of ICTs, whereas others described only 1 form of ICT. Conclusions: This review indicates that technology has been given limited strategic attention in Canadian MHA policy. Policy makers may have limited knowledge on the evidence and potential of using technology in this field, highlighting the value for knowledge translation and collaborative initiatives among policy makers and researchers. The development of a pan-Canadian framework for action addressing the integration and coordination of technology in mental health services can also guide initiatives in this field. Our findings provide a prepandemic baseline and replicable methods to monitor how the use of technology-supported services and innovations emerge relative to other priorities in MHA policy during and after the COVID-19 pandemic. %M 33949955 %R 10.2196/25547 %U https://www.jmir.org/2021/5/e25547 %U https://doi.org/10.2196/25547 %U http://www.ncbi.nlm.nih.gov/pubmed/33949955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24908 %T The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands %A Huygens,Martine W J %A Voogdt-Pruis,Helene R %A Wouters,Myrah %A Meurs,Maaike M %A van Lettow,Britt %A Kleijweg,Conchita %A Friele,Roland D %+ Department of Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 0651964815, h.r.pruis@umcutrecht.nl %K eHealth %K telemonitoring %K self-management %K telemedicine %K telehealth %D 2021 %7 3.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2% (18/161) in 2014 to 19.6% (36/184) in 2019 (χ24=12.3; P=.02). In 2019, telemonitoring was used by 5.8% (28/485) of people with chronic disease. This was 18.2% (41/225) in GP organizations and 40.4% (44/109), 38.0% (78/205), and 8.9% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were “comfort” (421/1043, 40.4%) and “living at home for longer/more comfortably” (334/1047, 31.9%). Health care professionals added “improvement of self-management” (63/176, 35.8% to 57/71, 80.3%), “better understanding of the patient’s condition” (47/176, 26.7% to 42/71, 59.2%), “reduction of workload” (53/134, 39.6% of nurses in elderly care), “better tailoring of care plan to the patient’s situation” (95/225, 42.2% of GPs), and “saves time for patients/caregivers” (61/176, 34.7% of medical specialists). Disadvantages mentioned by professionals were that “it takes time to monitor data” (13/130, 10% to 108/225, 48.0%), “it takes time to follow up alerts” (15/130, 11.5% to 117/225, 52.0%), and “it is difficult to estimate which patients can work with telemonitoring” (22/113, 19.5% to 94/225, 41.8%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. %M 33938808 %R 10.2196/24908 %U https://www.jmir.org/2021/5/e24908 %U https://doi.org/10.2196/24908 %U http://www.ncbi.nlm.nih.gov/pubmed/33938808 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21357 %T Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review %A Støme,Linn Nathalie %A Wilhelmsen,Christian Ringnes %A Kværner,Kari Jorunn %+ Centre for Connected Care, Oslo University Hospital, Kirkeveien 166, Oslo, Norway, 47 94 88 08 25, linast@ous-hf.no %K eHealth %K feasibility %K global health %K implementation %D 2021 %7 30.4.2021 %9 Review %J JMIR Form Res %G English %X Background: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. Objective: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. Methods: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. Results: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. Conclusions: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods. %M 33929330 %R 10.2196/21357 %U https://formative.jmir.org/2021/4/e21357 %U https://doi.org/10.2196/21357 %U http://www.ncbi.nlm.nih.gov/pubmed/33929330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25773 %T Development of a Resource Guide to Support the Engagement of Mental Health Providers and Patients With Digital Health Tools: Multimethod Study %A Strudwick,Gillian %A McLay,David %A Lo,Brian %A Shin,Hwayeon Danielle %A Currie,Leanne %A Thomson,Nicole %A Maillet,Éric %A Strong,Vanessa %A Miller,Alanna %A Shen,Nelson %A Campbell,Janis %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 39333, gillian.strudwick@camh.ca %K digital health %K mental health %K psychiatry %K COVID-19 %K nursing informatics %K health informatics %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. Objective: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. Methods: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. Results: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). Conclusions: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways. %M 33885374 %R 10.2196/25773 %U https://www.jmir.org/2021/4/e25773 %U https://doi.org/10.2196/25773 %U http://www.ncbi.nlm.nih.gov/pubmed/33885374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27069 %T A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study %A Tsai,Wen-Hsun %A Wu,Yi-Syuan %A Cheng,Chia-Shiang %A Kuo,Ming-Hao %A Chang,Yu-Tien %A Hu,Fu-Kang %A Sun,Chien-An %A Chang,Chi-Wen %A Chan,Ta-Chien %A Chen,Chao-Wen %A Lee,Chia-Cheng %A Chu,Chi-Ming %+ School of Public Health, National Defense Medical Center, 4F, No161, Min-Chun E Rd, Sec 6, Neihu Dist, Taipei, Taiwan, 886 2 8792 3100 ext 18473, chuchiming@web.de %K personal health record %K electronic medical record %K my health bank %K technology acceptance model %K structural equation model %K electronic health record %K COVID-19 %K protection %K survey %K model %K intention %K usage %K literacy %K privacy %K security %D 2021 %7 21.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread. Objective: This study aims to understand people’s intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform. Methods: From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software. Results: A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income 6 hours: AOR 8.766, 95% CI 1.883-40.804), and adoption of mHealth before the COVID-19 outbreak (yes: AOR 3.413, 95% CI 1.234-9.444) were significantly correlated with the parents’ willingness to adopt mHealth during the COVID-19 outbreak. The frequency of mHealth use among parents was correlated with their behaviors in regard to handwashing (χ26=18.967, P=.004), mask wearing (χ26=45.364, P<.001), frequency of leaving the home (χ26=16.767, P=.01), room disinfection and ventilation (χ26=19.515, P=.003), temperature checking (χ26=17.47, P=.007), and mental health care of children (χ26=63.810, P<.001) during the COVID-19 pandemic. Conclusions: We found various objective factors that were associated with parents’ willingness to adopt mHealth during the COVID-19 outbreak. Overall, parents’ willingness to adopt mHealth was high. The frequency of mHealth use among parents was correlated with their attitudes toward child health care at home. The option of mHealth to patients at home during the COVID-19 outbreak would be beneficial for education and improvement in self-management of child health care at home. %M 33406052 %R 10.2196/23155 %U http://mhealth.jmir.org/2021/1/e23155/ %U https://doi.org/10.2196/23155 %U http://www.ncbi.nlm.nih.gov/pubmed/33406052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23775 %T Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework %A James,Hannah M %A Papoutsi,Chrysanthi %A Wherton,Joseph %A Greenhalgh,Trisha %A Shaw,Sara E %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, , United Kingdom, 44 1865617873, sara.shaw@phc.ox.ac.uk %K delivery of health care %K remote consultation %K telemedicine %K videoconferencing %K spread and scale-up %K sustainability %K mobile phone %K COVID-19 %K remote care %K consultation %K review %D 2021 %7 26.1.2021 %9 Review %J J Med Internet Res %G English %X Background: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use. %M 33434141 %R 10.2196/23775 %U http://www.jmir.org/2021/1/e23775/ %U https://doi.org/10.2196/23775 %U http://www.ncbi.nlm.nih.gov/pubmed/33434141 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e17500 %T Patients’ Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis %A Abd-Alrazaq,Alaa %A Safi,Zeineb %A Bewick,Bridgette M %A Househ,Mowafa %A Gardner,Peter H %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, LAS Building,, Education city, Doha, RD5256, Qatar, 974 55708549, alaa_alzoubi88@yahoo.com %K electronic personal health records %K tethered personal health records %K patient portal %K patient online %K technology acceptance %K technology adoption %K qualitative research %K mobile phone %D 2021 %7 13.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients’ adoption and implementation success of the system, it is important to understand the factors affecting their use of the system. Objective: The aim of this study is to explore patients’ perspectives of factors affecting their use of ePHRs in England. Methods: A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis. Results: Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants’ responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online. Conclusions: The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system. %M 33439126 %R 10.2196/17500 %U http://www.jmir.org/2021/1/e17500/ %U https://doi.org/10.2196/17500 %U http://www.ncbi.nlm.nih.gov/pubmed/33439126 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21815 %T Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters %A Petracca,Francesco %A Ciani,Oriana %A Cucciniello,Maria %A Tarricone,Rosanna %+ Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Via Roentgen 1, 20136, Milan, Italy, 39 02 58365257, francesco.petracca@unibocconi.it %K mobile apps %K coronavirus %K COVID-19 %K digital health %K mHealth %K organizational context %K public health %K telemedicine %D 2020 %7 30.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after. %M 33351777 %R 10.2196/21815 %U http://www.jmir.org/2020/12/e21815/ %U https://doi.org/10.2196/21815 %U http://www.ncbi.nlm.nih.gov/pubmed/33351777 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22792 %T Patterns and Perceptions of Smartphone Use Among Academic Neurologists in the United States: Questionnaire Survey %A Zeiger,William %A DeBoer,Scott %A Probasco,John %+ Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 6-113, Baltimore, MD, 21287, United States, 1 410 955 8174, jprobas1@jhmi.edu %K smartphone %K mobile phone %K mobile apps %K mobile health %K neurology %K neurologic exam %K physical exam %D 2020 %7 24.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone technology is ubiquitous throughout neurologic practices, and numerous apps relevant to a neurologist’s clinical practice are now available. Data from other medical specialties suggest high utilization of smartphones in routine clinical care. However, the ways in which these devices are used by neurologists for patient care–related activities are not well defined. Objective: This paper aims to characterize current patterns of smartphone use and perceptions of the utility of smartphones for patient care–related activities among academic neurology trainees and attending physicians. We also seek to characterize areas of need for future app development. Methods: We developed a 31-item electronic questionnaire to address these questions and invited neurology trainees and attendings of all residency programs based in the United States to participate. We summarized descriptive statistics for respondents and specifically compared responses between trainees and attending physicians. Results: We received 213 responses, including 112 trainee and 87 attending neurologist responses. Neurology trainees reported more frequent use of their smartphone for patient care–related activities than attending neurologists (several times per day: 84/112, 75.0% of trainees; 52/87, 59.8% of attendings; P=.03). The most frequently reported activities were internet use, calendar use, communication with other physicians, personal education, and health care–specific app use. Both groups also reported regular smartphone use for the physical examination, with trainees again reporting more frequent usage compared with attendings (more than once per week: 35/96, 36.5% of trainees; 8/58, 13.8% of attendings; P=.03). Respondents used their devices most commonly for the vision, cranial nerve, and language portions of the neurologic examination. The majority of respondents in both groups reported their smartphones as “very useful” or “essential” for the completion of patient care–related activities (81/108, 75.0% of trainees; 50/83, 60.2% of attendings; P=.12). Neurology trainees reported a greater likelihood of using their smartphones in the future than attending neurologists (“very likely”: 73/102, 71.6% of trainees; 40/82, 48.8% of attendings; P=.005). The groups differed in their frequencies of device usage for specific patient care–related activities, with trainees reporting higher usage for most activities. Despite high levels of use, only 12 of 184 (6.5%) respondents reported ever having had any training on how to use their device for clinical care. Regarding future app development, respondents rated vision, language, mental status, and cranial nerve testing as potentially being the most useful to aid in the performance of the neurologic examination. Conclusions: Smartphones are used frequently and are subjectively perceived to be highly useful by academic neurologists. Trainees tended to use their devices more frequently than attendings. Our results suggest specific avenues for future technological development to improve smartphone use for patient care–related activities. They also suggest an unmet need for education on effectively using smartphone technology for clinical care. %M 33361053 %R 10.2196/22792 %U http://mhealth.jmir.org/2020/12/e22792/ %U https://doi.org/10.2196/22792 %U http://www.ncbi.nlm.nih.gov/pubmed/33361053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23955 %T Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey %A Maassen,Oliver %A Fritsch,Sebastian %A Gantner,Julia %A Deffge,Saskia %A Kunze,Julian %A Marx,Gernot %A Bickenbach,Johannes %+ Department of Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany, 49 2418080444, oliver.maassen@rwth-aachen.de %K mobile devices %K mobile applications %K apps %K mHealth %K smartphones %K tablets %K device usage %K requirements %K expectations %K hospital %K working equipment %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile devices in hospital care constantly increases. However, smartphones and tablets have not yet widely become official working equipment in medical care. Meanwhile, the parallel use of private and official devices in hospitals is common. Medical staff use smartphones and tablets in a growing number of ways. This mixture of devices and how they can be used is a challenge to persons in charge of defining strategies and rules for the usage of mobile devices in hospital care. Objective: Therefore, we aimed to examine the status quo of physicians’ mobile device usage and concrete requirements and their future expectations of how mobile devices can be used. Methods: We performed a web-based survey among physicians in 8 German university hospitals from June to October 2019. The online survey was forwarded by hospital management personnel to physicians from all departments involved in patient care at the local sites. Results: A total of 303 physicians from almost all medical fields and work experience levels completed the web-based survey. The majority regarded a tablet (211/303, 69.6%) and a smartphone (177/303, 58.4%) as the ideal devices for their operational area. In practice, physicians are still predominantly using desktop computers during their worktime (mean percentage of worktime spent on a desktop computer: 56.8%; smartphone: 12.8%; tablet: 3.6%). Today, physicians use mobile devices for basic tasks such as oral (171/303, 56.4%) and written (118/303, 38.9%) communication and to look up dosages, diagnoses, and guidelines (194/303, 64.0%). Respondents are also willing to use mobile devices for more advanced applications such as an early warning system (224/303, 73.9%) and mobile electronic health records (211/303, 69.6%). We found a significant association between the technical affinity and the preference of device in medical care (χs2=53.84, P<.001) showing that with increasing self-reported technical affinity, the preference for smartphones and tablets increases compared to desktop computers. Conclusions: Physicians in German university hospitals have a high technical affinity and positive attitude toward the widespread implementation of mobile devices in clinical care. They are willing to use official mobile devices in clinical practice for basic and advanced mobile health uses. Thus, the reason for the low usage is not a lack of willingness of the potential users. Challenges that hinder the wider adoption of mobile devices might be regulatory, financial and organizational issues, and missing interoperability standards of clinical information systems, but also a shortage of areas of application in which workflows are adapted for (small) mobile devices. %M 33346735 %R 10.2196/23955 %U http://www.jmir.org/2020/12/e23955/ %U https://doi.org/10.2196/23955 %U http://www.ncbi.nlm.nih.gov/pubmed/33346735 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18655 %T Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients %A Schmalz,Oliver %A Jacob,Christine %A Ammann,Johannes %A Liss,Blasius %A Iivanainen,Sanna %A Kammermann,Manuel %A Koivunen,Jussi %A Klein,Alexander %A Popescu,Razvan Andrei %+ Medical Affairs (Personalised Healthcare and Patient Access), F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070 Basel, Switzerland, 41 792 921 758, johannes.ammann@roche.com %K advanced or metastatic non-small cell lung cancer %K cancer immunotherapy %K digital patient monitoring %K drug- and indication-specific cancer immunotherapy module %K eHealth %K mHealth %K quality of patient care %K patient-reported outcomes %K real-time symptom reporting %K user experience %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer immunotherapy (CIT), as a monotherapy or in combination with chemotherapy, has been shown to extend overall survival in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). However, patients experience treatment-related symptoms that they are required to recall between hospital visits. Digital patient monitoring and management (DPMM) tools may improve clinical practice by allowing real-time symptom reporting. Objective: This proof-of-concept pilot study assessed patient and health care professional (HCP) adoption of our DPMM tool, which was designed specifically for patients with advanced or metastatic NSCLC treated with CIT, and the tool’s impact on clinical care. Methods: Four advisory boards were assembled in order to co-develop a drug- and indication-specific CIT (CIT+) module, based on a generic CIT DPMM tool from Kaiku Health, Helsinki, Finland. A total of 45 patients treated with second-line single-agent CIT (ie, atezolizumab or otherwise) for advanced or metastatic NSCLC, as well as HCPs, whose exact number was decided by the clinics, were recruited from 10 clinics in Germany, Finland, and Switzerland between February and May 2019. All clinics were provided with the Kaiku Health generic CIT DPMM tool, including our CIT+ module. Data on user experience, overall satisfaction, and impact of the tool on clinical practice were collected using anonymized surveys—answers ranged from 1 (low agreement) to 5 (high agreement)—and HCP interviews; surveys and interviews consisted of closed-ended Likert scales and open-ended questions, respectively. The first survey was conducted after 2 months of DPMM use, and a second survey and HCP interviews were conducted at study end (ie, after ≥3 months of DPMM use); only a subgroup of HCPs from each clinic responded to the surveys and interviews. Survey data were analyzed quantitatively; interviews were recorded, transcribed verbatim, and translated into English, where applicable, for coding and qualitative thematic analysis. Results: Among interim survey respondents (N=51: 13 [25%] nurses, 11 [22%] physicians, and 27 [53%] patients), mean rankings of the tool’s seven usability attributes ranged from 3.2 to 4.4 (nurses), 3.7 to 4.5 (physicians), and 3.7 to 4.2 (patients). At the end-of-study survey (N=48: 19 [40%] nurses, 8 [17%] physicians, and 21 [44%] patients), most respondents agreed that the tool facilitated more efficient and focused discussions between patients and HCPs (nurses and patients: mean rating 4.2, SD 0.8; physicians: mean rating 4.4, SD 0.8) and allowed HCPs to tailor discussions with patients (mean rating 4.35, SD 0.65). The standalone tool was well integrated into HCP daily clinical workflow (mean rating 3.80, SD 0.75), enabled workflow optimization between physicians and nurses (mean rating 3.75, SD 0.80), and saved time by decreasing phone consultations (mean rating 3.75, SD 1.00) and patient visits (mean rating 3.45, SD 1.20). Workload was the most common challenge of tool use among respondents (12/19, 63%). Conclusions: Our results demonstrate high user satisfaction and acceptance of DPMM tools by HCPs and patients, and highlight the improvements to clinical care in patients with advanced or metastatic NSCLC treated with CIT monotherapy. However, further integration of the tool into the clinical information technology data flow is required. Future studies or registries using our DPMM tool may provide insights into significant effects on patient quality of life or health-economic benefits. %M 33346738 %R 10.2196/18655 %U http://www.jmir.org/2020/12/e18655/ %U https://doi.org/10.2196/18655 %U http://www.ncbi.nlm.nih.gov/pubmed/33346738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23014 %T Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study %A Carolan,Kelsi %A Grabowski,David C %A Mehrotra,Ateev %A Hatfield,Laura A %+ School of Social Work, University of Connecticut, 38 Prospect St, Hartford, CT, 06103, United States, 1 959 200 3680, kelsi.carolan@uconn.edu %K telemedicine %K telehealth %K independent senior living communities %K emergency care %K first responders %D 2020 %7 17.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. Objective: We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. Methods: In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. Results: Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. Conclusions: Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers. %M 33331827 %R 10.2196/23014 %U http://www.jmir.org/2020/12/e23014/ %U https://doi.org/10.2196/23014 %U http://www.ncbi.nlm.nih.gov/pubmed/33331827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14787 %T Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany %A Dittrich,Florian %A Back,David Alexander %A Harren,Anna Katharina %A Landgraeber,Stefan %A Reinecke,Felix %A Serong,Sebastian %A Beck,Sascha %+ Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstraße 100, Building 37, Homburg, 66421, Germany, 49 68411624520, Florian.Dittrich@uks.eu %K mHealth %K smartphone %K communication %K medicine %K surveys and questionnaires %K technology %K orthopedics %K trauma surgery %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective: This study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior. Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection. %M 33252340 %R 10.2196/14787 %U http://formative.jmir.org/2020/11/e14787/ %U https://doi.org/10.2196/14787 %U http://www.ncbi.nlm.nih.gov/pubmed/33252340 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e22136 %T Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Patients and Professionals’ Acceptability Study %A de Batlle,Jordi %A Massip,Mireia %A Vargiu,Eloisa %A Nadal,Nuria %A Fuentes,Araceli %A Ortega Bravo,Marta %A Colomina,Jordi %A Drudis,Reis %A Torra,Montserrat %A Pallisó,Francesc %A Miralles,Felip %A Barbé,Ferran %A Torres,Gerard %A , %+ Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, 80 Rovira Roure Lleida, Lleida, 25198, Spain, 34 973705372, gtorres@gss.cat %K mHealth %K eHealth %K patient acceptance of health care %K patient satisfaction %K health plan implementation %K chronic diseases %D 2020 %7 20.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. Objective: This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). Results: The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals’ acceptability was low (UC1: NPS −25%; UC2: NPS −35%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight. Conclusions: The mHealth-enabled IC model showed outstanding results from the patients’ perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults. %M 33216004 %R 10.2196/22136 %U https://mhealth.jmir.org/2020/11/e22136 %U https://doi.org/10.2196/22136 %U http://www.ncbi.nlm.nih.gov/pubmed/33216004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22036 %T Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study %A Grady,Alice %A Barnes,Courtney %A Wolfenden,Luke %A Lecathelinais,Christophe %A Yoong,Sze Lin %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0249246310, alice.grady@health.nsw.gov.au %K early childhood education and care %K digital health technologies %K adoption %K dissemination %K guidelines %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. Objective: This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. Methods: A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. Results: Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization’s capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. Conclusions: A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood. %M 33216005 %R 10.2196/22036 %U http://www.jmir.org/2020/11/e22036/ %U https://doi.org/10.2196/22036 %U http://www.ncbi.nlm.nih.gov/pubmed/33216005 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e21874 %T Assessment of mHealth Interventions: Need for New Studies, Methods, and Guidelines for Study Designs %A Ologeanu-Taddei,Roxana %+ TBS Business School, 1, place Alphonse Jourdain, Toulouse, 31068, France, 33 5 61 29 48 51, r.ologeanu-taddei@tbs-education.fr %K eHealth %K mHealth %K usability %K management %K survey %K trust %K guidelines %K evaluation %D 2020 %7 18.11.2020 %9 Viewpoint %J JMIR Med Inform %G English %X This viewpoint argues that the clinical effects of mobile health (mHealth) interventions depends on the acceptance and adoption of these interventions and their mediators, such as usability of the mHealth software, software performance and features, training and motivation of patients and health care professionals to participate in the experience, or characteristics of the intervention (eg, personalized feedback). %M 33206060 %R 10.2196/21874 %U http://medinform.jmir.org/2020/11/e21874/ %U https://doi.org/10.2196/21874 %U http://www.ncbi.nlm.nih.gov/pubmed/33206060 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22280 %T Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature %A Golinelli,Davide %A Boetto,Erik %A Carullo,Gherardo %A Nuzzolese,Andrea Giovanni %A Landini,Maria Paola %A Fantini,Maria Pia %+ Department of Biomedical and Neuromotor Sciences, University of Bologna, via San Giacomo 12, Bologna, 40126, Italy, 39 0512094830, erik.boetto@gmail.com %K COVID-19 %K SARS-CoV-2 %K pandemic %K digital heath %K review %K literature %K mitigate %K impact %K eHealth %D 2020 %7 6.11.2020 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools. Objective: The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems. Methods: We conducted a systematic review of early COVID-19–related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas. Results: The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)–powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement. Conclusions: In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years. %M 33079693 %R 10.2196/22280 %U http://www.jmir.org/2020/11/e22280/ %U https://doi.org/10.2196/22280 %U http://www.ncbi.nlm.nih.gov/pubmed/33079693 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22716 %T Determinants of Patients’ Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China %A Li,Dehe %A Hu,Yinhuan %A Pfaff,Holger %A Wang,Liuming %A Deng,Lu %A Lu,Chuntao %A Xia,Shixiao %A Cheng,Siyu %A Zhu,Ximin %A Wu,Xiaoyue %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, Hubei, , China, 86 13554285879, hyh288@hotmail.com %K internet hospital %K health care–seeking intention %K online inquiry %K theory of planned behavior %K chronic disease %K structural equation modeling %K China %K COVID-19 %K intention %K online service %K eHealth %K behavior %K modeling %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals show great potential for adequately fulfilling people’s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients’ intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients’ behavioral intention is necessary to support the development of internet hospitals in China and promote patients’ intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. Objective: The purpose of this study is to identify the determinants of patients’ intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). Methods: The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. Results: A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (β=.624, P=.004 and β=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (β=.207; P=.001). Conclusions: Perceived behavioral control and perceived severity of disease are the most important determinants of patients’ intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients’ adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients’ intention to use online inquiry services provided by internet hospitals. %M 33006941 %R 10.2196/22716 %U http://www.jmir.org/2020/10/e22716/ %U https://doi.org/10.2196/22716 %U http://www.ncbi.nlm.nih.gov/pubmed/33006941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22913 %T Adoption of a Personal Health Record in the Digital Age: Cross-Sectional Study %A Yousef,Consuela Cheriece %A Thomas,Abin %A Alenazi,Ahmed O %A Elgadi,Sumaya %A Abu Esba,Laila Carolina %A AlAzmi,Aeshah %A Alhameed,Abrar Fahad %A Hattan,Ahmed %A Almekhloof,Saleh %A AlShammary,Mohammed A %A Alanezi,Nazzal Abdullah %A Alhamdan,Hani Solaiman %A Eldegeir,Manal %A Abulezz,Rayf %A Khoshhal,Sahal %A Masala,Clara Glynis %A Ahmed,Omaima %+ Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, PO Box 4616, Dammam, 31412, Saudi Arabia, 966 853 2555 ext 31680, yousefco@ngha.med.sa %K patient portal %K personal health record %K eHealth %K Middle East %K Saudi Arabia %D 2020 %7 28.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As health care organizations strive to improve health care access, quality, and costs, they have implemented patient-facing eHealth technologies such as personal health records to better engage patients in the management of their health. In the Kingdom of Saudi Arabia, eHealth is also growing in accordance with Vision 2030 and its National Transformation Program framework, creating a roadmap for increased quality and efficiency of the health care system and supporting the goal of patient-centered care. Objective: The aim of this study was to investigate the adoption of the personal health record of the Ministry of National Guard Health Affairs (MNGHA Care). Methods: A cross-sectional survey was conducted in adults visiting outpatient clinics in hospitals at the Ministry of National Guard Health Affairs hospitals in Riyadh, Jeddah, Dammam, Madinah, and Al Ahsa, and primary health care clinics in Riyadh and Qassim. The main outcome measure was self-reported use of MNGHA Care. Results: In the sample of 546 adult patients, 383 (70.1%) reported being users of MNGHA Care. MNGHA Care users were more likely to be younger (P<.001), high school or university educated (P<.001), employed (P<.001), have a chronic condition (P=.046), use the internet to search for health-related information (P<.001), and use health apps on their mobile phones (P<.001). Conclusions: The results of this study show that there is substantial interest for the use of MNGHA Care personal health record with 70% of participants self-reporting use. To confirm these findings, objective data from the portal usage logs are needed. Maximizing the potential of MNGHA Care supports patient engagement and is aligned with the national eHealth initiative to encourage the use of technology for high-quality, accessible patient-centered care. Future research should include health care provider perspectives, incorporate objective data, employ a mixed-methods approach, and use a theoretical framework. %M 32998854 %R 10.2196/22913 %U http://www.jmir.org/2020/10/e22913/ %U https://doi.org/10.2196/22913 %U http://www.ncbi.nlm.nih.gov/pubmed/32998854 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e20813 %T Investigating the Acceptance of Video Consultation by Patients in Rural Primary Care: Empirical Comparison of Preusers and Actual Users %A Mueller,Marius %A Knop,Michael %A Niehaves,Bjoern %A Adarkwah,Charles Christian %+ Chair of Information Systems, University of Siegen, Kohlbettstraße 15, Siegen, 57072, Germany, 49 2717402289, marius.mueller@uni-siegen.de %K video consultation %K technology acceptance %K digital health care technology %K primary care %K rural areas %K telemedicine %K behavioral intention %K eHealth %K teleconsultation %K electronic consultation %K general practitioners %D 2020 %7 22.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The ongoing digitalization in health care is enabling patients to receive treatment via telemedical technologies, such as video consultation (VC), which are increasingly being used by general practitioners. Rural areas in particular exhibit a rapidly aging population, with an increase in associated health issues, whereas the level of attraction for working in those regions is decreasing for young physicians. Integrating telemedical approaches in treating patients can help lessen the professional workload and counteract the trend toward the spatial undersupply in many countries. As a result, an increasing number of patients are being confronted with digital treatment and new forms of care delivery. These novel ways of care engender interactions with patients and their private lives in unprecedented ways, calling for studies that incorporate patient needs, expectations, and behavior into the design and application of telemedical technology within the field of primary care. Objective: This study aims to unveil and compare the acceptance-promoting factors of patients without (preusers) and with experiences (actual users) in using VC in a primary care setting and to provide implications for the design, theory, and use of VC. Methods: In total, 20 semistructured interviews were conducted with patients in 2 rural primary care practices to identify and analyze patient needs, perceptions, and experiences that facilitate the acceptance of VC technology and adoption behavior. Both preusers and actual users of VC were engaged, allowing for an empirical comparison. For data analysis, a procedure was followed based on open, axial, and selective coding. Results: The study delivers factors and respective subdimensions that foster the perceptions of patients toward VC in rural primary care. Factors cover attitudes and expectations toward the use of VC, the patient-physician relationship and its impact on technology assessment and use, patients’ rights and obligations that emerge with the introduction of VC in primary care, and the influence of social norms on the use of VC and vice versa. With regard to these factors, the results indicate differences between preusers and actual users of VC, which imply ways of designing and implementing VC concerning the respective user group. Actual users attach higher importance to the perceived benefits of VC and their responsibility to use it appropriately, which might be rooted in the technological intervention they experienced. On the contrary, preusers valued the opinions and expectations of their peers. Conclusions: The way the limitations and potential of VC are perceived varies across patients. When practicing VC in primary care, different aspects should be considered when dealing with preusers, such as maintaining a physical interaction with the physician or incorporating social cues. Once the digital intervention takes place, patients tend to value benefits such as flexibility and effectiveness over potential concerns. %M 32969339 %R 10.2196/20813 %U http://medinform.jmir.org/2020/10/e20813/ %U https://doi.org/10.2196/20813 %U http://www.ncbi.nlm.nih.gov/pubmed/32969339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18801 %T Wearable Technology Acceptance in Health Care Based on National Culture Differences: Cross-Country Analysis Between Chinese and Swiss Consumers %A Yang Meier,Dong %A Barthelmess,Petra %A Sun,Wei %A Liberatore,Florian %+ International Management Institute, School of Management and Law, Zurich University of Applied Sciences, Theaterstrasse 17, Winterthur, 8400, Switzerland, 41 792987655, yanm@zhaw.ch %K wearables %K health care wearables %K wearables acceptance %K cross culture %K national culture %K Chinese %K Swiss %K moderator %K digital health %K health technology acceptance %K smartwatch %D 2020 %7 22.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The advancement of wearable devices and growing demand of consumers to monitor their own health have influenced the medical industry. Health care providers, insurers, and global technology companies intend to develop more wearable devices incorporating medical technology and to target consumers worldwide. However, acceptance of these devices varies considerably among consumers of different cultural backgrounds. Consumer willingness to use health care wearables is influenced by multiple factors that are of varying importance in various cultures. However, there is insufficient knowledge of the extent to which social and cultural factors affect wearable technology acceptance in health care. Objective: The aims of this study were to examine the influential factors on the intention to adopt health care wearables, and the differences in the underlying motives and usage barriers between Chinese and Swiss consumers. Methods: A new model for acceptance of health care wearables was conceptualized by incorporating predictors of different theories such as technology acceptance, health behavior, and privacy calculus based on an existing framework. To verify the model, a web-based survey in both the Chinese and German languages was conducted in China and Switzerland, resulting in 201 valid Chinese and 110 valid Swiss respondents. A multigroup partial least squares path analysis was applied to the survey data. Results: Performance expectancy (β=.361, P<.001), social influence (β=.475, P<.001), and hedonic motivation (β=.111, P=.01) all positively affected the behavioral intention of consumers to adopt wearables, whereas effort expectancy, functional congruence, health consciousness, and perceived privacy risk did not demonstrate a significant impact on behavioral intention. The group-specific path coefficients indicated health consciousness (β=.150, P=.01) as a factor positively affecting only the behavior intention of the Chinese respondents, whereas the factors affecting only the behavioral intention of the Swiss respondents proved to be effort expectancy (β=.165, P=.02) and hedonic motivation (β=.212, P=.02). Performance expectancy asserted more of an influence on the behavioral intention of the Swiss (β=.426, P<.001) than the Chinese (β=.271, P<.001) respondents, whereas social influence had a greater influence on the behavioral intention of the Chinese (β=.321, P<.001) than the Swiss (β=.217, P=.004) respondents. Overall, the Chinese consumers displayed considerably higher behavioral intention (P<.001) than the Swiss. These discrepancies are explained by differences in national culture. Conclusions: This is one of the first studies to investigate consumers’ intention to adopt wearables from a cross-cultural perspective. This provides a theoretical and methodological foundation for future research, as well as practical implications for global vendors and insurers developing and promoting health care wearables with appropriate features in different countries. The testimonials and support by physicians, evidence of measurement accuracy, and easy handling of health care wearables would be useful in promoting the acceptance of wearables in Switzerland. The opinions of in-group members, involvement of employers, and multifunctional apps providing credible health care advice and solutions in cooperation with health care institutions would increase acceptance among the Chinese. %M 33090108 %R 10.2196/18801 %U http://www.jmir.org/2020/10/e18801/ %U https://doi.org/10.2196/18801 %U http://www.ncbi.nlm.nih.gov/pubmed/33090108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18312 %T Comparison of Older and Younger Adults’ Attitudes Toward the Adoption and Use of Activity Trackers %A Kim,Sunyoung %A Choudhury,Abhishek %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sunyoung.kim@rutgers.edu %K older adults %K technology acceptance %K activity tracker %K fitness tracker %K mHealth %K health care %K quality of life %D 2020 %7 22.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Activity tracking devices have significant potential in assisting older adults’ health care and quality of life, but this population lags behind in the adoption of these devices. While theoretical frameworks have been introduced to explain and increase the adoption of this technology by older adults, little effort has been made to validate the frameworks with people in other age groups. Objective: The goal of this study was to validate the theoretical framework of technology acceptance by older adults that we previously proposed through a direct comparison of the attitudes to and experiences of activity trackers in older and younger users. Methods: Semistructured interviews were conducted with 2 groups of 15 participants to investigate their experiences of using activity trackers. The recruitment criteria included age (between 18 years and 24 years for the younger participant group or 65 years and older for the older participant group) and prior experiences of using mobile devices or apps for activity tracking for 2 months and longer. Results: Our findings showed that the phase of perceived ease of learning as a significant influencer of the acceptance of activity trackers existed only in the older participant group, but this phase never emerged in the younger participant group. In addition, this study confirmed that other phases exist in both age groups, but 2 distinct patterns emerged according to age groups: (1) the social influence construct influenced the older participants positively but the younger participants negatively and (2) older participants’ exploration in the system experiment phase was purpose-driven by particular needs or benefits but for younger participants, it was a phase to explore a new technology. Conclusions: This study confirms the validity of the proposed theoretical framework to account for the unique aspect of older adults’ technology adoption. This framework can provide theoretical guidelines when designing technology for older adults as well as when generating new investigations and experiments for older adults and technology use. %M 33090116 %R 10.2196/18312 %U https://mhealth.jmir.org/2020/10/e18312 %U https://doi.org/10.2196/18312 %U http://www.ncbi.nlm.nih.gov/pubmed/33090116 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20099 %T eHealth Literacy of German Physicians in the Pre–COVID-19 Era: Questionnaire Study %A Kirchberg,Johanna %A Fritzmann,Johannes %A Weitz,Jürgen %A Bork,Ulrich %+ Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, Dresden, 01307, Germany, 49 3514585400, ulrich.bork@ukdd.de %K eHealth %K electronic health %K mobile health %K health apps %K mobile health apps %K eHealth literacy %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digitalization is a disruptive technology that changes the way we deliver diagnostic procedures and treatments in medicine. Different stakeholders have varying interests in and expectations of the digitalization of modern medicine. Many recent digital advances in the medical field, such as the implementation of electronic health records, telemedical services, and mobile health apps, are increasingly used by medical professionals and patients. During the current pandemic outbreak of a novel coronavirus-caused respiratory disease (COVID-19), many modern information and communication technologies (ICT) have been used to overcome the physical barriers and limitations caused by government-issued curfews and workforce shortages. Therefore, the COVID-19 pandemic has led to a surge in the usage of modern ICT in medicine. At the same time, the eHealth literacy of physicians working with these technologies has probably not improved since our study. Objective: This paper describes a representative cohort of German physicians before the COVID-19 pandemic and their eHealth literacy and attitude towards modern ICT. Methods: A structured, self-developed questionnaire about user behavior and attitudes towards eHealth applications was administered to a representative cohort of 93 German physicians. Results: Of the 93 German physicians who participated in the study, 97% (90/93) use a mobile phone. Medical apps are used by 42% (39/93). Half of the surveyed physicians (47/93, 50%) use their private mobile phones for official purposes on a daily basis. Telemedicine is part of the daily routine for more than one-third (31/93, 33%) of all participants. More than 80% (76/93, 82%) of the trial participants state that their knowledge regarding the legal aspects and data safety of medical apps and cloud computing is insufficient. Conclusions: Modern ICT is frequently used and mostly welcomed by German physicians. However, there is a tremendous lack of eHealth literacy and knowledge about the safe and secure implementation of these technologies in routine clinical practice. %M 33064102 %R 10.2196/20099 %U http://mhealth.jmir.org/2020/10/e20099/ %U https://doi.org/10.2196/20099 %U http://www.ncbi.nlm.nih.gov/pubmed/33064102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22443 %T Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey %A Chandrasekaran,Ranganathan %A Katthula,Vipanchi %A Moustakas,Evangelos %+ Department of Information & Decision Sciences, University of Illinois at Chicago, 601 S Morgan St, Chicago, IL, 60607, United States, 1 3129962847, ranga@uic.edu %K wearable healthcare devices %K mobile health %K HINTS %K health technology adoption and use %K smart wearables %D 2020 %7 16.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults. Objective: The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults. Methods: Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis. Results: About 30% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33%) use the devices every day, with a majority (82.38% weighted) willing to share the health data from wearables with their care providers. Women (16.25%), White individuals (19.74%), adults aged 18-50 years (19.52%), those with some level of college education or college graduates (25.60%), and those with annual household incomes greater than US $75,000 (17.66%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95% CI 0.96-1.65), White individuals (OR 1.65, 95% CI 0.97-2.79), college graduates (OR 1.05, 95% CI 0.31-3.51), and those with annual household incomes greater than US $75,000 (OR 2.6, 95% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95% CI 0.98-1.39), were overweight (OR 1.16, 95% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health. Conclusions: The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society. %M 33064083 %R 10.2196/22443 %U http://www.jmir.org/2020/10/e22443/ %U https://doi.org/10.2196/22443 %U http://www.ncbi.nlm.nih.gov/pubmed/33064083 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e23660 %T Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory %A Haun,Markus W %A Stephan,Isabella %A Wensing,Michel %A Hartmann,Mechthild %A Hoffmann,Mariell %A Friederich,Hans-Christoph %+ Department of General Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, D-69120, Germany, 49 622156 ext 8774, markus.haun@med.uni-heidelberg.de %K video consultations %K videoconferencing %K telehealth %K integrated care %K mental health %K preimplementation %K diffusion of innovations %K early adopters %K mixed methods %K cumulative logit model %K content analysis %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. Objective: This mixed method preimplementation study aims to assess GPs’ intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). Methods: Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. Results: This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (β=2.03, SE 0.345, P<.001), supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC, and characteristics of supporting and nonsupporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. Conclusions: A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs. %M 33055058 %R 10.2196/23660 %U http://mental.jmir.org/2020/10/e23660/ %U https://doi.org/10.2196/23660 %U http://www.ncbi.nlm.nih.gov/pubmed/33055058 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20741 %T COVID-19 Contact Tracing Apps: Predicted Uptake in the Netherlands Based on a Discrete Choice Experiment %A Jonker,Marcel %A de Bekker-Grob,Esther %A Veldwijk,Jorien %A Goossens,Lucas %A Bour,Sterre %A Rutten-Van Mölken,Maureen %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, , Rotterdam, Netherlands, 31 10 408 8555, marcel@mfjonker.com %K COVID-19 %K discrete choice experiment %K contact tracing %K participatory epidemiology %K participatory surveillance %K app %K uptake %K prediction %K smartphone %K transmission %K privacy %K mobile phone %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based contact tracing apps can contribute to reducing COVID-19 transmission rates and thereby support countries emerging from lockdowns as restrictions are gradually eased. Objective: The primary objective of our study is to determine the potential uptake of a contact tracing app in the Dutch population, depending on the characteristics of the app. Methods: A discrete choice experiment was conducted in a nationally representative sample of 900 Dutch respondents. Simulated maximum likelihood methods were used to estimate population average and individual-level preferences using a mixed logit model specification. Individual-level uptake probabilities were calculated based on the individual-level preference estimates and subsequently aggregated into the sample as well as subgroup-specific contact tracing app adoption rates. Results: The predicted app adoption rates ranged from 59.3% to 65.7% for the worst and best possible contact tracing app, respectively. The most realistic contact tracing app had a predicted adoption of 64.1%. The predicted adoption rates strongly varied by age group. For example, the adoption rates of the most realistic app ranged from 45.6% to 79.4% for people in the oldest and youngest age groups (ie, ≥75 years vs 15-34 years), respectively. Educational attainment, the presence of serious underlying health conditions, and the respondents’ stance on COVID-19 infection risks were also correlated with the predicted adoption rates but to a lesser extent. Conclusions: A secure and privacy-respecting contact tracing app with the most realistic characteristics can obtain an adoption rate as high as 64% in the Netherlands. This exceeds the target uptake of 60% that has been formulated by the Dutch government. The main challenge will be to increase the uptake among older adults, who are least inclined to install and use a COVID-19 contact tracing app. %M 32795998 %R 10.2196/20741 %U https://mhealth.jmir.org/2020/10/e20741 %U https://doi.org/10.2196/20741 %U http://www.ncbi.nlm.nih.gov/pubmed/32795998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18148 %T Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective %A van Lieshout,Florence %A Yang,Rebecca %A Stamenova,Vess %A Agarwal,Payal %A Cornejo Palma,Daniel %A Sidhu,Aman %A Engel,Katrina %A Erwood,Adam %A Bhatia,R Sacha %A Bhattacharyya,Onil %A Shaw,James %+ University of Amsterdam, Spui 21, Amsterdam, 1012 WX, Netherlands, 31 4163236400, floorvanlieshout@gmail.com %K service design %K digital health %K innovation %K implementation science %K remote monitoring %K telemedicine %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Implementing digital health technologies is complex but can be facilitated by considering the features of the tool that is being implemented, the team that will use it, and the routines that will be affected. Objective: The goal of this study was to assess the implementation of a remote-monitoring initiative for patients with chronic obstructive pulmonary disease in Ontario, Canada using the Tool+Team+Routine framework and to refine this approach to conceptualize the adoption of technologies in health care. Methods: This study was a qualitative research project that took place alongside a randomized controlled trial comparing a technology-enabled self-monitoring program with a technology-enabled self- and remote-monitoring program in patients with chronic obstructive pulmonary disease and with standard care. This study included interviews with 5 remote-monitoring patients, 3 self-monitoring patients, 2 caregivers, 5 health care providers, and 3 hospital administrators. The interview questions were structured around the 3 main concepts of the Tool+Team+Routine framework. Results: Findings emphasized that (1) technologies can alter relationships between providers and patients, and that these relationships drove the development of a new service arising from the technology, in our case, and (2) technologies can create additional work that is not visible to management as a result of not being considered within the scope of the service. Conclusions: Literature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships to conventional implementation strategies. By acknowledging the centrality of such relationships, implementation teams can better plan for the adaptations required in order to make new technologies work for patients and health care providers. Further work will need to address how specific individuals administering a remote-monitoring program work to build relationships, and how these relationships and other sources of activity might lead to technological scope creep—an unanticipated expanding scope of work activities in relation to the function of the tool. %M 33034565 %R 10.2196/18148 %U https://www.jmir.org/2020/10/e18148 %U https://doi.org/10.2196/18148 %U http://www.ncbi.nlm.nih.gov/pubmed/33034565 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18200 %T Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study %A Poss-Doering,Regina %A Kuehn,Lukas %A Kamradt,Martina %A Glassen,Katharina %A Wensing,Michel %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 ext 38643, regina.poss-doering@med.uni-heidelberg.de %K antimicrobial resistance %K educative digital solutions %K health literacy %K diffusion of innovations %D 2020 %7 7.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174. %M 32960773 %R 10.2196/18200 %U http://www.jmir.org/2020/10/e18200/ %U https://doi.org/10.2196/18200 %U http://www.ncbi.nlm.nih.gov/pubmed/32960773 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17499 %T Patients’ Adoption of Electronic Personal Health Records in England: Secondary Data Analysis %A Abd-Alrazaq,Alaa %A Alalwan,Ali Abdallah %A McMillan,Brian %A Bewick,Bridgette M %A Househ,Mowafa %A AL-Zyadat,Alaa T %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, LAS Building, Education City, Doha, , Qatar, 974 55708549, alaa_alzoubi88@yahoo.com %K health records, personal %K patient portal %K medical informatics %D 2020 %7 7.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In England, almost all general practices (GPs) have implemented GP online services such as electronic personal health records (ePHRs) that allow people to schedule appointments, request repeat prescriptions, and access parts of their medical records. The overall adoption rate of GP online services has been low, reaching just 28% in October 2019. In a previous study, Abd-Alrazaq et al adopted a model to assess the factors that influence patients’ use of GP online services in England. According to the previous literature, the predictive power of the Abd-Alrazaq model could be improved by proposing new associations between the existing variables in the model. Objective: This study aims to improve the predictive power of the Abd-Alrazaq model by proposing new relationships between the existing variables in the model. Methods: The Abd-Alrazaq model was amended by proposing new direct, mediating, moderating, and moderated mediating effects. The amended model was examined using data from a previous study, which were collected by a cross-sectional survey of a convenience sample of 4 GPs in West Yorkshire, England. Structural equation modeling was used to examine the theoretical model and hypotheses. Results: The new model accounted for 53% of the variance in performance expectancy (PE), 76% of the variance in behavioral intention (BI), and 49% of the variance in use behavior (UB). In addition to the significant associations found in the previous study, this study found that social influence (SI) and facilitating conditions (FCs) are associated with PE directly and BI indirectly through PE. The association between BI and UB was stronger for younger women with higher levels of education, income, and internet access. The indirect effects of effort expectancy (EE), perceived privacy and security (PPS), and SI on BI were statistically stronger for women without internet access, patients with internet access, and patients without internet access, respectively. The indirect effect of PPS on BI was stronger for patients with college education or diploma than for those with secondary school education and lower, whereas the indirect effect of EE on BI was stronger for patients with secondary school education or lower than for those with college education or a diploma. Conclusions: The predictive power of the Abd-Alrazaq model improved by virtue of new significant associations that were not examined before in the context of ePHRs. Further studies are required to validate the new model in different contexts and to improve its predictive power by proposing new variables. The influential factors found in this study should be considered to improve patients’ use of ePHRs. %M 33026353 %R 10.2196/17499 %U https://www.jmir.org/2020/10/e17499 %U https://doi.org/10.2196/17499 %U http://www.ncbi.nlm.nih.gov/pubmed/33026353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17757 %T Psychometric Evaluation of the TWente Engagement with Ehealth Technologies Scale (TWEETS): Evaluation Study %A Kelders,Saskia Marion %A Kip,Hanneke %A Greeff,Japie %+ Center for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, PO Box 217, Enschede, 7500AE, Netherlands, 31 534896055, s.m.kelders@utwente.nl %K engagement %K attrition %K eHealth %K adoption %K adherence %K questionnaire %K scale validation %K digital health interventions %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Engagement emerges as a predictor for the effectiveness of digital health interventions. However, a shared understanding of engagement is missing. Therefore, a new scale has been developed that proposes a clear definition and creates a tool to measure it. The TWente Engagement with Ehealth Technologies Scale (TWEETS) is based on a systematic review and interviews with engaged health app users. It defines engagement as a combination of behavior, cognition, and affect. Objective: This paper aims to evaluate the psychometric properties of the TWEETS. In addition, a comparison is made with the experiential part of the Digital Behavior Change Intervention Engagement Scale (DBCI-ES-Ex), a scale that showed some issues in previous psychometric analyses. Methods: In this study, 288 participants were asked to use any step counter app on their smartphones for 2 weeks. They completed online questionnaires at 4 time points: T0=baseline, T1=after 1 day, T2=1 week, and T3=2 weeks. At T0, demographics and personality (conscientiousness and intellect/imagination) were assessed; at T1-T3, engagement, involvement, enjoyment, subjective usage, and perceived behavior change were included as measures that are theoretically related to our definition of engagement. Analyses focused on internal consistency, reliability, and the convergent, divergent, and predictive validity of both engagement scales. Convergent validity was assessed by correlating the engagement scales with involvement, enjoyment, and subjective usage; divergent validity was assessed by correlating the engagement scales with personality; and predictive validity was assessed by regression analyses using engagement to predict perceived behavior change at later time points. Results: The Cronbach alpha values of the TWEETS were .86, .86, and .87 on T1, T2, and T3, respectively. Exploratory factor analyses indicated that a 1-factor structure best fits the data. The TWEETS is moderately to strongly correlated with involvement and enjoyment (theoretically related to cognitive and affective engagement, respectively; P<.001). Correlations between the TWEETS and frequency of use were nonsignificant or small, and differences between adherers and nonadherers on the TWEETS were significant (P<.001). Correlations between personality and the TWEETS were nonsignificant. The TWEETS at T1 was predictive of perceived behavior change at T3, with an explained variance of 16%. The psychometric properties of the TWEETS and the DBCI-ES-Ex seemed comparable in some aspects (eg, internal consistency), and in other aspects, the TWEETS seemed somewhat superior (divergent and predictive validity). Conclusions: The TWEETS performs quite well as an engagement measure with high internal consistency, reasonable test-retest reliability and convergent validity, good divergent validity, and reasonable predictive validity. As the psychometric quality of a scale is a reflection of how closely a scale matches the conceptualization of a concept, this paper is also an attempt to conceptualize and define engagement as a unique concept, providing a first step toward an acceptable standard of defining and measuring engagement. %M 33021487 %R 10.2196/17757 %U https://www.jmir.org/2020/10/e17757 %U https://doi.org/10.2196/17757 %U http://www.ncbi.nlm.nih.gov/pubmed/33021487 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e16911 %T Adoption of Mobile Health Apps in Dietetic Practice: Case Study of Diyetkolik %A Akdur,Gorkem %A Aydin,Mehmet Nafiz %A Akdur,Gizdem %+ Department of Management Information Systems, Kadir Has University, Kadir Has St., Cibali / Fatih, Istanbul, 34083, Turkey, 90 5360662866, gorkemakdur@gmail.com %K mHealth %K technology acceptance %K user acceptance %K mobile apps %K diet apps %K Technology Acceptance Model %K TAM %K dietetics %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietetics mobile health apps provide lifestyle tracking and support on demand. Mobile health has become a new trend for health service providers through which they have been shifting their services from clinical consultations to online apps. These apps usually offer basic features at no cost and charge a premium for advanced features. Although diet apps are now more common and have a larger user base, in general, there is a gap in literature addressing why users intend to use diet apps. We used Diyetkolik, Turkey’s most widely used online dietetics platform for 7 years, as a case study to understand the behavioral intentions of users. Objective: The aim of this study was to investigate the factors that influence the behavioral intentions of users to adopt and use mobile health apps. We used the Technology Acceptance Model and extended it by exploring other factors such as price-value, perceived risk, and trust factors in order to assess the technology acceptance of users. Methods: We conducted quantitative research on the Diyetkolik app users by using random sampling. Valid data samples gathered from 658 app users were analyzed statistically by applying structural equation modeling. Results: Statistical findings suggested that perceived usefulness (P<.001), perceived ease of use (P<.001), trust (P<.001), and price-value (P<.001) had significant relationships with behavioral intention to use. However, no relationship between perceived risk and behavioral intention was found (P=.99). Additionally, there was no statistical significance for age (P=.09), gender (P=.98), or previous app use experience (P=.14) on the intention to use the app. Conclusions: This research is an invaluable addition to Technology Acceptance Model literature. The results indicated that 2 external factors (trust and price-value) in addition to Technology Acceptance Model factors showed statistical relevance with behavioral intention to use and improved our understanding of user acceptance of a mobile health app. The third external factor (perceived risk) did not show any statistical relevance regarding behavioral intention to use. Most users of the Diyetkolik dietetics app were hesitant in purchasing dietitian services online. Users should be frequently reassured about the security of the platform and the authenticity of the platform’s dietitians to ensure that users’ interactions with the dietitians are based on trust for the platform and the brand. %M 33006566 %R 10.2196/16911 %U https://mhealth.jmir.org/2020/10/e16911 %U https://doi.org/10.2196/16911 %U http://www.ncbi.nlm.nih.gov/pubmed/33006566 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e22118 %T Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study %A Gordon,Kayleigh %A Dainty,Katie N %A Steele Gray,Carolyn %A DeLacy,Jane %A Shah,Amika %A Resnick,Myles %A Seto,Emily %+ Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, 155 College St. 4th Floor, Toronto, ON, Canada, 1 416 978 4326, kayleigh.gordon@mail.utoronto.ca %K telemonitoring %K adherence %K patient experience %K complex patients %K normalization process theory %K implementation %K mobile phone %D 2020 %7 29.9.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs. Objective: This study aims to evaluate the feasibility and patients’ perceived usefulness of a multi-condition TM platform in a nurse-led model of care. Methods: A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor. Results: In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs. Conclusions: Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team. %M 34406972 %R 10.2196/22118 %U https://nursing.jmir.org/2020/1/e22118/ %U https://doi.org/10.2196/22118 %U http://www.ncbi.nlm.nih.gov/pubmed/34406972 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20203 %T Factors Impacting Clinicians’ Adoption of a Clinical Photo Documentation App and its Implications for Clinical Workflows and Quality of Care: Qualitative Case Study %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, United Kingdom, 41 798769376, christine.k.jacob@gmail.com %K mHealth %K mobile health %K telehealth %K eHealth %K health tech %K digital health %K user-engagement %K dermatology %K wound care %K mobile phone %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) tools have shown promise in clinical photo and wound documentation for their potential to improve workflows, expand access to care, and improve the quality of patient care. However, some barriers to adoption persist. Objective: This study aims to understand the social, organizational, and technical factors affecting clinicians’ adoption of a clinical photo documentation mHealth app and its implications for clinical workflows and quality of care. Methods: A qualitative case study of a clinical photo and wound documentation app called imitoCam was conducted. The data were collected through 20 in-depth interviews with mHealth providers, clinicians, and medical informatics experts from 8 clinics and hospitals in Switzerland and Germany. Results: According to the study participants, the use of mHealth in clinical photo and wound documentation provides numerous benefits such as time-saving and efficacy, better patient safety and quality of care, enhanced data security and validation, and better accessibility. The clinical workflow may also improve when the app is a good fit, resulting in better collaboration and transparency, streamlined daily work, clinician empowerment, and improved quality of care. The findings included important factors that may contribute to or hinder adoption. Factors may be related to the material nature of the tool, such as the perceived usefulness, ease of use, interoperability, cost, or security of the app, or social aspects such as personal experience, attitudes, awareness, or culture. Organizational and policy barriers include the available clinical practice infrastructure, workload and resources, the complexity of decision making, training, and ambiguity or lack of regulations. User engagement in the development and implementation process is a vital contributor to the successful adoption of mHealth apps. Conclusions: The promising potential of mHealth in clinical photo and wound documentation is clear and may enhance clinical workflow and quality of care; however, the factors affecting adoption go beyond the technical features of the tool itself to embrace significant social and organizational elements. Technology providers, clinicians, and decision makers should work together to carefully address any barriers to improve adoption and harness the potential of these tools. %M 32965232 %R 10.2196/20203 %U http://mhealth.jmir.org/2020/9/e20203/ %U https://doi.org/10.2196/20203 %U http://www.ncbi.nlm.nih.gov/pubmed/32965232 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e19776 %T Exploring the Usage Intentions of Wearable Medical Devices: A Demonstration Study %A Chang,Chiao-Chen %+ College of Management, Taipei Medical University, 11F, No 172-1, Sec 2, Keelung Rd, Da an Dist, Taipei City, 10675, Taiwan, 886 266382736 ext 1128, ariel66@tmu.edu.tw %K wearable medical device %K unified theory of acceptance and use of technology %K usage intention %K health consciousness %K trust %D 2020 %7 18.9.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: In the face of an aging society, an immediate and preventive medical system urgently needs to be established, and the application of wearable devices is essential. However, the application of smart medical care in Taiwan is still not widespread, and few studies have explored the related issues of wearable medical device usage. Thus, determining the success of a wearable medical device mainly depends on the degree of user adoption and use. Objective: The purpose of this study was to examine the factors that influence the intention to use wearable medical devices. Methods: This study applied the unified theory of acceptance and use of technology (UTAUT) to build a comprehensive model that explains intentions to use wearable medical devices. Results: The research findings showed that health consciousness and trust were the strongest predictors of intentions to use wearable medical devices. Conclusions: The results reveal the magnitudes of the impacts of the variables in a well-accepted revised UTAUT model in the context of the medical industry, particularly in the setting of wearable medical devices. Several important implications for academics and industry decision-makers can be formulated from these results. %M 32945778 %R 10.2196/19776 %U http://www.i-jmr.org/2020/3/e19776/ %U https://doi.org/10.2196/19776 %U http://www.ncbi.nlm.nih.gov/pubmed/32945778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19358 %T Primary Care Pre-Visit Electronic Patient Questionnaire for Asthma: Uptake Analysis and Predictor Modeling %A Kouri,Andrew %A Yamada,Janet %A Sale,Joanna E M %A Straus,Sharon E %A Gupta,Samir %+ Division of Respirology, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Bond Wing, Suite 6042, 30 Bond St., Toronto, ON, M5B 1W8, Canada, 1 416 864 6026, samir.gupta@unityhealth.to %K electronic questionnaire %K tablet %K mHealth uptake %K asthma %K modeling %D 2020 %7 18.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: mHealth tablet-based interventions are increasingly being studied and deployed in various health care settings, yet little knowledge exists regarding patient uptake and acceptance or how patient demographics influence these important implementation metrics. Objective: To determine which factors influence the uptake and successful completion of an mHealth tablet questionnaire by analyzing its implementation in a primary care setting. Methods: We prospectively studied a patient-facing electronic touch-tablet asthma questionnaire deployed as part of the Electronic Asthma Management System. We describe tablet uptake and completion rates and corresponding predictor models for these behaviors. Results: The tablet was offered to and accepted by patients in 891/1715 (52.0%) visits. Patients refused the tablet in 33.0% (439/1330) visits in which it was successfully offered. Patients aged older than 65 years of age (odds ratio [OR] 2.30, 95% CI 1.33-3.95) and with concurrent chronic obstructive pulmonary disease (OR 2.22, 95% CI 1.05-4.67) were more likely to refuse the tablet, and those on an asthma medication (OR 0.55, 95% CI 0.30-0.99) were less likely to refuse it. Once accepted, the questionnaire was completed in 784/891 (88.0%) instances, with those on an asthma medication (OR 0.53, 95% CI 0.32-0.88) being less likely to leave it incomplete. Conclusions: Older age predicted initial tablet refusal but not tablet questionnaire completion, suggesting that perceptions of mHealth among older adults may negatively impact uptake, independent of usability. The influence of being on an asthma medication suggests that disease severity may also mediate mHealth acceptance. Although use of mHealth questionnaires is growing rapidly across health care settings and diseases, few studies describe their real-world acceptance and its predictors. Our results should be complemented by qualitative methods to identify barriers and enablers to uptake and may inform technological and implementation strategies to drive successful usage. %M 32945779 %R 10.2196/19358 %U http://www.jmir.org/2020/9/e19358/ %U https://doi.org/10.2196/19358 %U http://www.ncbi.nlm.nih.gov/pubmed/32945779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18870 %T Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study %A Turner,Kea %A Clary,Alecia %A Hong,Young-Rock %A Alishahi Tabriz,Amir %A Shea,Christopher M %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, United States, 1 813 745 5213, kea.turner@gmail.com %K patient portal %K personal health record %K electronic health record %K implementation %D 2020 %7 17.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Past studies examining barriers to patient portal adoption have been conducted with a small number of patients and health care settings, limiting generalizability. Objective: This study had the following two objectives: (1) to assess the prevalence of barriers to patient portal adoption among nonadopters and (2) to examine the association between nonadopter characteristics and reported barriers in a nationally representative sample. Methods: Data from this study were obtained from the 2019 Health Information National Trends Survey. We calculated descriptive statistics to determine the most prevalent barriers and conducted multiple variable logistic regression analysis to examine which characteristics were associated with the reported barriers. Results: The sample included 4815 individuals. Among these, 2828 individuals (58.73%) had not adopted a patient portal. Among the nonadopters (n=2828), the most prevalent barriers were patient preference for in-person communication (1810/2828, 64.00%), no perceived need for the patient portal (1385/2828, 48.97%), and lack of comfort and experience with computers (735/2828, 25.99%). Less commonly, individuals reported having no patient portal (650/2828, 22.98%), no internet access (650/2828, 22.98%), privacy concerns (594/2828, 21.00%), difficulty logging on (537/2828, 18.99%), and multiple patient portals (255/2828, 9.02%) as barriers. Men had significantly lower odds of indicating a preference for speaking directly to a provider compared with women (odds ratio [OR] 0.75, 95% CI 0.60-0.94; P=.01). Older age (OR 1.01, 95% CI 1.00-1.02; P<.001), having a chronic condition (OR 1.83, 95% CI 1.44-2.33; P<.001), and having an income lower than US $20,000 (OR 1.61, 95% CI 1.11-2.34; P=.01) were positively associated with indicating a preference for speaking directly to a provider. Hispanic individuals had significantly higher odds of indicating that they had no need for a patient portal (OR 1.59, 95% CI 1.24-2.05; P<.001) compared with non-Hispanic individuals. Older individuals (OR 1.05, 95% CI 1.04-1.06; P<.001), individuals with less than a high school diploma (OR 3.15, 95% CI 1.79-5.53; P<.001), and individuals with a household income of less than US $20,000 (OR 2.78, 95% CI 1.88-4.11; P<.001) had significantly higher odds of indicating that they were uncomfortable with a computer. Conclusions: The most common barriers to patient portal adoption are preference for in-person communication, not having a need for the patient portal, and feeling uncomfortable with computers, which are barriers that are modifiable and can be intervened upon. Patient characteristics can help predict which patients are most likely to experience certain barriers to patient portal adoption. Further research is needed to tailor implementation approaches based on patients’ needs and preferences. %M 32940620 %R 10.2196/18870 %U http://www.jmir.org/2020/9/e18870/ %U https://doi.org/10.2196/18870 %U http://www.ncbi.nlm.nih.gov/pubmed/32940620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17423 %T Adoption of Blockchain in Health Care %A Gaynor,Mark %A Tuttle-Newhall,Janet %A Parker,Jessica %A Patel,Arti %A Tang,Clare %+ School of Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St Louis, MO, 63104, United States, 1 314 977 8304, mark.gaynor@slu.edu %K blockchain adoption %K blockchain technology in health care %K supply chain %K data management %D 2020 %7 17.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X This study aims to review current issues regarding the application of blockchain technology in health care. We illustrated the various ways in which blockchain can solve current health care issues in three main arenas: data exchange, contracts, and supply chain management. This paper presents several current and projected uses of blockchain technology in the health care industry. We predicted which of these applications are likely to be adopted quickly and provided a supply chain example of tracking the transportation of organs for transplantation. %M 32940618 %R 10.2196/17423 %U https://www.jmir.org/2020/9/e17423 %U https://doi.org/10.2196/17423 %U http://www.ncbi.nlm.nih.gov/pubmed/32940618 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21195 %T Health Technology Readiness Profiles Among Danish Individuals With Type 2 Diabetes: Cross-Sectional Study %A Thorsen,Ida Kær %A Rossen,Sine %A Glümer,Charlotte %A Midtgaard,Julie %A Ried-Larsen,Mathias %A Kayser,Lars %+ The Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet 7641, Blegdamsvej 9, Copenhagen, DK-2100, Denmark, 45 35 45 76 41, ida.kaer.thorsen@regionh.dk %K readiness for health technology %K telemedicine %K diabetes mellitus, type 2 %K socioeconomic factors %K mental health %K psychological distress %K healthcare disparities %K delivery of healthcare %K exercise %D 2020 %7 15.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information technologies (IT) are increasingly implemented in type 2 diabetes (T2D) treatment as a resource for remotely supported health care. However, possible pitfalls of introducing IT in health care are generally overlooked. Specifically, the effectiveness of IT to improve health care may depend on the user’s readiness for health technology. Objective: We aim to investigate readiness for health technology in relation to mental well-being, sociodemographic, and disease-related characteristics among individuals with T2D. Methods: Individuals with T2D (aged ≥18 years) who had been referred to self-management education, exercise, diet counseling, smoking cessation, or alcohol counseling completed a questionnaire survey covering (1) background information, (2) the 5-item World Health Organization Well-Being Index (WHO-5), (3) receptiveness to IT use in physical activity, and (4) the Readiness and Enablement Index for Health Technology (READHY), constituted by dimensions related to self-management, social support, and eHealth literacy. Individuals were divided into profiles using cluster analysis based on their READHY scores. Outcomes included differences across profiles in mental well-being, sociodemographic, and disease-related characteristics. Results: Participants in the study were 155 individuals with T2D with a mean age of 60.2 (SD 10.7) years, 55.5% (86/155) of which were men and 44.5% (69/155) of which were women. Participants were stratified into 5 health technology readiness profiles based on the cluster analysis: Profile 1, high health technology readiness; Profile 2, medium health technology readiness; Profile 3, medium health technology readiness and high level of emotional distress; Profile 4, medium health technology readiness and low-to-medium eHealth literacy; Profile 5, low health technology readiness. No differences in sociodemographic and disease-related characteristics were observed across profiles; however, we identified 3 vulnerable subgroups of individuals: Profile 3 (21/155, 13.5%), younger individuals (mean age of 53.4 years, SD 8.9 years) with low mental well-being (mean 42.7, SD 14.7) and emotional distress (mean 1.69, SD 0.38); Profile 4 (20/155, 12.9%), older individuals (mean age 66.3 years, SD 9.0 years) with less IT use (50.0% used IT for communication) and low-to-medium eHealth literacy; and Profile 5 (36/155, 23.2%) with low mental well-being (mean 43.4, SD 20.1) and low readiness for health technology. Conclusions: Implementation of IT in health care of individuals with T2D should be based on comprehensive consideration of mental well-being, emotional distress, and readiness for health technology rather than sociodemographic and disease-related characteristics to identify the individuals in need of social support, self-management education, and extensive IT support. A one-size-fits-all approach to IT implementation in health care will potentially increase the risk of treatment failure among the most vulnerable individuals. %M 32930669 %R 10.2196/21195 %U http://www.jmir.org/2020/9/e21195/ %U https://doi.org/10.2196/21195 %U http://www.ncbi.nlm.nih.gov/pubmed/32930669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17718 %T Exploring the Use of Evidence From the Development and Evaluation of an Electronic Health (eHealth) Trial: Case Study %A Jurkeviciute,Monika %A Eriksson,Henrik %+ Centre for Healthcare Improvement, Chalmers University of Technology, Vera Sandbergs allé 8, Gothenburg, , Sweden, 46 766061558, monika.jurkeviciute@chalmers.se %K evidence-based practice %K evidence use %K eHealth %K evaluation %K evaluation use %D 2020 %7 28.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence-based practice refers to building clinical decisions on credible research evidence, professional experience, and patient preferences. However, there is a growing concern that evidence in the context of electronic health (eHealth) is not sufficiently used when forming policies and practice of health care. In this context, using evaluation and research evidence in clinical or policy decisions dominates the discourse. However, the use of additional types of evidence, such as professional experience, is underexplored. Moreover, there might be other ways of using evidence than in clinical or policy decisions. Objective: This study aimed to analyze how different types of evidence (such as evaluation outcomes [including patient preferences], professional experiences, and existing scientific evidence from other research) obtained within the development and evaluation of an eHealth trial are used by diverse stakeholders. An additional aim was to identify barriers to the use of evidence and ways to support its use. Methods: This study was built on a case of an eHealth trial funded by the European Union. The project included 4 care centers, 2 research and development companies that provided the web-based physical exercise program and an activity monitoring device, and 2 science institutions. The qualitative data collection included 9 semistructured interviews conducted 8 months after the evaluation was concluded. The data analysis concerned (1) activities and decisions that were made based on evidence after the project ended, (2) evidence used for those activities and decisions, (3) in what way the evidence was used, and (4) barriers to the use of evidence. Results: Evidence generated from eHealth trials can be used by various stakeholders for decisions regarding clinical integration of eHealth solutions, policy making, scientific publishing, research funding applications, eHealth technology, and teaching. Evaluation evidence has less value than professional experiences to local decision making regarding eHealth integration into clinical practice. Professional experiences constitute the evidence that is valuable to the highest variety of activities and decisions in relation to eHealth trials. When using existing scientific evidence related to eHealth trials, it is important to consider contextual relevance, such as location or disease. To support the use of evidence, it is suggested to create possibilities for health care professionals to gain experience, assess a few rather than a large number of variables, and design for shorter iterative cycles of evaluation. Conclusions: Initiatives to support and standardize evidence-based practice in the context of eHealth should consider the complexities in how the evidence is used in order to achieve better uptake of evidence in practice. However, one should be aware that the assumption of fact-based decision making in organizations is misleading. In order to create better chances that the evidence produced would be used, this should be addressed through the design of eHealth trials. %M 32857057 %R 10.2196/17718 %U http://www.jmir.org/2020/8/e17718/ %U https://doi.org/10.2196/17718 %U http://www.ncbi.nlm.nih.gov/pubmed/32857057 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e23023 %T Comment on "Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow" %A Jain,Nikhil %A Jayaram,Mahesh %+ Northwestern Mental Health, Melbourne Health, Harvester Clinic, 4a Devonshire Road, Sunshine, Melbourne, 3020, Australia, 61 392887000, nikhil.jain@mh.org.au %K telepsychiatry %K COVID-19 %K Australia %D 2020 %7 21.8.2020 %9 Letter to the Editor %J JMIR Ment Health %G English %X %M 32750003 %R 10.2196/23023 %U https://mental.jmir.org/2020/8/e23023 %U https://doi.org/10.2196/23023 %U http://www.ncbi.nlm.nih.gov/pubmed/32750003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16778 %T Capturing Relevant Patient Data in Clinical Encounters Through Integration of an Electronic Patient-Reported Outcome System Into Routine Primary Care in a Boston Community Health Center: Development and Implementation Study %A Loo,Stephanie %A Grasso,Chris %A Glushkina,Jessica %A McReynolds,Justin %A Lober,William %A Crane,Heidi %A Mayer,Kenneth H %+ The Fenway Institute, 1340 Boylston St, Boston, MA, 02215, United States, 1 857 313 6582, sloo@fenwayhealth.org %K information technology in health %K primary care %K technology adoption %K technology diffusion %D 2020 %7 19.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation. Objective: This study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. Methods: An ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit. Results: Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care. Conclusions: Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care. %M 32554372 %R 10.2196/16778 %U http://www.jmir.org/2020/8/e16778/ %U https://doi.org/10.2196/16778 %U http://www.ncbi.nlm.nih.gov/pubmed/32554372 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e18642 %T Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners’ Views %A Titzler,Ingrid %A Berking,Matthias %A Schlicker,Sandra %A Riper,Heleen %A Ebert,David Daniel %+ Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Nägelsbachstraße 25a, Erlangen, 91052, Germany, 49 91318567567, ingrid.titzler@fau.de %K barriers and facilitators %K general practitioners %K depression %K referral %K blended therapy %K internet-based intervention %K mobile phone %K psychotherapy %K qualitative research %D 2020 %7 18.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users’ perspectives and behavior. Objective: This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. Methods: Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. Results: GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs’ referrals and their self-rated pharmacotherapeutic competence, r(73)=−0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included “little knowledge about internet-based interventions” and “patients’ lack of familiarity with technology/internet/media” (number of statements, each k=22). Key facilitators were “perceived patient suitability, e.g. well-educated, young” (k=22) and “no conflict with GP’s role” (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. Conclusions: This study provides insights into factors influencing GPs’ referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates. %M 32673213 %R 10.2196/18642 %U http://mental.jmir.org/2020/8/e18642/ %U https://doi.org/10.2196/18642 %U http://www.ncbi.nlm.nih.gov/pubmed/32673213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17022 %T Technological Capabilities to Assess Digital Excellence in Hospitals in High Performing Health Care Systems: International eDelphi Exercise %A Krasuska,Marta %A Williams,Robin %A Sheikh,Aziz %A Franklin,Bryony Dean %A Heeney,Catherine %A Lane,Wendy %A Mozaffar,Hajar %A Mason,Kathy %A Eason,Sally %A Hinder,Susan %A Dunscombe,Rachel %A Potts,Henry W W %A Cresswell,Kathrin %+ Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 131 651 7878, Kathrin.Cresswell@ed.ac.uk %K digital excellence %K digital maturity %K Delphi technique %K hospitals, eHealth %D 2020 %7 18.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospitals worldwide are developing ambitious digital transformation programs as part of broader efforts to create digitally advanced health care systems. However, there is as yet no consensus on how best to characterize and assess digital excellence in hospitals. Objective: Our aim was to develop an international agreement on a defined set of technological capabilities to assess digital excellence in hospitals. Methods: We conducted a two-stage international modified electronic Delphi (eDelphi) consensus-building exercise, which included a qualitative analysis of free-text responses. In total, 31 international health informatics experts participated, representing clinical, academic, public, and vendor organizations. Results: We identified 35 technological capabilities that indicate digital excellence in hospitals. These are divided into two categories: (a) capabilities within a hospital (n=20) and (b) capabilities enabling communication with other parts of the health and social care system, and with patients and carers (n=15). The analysis of free-text responses pointed to the importance of nontechnological aspects of digitally enabled change, including social and organizational factors. Examples included an institutional culture characterized by a willingness to transform established ways of working and openness to risk-taking. The availability of a range of skills within digitization teams, including technological, project management and business expertise, and availability of resources to support hospital staff, were also highlighted. Conclusions: We have identified a set of criteria for assessing digital excellence in hospitals. Our findings highlight the need to broaden the focus from technical functionalities to wider digital transformation capabilities. %M 32808938 %R 10.2196/17022 %U https://www.jmir.org/2020/8/e17022 %U https://doi.org/10.2196/17022 %U http://www.ncbi.nlm.nih.gov/pubmed/32808938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e15630 %T Identification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging: In-Depth Interview Study %A De Leeuw,Jacqueline A %A Woltjer,Hetty %A Kool,Rudolf B %+ Department of Information Management, Radboud University Medical Center, PO Box 9100, Nijmegen, 6500HB, Netherlands, 31 643914595, jacqueline.deleeuw@radboudumc.nl %K qualitative research %K semi-structured interview %K purposive sampling %K health information systems %K computer user training %K professional education %K professional competence %K registered nurses %K nursing informatics %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The introduction of health information technology (HIT) has drastically changed health care organizations and the way health care professionals work. Some health care professionals have trouble coping efficiently with the demands of HIT and the personal and professional changes it requires. Lagging in digital knowledge and skills hampers health care professionals from adhering to professional standards regarding the use of HIT and may cause professional performance problems, especially in the older professional population. It is important to gain more insight into the reasons and motivations behind the technology issues experienced by these professionals, as well as to explore what could be done to solve them. Objective: Our primary research objective was to identify factors that influence the adoption of HIT in a sample of nurses who describe themselves as digitally lagging behind the majority of their colleagues in their workplaces. Furthermore, we aimed to formulate recommendations for practice and leadership on how to help and guide these nurses through ongoing digital transformations in their health care work settings. Methods: In a Dutch university medical center, 10 face-to-face semi-structured interviews were performed with registered nurses (RN). Ammenwerth’s FITT-framework (fit between the Individual, Task, and Technology) was used to guide the interview topic list and to formulate themes to explore. Thematic analysis was used to analyze the interview data. The FITT-framework was also used to further interpret and clarify the interview findings. Results: Analyses of the interview data uncovered 5 main categories and 12 subthemes. The main categories were: (1) experience with digital working, (2) perception and meaning, (3) barriers, (4) facilitators, and (5) future perspectives. All participants used electronic devices and digital systems, including the electronic health record. The latter was experienced by some as user-unfriendly, time-consuming, and not supportive in daily professional practice. Most of the interviewees described digital working as “no fun at all,” “working in a fake world,” “stressful,” and “annoying.” There was a lack of general digital knowledge and little or no formal basic digital training or education. A negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetency and postponement or avoidance of the use of HIT, both privately and professionally. Learning conditions of digital training and education did not meet personal learning needs and learning styles. A positive impact was seen in the work environment when colleagues and nurse managers were aware and sensitive to the difficulties participants experienced in developing digital skills, and when there was continuous training on the job and peer support from digitally savvy colleagues. The availability of a digital play environment combined with learning on the job and support of knowledgeable peers was experienced as helpful and motivating by participants. Conclusions: Nurses who are digitally lagging often have had insufficient and ineffective digital education. This leads to stress, frustration, feelings of incompetency, and postponement or avoidance of HIT use. A digital training approach tailored to the learning needs and styles of these nurses is needed, as well as an on-the-job training structure and adequate peer support. Hospital management and nurse leadership should be informed about the importance of the fit between technology, task, and the individual for adequate adoption of HIT. %M 32663142 %R 10.2196/15630 %U http://www.jmir.org/2020/8/e15630/ %U https://doi.org/10.2196/15630 %U http://www.ncbi.nlm.nih.gov/pubmed/32663142 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18078 %T Cultural Impact on the Intention to Use Nursing Information Systems of Nurses in Taiwan and China: Survey and Analysis %A Chang,I-Chiu %A Lin,Po-Jin %A Chen,Ting-Hung %A Chang,Chia-Hui %+ Department of Nursing, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect 4, Taichung, 407204, Taiwan, 886 4 2359 2525, cjhsnd@gmail.com %K Nursing information system %K intention to use %K cultural differences %K information literacy %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Nursing workforce shortage has emerged as a global problem. Foreign nurse importation is a popular strategy to address the shortage. The interactions between nursing staff on either side of the Taiwan Strait continue to increase. Since both nurses in Taiwan and nurses in China have adopted nursing information systems to improve health care processes and quality, it is necessary to investigate factors influencing nursing information system usage in nursing practice. Objective: This study examined the effects of cultural and other related factors on nurses’ intentions to use nursing information systems. The findings were expected to serve as an empirical base for further benchmarking and management of cross-strait nurses. Methods: This survey was conducted in two case hospitals (one in Taiwan and one in China). A total of 880 questionnaires were distributed (n=440 in each hospital). Results: The results showed effort expectancy had a significant effect on the intention to use nursing information systems of nurses in China (P=.003) but not nurses in Taiwan (P=.16). Conclusions: Findings suggest nursing managers should adopt different strategies to motivate cross-strait nurses to use nursing information systems. Promoting effort expectancy is more likely to motivate nurses in China than in Taiwan. This discrepancy is probably due to the less hierarchical and more feminine society in Taiwan. %M 32784174 %R 10.2196/18078 %U https://www.jmir.org/2020/8/e18078 %U https://doi.org/10.2196/18078 %U http://www.ncbi.nlm.nih.gov/pubmed/32784174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18033 %T Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden %A Brantnell,Anders %A Woodford,Joanne %A Baraldi,Enrico %A van Achterberg,Theo %A von Essen,Louise %+ Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds Väg 14B, Uppsala, Sweden, 46 18 471 70 55, anders.brantnell@angstrom.uu.se %K mental health %K internet-administered CBT %K self-management %K implementation %K barriers and facilitators %K decision-making %K eHealth %K primary care %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation. Objective: The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers’ (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT). Methods: An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society. Results: The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (P<.05) differences out of 37 possible between implementers and nonimplementers. For example, more implementers (48/51, 94%) than nonimplementers (107/139, 76.9%) perceived few technical problems (P<.001), and more implementers (53/77, 68%) than nonimplementers (103/215, 47.9%) considered that their organization has resources to offer ICBT programs (P<.001). Conclusions: Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its use, ICBT is implemented in few primary care organizations in Sweden. Several interesting differences between implementers and nonimplementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT. %M 32784186 %R 10.2196/18033 %U https://www.jmir.org/2020/8/e18033 %U https://doi.org/10.2196/18033 %U http://www.ncbi.nlm.nih.gov/pubmed/32784186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17696 %T Applying and Extending the FITT Framework to Identify the Challenges and Opportunities of Successful eHealth Services for Patient Self-Management: Qualitative Interview Study %A Kujala,Sari %A Ammenwerth,Elske %A Kolanen,Heta %A Ervast,Minna %+ Department of Computer Science, Aalto University, Konemiehentie 2, Espoo, Finland, 358 50 3862768, sari.kujala@aalto.fi %K interview %K implementation %K adoption %K patient self-management %K organization %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges. Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use. Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland. The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings. Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework. Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension. %M 32784175 %R 10.2196/17696 %U https://www.jmir.org/2020/8/e17696 %U https://doi.org/10.2196/17696 %U http://www.ncbi.nlm.nih.gov/pubmed/32784175 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17709 %T Influence of Personality on mHealth Use in Patients with Diabetes: Prospective Pilot Study %A Su,Jingyuan %A Dugas,Michelle %A Guo,Xitong %A Gao,Guodong (Gordon) %+ eHealth Research Institute, School of Management, Harbin Institute of Technology, 92 West Dazhi Street, Nangang District, Harbin, , China, 86 451 86414022, xitongguo@hit.edu.cn %K mHealth %K diabetes %K adoption %K active utilization %K personality traits %K app %D 2020 %7 10.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology for health (mHealth) interventions are increasingly being used to help improve self-management among patients with diabetes; however, these interventions have not been adopted by a large number of patients and often have high dropout rates. Patient personality characteristics may play a critical role in app adoption and active utilization, but few studies have focused on addressing this question. Objective: This study aims to address a gap in understanding of the relationship between personality traits and mHealth treatment for patients with diabetes. We tested the role of the five-factor model of personality traits (openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism) in mHealth adoption preference and active utilization. Methods: We developed an mHealth app (DiaSocial) aimed to encourage diabetes self-management. We recruited 98 patients with diabetes—each patient freely chose whether to receive the standard care or the mHealth app intervention. Patient demographic information and patient personality characteristics were assessed at baseline. App usage data were collected to measure user utilization of the app. Patient health outcomes were assessed with lab measures of glycated hemoglobin (HbA1c level). Logistic regression models and linear regression were employed to explore factors predicting the relationship between mHealth use (adoption and active utilization) and changes in health outcome. Results: Of 98 study participants, 46 (47%) downloaded and used the app. Relatively younger patients with diabetes were 9% more likely to try and use the app (P=.02, odds ratio [OR] 0.91, 95% CI 0.85-0.98) than older patients with diabetes were. Extraversion was negatively associated with adoption of the mHealth app (P=.04, OR 0.71, 95% CI 0.51-0.98), and openness to experience was positively associated with adoption of the app (P=.03, OR 1.73, 95% CI 1.07-2.80). Gender (P=.43, OR 0.66, 95% CI 0.23-1.88), education (senior: P=.99, OR 1.00, 95% CI 0.32-3.11; higher: P=.21, OR 2.51, 95% CI 0.59-10.66), and baseline HbA1c level (P=.36, OR 0.79, 95% CI 0.47-1.31) were not associated with app adoption. Among those who adopted the app, a low education level (senior versus primary P=.003; higher versus primary P=.03) and a high level of openness to experience (P=.048, OR 2.01, 95% CI 1.01-4.00) were associated with active app utilization. Active users showed a significantly greater decrease in HbA1c level than other users (ΔHbA1c=−0.64, P=.05). Conclusions: This is one of the first studies to investigate how different personality traits influence the adoption and active utilization of an mHealth app among patients with diabetes. The research findings suggest that personality is a factor that should be considered when trying to identify patients who would benefit the most from apps for diabetes management. %M 32773382 %R 10.2196/17709 %U https://mhealth.jmir.org/2020/8/e17709 %U https://doi.org/10.2196/17709 %U http://www.ncbi.nlm.nih.gov/pubmed/32773382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18388 %T A Conceptual Framework to Study the Implementation of Clinical Decision Support Systems (BEAR): Literature Review and Concept Mapping %A Camacho,Jhon %A Zanoletti-Mannello,Manuela %A Landis-Lewis,Zach %A Kane-Gill,Sandra L %A Boyce,Richard D %+ I&E Meaningful Research, Calle 119a #70-31, Bogotá, 111121, Colombia, 57 315 695 5484, jjcamachosanchez@gmail.com %K clinical decision support system %K computerized decision support system %K implementation science %K technology acceptance %K barriers %K facilitators %K determinants %K decision support system %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance. Objective: Our objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs. Methods: We employed an iterative process to map constructs from four contributing frameworks—the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)—and the findings of 10 literature reviews, identified through a systematic review of reviews approach. Results: The resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient–health professional relationship; patient’s preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects. Conclusions: We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models. %M 32759098 %R 10.2196/18388 %U https://www.jmir.org/2020/8/e18388 %U https://doi.org/10.2196/18388 %U http://www.ncbi.nlm.nih.gov/pubmed/32759098 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18973 %T Patient Portal Implementation and Uptake: Qualitative Comparative Case Study %A Avdagovska,Melita %A Ballermann,Mark %A Olson,Karin %A Graham,Timothy %A Menon,Devidas %A Stafinski,Tania %+ University of Alberta, School of Public Health, 3021, Research Transition Facility, 8308 114 Street, Edmonton, AB, T6G 2V2, Canada, 1 7809083334, avdagovs@ualberta.ca %K patient portals %K information technology %K adoption %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot. Objective: This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation. Methods: A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data. Results: Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users. Conclusions: There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care. %M 32716308 %R 10.2196/18973 %U http://www.jmir.org/2020/7/e18973/ %U https://doi.org/10.2196/18973 %U http://www.ncbi.nlm.nih.gov/pubmed/32716308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17220 %T Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study %A Wickerson,Lisa %A Fujioka,Jamie K %A Kishimoto,Vanessa %A Jamieson,Trevor %A Fine,Ben %A Bhatia,R Sacha %A Desveaux,Laura %+ Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 4163236400 ext 4302, laura.desveaux@wchospital.ca %K diagnostic imaging %K eHealth %K health care delivery %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province. Objective: The aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption. Methods: This multimethod study included semistructured interviews with physicians and administrative stakeholders and descriptive analysis of the current DICS usage data. Results: In this study, 41 participants were interviewed, that is, 34 physicians and 7 administrative stakeholders. The following 4 key themes emerged: (1) utilization of the DICS depended on the awareness of the technology and the preferred channels for accessing images, which varied widely, (2) clinical responsibilities and available institutional resources were the drivers of utilization (or lack thereof), (3) centralized image repositories were perceived to offer value at the patient, clinician, and health care system levels, and (4) the enabling factors to realize value included aspects of technology infrastructure (ie, available functionality) alongside policy supports. High-volume DICS usage was not evenly distributed throughout the province. Conclusions: Suboptimal adoption of the DICS was driven by poor awareness and variations in the clinical workflow. Alignment with physician workflow, policy supports, and investment in key technological features and infrastructure would improve functionality and data comprehensiveness, thereby optimizing health system performance, patient and provider experience, population health, and health care costs. %M 32459644 %R 10.2196/17220 %U https://formative.jmir.org/2020/7/e17220 %U https://doi.org/10.2196/17220 %U http://www.ncbi.nlm.nih.gov/pubmed/32459644 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17362 %T Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives %A Davies,Fiona %A Shepherd,Heather L %A Beatty,Lisa %A Clark,Brodie %A Butow,Phyllis %A Shaw,Joanne %+ Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Lifehouse Level 6-North (C39Z), Sydney, 2006, Australia, 61 2 8627 0828, heather.shepherd@sydney.edu.au %K health professional views %K implementation %K online psychological therapy %K online CBT %K barriers %K facilitators %K models of care %K cognitive behavioral therapy %K internet-based intervention %D 2020 %7 23.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. Objective: Our objective in this review was to summarize what is known about health care professionals’ perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. Methods: We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals’ views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. Results: We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. Conclusions: Without health professionals’ support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. Trial Registration: PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk %M 32706713 %R 10.2196/17362 %U http://www.jmir.org/2020/7/e17362/ %U https://doi.org/10.2196/17362 %U http://www.ncbi.nlm.nih.gov/pubmed/32706713 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16300 %T Adoption and Performance of Complementary Clinical Information Technologies: Analysis of a Survey of General Practitioners %A Poba-Nzaou,Placide %A Uwizeyemungu,Sylvestre %A Liu,Xuecheng %+ Department of Organization and Human Resources, University of Quebec in Montreal, 315, Sainte-Catherine East, Montreal, QC, H2X 3X2, Canada, 1 514 987 3000 ext 7744, poba-nzaou.placide@uqam.ca %K electronic health record %K personal health record %K health information exchange %K telehealth %K general practitioners %K quality of care %K efficiency %K organizational productivity %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The benefits from the combination of 4 clinical information systems (CISs)—electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth—in primary care depend on the configuration of their functional capabilities available to clinicians. However, our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation. Objective: This study aims to pursue 3 objectives: (1) characterize general practitioners (GPs) by uncovering the typical profiles of combinations of 4 major CIS capabilities, (2) identify physician and practice characteristics that predict cluster membership, and (3) assess the variation in the levels of performance associated with each configuration. Methods: We used data from a survey of GPs conducted throughout the European Union (N=5793). First, 4 factors, that is, EHRs, HIE, PHRs, and Telehealth, were created. Second, a cluster analysis helps uncover clusters of GPs based on the 4 factors. Third, we compared the clusters according to five performance outcomes using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. Fourth, univariate and multivariate multinomial logistic regressions were used to identify predictors of the clusters. Finally, with a multivariate multinomial logistic regression, among the clusters, we compared performance in terms of the number of patients treated (3 levels) over the last 2 years. Results: We unveiled 3 clusters of GPs with different levels of CIS capability profiles: strong (1956/5793, 37.36%), medium (2764/5793, 47.71%), and weak (524/5793, 9.04%). The logistic regression analysis indicates that physicians (younger, female, and less experienced) and practice (solo) characteristics are significantly associated with a weak profile. The ANOVAs revealed a strong cluster associated with significantly high practice performance outcomes in terms of the quality of care, efficiency, productivity, and improvement of working processes, and two noncomprehensive medium and weak profiles associated with medium (equifinal) practice performance outcomes. The logistic regression analysis also revealed that physicians in the weak profile are associated with a decrease in the number of patients treated over the last 2 years. Conclusions: Different CIS capability profiles may lead to similar equifinal performance outcomes. This underlines the importance of looking beyond the adoption of 1 CIS capability versus a cluster of capabilities when studying CISs. GPs in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes. Our findings indicate that medical practices should develop high capabilities in all 4 CISs if they have to maximize their performance outcomes because efforts to develop high capabilities selectively may only be in vain. %M 32706715 %R 10.2196/16300 %U http://www.jmir.org/2020/7/e16300/ %U https://doi.org/10.2196/16300 %U http://www.ncbi.nlm.nih.gov/pubmed/32706715 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e14795 %T Exploring the Determinants of Mobile Health Adoption by Hospitals in China: Empirical Study %A Ramdani,Boumediene %A Duan,Binheng %A Berrou,Ilhem %+ Centre for Entrepreneurship, College of Business & Economics, Qatar University, PO Box 2713, Doha, Qatar, 974 44037762, B.Ramdani@qu.edu.qa %K mHealth %K mobile phone %K adoption %K hospitals %K TOE %K China %D 2020 %7 14.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although mobile health (mHealth) has the potential to transform health care by delivering better outcomes at a much lower cost than traditional health care services, little is known about mHealth adoption by hospitals. Objective: This study aims to explore the determinants of mHealth adoption by hospitals using the technology-organization-environment (TOE) framework. Methods: We conducted an interviewer-administered survey with 87 managers in Chinese public hospitals and analyzed the data using logistic regression. Results: The results of our survey indicate that perceived ease of use (β=.692; P<.002), system security (β=.473; P<.05), top management support (β=1.466; P<.002), hospital size (β=1.069; P<.004), and external pressure (β=.703; P<.005) are significantly related to hospitals’ adoption of mHealth. However, information technology infrastructure (β=.574; P<.02), system reliability (β=−1.291; P<.01), and government policy (β=2.010; P<.04) are significant but negatively related to hospitals’ adoption of mHealth. Conclusions: We found that TOE model works in the context of mHealth adoption by hospitals. In addition to technological predictors, organizational and environmental predictors are critical for explaining mHealth adoption by Chinese hospitals. %M 32459630 %R 10.2196/14795 %U https://medinform.jmir.org/2020/7/e14795 %U https://doi.org/10.2196/14795 %U http://www.ncbi.nlm.nih.gov/pubmed/32459630 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17588 %T Drivers of Mobile Health Acceptance and Use From the Patient Perspective: Survey Study and Quantitative Model Development %A Salgado,Tânia %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School, Universidade Nova de Lisboa, Campus de Campolide, Lisbon, 1070-312 Lisboa, Portugal, 351 213828610, d2012072@novaims.unl.pt %K digital health %K mHealth %K UTAUT2 %K health management %K patient empowerment %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) has potential to play a significant role in realizing a reversal of the current paradigm in health care toward a more patient-centric and more collaborative system to improve the outcomes obtained along with the quality and sustainability of health care systems. Objective: The aim of this study was to explore and understand individual mHealth acceptance drivers between two groups of users: those with chronic health conditions and those without. Methods: The extended unified theory of acceptance and usage of technology (UTAUT2) was enhanced with a new health-related framework: behavior intention to recommend and new mediation effects. We applied partial least squares (PLS) causal modeling to test the research model. Results: We obtained 322 valid responses through an online questionnaire. The drivers of behavior intention with statistical significance were performance expectancy (β=.29, P<.001), habit (β=.39, P<.001), and personal empowerment (β=.18, P=.01). The precursors of use behavior were habit (β= .47, P<.001) and personal empowerment (β=.17, P=.01). Behavior intention to recommend was significantly influenced by behavior intention (β=.58, P<.001) and personal empowerment (β=.26, P<.001). The model explained 66% of the total variance in behavior intention, 54% of the variance in use behavior, and 70% of the variance in behavior intention to recommend. Conclusions: Our study demonstrates a significant role of personal empowerment, as a second-order construct, in the mHealth acceptance context. The presence of a chronic health condition predicates an impact on acceptance of this technology. %M 32673249 %R 10.2196/17588 %U https://mhealth.jmir.org/2020/7/e17588 %U https://doi.org/10.2196/17588 %U http://www.ncbi.nlm.nih.gov/pubmed/32673249 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18072 %T Understanding Clinicians’ Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, United Kingdom, 41 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K electronic health record %K workflow %K workload %K workplace %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although there is a push toward encouraging mobile health (mHealth) adoption to harness its potential, there are many challenges that sometimes go beyond the technology to involve other elements such as social, cultural, and organizational factors. Objective: This review aimed to explore which frameworks are used the most, to understand clinicians’ adoption of mHealth as well as to identify potential shortcomings in these frameworks. Highlighting these gaps and the main factors that were not specifically covered in the most frequently used frameworks will assist future researchers to include all relevant key factors. Methods: This review was an in-depth subanalysis of a larger systematic review that included research papers published between 2008 and 2018 and focused on the social, organizational, and technical factors impacting clinicians’ adoption of mHealth. The initial systematic review included 171 studies, of which 50 studies used a theoretical framework. These 50 studies are the subject of this qualitative review, reflecting further on the frameworks used and how these can help future researchers design studies that investigate the topic of mHealth adoption more robustly. Results: The most commonly used frameworks were different forms of extensions of the Technology Acceptance Model (TAM; 17/50, 34%), the diffusion of innovation theory (DOI; 8/50, 16%), and different forms of extensions of the unified theory of acceptance and use of technology (6/50, 12%). Some studies used a combination of the TAM and DOI frameworks (3/50, 6%), whereas others used the consolidated framework for implementation research (3/50, 6%) and sociotechnical systems (STS) theory (2/50, 4%). The factors cited by more than 20% of the studies were usefulness, output quality, ease of use, technical support, data privacy, self-efficacy, attitude, organizational inner setting, training, leadership engagement, workload, and workflow fit. Most factors could be linked to one framework or another, but there was no single framework that could adequately cover all relevant and specific factors without some expansion. Conclusions: Health care technologies are generally more complex than tools that address individual user needs as they usually support patients with comorbidities who are typically treated by multidisciplinary teams who might even work in different health care organizations. This special nature of how the health care sector operates and its highly regulated nature, the usual budget deficits, and the interdependence between health care organizations necessitate some crucial expansions to existing theoretical frameworks usually used when studying adoption. We propose a shift toward theoretical frameworks that take into account implementation challenges that factor in the complexity of the sociotechnical structure of health care organizations and the interplay between the technical, social, and organizational aspects. Our consolidated framework offers recommendations on which factors to include when investigating clinicians’ adoption of mHealth, taking into account all three aspects. %M 32442132 %R 10.2196/18072 %U https://mhealth.jmir.org/2020/7/e18072 %U https://doi.org/10.2196/18072 %U http://www.ncbi.nlm.nih.gov/pubmed/32442132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17704 %T Barriers and Facilitators to the Adoption of Mobile Health Among Health Care Professionals From the United Kingdom: Discrete Choice Experiment %A Leigh,Simon %A Ashall-Payne,Liz %A Andrews,Tim %+ The Organisation for the Review of Care and Health Applications, Sci-Tech Daresbury, Vanguard House, Keckwick Lane, Daresbury, WA4 4AB, United Kingdom, 44 07503955592, simon.leigh@orcha.co.uk %K digital health %K mHealth %K discrete-choice %K preferences %K mobile phone %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing availability of mobile health services, clinical engagement remains minimal. Objective: This study aims to identify and weight barriers to and drivers of health app use among health care professionals (HCPs) from the United Kingdom. Methods: A discrete choice experiment was conducted with 222 HCPs using a web-based survey between March 2019 and June 2019. Participants were recruited to take part via social media and asked to choose their preferred option of 2 hypothetical health apps to prescribe to a hypothetical patient or to prescribe neither. Choices were characterized by differing levels of patient age, cost, published evidence bases, whether they had a National Health Service (NHS) stamp of approval, personal familiarity with the technology, and whether they were recommended by a fellow HCP. The results were analyzed using a mixed logit model, with subgroup analyses to account for heterogeneity. Results: We received 230 responses, a total of 96.5% (n=222/230) of respondents understood the survey task and passed the test of rationality. The median age was between 36 and 45 years, and 62.6% (n=139/222) of the health care providers responding to the survey had previously recommended the use of health apps to patients. Health apps were most likely to be prescribed to patients if they had an NHS stamp of approval or if they were recommended by another HCP (both P<.001). Published studies detailing clinical effectiveness were important (P<.001), but it would take five published studies to have the same impact on prescribing behavior as an NHS stamp of approval and two studies to be as convincing as having used the technology personally. Increasing patient age and costs resulted in significant reductions in digital health prescribing (P<.001), none more so than among allied health professionals. Willingness-to-pay for health apps increased by £124.61 (US $151.14) if an NHS stamp of approval was present and by £29.20 (US $35.42) for each published study. Overall, 8.1% (n=18/222) of respondents were reluctant to use health apps, always choosing the I would prescribe neither option, particularly among older HCPs, nurses, and those who do not use health apps personally. Subgroup analyses revealed significant differences in preferences among HCPs of differing ages and clinical backgrounds. Conclusions: An NHS stamp of approval, published studies, and recommendations from fellow HCPs are significant facilitators of digital prescribing, whereas increasing costs and patient age are significant barriers to engagement. These findings suggest that demonstrating assurances of health apps and supporting both the dissemination and peer-to-peer recommendation of evidence-based technologies are critical if the NHS is to achieve its long-term digital transformation ambitions. %M 32628118 %R 10.2196/17704 %U https://mhealth.jmir.org/2020/7/e17704 %U https://doi.org/10.2196/17704 %U http://www.ncbi.nlm.nih.gov/pubmed/32628118 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17256 %T Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement %A Nadal,Camille %A Sas,Corina %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin, D2, Ireland, 353 18963858, nadalc@tcd.ie %K Technology Acceptance Lifecycle %K patient acceptance %K mobile applications %K mHealth %K mobile phone %D 2020 %7 6.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Designing technologies that users will be interested in, start using, and keep using has long been a challenge. In the health domain, the question of technology acceptance is even more important, as the possible intrusiveness of technologies could lead to patients refusing to even try them. Developers and researchers must address this question not only in the design and evaluation of new health care technologies but also across the different stages of the user’s journey. Although a range of definitions for these stages exists, many researchers conflate related terms, and the field would benefit from a coherent set of definitions and associated measurement approaches. Objective: This review aims to explore how technology acceptance is interpreted and measured in mobile health (mHealth) literature. We seek to compare the treatment of acceptance in mHealth research with existing definitions and models, identify potential gaps, and contribute to the clarification of the process of technology acceptance. Methods: We searched the PubMed database for publications indexed under the Medical Subject Headings terms “Patient Acceptance of Health Care” and “Mobile Applications.” We included publications that (1) contained at least one of the terms “acceptability,” “acceptance,” “adoption,” “accept,” or “adopt”; and (2) defined the term. The final corpus included 68 relevant studies. Results: Several interpretations are associated with technology acceptance, few consistent with existing definitions. Although the literature has influenced the interpretation of the concept, usage is not homogeneous, and models are not adapted to populations with particular needs. The prevalence of measurement by custom surveys suggests a lack of standardized measurement tools. Conclusions: Definitions from the literature were published separately, which may contribute to inconsistent usage. A definition framework would bring coherence to the reporting of results, facilitating the replication and comparison of studies. We propose the Technology Acceptance Lifecycle, consolidating existing definitions, articulating the different stages of technology acceptance, and providing an explicit terminology. Our findings illustrate the need for a common definition and measurement framework and the importance of viewing technology acceptance as a staged process, with adapted measurement methods for each stage. %M 32628122 %R 10.2196/17256 %U https://www.jmir.org/2020/7/e17256 %U https://doi.org/10.2196/17256 %U http://www.ncbi.nlm.nih.gov/pubmed/32628122 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e16704 %T Factors Influencing Doctors’ Participation in the Provision of Medical Services Through Crowdsourced Health Care Information Websites: Elaboration-Likelihood Perspective Study %A Si,Yan %A Wu,Hong %A Liu,Qing %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong road, Qiaokou District, Wuhan, China, 86 13277942186, hongwu@hust.edu.cn %K crowdsourcing %K crowdsourced medical services %K online health communities %K doctors’ participation %K elaboration-likelihood model %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Web-based crowdsourcing promotes the goals achieved effectively by gaining solutions from public groups via the internet, and it has gained extensive attention in both business and academia. As a new mode of sourcing, crowdsourcing has been proven to improve efficiency, quality, and diversity of tasks. However, little attention has been given to crowdsourcing in the health sector. Objective: Crowdsourced health care information websites enable patients to post their questions in the question pool, which is accessible to all doctors, and the patients wait for doctors to respond to their questions. Since the sustainable development of crowdsourced health care information websites depends on the participation of the doctors, we aimed to investigate the factors influencing doctors’ participation in providing health care information in these websites from the perspective of the elaboration-likelihood model. Methods: We collected 1524 questions with complete patient-doctor interaction processes from an online health community in China to test all the hypotheses. We divided the doctors into 2 groups based on the sequence of the answers: (1) doctor who answered the patient’s question first and (2) the doctors who answered that question after the doctor who answered first. All analyses were conducted using the ordinary least squares method. Results: First, the ability of the doctor who first answered the health-related question was found to positively influence the participation of the following doctors who answered after the first doctor responded to the question (βoffline1=.177, P<.001; βoffline2=.063, P=.048; βonline=.418, P<.001). Second, the reward that the patient offered for the best answer showed a positive effect on doctors’ participation (β=.019, P<.001). Third, the question’s complexity was found to positively moderate the relationships between the ability of the first doctor who answered and the participation of the following doctors (β=.186, P=.05) and to mitigate the effect between the reward and the participation of the following doctors (β=–.003, P=.10). Conclusions: This study has both theoretical and practical contributions. Online health community managers can build effective incentive mechanisms to encourage highly competent doctors to participate in the provision of medical services in crowdsourced health care information websites and they can increase the reward incentives for each question to increase the participation of the doctors. %M 32597787 %R 10.2196/16704 %U http://medinform.jmir.org/2020/6/e16704/ %U https://doi.org/10.2196/16704 %U http://www.ncbi.nlm.nih.gov/pubmed/32597787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19091 %T Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study %A Poncette,Akira-Sebastian %A Mosch,Lina %A Spies,Claudia %A Schmieding,Malte %A Schiefenhövel,Fridtjof %A Krampe,Henning %A Balzer,Felix %+ Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany, 49 30 450 651166, felix.balzer@charite.de %K digital health %K patient monitoring %K monitoring %K intensive care medicine %K intensive care unit %K technological innovation %K user-centered %K usability %K online survey %K transdisciplinary %K REDCap %K email %D 2020 %7 19.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development. Objective: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups. Methods: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups. Results: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring. Conclusions: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 %M 32459655 %R 10.2196/19091 %U http://www.jmir.org/2020/6/e19091/ %U https://doi.org/10.2196/19091 %U http://www.ncbi.nlm.nih.gov/pubmed/32459655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15450 %T Views of Swedish Elder Care Personnel on Ongoing Digital Transformation: Cross-Sectional Study %A Baudin,Katarina %A Gustafsson,Christine %A Frennert,Susanne %+ School of Health, Care and Social Welfare, Mälardalen University, Box 325, Eskilstuna, SE-631 05, Sweden, 46 735029494, katarina.baudin@mdh.se %K elder care %K welfare technology %K gender %K municipality %K participation %K digitalization %K age %D 2020 %7 16.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Swedish municipalities are facing demographic challenges due to the growing number of older people and the resulting increased need for health care services. Welfare technologies are being launched as possible solutions for meeting some of these challenges. Objective: The aim of this study was to explore the perception, experimentation, evaluation, and procurement of welfare technology practices among professionals working in municipal elder care in relation to their gender, age, and profession. Methods: Data for this explorative cross-sectional study were collected from 393 responses to a web-based survey on municipal elder care in Sweden. Chi square tests were performed to determine the associations. Results: The results revealed gender, age, and professional differences in perspectives of municipal elder care workers. Differences were particularly evident in attitudes toward technology, both the use of technology in general and in the workplace, and involvement and participation in decision making regarding the procurement of new welfare technologies. Men (37/53, 70%) expressed a more positive attitude toward and curiosity regarding new technologies than women (157/336, 46.7%) (P=.03). Regarding age, the younger respondents (18-24 years old) perceived the digital transformation in the workplace as “too slow” (4/4, 100%), whereas the majority of older respondents (65-74 years old) perceived it as happening at the “right pace” (4/7, 57%). The elder care personnel felt encouraged by management to explore and experiment with new welfare technologies, but never did so either for management or with patients. Even though the majority of the respondents were women, more men (4/7, 57%) were involved in the procurement process for welfare technology devices and solutions than women (98/336, 29.2%) (P<.001). Conclusions: Personnel working within municipal elder care were generally very positive toward new technologies. However, both gender and age differences may influence these perspectives such as the personnel’s resistance to welfare technology and patients’ participation in welfare technology usage and deployment. Different levels of participation in the decision-making process regarding new technology deployment may negatively affect the overall digital transformation within municipal elder care. %M 32543444 %R 10.2196/15450 %U http://www.jmir.org/2020/6/e15450/ %U https://doi.org/10.2196/15450 %U http://www.ncbi.nlm.nih.gov/pubmed/32543444 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e15749 %T Applied Practice and Possible Leverage Points for Information Technology Support for Patient Screening in Clinical Trials: Qualitative Study %A Becker,Linda %A Ganslandt,Thomas %A Prokosch,Hans-Ulrich %A Newe,Axel %+ Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, 91058, Germany, 49 91318526720, axel.newe@fau.de %K clinical trial %K patient screening %K electronic support %K clinical information systems %K inclusion criteria %K exclusion criteria %K feasibility studies %K mobile phone %D 2020 %7 16.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Clinical trials are one of the most challenging and meaningful designs in medical research. One essential step before starting a clinical trial is screening, that is, to identify patients who fulfill the inclusion criteria and do not fulfill the exclusion criteria. The screening step for clinical trials might be supported by modern information technology (IT). Objective: This explorative study aimed (1) to obtain insights into which tools for feasibility estimations and patient screening are actually used in clinical routine and (2) to determine which method and type of IT support could benefit clinical staff. Methods: Semistandardized interviews were conducted in 5 wards (cardiology, gynecology, gastroenterology, nephrology, and palliative care) in a German university hospital. Of the 5 interviewees, 4 were directly involved in patient screening. Three of them were clinicians, 1 was a study nurse, and 1 was a research assistant. Results: The existing state of study feasibility estimation and the screening procedure were dominated by human communication and estimations from memory, although there were many possibilities for IT support. Success mostly depended on the experience and personal motivation of the clinical staff. Electronic support has been used but with little importance so far. Searches in ward-specific patient registers (databases) and searches in clinical information systems were reported. Furthermore, free-text searches in medical reports were mentioned. For potential future applications, a preference for either proactive or passive systems was not expressed. Most of the interviewees saw the potential for the improvement of the actual systems, but they were also largely satisfied with the outcomes of the current approach. Most of the interviewees were interested in learning more about the various ways in which IT could support and relieve them in their clinical routine. Conclusions: Overall, IT support currently plays a minor role in the screening step for clinical trials. The lack of IT usage and the estimations made from memory reported by all the participants might constrain cognitive resources, which might distract from clinical routine. We conclude that electronic support for the screening step for clinical trials is still a challenge and that education of the staff about the possibilities for electronic support in clinical trials is necessary. %M 32442156 %R 10.2196/15749 %U http://medinform.jmir.org/2020/6/e15749/ %U https://doi.org/10.2196/15749 %U http://www.ncbi.nlm.nih.gov/pubmed/32442156 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16849 %T Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development %A Di Tosto,Gennaro %A McAlearney,Ann Scheck %A Fareed,Naleef %A Huerta,Timothy R %+ CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 515, Columbus, OH, 43210, United States, 1 6142938973, gennaro.ditosto@osumc.edu %K patient portals %K health records, personal %K health information technology %K electronic health record %D 2020 %7 12.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients’ use of an outpatient portal to examine how patients engage with the tool. Objective: This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. Methods: Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. Results: Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. Conclusions: In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use. %M 32530435 %R 10.2196/16849 %U https://www.jmir.org/2020/6/e16849 %U https://doi.org/10.2196/16849 %U http://www.ncbi.nlm.nih.gov/pubmed/32530435 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17221 %T Patients’ Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China %A Li,Peiyi %A Luo,Yunmei %A Yu,Xuexin %A Wen,Jin %A Mason,Elizabeth %A Li,Weimin %A Jalali,Mohammad S %+ Department of Respiratory Medicine, West China Hospital of Sichuan University, Guo Xue Xiang 37, Chengdu, 610041, China, 86 2885424666, weimi003@scu.edu.cn %K innovation adoption %K e-hospital %K internet hospital %K eHealth %K barriers %K facilitators %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users’ acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective: This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients’ willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods: We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions: We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries. %M 32525483 %R 10.2196/17221 %U http://www.jmir.org/2020/6/e17221/ %U https://doi.org/10.2196/17221 %U http://www.ncbi.nlm.nih.gov/pubmed/32525483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15068 %T Developing and Applying a Formative Evaluation Framework for Health Information Technology Implementations: Qualitative Investigation %A Cresswell,Kathrin %A Williams,Robin %A Sheikh,Aziz %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, , United Kingdom, 44 1316508102, kathrin.beyer@ed.ac.uk %K health information technology %K evaluation %K sociotechnical %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed. Objective: The aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers. Methods: We drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base. Results: TPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff. Conclusions: The TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value. %M 32519968 %R 10.2196/15068 %U http://www.jmir.org/2020/6/e15068/ %U https://doi.org/10.2196/15068 %U http://www.ncbi.nlm.nih.gov/pubmed/32519968 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16721 %T The Mediating Role of Organizational Reputation and Trust in the Intention to Use Wearable Health Devices: Cross-Country Study %A Adebesin,Funmi %A Mwalugha,Revingstone %+ Department of Informatics, University of Pretoria, Corner of Lynwood and Roper Street, Hatfield, Pretoria, 0083, South Africa, 27 0124205667, funmi.adebesin@up.ac.za %K fitness trackers %K intention %K Kenya %K physical activity %K privacy %K South Africa %K trust %K regression analysis %D 2020 %7 9.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of consumer wearable health devices for fitness tracking has seen an upward trend across the globe. Previous studies have shown that trust is an important factor in the adoption and use of new technologies. However, little is known about the influence of organizational reputation and trust on the intention to use wearable health devices. Objective: This study aimed to investigate the mediating role of organizational reputation and trust in the intention to use wearable health devices and to examine the extent to which the country of residence influenced the effect of organizational reputation on consumers’ trust in and intention to use wearable health devices. Methods: We conducted a cross-country survey with participants from Kenya and South Africa using a Google Forms questionnaire derived from previously validated items. A series of mediation regression analyses were carried out using the PROCESS macro with the bootstrap CI procedure. A one-way, between-group multivariate analysis of variance (MANOVA) was also used to determine the key factors that distinguish Kenyans and South Africans in their intention to use wearable health devices. Results: A total of 232 questionnaire responses were collected. The results revealed that organizational reputation significantly mediates the relationship between trust propensity and trust, with an indirect effect of 0.22 (95% CI 0.143-0.309). Organizational reputation also plays a significant direct role in the intention to use a wearable health device, with a direct effect of 0.32 (95% CI 0.175-0.483). This role is regardless of participants’ country of residence. Furthermore, there is a significant mediating effect of trust on the relationship between trust propensity and the intention to use a wearable health device, with an indirect effect of 0.26 (95% CI 0.172-0.349); between perceived security and the intention to use a wearable health device, with an indirect effect of 0.36 (95% CI 0.255-0.461); and between perceived privacy and the intention to use a wearable health device, with an indirect effect of 0.42 (95% CI 0.282-0.557). The MANOVA test shows statistically significant differences in all variables for both groups, with the exception of organizational reputation where there is no significant difference between the two cohorts. Conclusions: Organizational reputation has a significant direct influence on participants’ trust in and the intention to use a wearable health device irrespective of their country of residence. Even in the presence of perceived security and perceived privacy, trust has a significant mediating effect on the intention to use a wearable health device. %M 32348260 %R 10.2196/16721 %U http://mhealth.jmir.org/2020/6/e16721/ %U https://doi.org/10.2196/16721 %U http://www.ncbi.nlm.nih.gov/pubmed/32348260 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17930 %T Perceptions About Technologies That Help Community-Dwelling Older Adults Remain at Home: Qualitative Study %A Verloo,Henk %A Kampel,Thomas %A Vidal,Nicole %A Pereira,Filipa %+ School of Health Sciences, HES-SO Valais/Wallis, 5, Chemin de l’Agasse, Sion, 1950, Switzerland, 41 276036752, henk.verloo@netplus.ch %K technology %K gerontechnology %K photo-elicitation %K informal caregivers %K cognitive impairment %K professional caregivers %K interviews %K focus groups %K content analysis %K physical impairment %K frailty %D 2020 %7 4.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The population of Europe is aging rapidly. Most community-dwelling older adults (CDOAs) want to remain in their homes, particularly those experiencing functional decline. Politicians and academics repeatedly praise technological instruments for being the preferred solution for helping older adults with deteriorating health to remain at home. Objective: This study aimed to understand the perceptions of CDOAs and their informal caregivers (ICs) and professional caregivers (PCs) about technologies that can help keep older adults at home. Methods: This qualitative study used personal interviews, focus groups, and photo-elicitation interviews to better understand the perceptions of a convenience sample of 68 CDOAs, 21 ICs, and 32 PCs. Results: A fraction of CDOAs did not perceive technological instruments to be a very useful means of helping them remain at home. However, the ICs and PCs were more positive. The CDOAs preferred and were more willing to adopt technologies related to their mobility and safety and those that would help slow down their cognitive decline. The ICs preferred technological aids that assist in the activities of daily living as well as safety-related technologies for detecting falls and helping to locate disoriented older adults. The PCs preferred integrated communication and information systems to improve collaboration between all stakeholders, housing equipped with technologies to manage complex care, high-performance ancillary equipment to transfer people with reduced mobility, and surveillance systems to ensure safety at home. Conclusions: Although our study reports that CDOAs have limited interest in innovative technologies to help them remain at home, their technological skills will undoubtedly improve in the future, as will those of ICs and PCs. Technological tools will play an increasingly important role in home health care. %M 32496197 %R 10.2196/17930 %U http://www.jmir.org/2020/6/e17930/ %U https://doi.org/10.2196/17930 %U http://www.ncbi.nlm.nih.gov/pubmed/32496197 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e14835 %T Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated “Promoting Action on Research Implementation in Health Services” Framework: Qualitative Study %A Raphiphatthana,Buaphrao %A Sweet,Michelle %A Puszka,Stefanie %A Whitty,Megan %A Dingwall,Kylie %A Nagel,Tricia %+ Menzies School of Health Research, Charles Darwin University, Casuarina, 0810, Australia, 61 0889468478, buaphrao.raphiphatthana@menzies.edu.au %K eHealth %K implementation science %K health care delivery %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches. Objective: This study aimed to understand service providers’ perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people. Methods: Qualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who had undergone electronic mental health training workshops. Results: Several factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training. Conclusions: The i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support. %M 32452812 %R 10.2196/14835 %U http://mental.jmir.org/2020/5/e14835/ %U https://doi.org/10.2196/14835 %U http://www.ncbi.nlm.nih.gov/pubmed/32452812 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14375 %T Understanding and Preventing Health Concerns About Emerging Mobile Health Technologies %A Materia,Frank T %A Faasse,Kate %A Smyth,Joshua M %+ The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 863 8402, Smyth@psu.edu %K mHealth %K technology %K nocebo effect %K implementation science %K medically unexplained symptoms %D 2020 %7 25.5.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X New technologies and innovations have often improved population well-being and societal function; however, these are also often initially accompanied by worry and fear. In some cases, such worries can impede, or even prevent entirely, the adoption of the technology. Mobile health (mHealth), a discipline broadly focused on employing ambulatory technologies to improve the affordability, reach, and effectiveness of health promotion and clinical intervention approaches, offers new innovations and opportunities. Despite emerging evidence supporting mHealth efficacy (eg, for improving health outcomes), some individuals have concerns about mHealth technology that may impede scalability, efficacy, and, ultimately, the public health benefits of mHealth. We present a review and conceptual framework to examine these issues, focusing on three overarching themes: biophysiological, psychological, and societal concerns. There are features of mHealth that lead to worries about the potential negative effects on an individual’s health (eg, due to exposure to electromagnetic or radio waves), despite evidence supporting the safety of these technologies. When present, such beliefs can lead to worry that gives rise to the experience of unpleasant and concerning physical symptoms—the nocebo effect. This may represent an important implementational barrier because of apprehension toward beneficial mHealth products (or features thereof, such as wireless charging, wearable or implantable sensors, etc) and may also have broader ramifications (eg, leading to economic, governmental, and legislative actions). In addition to reviewing evidence on these points, we provide a broad three-step model of implementation research in mHealth that focuses on understanding and preventing health concerns to facilitate the safe and effective scalability of mHealth (and that may be generalizable and applied to similar technologies): (1) evaluating and better discerning public perceptions and misperceptions (and how these may differ between populations), (2) developing theory-based public health communication strategies regarding the safety of mHealth, and (3) disseminating this messaging using evidence-based methods. Collectively, these steps converge on reviewing evidence regarding the potential role of worry and nocebo in mHealth and providing a model for understanding and changing attitudes and preventing unfounded negative perceptions related to mHealth technology. %M 32449688 %R 10.2196/14375 %U http://mhealth.jmir.org/2020/5/e14375/ %U https://doi.org/10.2196/14375 %U http://www.ncbi.nlm.nih.gov/pubmed/32449688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16921 %T Adopting Patient Portals in Hospitals: Qualitative Study %A Hulter,Pauline %A Pluut,Bettine %A Leenen-Brinkhuis,Christine %A de Mul,Marleen %A Ahaus,Kees %A Weggelaar-Jansen,Anne Marie %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 618406943, hulter@eshpm.eur.nl %K patient portal %K adoption %K adoption processes %K eHealth %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Theoretical models help to explain or predict the adoption of electronic health (eHealth) technology and illustrate the complexity of the adoption process. These models provide insights into general factors that influence the use of eHealth technology. However, they do not give hospitals much actionable knowledge on how to facilitate the adoption process. Objective: Our study aims to provide insights into patient portal adoption processes among patients and hospital staff, including health care professionals (HCPs), managers, and administrative clerks. Studying the experiences and views of stakeholders answers the following question: How can hospitals encourage patients and HCPs to adopt a patient portal? Methods: We conducted 22 semistructured individual and group interviews (n=69) in 12 hospitals and four focus groups with members of national and seminational organizations and patient portal suppliers (n=53). Results: The effort hospitals put into adopting patient portals can be split into three themes. First, inform patients and HCPs about the portal. This communication strategy has four objectives: users should (1) know about the portal, (2) know how the portal works, (3) know that action on the portal is required, and (4) know where to find help with the portal. Second, embed the patient portal in the daily routine of HCPs and management. This involves three forms of support: (1) hospital policy, (2) management by monitoring the numbers, and (3) a structured implementation strategy that includes all staff of one department. Third, try to adjust the portal to meet patients’ needs to optimize user-friendliness in two ways: (1) use patients’ feedback and (2) focus on optimizing for patients with special needs (eg, low literacy and low digital skills). Conclusions: Asking stakeholders what they have learned from their efforts to stimulate patient portal use in hospitals elicited rich insights into the adoption process. These insights are missing in the theoretical models. Therefore, our findings help to translate the relatively abstract factors one finds in theoretical models to the everyday pragmatics of eHealth projects in hospitals. %M 32427110 %R 10.2196/16921 %U http://www.jmir.org/2020/5/e16921/ %U https://doi.org/10.2196/16921 %U http://www.ncbi.nlm.nih.gov/pubmed/32427110 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e17647 %T Clinical Desire for an Artificial Intelligence–Based Surgical Assistant System: Electronic Survey–Based Study %A Park,Soo Jin %A Lee,Eun Ji %A Kim,Se Ik %A Kong,Seong-Ho %A Jeong,Chang Wook %A Kim,Hee Seung %+ Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea, 82 02 2072 4863, bboddi0311@gmail.com %K artificial intelligence %K solo surgery %K laparoscopic surgery %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Techniques utilizing artificial intelligence (AI) are rapidly growing in medical research and development, especially in the operating room. However, the application of AI in the operating room has been limited to small tasks or software, such as clinical decision systems. It still largely depends on human resources and technology involving the surgeons’ hands. Therefore, we conceptualized AI-based solo surgery (AISS) defined as laparoscopic surgery conducted by only one surgeon with support from an AI-based surgical assistant system, and we performed an electronic survey on the clinical desire for such a system. Objective: This study aimed to evaluate the experiences of surgeons who have performed laparoscopic surgery, the limitations of conventional laparoscopic surgical systems, and the desire for an AI-based surgical assistant system for AISS. Methods: We performed an online survey for gynecologists, urologists, and general surgeons from June to August 2017. The questionnaire consisted of six items about experience, two about limitations, and five about the clinical desire for an AI-based surgical assistant system for AISS. Results: A total of 508 surgeons who have performed laparoscopic surgery responded to the survey. Most of the surgeons needed two or more assistants during laparoscopic surgery, and the rate was higher among gynecologists (251/278, 90.3%) than among general surgeons (123/173, 71.1%) and urologists (35/57, 61.4%). The majority of responders answered that the skillfulness of surgical assistants was “very important” or “important.” The most uncomfortable aspect of laparoscopic surgery was unskilled movement of the camera (431/508, 84.8%) and instruments (303/508, 59.6%). About 40% (199/508, 39.1%) of responders answered that the AI-based surgical assistant system could substitute 41%-60% of the current workforce, and 83.3% (423/508) showed willingness to buy the system. Furthermore, the most reasonable price was US $30,000-50,000. Conclusions: Surgeons who perform laparoscopic surgery may feel discomfort with the conventional laparoscopic surgical system in terms of assistant skillfulness, and they may think that the skillfulness of surgical assistants is essential. They desire to alleviate present inconveniences with the conventional laparoscopic surgical system and to perform a safe and comfortable operation by using an AI-based surgical assistant system for AISS. %M 32412421 %R 10.2196/17647 %U http://medinform.jmir.org/2020/5/e17647/ %U https://doi.org/10.2196/17647 %U http://www.ncbi.nlm.nih.gov/pubmed/32412421 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e17334 %T Factors Influencing the Adoption of Health Information Standards in Health Care Organizations: A Systematic Review Based on Best Fit Framework Synthesis %A Han,Lu %A Liu,Jing %A Evans,Richard %A Song,Yang %A Ma,Jingdong %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 27 83692826, jdma@hust.edu.cn %K health information systems %K health information interoperability %K adoption %K health care sector %D 2020 %7 15.5.2020 %9 Review %J JMIR Med Inform %G English %X Background: Since the early 1970s, health care provision has experienced rapid growth in the investment and adoption of health information technologies (HITs). However, the development and deployment of HITs has often been conducted in silos, at different organizational levels, within different regions, and in various health care settings; this has resulted in their infrastructures often being difficult to manage or integrate. Health information standards (ie, the set norms and requirements that underpin the deployment of HITs in health care settings) are expected to address these issues, yet their adoption remains to be frustratingly low among health care information technology vendors. Objective: This study aimed to synthesize a comprehensive framework of factors that affect the adoption and deployment of health information standards by health care organizations. Methods: First, electronic databases, including Web of Science, Scopus, and PubMed, were searched for relevant articles, with the results being exported to the EndNote reference management software. Second, study selection was conducted according to pre-established inclusion and exclusion criteria. Finally, a synthesized best fit framework was created, which integrated a thematic analysis of the included articles. Results: In total, 35 records were incorporated into the synthesized framework, with 4 dimensions being identified: technology, organization, environment, and interorganizational relationships. The technology dimension included relative advantage, complexity, compatibility, trialability, observability, switching cost, standards uncertainty, and shared business process attributes. The organization dimension included organizational scale, organizational culture, staff resistance to change, staff training, top management support, and organizational readiness. The environment dimension included external pressure, external support, network externality, installed base, and information communication. Finally, the interorganizational relationships dimension included partner trust, partner dependence, relationship commitment, and partner power. Conclusions: The synthesized framework presented in this paper extends the current understanding of the factors that influence the adoption of health information standards in health care organizations. It provides policy and decision makers with a greater awareness of factors that hinder or facilitate their adoption, enabling better judgement and development of adoption intervention strategies. Furthermore, suggestions for future research are provided. %M 32347800 %R 10.2196/17334 %U https://medinform.jmir.org/2020/5/e17334 %U https://doi.org/10.2196/17334 %U http://www.ncbi.nlm.nih.gov/pubmed/32347800 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e16861 %T The NASSS-CAT Tools for Understanding, Guiding, Monitoring, and Researching Technology Implementation Projects in Health and Social Care: Protocol for an Evaluation Study in Real-World Settings %A Greenhalgh,Trisha %A Maylor,Harvey %A Shaw,Sara %A Wherton,Joseph %A Papoutsi,Chrysanthi %A Betton,Victoria %A Nelissen,Natalie %A Gremyr,Andreas %A Rushforth,Alexander %A Koshkouei,Mona %A Taylor,John %+ Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 7769177924, trish.greenhalgh@phc.ox.ac.uk %K evaluation %K complexity %K theory-driven evaluation %K diffusion of innovation %K scale-up %K sustainability %K implementation %K NASSS (nonadoption, abandonment, scale-up, spread, sustainability) framework %K innovation adoption %K project management %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al’s nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects. Objective: We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings. Methods: Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals. Results: The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects’ progress. Conclusions: The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. International Registered Report Identifier (IRRID): DERR1-10.2196/16861 %M 32401224 %R 10.2196/16861 %U https://www.researchprotocols.org/2020/5/e16861 %U https://doi.org/10.2196/16861 %U http://www.ncbi.nlm.nih.gov/pubmed/32401224 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17315 %T Health System Stakeholders’ Perspective on the Role of Mobile Health and Its Adoption in the Swiss Health System: Qualitative Study %A Lingg,Myriam %A Lütschg,Verena %+ SOS Beobachter Foundation, Flurstrasse 55, Zurich, 8048, Switzerland, 41 058 269 21 21, myriam.lingg@ringier.ch %K mobile health %K mHealth %K eHealth %K telehealth %K telemedicine %K digitization %K electronic health record %K technology %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health solutions have great potential to change the way health care is delivered, including better clinical outcomes and improved processes and access to health services. However, the adoption of mobile health (mHealth) solutions for patient monitoring has been rather slow in Switzerland. The reasons are complex, and a better understanding is needed to leverage the full potential of mHealth. Objective: This study aimed to deepen the understanding of the potential relevance and influence of mHealth for the health system and health care provision, and factors influencing its adoption. The findings will be used to provide an outlook on feasible recommendations for action. Methods: We conducted a qualitative survey using a maximum variation sample of a heterogeneous group of stakeholders (N=50) in the Swiss health care system with a profound knowledge of digital health and medical devices. A semistructured interview guide including open- and closed-ended questions was used to address questions around mHealth relevance and its influence on the health system, the relevance of selected determinants for mHealth adoption, and important influencing factors. A content analysis method was applied. Results: Overall, respondents thought that mHealth would have a beneficial impact on the Swiss health system but that its adoption would evolve slowly. We derived 23 key opportunities regarding patient and patient pathway, treatment of disease, and diseases and health conditions. High consistency in answers among respondents was observed for treatment of disease. Stakeholders’ attitudes toward mHealth adoption along the relevance of 23 preselected determinants were relatively consistent. However, we obtained diverging attitudes regarding the influence of trends, enablers, and restraints in Switzerland and translated them into 26 key themes influencing mHealth adoption. Relevant trends comprise changing needs and expectations of patients, a rising need for efficient health care delivery, growing interest in improved outpatient care, and emerging technologies and progressing digitization. Important enablers include growing demand for new financing schemes and incentive concepts, rising demand for comprehensive information on and stronger body of evidence for mHealth use cases, and increasing need for easy to use alternate care approaches. Challenging restraints are rigidness of thinking and siloed actions of health system actors, complexity of changing the existing regulations and structures, little understanding of mHealth use and the role of clinicians, and risk of further polarization of the population. Conclusions: This study provides a comprehensive look at mHealth in the Swiss health system. It becomes apparent that strong governance is inevitable to foster a sustainable data strategy and to reconcile the different interests of stakeholders. The use of mHealth will add value but will not necessarily reduce the burden on the system caused by emerging societal needs and changing disease prevalence. %M 32391802 %R 10.2196/17315 %U https://mhealth.jmir.org/2020/5/e17315 %U https://doi.org/10.2196/17315 %U http://www.ncbi.nlm.nih.gov/pubmed/32391802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15521 %T Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study %A Gremyr,Andreas %A Andersson Gäre,Boel %A Greenhalgh,Trisha %A Malm,Ulf %A Thor,Johan %A Andersson,Ann-Christine %+ Department of Schizophrenia Spectrum Disorders (Psykiatri Psykos), Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 43180, Sweden, 46 733664000, andreas.gremyr@vgregion.se %K health care %K complexity %K schizophrenia %K coproduction %K learning health systems %D 2020 %7 23.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders’ experiences with using NASSS-CAT, and practical implications. Methods: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general. %M 32324143 %R 10.2196/15521 %U http://www.jmir.org/2020/4/e15521/ %U https://doi.org/10.2196/15521 %U http://www.ncbi.nlm.nih.gov/pubmed/32324143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16520 %T The French eHealth Acceptability Scale Using the Unified Theory of Acceptance and Use of Technology 2 Model: Instrument Validation Study %A Hayotte,Meggy %A Thérouanne,Pierre %A Gray,Laura %A Corrion,Karine %A d'Arripe-Longueville,Fabienne %+ Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, 261 Boulevard du Mercantour, Nice, 06200, France, 33 4 89 15 39 52, meggy.hayotte@etu.univ-cotedazur.fr %K telemedicine %K validation study %K factor analysis, statistical %K surveys and questionnaires %K acceptability %D 2020 %7 15.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-based physical activity suggests new opportunities for public health initiatives. Yet only 45% of technology interventions are theoretically based, and the acceptability mechanisms have been insufficiently studied. Acceptability and acceptance theories have provided interesting insights, particularly the unified theory of acceptance and use of technology 2 (UTAUT2). In several studies, the psychometric qualities of acceptability scales have not been well demonstrated. Objective: The aim of this study was to adapt the UTAUT2 to the electronic health (eHealth) context and provide a preliminary validation of the eHealth acceptability scale in a French sample. Methods: In line with the reference validation methodologies, we carried out the following stages of validating the scale with a total of 576 volunteers: translation and adaptation, dimensionality tests, reliability tests, and construct validity tests. We used confirmatory factor analysis to validate a 22-item instrument with 7 subscales: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, Hedonic Motivation, Price Value, and Habit. Results: The dimensionality tests showed that the bifactor confirmatory model presented the best fit indexes: χ2173=434.86 (P<.001), χ2/df=2.51, comparative fit index=.97, Tucker-Lewis index=.95, and root mean square error of approximation=.053 (90% CI .047-.059). The invariance tests of the eHealth acceptability factor structure by sex demonstrated no significant differences between models, except for the strict model. The partial strict model demonstrated no difference from the strong model. Cronbach alphas ranged from .77 to .95 for the 7 factors. We measured the internal reliability with a 4-week interval. The intraclass correlation coefficients for each subscale ranged from .62 to .88, and there were no significant differences in the t tests from time 1 to time 2. Assessments for convergent validity demonstrated that the eHealth acceptability constructs were significantly and positively related to behavioral intention, usage, and constructs from the technology acceptance model and the theory of planned behavior. Conclusions: The 22-item French-language eHealth acceptability scale, divided into 7 subscales, showed good psychometric qualities. This scale is thus a valid and reliable tool to assess the acceptability of eHealth technology in French-speaking samples and offers promising avenues in research, clinical practice, and marketing. %M 32293569 %R 10.2196/16520 %U https://www.jmir.org/2020/4/e16520 %U https://doi.org/10.2196/16520 %U http://www.ncbi.nlm.nih.gov/pubmed/32293569 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16140 %T Adoption and Attitudes of eHealth Among People Living With HIV and Their Physicians: Online Multicenter Questionnaire Study %A Jacomet,Christine %A Ologeanu-Taddei,Roxana %A Prouteau,Justine %A Lambert,Céline %A Linard,Françoise %A Bastiani,Pascale %A Dellamonica,Pierre %+ Infectious Diseases Department, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, 58 rue Montalembert, Clermont-Ferrand, France, 33 473754931, cjacomet@chu-clermontferrand.fr %K survey %K HIV %K eHealth %K internet for information retrieval %K health applications %K connected objects %K telemedicine %K collection of digitized personal information %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The development of electronic health (eHealth) has offered the opportunity for remote care provision. eHealth addresses issues for patients and professionals favoring autonomy and compliance, respectively, while fostering closer links both between patients and health care professionals and among health care professionals themselves. Objective: The aim of this study was to analyze the patterns of use, benefits, and perceived obstacles in eHealth among people living with HIV (PLHIV) and their caring physicians at hospitals. Methods: An online multicenter observational survey was conducted October 15-19, 2018 in 51 medical units across France by means of self-administered questionnaires to collect sociodemographic and medical data, and perceptions of eHealth. Multiple correspondence analysis followed by mixed unsupervised classification were performed to analyze data of the respondents. Results: A total of 279 PLHIV and 219 physicians responded to all parts of the questionnaire. Three groups of PLHIV were identified based on multivariate analysis. Group 1 comprised “eHealth believers” (121/279, 43.4%), who were more frequently above 60 years old and more likely to be receiving treatments other than antiretrovirals. Group 2, the “technology skeptics” (86/279, 30.8%), comprised more women with at least one child. Group 3, the “internet adopters” (72/279, 25.8%), were more frequently under 49 years of age, men who have sex with men, and more likely to use mobile apps for obtaining wellness/health information and related subjects. Three groups of physicians also emerged. Group 1 comprised those “strongly confident in eHealth” (95/219, 43.4%), who more frequently used mobile apps for wellness/health information and were more likely to accept prescription assistance software. Group 2 comprised physicians “strongly opposed to eHealth” (80/219, 36.5%), frequently asserting that eHealth challenges confidentiality. Group 3 were “open to eHealth” (44/219, 20.1%), comprising a higher proportion of infectious disease specialists, and were more likely to believe that medical apps are useful for patient education and information. No link was found between the groups of PLHIV and physicians. Conclusions: The literature on eHealth mainly classifies people as enthusiasts and skeptics; however, we identified a third profile among both PLHIV and physicians, albeit without a direct link between them. For PLHIV, this third group is attentive to eHealth for improving their health condition, and for physicians, this group considers eHealth to offer benefits to patients and their own practice. %M 32293581 %R 10.2196/16140 %U http://mhealth.jmir.org/2020/4/e16140/ %U https://doi.org/10.2196/16140 %U http://www.ncbi.nlm.nih.gov/pubmed/32293581 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e16817 %T Portuguese Psychologists' Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study %A Mendes-Santos,Cristina %A Weiderpass,Elisabete %A Santana,Rui %A Andersson,Gerhard %+ Department of Culture and Society, Linköping University, Linköping, Sweden, 46 13 28 10 0, cristina.mendes.santos@liu.se %K attitudes %K psychologists %K e-mental health %K internet interventions %K Attitudes Toward Internet Interventions Survey (ATIIS) %K Portugal %K EU %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists’ use and their attitudes towards such interventions is largely unknown. Objective: The aim of this study was to explore Portuguese psychologists’ knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. Methods: An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. Results: A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), client’s ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (χ24=90.4; P<.001), training (χ24=94.6; P<.001), attitudes (χ23=38.4; P<.001) and previous use of internet interventions and between knowledge (χ212=109.7; P<.001), training (χ212=64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. Conclusions: This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation. %M 32250273 %R 10.2196/16817 %U https://mental.jmir.org/2020/4/e16817 %U https://doi.org/10.2196/16817 %U http://www.ncbi.nlm.nih.gov/pubmed/32250273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13761 %T Adoption of an Electronic Patient Record Sharing Pilot Project: Cross-Sectional Survey %A Wang,Jingxuan %A Huang,Junjie %A Cheung,Clement Shek Kei %A Wong,Wing Nam %A Cheung,Ngai Tseung %A Wong,Martin CS %+ The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, New Territories, Hong Kong, 852 2252 8782, wong_martin@cuhk.edu.hk %K health information exchange %K shared electronic health record %K online platform %K public-private partnership %D 2020 %7 6.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The Public Private Interface–Electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not been comprehensively assessed. Objective: This study aimed to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and the general public. Methods: From December 2012 to January 2013, 2435 telephone interviews were performed by trained interviewers to survey randomly selected patients who were enrolled or not enrolled in the PPI-ePR system. In addition, self-administered surveys were sent by postal mail to 4229 registered doctors in Hong Kong. The questionnaires for both patients and doctors contained questions on subjects’ awareness, acceptance, and perceptions of the PPI-ePR, perceived benefits and obstacles of participating in the program, reasons for not using the system after enrolling, and perceived areas for service improvement of the system. Results: More than 53.1% (266/501) of enrolled patients believed that the PPI-ePR system would improve health care quality by reducing duplicate tests and treatments, while more than 76.8% (314/409) of enrolled doctors emphasized timely access to patients’ medical records as the biggest benefit of their enrollment. Among nonenrolled patients, unawareness of the project was the most popular obstacle to enrolling in the PPI-ePR system (483/1200, 40.3%). Regarding nonenrolled doctors, the complicated registration process hindered them from participating in the program the most (95/198, 48.0%). Television, newspaper, and magazine advertisements and medical profession newsletters or journals were suggested as the most effective means to encourage participation in the program among surveyed patients (1297/1701, 76.2%) and doctors (428/610, 70.2%), respectively. Lack of clinical indication requiring data extraction from other hospitals was the main reason for low level of PPI-ePR use. Conclusions: This study comprehensively assessed the popularity, perceived benefits, and hindering factors of enrolling in the PPI-ePR system in Hong Kong. Low levels of awareness, few privacy concerns, and inactive use of the PPI-ePR system were among the key features for patients and physicians. Public promotions, simplified logistics, and a user-friendly online interface were suggested to improve the coverage and effectiveness of health information exchange between private and public health care sectors. %M 32250279 %R 10.2196/13761 %U https://www.jmir.org/2020/4/e13761 %U https://doi.org/10.2196/13761 %U http://www.ncbi.nlm.nih.gov/pubmed/32250279 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16917 %T Patient Attitudes Toward Mobile Device Use by Health Care Providers in the Emergency Department: Cross-Sectional Survey %A Alameddine,Mohamad %A Tamim,Hani %A Hadid,Dima %A Cheaito,Mohamad-Ali %A Makki,Maha %A Maatouk,Hadi %A Hitti,Eveline %+ Department of Emergency Medicine, American University of Beirut, Riad El Solh 1107 2020, Beirut, , Lebanon, 961 1350000, hittieveline@gmail.com %K smart devices %K emergency department %K patients %K attitudes %K digital professionalism %K code of conduct %K empathy %K professionalism %K distraction %K attention %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care provider usage of mobile devices is increasing globally; however, there is little understanding of patient perceptions on this behavior in a health care setting. Objective: The aim of this study was to assess patients’ attitudes toward mobile device usage by health care providers in the emergency department and to identify predictors of these attitudes. Methods: The study was carried out at the emergency department of a large academic tertiary care medical center in Lebanon. A cross-sectional survey design was adopted by administering a questionnaire to medically stable adult patients who presented to the emergency department with an emergency severity index of 3, 4, or 5 between January 2017 and March 2018. The questionnaire collected relevant patient demographic information and included questions related to their mobile device usage along with those evaluating attitudes for the use of mobile devices by health care providers with respect to six major domains: role in health care, distraction potential, impact on communication, empathy, privacy, and professionalism. The attitude toward mobile device usage by health care providers in the emergency department was the main outcome variable. A stepwise logistic regression model was used to assess the association between the outcome variable and the demographic and attitude-related independent variables. Results: Among the 438 eligible patients, 338 patients responded to the questionnaire for a response rate of 70.0%. Overall, 313/338 (92.6%) respondents agreed that mobile devices improve health care delivery, whereas 132/338 (39.1%) respondents were opposed to their usage by health care providers in the emergency department (95% CI: 34.0-44.4). The majority (240/338, 71.0%) of patients agreed that mobile devices are a source of distraction to health care providers in the workplace. Females (odds ratio [OR]=1.67, 95% CI: 1.00-2.78) as well as all patients (OR=2.54, 95% CI 1.36-4.76) who believed that mobile devices were a source of distraction, reflecting a lack of professionalism (OR=2.77, 95% CI 1.59-4.82) and impacting the provider’s ability to relate to the patient (OR=2.93, 95% CI 1.72-4.99), were more likely to agree that mobile devices should not be used in the emergency department. Conclusions: Patients’ negative attitude toward mobile device use in the emergency department is largely driven by patient gender (females), patient perception of the distraction potential of the devices, and their negative impact on the health care provider’s empathy and professionalism. The findings of this study shed light on the importance of encouraging stakeholders to impose a digital professionalism code of conduct for providers working in acute health care settings. %M 32229474 %R 10.2196/16917 %U http://mhealth.jmir.org/2020/3/e16917/ %U https://doi.org/10.2196/16917 %U http://www.ncbi.nlm.nih.gov/pubmed/32229474 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e15150 %T Towards an Adoption Framework for Patient Access to Electronic Health Records: Systematic Literature Mapping Study %A van Mens,Hugo J T %A Duijm,Ruben D %A Nienhuis,Remko %A de Keizer,Nicolette F %A Cornet,Ronald %+ Department of Medical Informatics, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22700, Amsterdam, 1100 DE, Netherlands, 31 20 566 51 88, h.j.vanmens@amsterdamumc.nl %K electronic health records %K evaluation studies as topic %K personal health records %K patient access to records %K patient portals %D 2020 %7 30.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient access to electronic health records (EHRs) is associated with increased patient engagement and health care quality outcomes. However, the adoption of patient portals and personal health records (PHRs) that facilitate this access is impeded by barriers. The Clinical Adoption Framework (CAF) has been developed to analyze EHR adoption, but this framework does not consider the patient as an end-user. Objective: We aim to extend the scope of the CAF to patient access to EHRs, develop guidance documentation for the application of the CAF, and assess the interrater reliability. Methods: We systematically reviewed existing systematic reviews on patients' access to EHRs and PHRs. Results of each review were mapped to one of the 43 CAF categories. Categories were iteratively adapted when needed. We measured the interrater reliability with Cohen’s unweighted kappa and statistics regarding the agreement among reviewers on mapping quotes of the reviews to different CAF categories. Results: We further defined the framework’s inclusion and exclusion criteria for 33 of the 43 CAF categories and achieved a moderate agreement among the raters, which varied between categories. Conclusions: In the reviews, categories about people, organization, system quality, system use, and the net benefits of system use were addressed more often than those about international and regional information and communication technology infrastructures, standards, politics, incentive programs, and social trends. Categories that were addressed less might have been underdefined in this study. The guidance documentation we developed can be applied to systematic literature reviews and implementation studies, patient and informal caregiver access to EHRs, and the adoption of PHRs. %M 32224485 %R 10.2196/15150 %U http://medinform.jmir.org/2020/3/e15150/ %U https://doi.org/10.2196/15150 %U http://www.ncbi.nlm.nih.gov/pubmed/32224485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16260 %T The Impact of Portal Satisfaction on Portal Use and Health-Seeking Behavior: Structural Equation Analysis %A Silver,Reginald A %A Subramaniam,Chandrasekar %A Stylianou,Antonis %+ University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, , United States, 1 7046876181, rsilver5@uncc.edu %K patient portals %K health care IT %K technology usage %K health-seeking behavior %D 2020 %7 27.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Our study addresses a gap in the modern information systems (IS) use literature by investigating factors that explain patient portal satisfaction (SWP) and perceptions about health-seeking behavior (HSB). A novel feature of our study is the incorporation of actual portal use data rather than the perceptions of use intention, which prevails in the modern IS literature. Objective: This study aimed to empirically validate factors that influence SWP as an influencing agent on portal use and HSB. Our population segment was comprised of college students with active patient portal accounts. Methods: Using web-based survey data from a population of portal users (n=1142) in a university health center, we proposed a theoretical model that adapts constructs from the Technology Acceptance Model by Davis, the revised Technology Adoption Model by Venkatesh, the Unified Theory of the Acceptance and Use of Technology 2, and the Health Belief Model by Rosenstock et al. We validated our model using structural equation modeling techniques. Results: Our model explained nearly 65% of the variance in SWP (R2=0.6499), nearly 33% of the variance in portal use (R2=0.3250), and 29% of the variance in HSB (R2=0.2900). Statistically significant antecedents of SWP included social influence (beta=.160, t499=6.145), habit (beta=.114, t499=4.89), facilitating conditions (beta=.062, t499=2.401), effort expectancy (beta=.311, t499=11.149), and performance expectancy (beta=.359, t499=11.588). SWP influenced HSB (beta=.505, t499=19.705) and portal use (beta=.050, t499=2.031). We did not find a statistically significant association between portal use and HSB (beta=.015, t499=0.513). Perceived severity significantly influenced HSB (beta=.129, t499=4.675) but not portal use (beta=.012, t499=.488). Conclusions: Understanding the importance of SWP and the role it plays in influencing HSB may point to future technology design considerations for information technology developers and health care providers. We extend current Expectancy Confirmation Theory research by finding a positive association between SWP and portal use. %M 32217505 %R 10.2196/16260 %U http://www.jmir.org/2020/3/e16260/ %U https://doi.org/10.2196/16260 %U http://www.ncbi.nlm.nih.gov/pubmed/32217505 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16381 %T Performance Evaluation of an Information Technology Intervention Regarding Charging for Inpatient Medical Materials at a Regional Teaching Hospital in Taiwan: Empirical Study %A Liao,Min-Chi %A Lin,I-Chun %+ Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan, 886 05 5342601 ext 5126, ichunlin@yuntech.edu.tw %K Information System Success Model %K information technology intervention %K charging %K medical materials %K work performance %D 2020 %7 25.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The process of manually recording the consumption of medical materials can be time consuming and prone to omission owing to its detailed and complicated nature. Implementing an information system will better improve work performance. Objective: The Information System Success Model was adopted as the theoretical foundation. The opinions of nursing staff were collected to verify the impact of the system intervention on their work performance. Methods: This cross-sectional study was conducted at a regional teaching hospital. Nursing staff were invited to participate in the field survey. A total of 296 questionnaires were collected, and of these, 284 (95.9%) were valid and returned. Results: The key findings showed that two critical factors (“subjective norm” and “system quality”) had significant positive effects (both P<.001) on user satisfaction (R2=0.709). The path of “service quality” to “user satisfaction” showed marginal significance (P=.08) under the 92% CI. Finally, the explanatory power of the model reached 68.9%. Conclusions: Support from the top management, appointment of a nurse supervisor as the change agent, recruitment of seed members to establish a pioneer team, and promotion of the system through the influence of opinion leaders in small groups were critical success factors needed for implementing the system in the case hospital. The target system was proven to be able to improve work performance, and the time saved could be further used for patient care, thereby increasing the value of nursing work. The positive experiences gained from this study could lay the foundation for the further promotion of the new system, and this is for future studies to replicate. The example of the successful experience of the case hospital could also serve as a reference for other hospitals in developing countries like Taiwan with regard to the promotion of nursing informatization. %M 32209534 %R 10.2196/16381 %U http://mhealth.jmir.org/2020/3/e16381/ %U https://doi.org/10.2196/16381 %U http://www.ncbi.nlm.nih.gov/pubmed/32209534 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e14599 %T Factors Influencing Motivation and Engagement in Mobile Health Among Patients With Sickle Cell Disease in Low-Prevalence, High-Income Countries: Qualitative Exploration of Patient Requirements %A Issom,David-Zacharie %A Henriksen,André %A Woldaregay,Ashenafi Zebene %A Rochat,Jessica %A Lovis,Christian %A Hartvigsen,Gunnar %+ Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1206, Switzerland, 41 223722601, david.issom@unige.ch %K mHealth %K wearable devices %K self-management %K sickle cell disease %K patient engagement %K adoption %K motivation %K user computer interfaces %K health behavior %K persuasion %D 2020 %7 24.3.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sickle cell disease (SCD) is a hematological genetic disease affecting over 25 million people worldwide. The main clinical manifestations of SCD, hemolytic anemia and vaso-occlusion, lead to chronic pain and organ damages. With recent advances in childhood care, high-income countries have seen SCD drift from a disease of early childhood mortality to a neglected chronic disease of adulthood. In particular, coordinated, preventive, and comprehensive care for adults with SCD is largely underresourced. Consequently, patients are left to self-manage. Mobile health (mHealth) apps for chronic disease self-management are now flooding app stores. However, evidence remains unclear about their effectiveness, and the literature indicates low user engagement and poor adoption rates. Finally, few apps have been developed for people with SCD and none encompasses their numerous and complex self-care management needs. Objective: This study aimed to identify factors that may influence the long-term engagement and user adoption of mHealth among the particularly isolated community of adult patients with SCD living in low-prevalence, high-income countries. Methods: Semistructured interviews were conducted. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Analysis was informed by the Braun and Clarke framework and mapped to the COM-B model (capability, opportunity, motivation, and behavior). Results were classified into high-level functional requirements (FRs) and nonfunctional requirements (NFRs) to guide the development of future mHealth interventions. Results: Overall, 6 males and 4 females were interviewed (aged between 21 and 55 years). Thirty FRs and 31 NFRs were extracted from the analysis. Most participants (8/10) were concerned about increasing their physical capabilities being able to stop pain symptoms quickly. Regarding the psychological capability aspects, all interviewees desired to receive trustworthy feedback on their self-care management practices. About their physical opportunities, most (7/10) expressed a strong desire to receive alerts when they would reach their own physiological limitations (ie, during physical activity). Concerning social opportunity, most (9/10) reported wanting to learn about the self-care practices of other patients. Relating to motivational aspects, many interviewees (6/10) stressed their need to learn how to avoid the symptoms and live as normal a life as possible. Finally, NFRs included inconspicuousness and customizability of user experience, automatic data collection, data shareability, and data privacy. Conclusions: Our findings suggest that motivation and engagement with mHealth technologies among the studied population could be increased by providing features that clearly benefit them. Self-management support and self-care decision aid are patients’ major demands. As the complexity of SCD self-management requires a high cognitive load, pervasive health technologies such as wearable sensors, implantable devices, or inconspicuous conversational user interfaces should be explored to ease it. Some of the required technologies already exist but must be integrated, bundled, adapted, or improved to meet the specific needs of people with SCD. %M 32207692 %R 10.2196/14599 %U http://humanfactors.jmir.org/2020/1/e14599/ %U https://doi.org/10.2196/14599 %U http://www.ncbi.nlm.nih.gov/pubmed/32207692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e14868 %T Implementing a Digital Tool to Support Shared Care Planning in Community-Based Mental Health Services: Qualitative Evaluation %A Pithara,Christalla %A Farr,Michelle %A Sullivan,Sarah A %A Edwards,Hannah B %A Hall,William %A Gadd,Caroline %A Walker,Julian %A Hebden,Nick %A Horwood,Jeremy %+ Population Health Sciences, Bristol Medical School, University of Bristol, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, United Kingdom, 44 1173421272 ext 21272, christalla.pithara@bristol.ac.uk %K health care technology %K mental health %K community health care %K patient-centered care %K patient care planning %K implementation science %D 2020 %7 19.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health services aim to provide recovery-focused care and facilitate coproduced care planning. In practice, mental health providers can find supporting individualized coproduced care with service users difficult while balancing administrative and performance demands. To help meet this aim and using principles of coproduction, an innovative mobile digital care pathway tool (CPT) was developed to be used on a tablet computer and piloted in the West of England. Objective: The aim of this study was to examine mental health care providers’ views of and experiences with the CPT during the pilot implementation phase and identify factors influencing its implementation. Methods: A total of 20 in-depth telephone interviews were conducted with providers participating in the pilot and managers in the host organization. Interviews were audio recorded, transcribed, anonymized, and thematically analyzed guided by the Consolidated Framework for Implementation Research. Results: The tool was thought to facilitate coproduced recovery-focused care planning, a policy and organizational as well as professional priority. Internet connectivity issues, system interoperability, and access to service users’ health records affected use of the tool during mobile working. The organization’s resources, such as information technology (IT) infrastructure and staff time and IT culture, influenced implementation. Participants’ levels of use of the tool were dependent on knowledge of the tool and self-efficacy; perceived service-user needs and characteristics; and perceptions of impact on the therapeutic relationship. Training and preparation time influenced participants’ confidence in using the tool. Conclusions: Findings highlight the importance of congruence between staff, organization, and external policy priorities and digital technologies in aiding intervention engagement, and the need for ongoing training and support of those intended to use the technology during and after the end of implementation interventions. %M 32191210 %R 10.2196/14868 %U https://www.jmir.org/2020/3/e14868 %U https://doi.org/10.2196/14868 %U http://www.ncbi.nlm.nih.gov/pubmed/32191210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16995 %T Technological, Organizational, and Environmental Factors Influencing Social Media Adoption by Hospitals in Switzerland: Cross-Sectional Study %A Beier,Michael %A Früh,Sebastian %+ University of Applied Sciences of the Grisons, Pulvermühlestrasse 57, Chur, 7000, Switzerland, 41 81 286 3755, michael.beier@fhgr.ch %K social media %K social media adoption %K hospitals %K Switzerland %K organizational technology adoption %K TOE framework %D 2020 %7 9.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms are important tools for hospitals. These platforms offer many potential benefits in various areas of application for hospitals to connect and interact with their stakeholders. However, hospitals differ immensely in their social media adoption. There are studies that provide initial findings on individual factors influencing social media adoption by hospitals, but there is no comprehensive and integrated model. Objective: This study aimed to develop a comprehensive model of social media adoption by hospitals in the context of the Swiss health care system and to test the model with empirical data from Switzerland. Methods: To develop our model, we applied the general technology-organization-environment framework of organizational technology adoption and adapted it to the specific context of social media adoption by hospitals in Switzerland. To test our model, we collected empirical data on all 283 hospitals in Switzerland and identified the accounts they operate on 7 different social media platforms (Facebook, Google+, Twitter, Instagram, LinkedIn, XING, and YouTube). We tested the hypotheses of our model by means of binary logistic regression (dependent variable: platform adoption) and negative binomial regression (dependent variable: number of different platforms adopted). Results: Our general model on social media adoption received broad support. Overall, hospitals in Switzerland are more likely to adopt social media if they have a higher share of patients with voluntary health insurance or have a higher patient volume. In contrast, they are less likely to operate their own social media accounts if they are associated with a hospital network. However, some hypotheses of our model received only partial support for specific social media platforms; for instance, hospitals in Switzerland are more likely to adopt XING if they provide an educational program and are more likely to adopt LinkedIn if they are located in regions with higher competition intensity. Conclusions: Our study provides a comprehensive model of social media adoption by hospitals in Switzerland. This model shows, in detail, the factors that influence hospitals in Switzerland in their social media adoption. In addition, it provides a basic framework that might be helpful in systematically developing and testing comprehensive models of social media adoption by hospitals in other countries. %M 32149718 %R 10.2196/16995 %U https://www.jmir.org/2020/3/e16995 %U https://doi.org/10.2196/16995 %U http://www.ncbi.nlm.nih.gov/pubmed/32149718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e13116 %T Impact of Illness on Electronic Health Use (The Seventh Tromsø Study - Part 2): Population-Based Questionnaire Study %A Marco-Ruiz,Luis %A Wynn,Rolf %A Oyeyemi,Sunday Oluwafemi %A Budrionis,Andrius %A Yigzaw,Kassaye Yitbarek %A Bellika,Johan Gustav %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 95748049, johan.gustav.bellika@ehealthresearch.no %K eHealth %K internet %K search engines %K mobile apps %K social media %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients who suffer from different diseases may use different electronic health (eHealth) resources. Thus, those who plan eHealth interventions should take into account which eHealth resources are used most frequently by patients that suffer from different diseases. Objective: The aim of this study was to understand the associations between different groups of chronic diseases and the use of different eHealth resources. Methods: Data from the seventh survey of the Tromsø Study (Tromsø 7) were analyzed to determine how different diseases influence the use of different eHealth resources. Specifically, the eHealth resources considered were use of apps, search engines, video services, and social media. The analysis contained data from 21,083 participants in the age group older than 40 years. A total of 15,585 (15,585/21,083; 73.92%) participants reported to have suffered some disease, 10,604 (10,604/21,083; 50.29%) participants reported to have used some kind of eHealth resource in the last year, and 7854 (7854/21,083; 37.25%) participants reported to have used some kind of eHealth resource in the last year and suffered (or had suffered) from some kind of specified disease. Logistic regression was used to determine which diseases significantly predicted the use of each eHealth resource. Results: The use of apps was increased among those individuals that (had) suffered from psychological problems (odds ratio [OR] 1.39, 95% CI 1.23-1.56) and cardiovascular diseases (OR 1.12, 95% CI 1.01-1.24) and those part-time workers that (had) suffered from any of the diseases classified as others (OR 2.08, 95% CI 1.35-3.32). The use of search engines for accessing health information increased among individuals who suffered from psychological problems (OR 1.39, 95% CI 1.25-1.55), cancer (OR 1.26, 95% CI 1.11-1.44), or any of the diseases classified as other diseases (OR 1.27, 95% CI 1.13-1.42). Regarding video services, their use for accessing health information was more likely when the participant was a man (OR 1.31, 95% CI 1.13-1.53), (had) suffered from psychological problems (OR 1.70, 95% CI 1.43-2.01), or (had) suffered from other diseases (OR 1.43, 95% CI 1.20-1.71). The factors associated with an increase in the use of social media for accessing health information were as follows: (had) suffered from psychological problems (OR 1.65, 95% CI 1.42-1.91), working part time (OR 1.35, 95% CI 0.62-2.63), receiving disability benefits (OR 1.42, 95% CI 1.14-1.76), having received an upper secondary school education (OR 1.20, 95% CI 1.03-1.38), being a man with a high household income (OR 1.67, 95% CI 1.07-2.60), suffering from cardiovascular diseases and having a high household income (OR 3.39, 95% CI 1.62-8.16), and suffering from respiratory diseases while being retired (OR 1.95, 95% CI 1.28-2.97). Conclusions: Our findings show that different diseases are currently associated with the use of different eHealth resources. This knowledge is useful for those who plan eHealth interventions as they can take into account which type of eHealth resource may be used for gaining the attention of the different user groups. %M 32134390 %R 10.2196/13116 %U https://www.jmir.org/2020/3/e13116 %U https://doi.org/10.2196/13116 %U http://www.ncbi.nlm.nih.gov/pubmed/32134390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e13118 %T Impact of the Use of Electronic Health Tools on the Psychological and Emotional Well-Being of Electronic Health Service Users (The Seventh Tromsø Study - Part 3): Population-Based Questionnaire Study %A Budrionis,Andrius %A Wynn,Rolf %A Marco-Ruiz,Luis %A Yigzaw,Kassaye Yitbarek %A Bergvik,Svein %A Oyeyemi,Sunday Oluwafemi %A Bellika,Johan Gustav %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 95748049, johan.gustav.bellika@ehealthresearch.no %K eHealth %K telemedicine %K health information %K Tromsø study %K health-related internet use %K emotions %K effect %K anxious %K confused %K knowledgeable %K reassured %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) has been described as a silver bullet for addressing how challenges of the current health care system may be solved by technological solutions in future strategies and visions for modern health care. However, the evidence of its effects on service quality and cost effectiveness remains unclear. In addition, patients’ psychological and emotional reactions to using eHealth tools are rarely addressed by the scientific literature. Objective: This study aimed to assess how the psychological and emotional well-being of eHealth service users is affected by the use of eHealth tools. Methods: We analyzed data from a population-based survey in Norway, conducted in the years 2015-2016 and representing 10,604 eHealth users aged over 40 years, to identify how the use of eHealth tools was associated with feeling anxious, confused, knowledgeable, or reassured. Associations between these four emotional outcomes and the use of four types of eHealth services (Web search engines, video search engines, health apps, and social media) were analyzed using logistic regression models. Results: The use of eHealth tools made 72.41% (6740/9308) of the participants feel more knowledgeable and 47.49% (4421/9308) of the participants feel more reassured about their health status. However, 25.69% (2392/9308) reported feeling more anxious and 27.88% (2595/9308) reported feeling more confused using eHealth tools. A high level of education and not having a full-time job were associated with positive reactions and emotions (feeling more knowledgeable and reassured), whereas low self-reported health status and not having enough friends who could provide help and support predicted negative reactions and emotions (ie, feeling anxious and confused). Overall, the positive emotional effects of eHealth use (feeling knowledgeable and reassured) were relatively more prevalent among users aged over 40 years than the negative emotional effects (ie, feeling anxious and confused). About one-fourth of eHealth users reported being more confused and anxious after using eHealth services. Conclusions: The search for health information on the internet can be motivated by a range of factors and needs (not studied in this study), and people may experience a range of reactions and feelings following health information searching on the Web. Drawing on prior studies, we categorized reactions as positive and negative reactions. Some participants had negative reactions, which is challenging to resolve and should be taken into consideration by eHealth service providers when designing services (ie, including concrete information about how users can get more help and support). There is a need for more studies examining a greater range of reactions to online health information and factors that might predict negative reactions to health information on the Web. %M 32134396 %R 10.2196/13118 %U https://www.jmir.org/2020/3/e13118 %U https://doi.org/10.2196/13118 %U http://www.ncbi.nlm.nih.gov/pubmed/32134396 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e13106 %T Electronic Health Use in a Representative Sample of 18,497 Respondents in Norway (The Seventh Tromsø Study - Part 1): Population-Based Questionnaire Study %A Wynn,Rolf %A Oyeyemi,Sunday Oluwafemi %A Budrionis,Andrius %A Marco-Ruiz,Luis %A Yigzaw,Kassaye Yitbarek %A Bellika,Johan Gustav %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 95748049, johan.gustav.bellika@ehealthresearch.no %K adoption %K digital health %K eHealth %K internet %K Web search engine %K health apps %K social media %K video service %K population study %K Tromsø study %D 2020 %7 5.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic health (eHealth) services may help people obtain information and manage their health, and they are gaining attention as technology improves, and as traditional health services are placed under increasing strain. We present findings from the first representative, large-scale, population-based study of eHealth use in Norway. Objective: The objectives of this study were to examine the use of eHealth in a population above 40 years of age, the predictors of eHealth use, and the predictors of taking action following the use of these eHealth services. Methods: Data were collected through a questionnaire given to participants in the seventh survey of the Tromsø Study (Tromsø 7). The study involved a representative sample of the Norwegian population aged above 40 years old. A subset of the more extensive questionnaire was explicitly related to eHealth use. Data were analyzed using logistic regression analyses. Results: Approximately half (52.7%; 9752/18,497) of the respondents had used some form of eHealth services during the last year. About 58% (5624/9698) of the participants who had responded to a question about taking some type of action based on information gained from using eHealth services had done so. The variables of being a woman (OR 1.58; 95% CI 1.47-1.68), of younger age (40-49 year age group: OR 4.28, 95% CI 3.63-5.04), with a higher education (tertiary/long: OR 3.77, 95% CI 3.40-4.19), and a higher income (>1 million kr [US $100,000]: OR 2.19, 95% CI 1.77-2.70) all positively predicted the use of eHealth services. Not living with a spouse (OR 1.14, 95% CI 1.04-1.25), having seen a general practitioner (GP) in the last year (OR 1.66, 95% CI 1.53-1.80), and having had some disease (such as heart disease, cancer, asthma, etc; OR 1.29, 95% CI 1.18-1.41) also positively predicted eHealth use. Self-rated health status did not significantly influence eHealth use. Taking some action following eHealth use was predicted with the variables of being a woman (OR 1.16, 95% CI 1.07-1.27), being younger (40-49 year age group: OR 1.72, 95% CI 1.34-2.22), having a higher education (tertiary/long: OR 1.65, 95% CI 1.42-1.92), having seen a GP in the last year (OR 1.58, 95% CI 1.41-1.77), and having ever had a disease (such as heart disease, cancer or asthma; OR 1.26, 95% CI 1.14-1.39). Conclusions: eHealth appears to be an essential supplement to traditional health services for those aged above 40 years old, and especially so for the more resourceful. Being a woman, being younger, having higher education, having had a disease, and having seen a GP in the last year all positively predicted using the internet to get health information and taking some action based on this information. %M 32134395 %R 10.2196/13106 %U https://medinform.jmir.org/2020/3/e13106 %U https://doi.org/10.2196/13106 %U http://www.ncbi.nlm.nih.gov/pubmed/32134395 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e15935 %T Social, Organizational, and Technological Factors Impacting Clinicians’ Adoption of Mobile Health Tools: Systematic Literature Review %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge, CB1 1PT, United Kingdom, 44 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K cell or mobile phone %K electronic health record %K workflow %K workload %K workplace %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %D 2020 %7 20.2.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective: The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods: A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results: The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions: The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits. %M 32130167 %R 10.2196/15935 %U http://mhealth.jmir.org/2020/2/e15935/ %U https://doi.org/10.2196/15935 %U http://www.ncbi.nlm.nih.gov/pubmed/32130167 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e17006 %T Evaluating the Applications of Health Information Technologies in China During the Past 11 Years: Consecutive Survey Data Analysis %A Liang,Jun %A Li,Ying %A Zhang,Zhongan %A Shen,Dongxia %A Xu,Jie %A Yu,Gang %A Dai,Siqi %A Ge,Fangmin %A Lei,Jianbo %+ Institute of Medical Technology, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China, 86 8280 5901, jblei@hsc.pku.edu.cn %K medical informatics %K health information technologies %K China %K health care reform %K hospitals %D 2020 %7 10.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: To achieve universal access to medical resources, China introduced its second health care reform in 2010, with health information technologies (HIT) as an important technical support point. Objective: This study is the first attempt to explore the unique contributions and characteristics of HIT development in Chinese hospitals from the three major aspects of hospital HIT—human resources, funding, and materials—in an all-around, multi-angled, and time-longitudinal manner, so as to serve as a reference for decision makers in China and the rest of the world when formulating HIT development strategies. Methods: A longitudinal research method is used to analyze the results of the CHIMA Annual Survey of Hospital Information System in China carried out by a Chinese national industrial association, CHIMA, from 2007 to 2018. The development characteristics of human resources, funding, and materials of HIT in China for the past 12 years are summarized. The Bass model is used to fit and predict the popularization trend of EMR in Chinese hospitals from 2007 to 2020. Results: From 2007 to 2018, the CHIMA Annual Survey interviewed 10,954 hospital CIOs across 32 administrative regions in Mainland China. Compared with 2007, as of 2018, in terms of human resources, the average full time equivalent (FTE) count in each hospital’s IT center is still lower than the average level of US counterparts in 2014 (9.66 FTEs vs. 34 FTEs). The proportion of CIOs with a master’s degree or above was 25.61%, showing an increase of 18.51%, among which those with computer-related backgrounds accounted for 64.75%, however, those with a medical informatics background only accounted for 3.67%. In terms of funding, the sampled hospitals’ annual HIT investment increased from ¥957,700 (US $136,874) to ¥6.376 million (US $911,261), and the average investment per bed increased from ¥4,600 (US $658) to ¥8,100 (US $1158). In terms of information system construction, as of 2018, the average EMR implementation rate of the sampled hospitals exceeded the average level of their US counterparts in 2015 and their German counterparts in 2017 (85.26% vs. 83.8% vs. 68.4%, respectively). The results of the Bass prediction model show that Chinese hospitals will likely reach an adoption rate of 91.4% by 2020 (R2=0.95). Conclusions: In more than 10 years, based on this top-down approach, China’s medical care industry has accepted government instructions and implemented the unified model planned by administrative intervention. With only about one-fifth of the required funding, and about one-fourth of the required human resources per hospital as compared to the US HITECH project, China’s EMR coverage in 2018 exceeded the average level of its US counterparts in 2015 and German counterparts in 2017. This experience deserves further study and analysis by other countries. %M 32039815 %R 10.2196/17006 %U https://medinform.jmir.org/2020/2/e17006 %U https://doi.org/10.2196/17006 %U http://www.ncbi.nlm.nih.gov/pubmed/32039815 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 1 %P e16484 %T Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study %A Fernández,Oscar Solans %A Seguí,Francesc López %A Vidal-Alaball,Josep %A Bonet Simo,Josep Maria %A Vian,Oscar Hernandez %A Cabo,Pascual Roig %A Hernandez,Marta Carrasco %A Dominguez,Carmen Olmos %A Reig,Xavier Alzaga %A Rodríguez,Yesika Díaz %A Peralta,Manuel Medina %A Hermosilla,Eduardo %A León,Nuria Martínez %A Guimferrer,Nuria %A González,Mercedes Abizanda %A Cuyàs,Francesc García %A Sust,Pol Pérez %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, C Pica d'Estats, 13-15, Sant Fruitós de Bages, Catalonia, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K tele-medicine %K tele-consultation %K remote consultation %K primary care %K general practitioners %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: eConsulta is a tele-consultation service involving doctors and patients, and is part of Catalonia's public health information technology system. The service has been in operation since the end of 2015 as an adjunct to face-to-face consultations. A key factor in understanding the barriers and facilitators to the acceptance of the tool is understanding the sociodemographic characteristics of general practitioners who determine its use. Objective: This study aimed to analyze the sociodemographic factors that affect the likelihood of doctors using eConsulta. Methods: A retrospective cross-sectional analysis of administrative data was used to perform a multivariate logistic regression analysis on the use of eConsulta in relation to sociodemographic variables. Results: The model shows that the doctors who use eConsulta are 45-54 years of age, score higher than the 80th percentile on the quality of care index, have a high degree of accessibility, are involved in teaching, and work on a health team in a high socioeconomic urban setting. Conclusions: The results suggest that certain sociodemographic characteristics associated with general practitioners determine whether they use eConsulta. These results must be taken into account if its deployment is to be encouraged in the context of a public health system. %M 32012061 %R 10.2196/16484 %U http://medinform.jmir.org/2020/1/e16484/ %U https://doi.org/10.2196/16484 %U http://www.ncbi.nlm.nih.gov/pubmed/32012061 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 1 %P e14548 %T The Adoption of a Virtual Reality–Assisted Training System for Mental Rotation: A Partial Least Squares Structural Equation Modeling Approach %A Chang,Chen-Wei %A Yeh,Shih-Ching %A Li,Mengtong %+ Department of Computer Science & Information Engineering, National Central University, No 300, Zhongda Rd, Zhongli District, Taoyuan City, 32001, Taiwan, 886 34227151 ext 35313, shihching.yeh@gmail.com %K virtual reality %K computer simulation %K educational technology %K training programs %D 2020 %7 17.1.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) technologies have been developed to assist education and training. Although recent research suggested that the application of VR led to effective learning and training outcomes, investigations concerning the acceptance of these VR systems are needed to better urge learners and trainees to be active adopters. Objective: This study aimed to create a theoretical model to examine how determining factors from relevant theories of technology acceptance can be used to explain the acceptance of a novel VR-assisted mental rotation (MR) training system created by our research team to better understand how to encourage learners to use VR technology to enhance their spatial ability. Methods: Stereo and interactive MR tasks based on Shepard and Metzler’s pencil and paper test for MR ability were created. The participants completed a set of MR tasks using 3D glasses and stereoscopic display and a 6-degree-of-freedom joystick controller. Following task completion, psychometric constructs from theories and previous studies (ie, perceived ease of use, perceived enjoyment, attitude, satisfaction, and behavioral intention to use the system) were used to measure relevant factors influencing behavior intentions. Results: The statistical technique of partial least squares structural equation modeling was applied to analyze the data. The model explained 47.7% of the novel, VR-assisted MR training system’s adoption intention, which suggests that the model has moderate explanatory power. Direct and indirect effects were also interpreted. Conclusions: The findings of this study have both theoretical and practical importance not only for MR training but also for other VR-assisted education. The results can extend current theories from the context of information systems to educational and training technology, specifically for the use of VR-assisted systems and devices. The empirical evidence has practical implications for educators, technology developers, and policy makers regarding MR training. %M 31804184 %R 10.2196/14548 %U http://games.jmir.org/2020/1/e14548/ %U https://doi.org/10.2196/14548 %U http://www.ncbi.nlm.nih.gov/pubmed/31804184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14994 %T Identifying and Overcoming Policy-Level Barriers to the Implementation of Digital Health Innovation: Qualitative Study %A Desveaux,Laura %A Soobiah,Charlene %A Bhatia,R Sacha %A Shaw,James %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5B1S2, Canada, 1 416 323 6400 ext 4302, laura.desveaux@wchospital.ca %K health care %K policy %K implementation %K health technology %D 2019 %7 20.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: High-level policy barriers impede widespread adoption for even the most well-positioned innovations. Most of the work in this field assumes rather than analyzes the driving forces of health innovation. Objective: The aim of this study was to explore the challenges and opportunities experienced by health system stakeholders in the implementation of digital health innovation in Ontario. Objective: The aim of this study was to explore the challenges and opportunities experienced by health system stakeholders in the implementation of digital health innovation in Ontario. Methods: We completed semistructured interviews with 10 members of senior leadership across key organizations that are engaged in health care–related digital health activities. Data were analyzed using qualitative description. Results: A total of 6 key policy priorities emerged, including the need for (1) a system-level definition of innovation, (2) a clear overarching mission, and (3) clearly defined organizational roles. Operationally, there is a need to (4) standardize processes, (5) shift the emphasis to change management, and (6) align funding structures. Conclusions: These findings emphasize the critical role of the government in developing a vision and creating the foundation upon which innovation activities will be modeled. %M 31859679 %R 10.2196/14994 %U http://www.jmir.org/2019/12/e14994/ %U https://doi.org/10.2196/14994 %U http://www.ncbi.nlm.nih.gov/pubmed/31859679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14985 %T Understanding Drivers of Resistance Toward Implementation of Web-Based Self-Management Tools in Routine Cancer Care Among Oncology Nurses: Cross-Sectional Survey Study %A de Wit,Matthijs %A Kleijnen,Mirella %A Lissenberg-Witte,Birgit %A van Uden-Kraan,Cornelia %A Millet,Kobe %A Frambach,Ruud %A Verdonck-de Leeuw,Irma %+ Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Van der Boechorstraat 7, Amsterdam, 1081 BT, Netherlands, 31 204440988, im.verdonck@vumc.nl %K psycho-oncology %K health-related quality of life %K self-management %K eHealth %K implementation science %K resistance to innovations %D 2019 %7 17.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting patients to engage in (Web-based) self-management tools is increasingly gaining importance, but the engagement of health care professionals is lagging behind. This can partly be explained by resistance among health care professionals. Objective: The aim of this study was to investigate drivers of resistance among oncology nurses toward Web-based self-management tools in cancer care. Methods: Drawing from previous research, combining clinical and marketing perspectives, and several variables and instruments, we developed the Resistance to Innovation model (RTI-model). The RTI-model distinguishes between passive and active resistance, which can be enhanced or reduced by functional drivers (incompatibility, complexity, lack of value, and risk) and psychological drivers (role ambiguity, social pressure from the institute, peers, and patients). Both types of drivers can be moderated by staff-, organization-, patient-, and environment-related factors. We executed a survey covering all components of the RTI-model on a cross-sectional sample of nurses working in oncology in the Netherlands. Structural equation modeling was used to test the full model, using a hierarchical approach. In total, 2500 nurses were approached, out of which 285 (11.40%) nurses responded. Results: The goodness of fit statistic of the uncorrected base model of the RTI-model (n=239) was acceptable (χ21=9.2; Comparative Fit Index=0.95; Tucker Lewis index=0.21; Root Mean Square Error of Approximation=0.19; Standardized Root Mean Square=0.016). In line with the RTI-model, we found that both passive and active resistance among oncology nurses toward (Web-based) self-management tools were driven by both functional and psychological drivers. Passive resistance toward Web-based self-management tools was enhanced by complexity, lack of value, and role ambiguity, and it was reduced by institutional social pressure. Active resistance was enhanced by complexity, lack of value, and social pressure from peers, and it was reduced by social pressure from the institute and patients. In contrast to what we expected, incompatibility with current routines was not a significant driver of either passive or active resistance. This study further showed that these drivers of resistance were moderated by expertise (P=.03), managerial support (P=.004), and influence from external stakeholders (government; P=.04). Conclusions: Both passive and active resistance in oncology nurses toward Web-based self-management tools for patients with cancer are driven by functional and psychological drivers, which may be more or less strong, depending on expertise, managerial support, and governmental influence. %M 31845900 %R 10.2196/14985 %U http://www.jmir.org/2019/12/e14985/ %U https://doi.org/10.2196/14985 %U http://www.ncbi.nlm.nih.gov/pubmed/31845900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15176 %T Attitudes Toward Health Care Virtual Communities of Practice: Survey Among Health Care Workers %A Yada,Nicole %A Head,Milena %+ DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada, 1 905 525 9140 ext 24435, headm@mcmaster.ca %K virtual community of practice %K eHealth %K digital health %K knowledge translation %K implementation science %K elaboration likelihood model %K technology adoption %D 2019 %7 4.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual communities of practice (VCoPs) have been shown to be an effective means for knowledge and research uptake, but little is known about why health care workers choose to use them. The elaboration likelihood model (ELM) is a theoretical model of persuasion that distinguishes between different routes of information processing that influence attitude formation and change. To date, no research has investigated the antecedents to these processing routes for VCoPs within a health care setting. In understanding these determinants, VCoPs can be appropriately designed to increase their chances of use and value among health care professionals. Objective: Our aim is to explore how motivation and ability affect attitudes toward using VCoPs for those working in health care. Methods: Data were collected from 86 health care workers using an online survey at two Canadian health care conferences. Participants were shown a mock VCoP and asked about their perceptions of the online platform and related technologies. The survey instrument was developed based on previously validated scales to measure participants’ ability and motivation toward using a VCoP. Attitudes were assessed both at the beginning and end of the study; intention to use the platform was assessed at the end. Results: Ability (expertise with CoPs and VCoPs) was found to directly affect intention to use the system (P<.001 and P=.009, respectively) as was motivation (P<.001). Argument quality had the greatest effect on formed attitudes toward VCoPs, regardless of the user’s level of experience (lower expertise: P=.04; higher expertise: P=.003). Those with higher levels of CoPs expertise were also influenced by peripheral cues of source credibility (P=.005 for attitude formation and intention to use the system) and connectedness (P=.04 for attitude formation; P=.008 for intention to use the system), whereas those with lower levels of CoP expertise were not (P>.05). A significant correlation between formed attitude and intention to use the VCoPs system was found for those with higher levels of expertise (P<.001). Conclusions: This research found that both user ability and motivation play an important and positive role in the attitude toward and adoption of health care VCoPs. Unlike previous ELM research, evidence-based arguments were found to be an effective messaging tactic for improving attitudes toward VCoPs for health care professionals with both high and low levels of expertise. Understanding these factors that influence the attitudes of VCoPs can provide insight into how to best design and position such systems to encourage their effective use among health care professionals. %M 31799934 %R 10.2196/15176 %U https://www.jmir.org/2019/12/e15176 %U https://doi.org/10.2196/15176 %U http://www.ncbi.nlm.nih.gov/pubmed/31799934 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 4 %P e13042 %T Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review %A Mold,Freda %A Hendy,Jane %A Lai,Yi-Ling %A de Lusignan,Simon %+ Faculty of Health and Medical Sciences, University of Surrey, Kate Granger Building, Surrey Research Park, Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 1483 684636, Freda.mold@surrey.ac.uk %K referral and consultation %K health services accessibility %K primary health care %K general practice %K patient access to records %K patient portals %K Web-based access %D 2019 %7 3.12.2019 %9 Review %J JMIR Med Inform %G English %X Background: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective: This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods: A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results: This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow. %M 31793888 %R 10.2196/13042 %U http://medinform.jmir.org/2019/4/e13042/ %U https://doi.org/10.2196/13042 %U http://www.ncbi.nlm.nih.gov/pubmed/31793888 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 4 %P e13318 %T Primary Care Physicians’ Experience Using Advanced Electronic Medical Record Features to Support Chronic Disease Prevention and Management: Qualitative Study %A Rahal,Rana Melissa %A Mercer,Jay %A Kuziemsky,Craig %A Yaya,Sanni %+ Population Health Program, University of Ottawa, 25 University Private, Ottawa, ON, K1N 7K4, Canada, 1 6138902193, rraha039@uottawa.ca %K electronic health record %K chronic disease %K primary health care %K medical informatics %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chronic diseases are the leading cause of death worldwide. In Canada, more than half of all health care spending is used for managing chronic diseases. Although studies have shown that the use of advanced features of electronic medical record (EMR) systems improves the quality of chronic disease prevention and management (CDPM), a 2012 international survey found that Canadian physicians were the least likely to use 2 or more EMR system functions. Some studies show that maturity vis-à-vis clinicians’ EMR use is an important factor when evaluating the use of advanced features of health information systems. The Clinical Adoption Framework (CAF), a common evaluation framework used to assess the success of EMR adoption, does not incorporate the process of maturing. Nevertheless, the CAF and studies that discuss the barriers to and facilitators of the adoption of EMR systems can be the basis for exploring the use of advanced EMR features. Objective: This study aimed to explore the factors that primary care physicians in Ontario identified as influencing their use of advanced EMR features to support CDPM and to extend the CAF to include primary care physicians’ perceptions of how their use of EMRs for performing clinical tasks has matured. Methods: Guided by the CAF, directed content analysis was used to explore the barriers and facilitating factors encountered by primary care physicians when using EMR features. Participants were primary care physicians in Ontario, Canada, who use EMRs. Data were coded using categories from the CAF. Results: A total of 9 face-to-face interviews were conducted from January 2017 to July 2017. Dimensions from the CAF emerged from the data, and one new dimension was derived: physicians’ perception of their maturity of EMR use. Primary care physicians identified the following key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, training and technical support, user satisfaction, provider’s productivity, personal characteristics and roles, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership. Conclusions: The CAF was extended to include physicians’ perceptions of how their use of EMR systems had matured. Most participants agreed that their use of EMR systems for performing clinical tasks had evolved since their adoption of the system and that certain system features facilitated their care for patients with chronic diseases. However, several barriers were identified and should be addressed to further enhance primary care physicians’ use of advanced EMR features to support CDPM. %M 31782742 %R 10.2196/13318 %U http://medinform.jmir.org/2019/4/e13318/ %U https://doi.org/10.2196/13318 %U http://www.ncbi.nlm.nih.gov/pubmed/31782742 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 4 %P e13472 %T Empirical Research on Acceptance of Digital Technologies in Medicine Among Patients and Healthy Users: Questionnaire Study %A Safi,Sabur %A Danzer,Gerhard %A Schmailzl,Kurt JG %+ Center for Connected Health Care UG, Medical School Brandenburg, digiLog, Fehrbelliner Straße 38, Neuruppin, 16816, Germany, 49 3391391009, sabur.safi@gmx.de %K innovative health care applications %K e-Health %K Technology Acceptance Model %K health care innovation %K electronic medical records %K ePatient Survey %K sex differences %K medical technology %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In recent years, interest in digital technologies such as electronic health, mobile health, telemedicine, big data, and health apps has been increasing in the health care sector. Acceptance and sustainability of these technologies play a considerable role for innovative health care apps. Objective: This study aimed to identify the spread of and experience with new digital technologies in the medical sector in Germany. Methods: We analyzed the acceptance of new health care technologies by applying the Technology Acceptance Model to data obtained in the German ePatient Survey 2018. This survey used standardized questionnaires to gain insight into the prevalence, impact, and development of digital health applications in a study sample of 9621 patients with acute and chronic conditions and healthy users. We extracted sociodemographic data and details on the different health app types used in Germany and conducted an evaluation based on the Technology Acceptance Model. Results: The average age of the respondents was 59.7 years, with a standard deviation of 16 years. Digital health care apps were generally accepted, but differences were observed among age groups and genders of the respondents. Men were more likely to accept digital technologies, while women preferred coaching and consultation apps. Analysis of the user typology revealed that most users were patients (n=4041, 42%), followed by patients with acute conditions (n=3175, 33%), and healthy users (n=2405, 25%). The majority (n=6542, 68%) discovered coaching or medication apps themselves on the internet, while more than half of the users faced initial difficulties operating such apps. The time of use of the same app or program ranged from a few days (n=1607, 37%) and several months (n=1694, 39%) to ≥1 year (n=1042, 24%). Most respondents (n=6927, 72%) stated that they would like to receive customized health care apps from their physician. Conclusions: The acceptance of digital technologies in the German health care sector varies depending on age and gender. The broad acceptance of medical digital apps could potentially improve individualized health care solutions and warrants governance. %M 31782741 %R 10.2196/13472 %U http://humanfactors.jmir.org/2019/4/e13472/ %U https://doi.org/10.2196/13472 %U http://www.ncbi.nlm.nih.gov/pubmed/31782741 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 4 %P e13661 %T Understanding the Adoption and Diffusion of a Telemonitoring Solution in Gestational Diabetes Mellitus: Qualitative Study %A Khalil,Carine %+ Paris Descartes University, 43 rue des Saints-Pères, Paris, 75006, France, 33 12133361585, carine.khalil@parisdescartes.fr %K gestational diabetes %K telemonitoring %K diffusion of innovation theory %K qualitative research %D 2019 %7 28.11.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: Women with gestational diabetes mellitus (GDM) require regular follow-ups and overall management to normalize maternal blood glucose and improve pregnancy outcomes. With the advancements made in the digital field, telemedicine is gaining popularity over traditional health care approaches in different medical fields. As for GDM, telemonitoring solutions seem to improve women’s quality of life and enhance self-management. Objective: The aim of this study is to understand, from patients’ and health care professionals’ (HCPs) perspectives, what drives the adoption and diffusion of a telemonitoring solution (myDiabby) in a context where telemonitoring activities are still not compensated like traditional follow-ups. Methods: The study was conducted in 12 diabetes services in France using myDiabby for monitoring and managing patients with GDM. A qualitative research approach was adopted for collecting and analyzing data. A total of 20 semistructured interviews were conducted with HCPs working in different health structures in France, and 15 semistructured interviews were conducted with patients who had been using myDiabby. Data were analyzed using a thematic analysis approach. Results: Different determinants need to be taken into consideration when adopting an innovative health technology. By drawing on the diffusion of innovation theory, a set of factors associated with the technology (the relative advantages, compatibility, ease of use, testability, and observability of the telemedicine platform) has been identified as affecting the adoption and diffusion of telemonitoring solutions in French diabetes services. In addition, data analysis shows a set of environmental factors (the demographic situation of HCPs, the health care access in rural communities, and the economic and political context in France) that also influences the spread and adoption of telemonitoring systems in French hospitals. Conclusions: Even though telemonitoring activities are still not remunerated as traditional follow-ups, many French HCPs support and encourage the adoption of telemonitoring systems in GDM. As for patients, telemonitoring systems are perceived as a useful and easy way to monitor their GDM. This study contributes to recognizing the value of telemonitoring interventions in managing GDM and considering the expansion of telemonitoring to other chronic conditions. %M 31778118 %R 10.2196/13661 %U http://diabetes.jmir.org/2019/4/e13661/ %U https://doi.org/10.2196/13661 %U http://www.ncbi.nlm.nih.gov/pubmed/31778118 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14197 %T Barriers and Facilitators to the Implementation of eHealth Services: Systematic Literature Analysis %A Schreiweis,Björn %A Pobiruchin,Monika %A Strotbaum,Veronika %A Suleder,Julian %A Wiesner,Martin %A Bergh,Björn %+ Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Arnold-Heller-Straße 3, Kiel, 24105, Germany, 49 431500 ext 30701, bjoern.schreiweis@uksh.de %K eHealth %K health information interoperability %K policy %K software design %D 2019 %7 22.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective: The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods: For this study, a twofold approach was applied. First, we gathered experts’ current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results: Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions: This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers. %M 31755869 %R 10.2196/14197 %U http://www.jmir.org/2019/11/e14197/ %U https://doi.org/10.2196/14197 %U http://www.ncbi.nlm.nih.gov/pubmed/31755869 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 4 %P e13466 %T Usability Factors Associated With Physicians’ Distress and Information System–Related Stress: Cross-Sectional Survey %A Heponiemi,Tarja %A Kujala,Sari %A Vainiomäki,Suvi %A Vehko,Tuulikki %A Lääveri,Tinja %A Vänskä,Jukka %A Ketola,Eeva %A Puttonen,Sampsa %A Hyppönen,Hannele %+ National Institute for Health and Welfare, PoBox 30, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K health information systems %K physicians %K electronic health records %K computers, digital %D 2019 %7 5.11.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Constantly changing and difficult-to-use information systems have arisen as a significant source of stress in physicians’ work. Physicians have reported several usability problems, system failures, and a lack of integration between the systems and have experienced that systems poorly support the documentation and retrieval of patient data. This stress has kept rising in the 21st century, and it seems that it may also affect physicians’ well-being. Objective: This study aimed to examine the associations of (1) usability variables (perceived benefits, technical problems, support for feedback, and user-friendliness), (2) the number of systems in daily use, (3) experience of using information systems, and (4) participation in information systems development work with physicians’ distress and levels of stress related to information systems (SRIS) levels. Methods: A cross-sectional survey was conducted among 4018 Finnish physicians (64.82%, 2572 out of 3968 women) aged between 24 and 64 years (mean 46.8 years) in 2017. The analyses of covariance were used to examine the association of independent variables with SRIS and distress (using the General Health Questionnaire) adjusted for age, gender, employment sector, specialization status, and the electronic health record system in use. Results: High levels of technical problems and a high number of systems in daily use were associated with high levels of SRIS, whereas high levels of user-friendliness, perceived benefits, and support for feedback were associated with low levels of SRIS. Moreover, high levels of technical problems were associated with high levels of psychological distress, whereas high levels of user-friendliness were associated with low distress levels. Those who considered themselves experienced users of information systems had low levels of both SRIS and distress. Conclusions: It seems that by investing in user-friendly systems with better technical quality and good support for feedback that professionals perceive as being beneficial would improve the work-related well-being and overall well-being of physicians. Moreover, improving physicians’ skills related to information systems by giving them training could help to lessen the stress that results from poorly functioning information systems and improve physicians’ well-being. %M 31687938 %R 10.2196/13466 %U http://medinform.jmir.org/2019/4/e13466/ %U https://doi.org/10.2196/13466 %U http://www.ncbi.nlm.nih.gov/pubmed/31687938 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 4 %P e14603 %T Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial %A Harsha,Prathiba %A Paul,James E %A Chong,Matthew A %A Buckley,Norm %A Tidy,Antonella %A Clarke,Anne %A Buckley,Diane %A Sirko,Zenon %A Vanniyasingam,Thuva %A Walsh,Jake %A McGillion,Michael %A Thabane,Lehana %+ Health Research Methods, Evidence and Impact, McMaster University, 3rd Floor Martha Wing, Room H325, 50 Charlton Avenue East, St Joseph's Healthcare, Hamilton, ON, L8N 4A6, Canada, 1 905 522 1155 ext 33720, thabanl@mcmaster.ca %K continuous pulse oximetry %K wireless notification %K issues %K evaluation of issues %K clinical adoption framework %K remote monitoring %K postoperative monitoring %K false alarm %D 2019 %7 28.10.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Research has shown that introducing electronic Health (eHealth) patient monitoring interventions can improve healthcare efficiency and clinical outcomes. The VIGILANCE (VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery) study was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts sent to nursing staff when respiratory resuscitations with naloxone, code blues, and intensive care unit transfers occurred in a cohort of postsurgical patients in a ward setting. This report identifies and evaluates key issues and challenges associated with introducing wireless monitoring systems into complex hospital infrastructure during the VIGILANCE eHealth intervention implementation. Potential solutions and suggestions for future implementation research are presented. Objective: The goals of this study were to: (1) identify issues related to the deployment of the eHealth intervention system of the VIGILANCE study; and (2) evaluate the influence of these issues on intervention adoption. Methods: During the VIGILANCE study, issues affecting the implementation of the eHealth intervention were documented on case report forms, alarm event forms, and a nursing user feedback questionnaire. These data were collated by the research and nursing personnel and submitted to the research coordinator. In this evaluation report, the clinical adoption framework was used as a guide to organize the identified issues and evaluate their impact. Results: Using the clinical adoption framework, we identified issues within the framework dimensions of people, organization, and implementation at the meso level, as well as standards and funding issues at the macro level. Key issues included: nursing workflow changes with blank alarm forms (24/1030, 2.33%) and missing alarm forms (236/1030, 22.91%), patient withdrawal (110/1030, 10.68%), wireless network connectivity, false alarms (318/1030, 30.87%), monitor malfunction (36/1030, 3.49%), probe issues (16/1030, 1.55%), and wireless network standards. At the micro level, these issues affected the quality of the service in terms of support provided, the quality of the information yielded by the monitors, and the functionality, reliability, and performance of the monitoring system. As a result, these issues impacted access through the decreased ability of nurses to make complete use of the monitors, impacted care quality of the trial intervention through decreased effectiveness, and impacted productivity through interference in the coordination of care, thus decreasing clinical adoption of the monitoring system. Conclusions: Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices is required to maximize the potential of eHealth monitoring. Trial Registration: ClinicalTrials.gov NCT02907255; https://clinicaltrials.gov/ct2/show/NCT02907255 %M 31661079 %R 10.2196/14603 %U http://medinform.jmir.org/2019/4/e14603/ %U https://doi.org/10.2196/14603 %U http://www.ncbi.nlm.nih.gov/pubmed/31661079 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14689 %T Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study %A Hansen,Arne %A Herrmann,Maximilian %A Ehlers,Jan P %A Mondritzki,Thomas %A Hensel,Kai Oliver %A Truebel,Hubert %A Boehme,Philip %+ Cardiovascular Research, Bayer Aktiengesellschaft, Apratherweg 18a, Wuppertal, 42113, Germany, 49 17632087847, philip.boehme@bayer.com %K digitization %K health care sector %K transformation %K mixed method %K delivery of health care %K diffusion of innovation %K reform %D 2019 %7 28.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate. Objective: We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption. Methods: This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market. Results: There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses “H8: Digitization in the health care system will free up jobs,” and “H6: Digitization in the health care system will empower the patients,” perceived to be in profound disagreement (P=.036 and P<.001, respectively). Conclusions: Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree. %M 31661082 %R 10.2196/14689 %U http://publichealth.jmir.org/2019/4/e14689/ %U https://doi.org/10.2196/14689 %U http://www.ncbi.nlm.nih.gov/pubmed/31661082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14683 %T Using Patient and Family Engagement Strategies to Improve Outcomes of Health Information Technology Initiatives: Scoping Review %A Leung,Kevin %A Lu-McLean,Drew %A Kuziemsky,Craig %A Booth,Richard G %A Collins Rossetti,Sarah %A Borycki,Elizabeth %A Strudwick,Gillian %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J1H4, Canada, 1 4165358501 ext 39333, gillian.strudwick@camh.ca %K health information technology %K informatics %K patient engagement %K medical informatics %K health services %D 2019 %7 8.10.2019 %9 Review %J J Med Internet Res %G English %X Background: Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use, and evaluation of these technologies. Despite knowing this, there is a lack of health care organizations using patient and family engagement strategies to enhance the use and adoption of health ITs, specifically. Objective: This study aimed to answer the following three research questions (RQs): (1) what current frameworks or theories have been used to guide patient and family engagement in health IT adoption, use, implementation, selection, and evaluation?, (2) what studies have been done on patient and family engagement strategies in health IT adoption, use, implementation, selection, and evaluation?, and (3) what patient and family engagement frameworks, studies, or resources identified in the literature can be applied to health IT adoption, use, implementation, selection, and evaluation? Methods: This scoping review used a five-step framework developed by Arksey and O’Malley and adapted by Levac et al. These steps include the following: (1) identifying the RQ, (2) identifying relevant studies, (3) selecting studies, (4) charting relevant data, and (5) summarizing and reporting the result. Retrieved academic and grey literature records were evaluated using a literature review software based on inclusion and exclusion criteria by two independent reviewers. If consensus was not achieved, two reviewers would resolve conflicts by discussion. Research findings and strategies were extracted from the studies and summarized in data tables. Results: A total of 35 academic articles and 23 gray literature documents met the inclusion criteria. In total, 20 of the 35 included studies have been published since 2017. Frameworks found include the patient engagement framework developed by Healthcare Information and Management Systems Society and the patient and family engagement framework proposed by Carman et al. Effective strategies include providing patients with clear expectations and responsibilities and providing reimbursement for time and travel. The gray literature sources outlined key considerations for planning and supporting engagement initiatives such as providing patients with professional development opportunities, and embedding patients in existing governance structures. Conclusions: Several studies have reported their findings regarding successful strategies to engage patients and family members in health IT initiatives and the positive impact that can emerge when patients and family members are engaged in such initiatives in an effective manner. Currently, no framework has consolidated all of the key strategies and considerations that were found in this review to guide health care organizations when engaging patients and family members in a health IT–specific project or initiative. Further research to evaluate and validate the existing strategies would be of value. %M 31596241 %R 10.2196/14683 %U https://www.jmir.org/2019/10/e14683 %U https://doi.org/10.2196/14683 %U http://www.ncbi.nlm.nih.gov/pubmed/31596241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e15087 %T The Association Between Willingness of Frontline Care Providers’ to Adaptively Use Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study %A Hah,Hyeyoung %A Goldin,Deana %A Ha,Sejin %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3053484342, hyeyoung.hah@gmail.com %K telehealth technology %K adaptive technology use %K frontline care providers %K virtual care service %K daily habit of technology use %K PLS modeling %K telehealth %K mhealth %K ehealth %K digital health %K adaptive technology %K frontline care %K virtual care %D 2019 %7 29.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth technology can create a disruptive communication environment for frontline care providers who mediate virtual communication with specialists in electronic consultations. As providers are dealing with various technology features when communicating with specialists, their flexible attitude and behaviors to use various telehealth-related technology features can change the outcome of virtual care service. Objective: The objective of this study is to examine frontline care providers’ technology adaptation behaviors in the electronic consultation context. From the perspective of frontline care providers, we reapply and retest a theoretical model, reflecting a mechanism through which technology users’ personal characteristics and technology adaptation behavior enhance virtual service performance, which is an important performance enabler in this online meeting context. In provider-to-provider communication, particularly, we explore the association among providers’ information technology (IT)–related personal characteristics, adaptive telehealth technology use, and virtual service performance. Methods: An online survey was administered to collect individual providers’ personal traits, IT adaptation, and perception on virtual service performance. Partial least squares-structural equation modeling was used to estimate our predictive model of personal traits—IT adaptation, such as exploitative use (use the telehealth technology in a standard way), and exploratory use (use the telehealth technology as innovative way)—and virtual service performance. Results: We collected 147 responses from graduate nursing students who were training to be nurse practitioners in their master’s program, resulting in 121 valid responses from the cross-section online survey. Our theoretical model explained 60.0% of the variance in exploitative use of telehealth technology, 44% of the variance in exploratory use of telehealth technology, and 66% of the variance in virtual service performance. We found that exploitative IT use is an important driver to increase virtual service performance (β=0.762, P<.001), and personal characteristics such as habit are positively associated with both exploitative (β=0.293, P=.008) and exploratory use behaviors (β=0.414, P=.006), while computer self-efficacy is positively associated with exploitative use of telehealth technology (β=0.311, P=.047). Conclusions: This study discusses the unique role of frontline care providers in a virtual care service context and highlights the importance of their telehealth adaptation behavior in provider-to-provider communication. We showed that providers perceive that telehealth technologies should function as intended, otherwise it may create frustration or avoidance of the telehealth technology. Moreover, providers’ habitual use of various technologies in daily lives also motivates them to adaptively use telehealth technology for improving virtual care service. Understanding providers’ technology habit and adaptation can inform health care policy and further provide a better view of the design of telehealth technology for online communication. %M 31469078 %R 10.2196/15087 %U http://www.jmir.org/2019/8/e15087/ %U https://doi.org/10.2196/15087 %U http://www.ncbi.nlm.nih.gov/pubmed/31469078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13408 %T Translation of the eHealth Impact Questionnaire for a Population of Dutch Electronic Health Users: Validation Study %A Neijenhuijs,Koen Ilja %A van der Hout,Anja %A Veldhuijzen,Evalien %A Scholten-Peeters,Gwendolijne G M %A van Uden-Kraan,Cornelia F %A Cuijpers,Pim %A Verdonck-de Leeuw,Irma M %+ Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van Der Boechorststaat 7, Amsterdam, 1081 BT, Netherlands, 31 20 444 0931, im.verdonck@amsterdamumc.nl %K eHealth %K evaluation %K e-Health Impact Questionnaire %K psychometrics %D 2019 %7 26.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Impact Questionnaire (eHIQ) provides a standardized method to measure attitudes of electronic health (eHealth) users toward eHealth. It has previously been validated in a population of eHealth users in the United Kingdom and consists of 2 parts and 5 subscales. Part 1 measures attitudes toward eHealth in general and consists of the subscales attitudes towards online health information (5 items) and attitudes towards sharing health experiences online (6 items). Part 2 measures the attitude toward a particular eHealth application and consists of the subscales confidence and identification (9 items), information and presentation (8 items), and understand and motivation (9 items). Objective: This study aimed to translate and validate the eHIQ in a Dutch population of eHealth users. Methods: The eHIQ was translated and validated in accordance with the COnsensus-based Standards for the selection of health status Measurement INstruments criteria. The validation comprised 3 study samples, with a total of 1287 participants. Structural validity was assessed using confirmatory factor analyses and exploratory factor analyses (EFAs; all 3 samples). Internal consistency was assessed using hierarchical omega (all 3 samples). Test-retest reliability was assessed after 2 weeks, using 2-way intraclass correlation coefficients (sample 1). Measurement error was assessed by calculating the smallest detectable change (sample 1). Convergent and divergent validity were assessed using correlations with the remaining measures (all 3 samples). A graded response model was fit, and item information curves were plotted to describe the information provided by items across item trait levels (all 3 samples). Results: The original factor structure showed a bad fit in all 3 study samples. EFAs showed a good fit for a modified factor structure in the first study sample. This factor structure was subsequently tested in samples 2 and 3 and showed acceptable to good fits. Internal consistency, test-retest reliability, convergent validity, and divergent validity were acceptable to good for both the original as the modified factor structure, except for test-retest reliability of one of the original subscales and the 2 derivative subscales in the modified factor structure. The graded response model showed that some items underperformed in both the original and modified factor structure. Conclusions: The Dutch version of the eHIQ (eHIQ-NL) shows a different factor structure compared with the original English version. Part 1 of the eHIQ-NL consists of 3 subscales: attitudes towards online health information (5 items), comfort with sharing health experiences online (3 items), and usefulness of sharing health experiences online (3 items). Part 2 of the eHIQ-NL consists of 3 subscales: motivation and confidence to act (10 items), information and presentation (13 items), and identification (3 items). %M 31452516 %R 10.2196/13408 %U http://www.jmir.org/2019/8/e13408/ %U https://doi.org/10.2196/13408 %U http://www.ncbi.nlm.nih.gov/pubmed/31452516 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e12949 %T Development of an eHealth Readiness Assessment Framework for Botswana and Other Developing Countries: Interview Study %A Mauco,Kabelo Leonard %A Scott,Richard Ernest %A Mars,Maurice %+ Department of TeleHealth, University of KwaZulu-Natal, Fifth Floor, Desmond Clarence Building, 238 Mazisi Kunene Rd, Glenwood Durban, 4041, Durban, 4041, South Africa, 27 312604543, mars@ukzn.ac.za %K eHealth %K eHealth readiness %K frameworks %K Botswana %K developing countries %D 2019 %7 22.08.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic health (eHealth) readiness has been defined as the preparedness of health care institutions or communities for the anticipated change brought about by programs related to information and communication technology use. To ascertain the degree of such preparedness, an eHealth readiness assessment (eHRA) is needed. Literature on the existing eHRA frameworks and tools shows high inconsistency in content, definitions, and recommendations, and none have been found to be entirely suitable for assessing eHealth readiness in the context of developing countries. To develop an informed eHRA framework and tools with applicability to Botswana and similar developing countries, insight was sought from a broad spectrum of eHealth key informants in Botswana to identify and inform relevant issues, including those not specifically addressed in available eHRA tools. Objective: The aim of this study was to evaluate key informant (local expert) opinions on aspects that need to be considered when developing an eHRA framework suitable for use in developing countries. Methods: Interviews with 18 purposively selected key informants were recorded and transcribed. Thematic analysis of transcripts involved the use of an iterative approach and NVivo 11 software. The major themes, as well as subthemes, emerging from the thematic analysis were then discussed and agreed upon by the authors through consensus. Results: Analysis of interviews identified four eHealth readiness themes (governance, stakeholder issues, resources, and access), with 33 subthemes and 9 sub-subthemes. A major finding was that these results did not directly correspond in content or order to those previously identified in the literature. The results highlighted the need to perform exploratory research before developing an eHRA to ensure that those topics of relevance and importance to the local setting are first identified and then explored in any subsequent eHRA using a locally relevant framework and stakeholder-specific tools. In addition, seven sectors in Botswana were found to play a role in ensuring successful implementation of eHealth projects and might be targets for assessment. Conclusions: Insight obtained from this study will be used to inform the development of an evidence-based eHealth readiness assessment framework suitable for use in developing countries such as Botswana. %M 31441429 %R 10.2196/12949 %U http://medinform.jmir.org/2019/3/e12949/ %U https://doi.org/10.2196/12949 %U http://www.ncbi.nlm.nih.gov/pubmed/31441429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e15023 %T Factors Influencing Patients’ Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey %A Zhang,Yiyu %A Liu,Chaoyuan %A Luo,Shuoming %A Xie,Yuting %A Liu,Fang %A Li,Xia %A Zhou,Zhiguang %+ Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No 139, Renmin Road, Changsha, 410011, China, 86 073185292154, zhouzhiguang@csu.edu.cn %K diabetes mellitus %K mobile applications %K survey %K structural equation modeling %K China %D 2019 %7 13.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients’ intention to use these apps are unclear. Understanding the patients’ behavioral intention is necessary to support the development and promotion of diabetes app use. Objective: This study aimed to identify the determinants of patients’ intention to use diabetes management apps based on an integrated theoretical model. Methods: The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data. Results: A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6% of the variance in performance expectancy and 57.1% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention (β=0.482; P=.001). Performance expectancy (β=0.482; P=.001), social influence (β=0.223; P=.003), facilitating conditions (β=0.17; P=.006), perceived disease threat (β=0.073; P=.005), and perceived privacy risk (β=–0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs (β=0.259; P=.001). Conclusions: Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps’ effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients’ intention to use diabetes management apps. Context-related determinants should also be taken into consideration. %M 31411146 %R 10.2196/15023 %U http://www.jmir.org/2019/8/e15023/ %U https://doi.org/10.2196/15023 %U http://www.ncbi.nlm.nih.gov/pubmed/31411146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13432 %T Internet-Based Cognitive Behavioral Therapy Among Psychologists in a Medical Setting: A Survey on Implementation %A IJzerman,Renée V H %A van der Vaart,Rosalie %A Evers,Andrea W M %+ Unit of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden,, Netherlands, 31 715275083, r.v.h.ijzerman@fsw.leidenuniv.nl %K eHealth %K chronic care %K self-management %K implementation %K psychologists %K UTAUT %D 2019 %7 09.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for patients with a chronic somatic illness to improve self-management skills and to learn to adjust to their chronic disease and its impact on daily life. However, the implementation of iCBT in clinical practice is challenging. Objective: This study aimed to examine the current degree of implementation of iCBT among psychologists in a medical setting and discover determinants influencing the implementation of iCBT among nonusers. Methods: A Web-based survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), was distributed among psychologists in a medical setting. The survey included questions regarding the current use of iCBT, intention to use iCBT in the future, and operationalized concepts of the UTAUT constructs, that is, performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Results: In total, 107 (24.8%) psychologists completed the survey. Of them, 16.8% have access to iCBT, 15.9% currently use iCBT, and 21.5% are expected to use iCBT within the next year. The constructs PE, EE, and SI together significantly influenced behavioral intention (BI; mean 3.9 [SD=0.8]) among nonusers (R2=0.490; F4.85=20.405; P<.001). Conclusions: In spite of an average to high BI, the current implementation of iCBT is rather low among psychologists in a medical setting. Further research should focus on reducing the gap between intention to use and actual use by focusing on influencing the predictive UTAUT constructs. %M 31400101 %R 10.2196/13432 %U https://www.jmir.org/2019/8/e13432/ %U https://doi.org/10.2196/13432 %U http://www.ncbi.nlm.nih.gov/pubmed/31400101 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13491 %T How Resource Scarcity and Accessibility Affect Patients’ Usage of Mobile Health in China: Resource Competition Perspective %A Ye,Qing %A Deng,Zhaohua %A Chen,Yanyan %A Liao,Jiazhi %A Li,Gang %A Lu,Yaobin %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 19945036079, zh-deng@hust.edu.cn %K mobile health %K technology adoption %K moderating effect %K resource scarcity %K resource accessibility %K resource competition %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The last decade has witnessed many achievements in China’s health care industry, but the industry still faces major challenges among which the uneven distribution of medical resources and the imbalance between supply and demand are the most pressing problems. Although mobile health (mHealth) services play a significant role in mitigating problems associated with health care delivery, their adoption rates have been low. Objective: The objective of this study was to explore the impact of resource scarcity and resource accessibility on the adoption of mHealth from the perspective of resource competition, to examine the concerning factors, and to provide a theoretical basis for promoting mHealth in China. Methods: We used 229,516 original registration records of outpatients to conduct an empirical analysis to examine the adoption of mHealth services from the perspective of resource competition. Results: The adoption rate of mobile services for outpatients was low, accounting for only 31.5% (N=71,707). The empirical results indicated that resource scarcity (beta=.435, P=.01) and accessibility (beta=−.134, P=.02) have a significant impact on the adoption of mHealth. In addition, gender (beta=.073, P=.01) and age (beta=−.009, P<.001) are significantly related to adoption of mHealth. Experience with mHealth has a moderating role in the relationship between resource scarcity (beta=−.129, P=.02), accessibility (beta=.138, P=.04), and adoption of mHealth. Conclusions: In this study we demonstrate that the external environment (resource scarcity and resource accessibility) has a significant impact on the adoption of mHealth. This study also demonstrates that experience with mHealth has a moderating role in the relationship between the elements of the external environment. Finally, we confirm that mHealth is a key factor in the delivery and allocation of medical resources and provide a theoretical basis for government agencies to develop policies on mHealth. %M 31400104 %R 10.2196/13491 %U https://mhealth.jmir.org/2019/8/e13491/ %U https://doi.org/10.2196/13491 %U http://www.ncbi.nlm.nih.gov/pubmed/31400104 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e14279 %T Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study %A Mather,Carey %A Cummings,Elizabeth %A Gale,Fred %+ College of Health and Medicine, School of Nursing, University of Tasmania, Building J, Newnham Drive, Launceston, 7248, Australia, 61 363243149, Carey.Mather@utas.edu.au %K digital %K health policy %K digital professionalism %K nursing education %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Nursing %G English %X 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. %M 34345771 %R 10.2196/14279 %U https://nursing.jmir.org/2019/1/e14279/ %U https://doi.org/10.2196/14279 %U http://www.ncbi.nlm.nih.gov/pubmed/34345771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e12373 %T Factors Affecting Patients’ Use of Electronic Personal Health Records in England: Cross-Sectional Study %A Abd-Alrazaq,Alaa %A Bewick,Bridgette M %A Farragher,Tracey %A Gardner,Peter %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Apartment 3, 21 Riding House Street, Doha, 00000, Qatar, 974 55708549, aabdalrazaq@hbku.edu.qa %K health records, personal %K patient portal %K electronic personal health records %K technology acceptance %K technology adoption %K intention %K unified theory of acceptance and use of technology %K structural equation modelling %D 2019 %7 31.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs. Objective: This study aimed to examine factors associated with patients’ use of ePHRs in England. Methods: The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling. Results: Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB. Conclusions: This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors. %M 31368442 %R 10.2196/12373 %U http://www.jmir.org/2019/7/e12373/ %U https://doi.org/10.2196/12373 %U http://www.ncbi.nlm.nih.gov/pubmed/31368442 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e14797 %T Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study %A Danak,Shivang U %A Guetterman,Timothy C %A Plegue,Melissa A %A Holmstrom,Heather L %A Kadri,Reema %A Duthler,Alexander %A Yoo,Anne %A Buis,Lorraine R %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7120, buisl@umich.edu %K electronic health records %K documentation %K medical informatics %D 2019 %7 11.07.2019 %9 Original Paper %J JMIR Med Inform %G English %X 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 by documenting 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. %M 31298218 %R 10.2196/14797 %U http://medinform.jmir.org/2019/3/e14797/ %U https://doi.org/10.2196/14797 %U http://www.ncbi.nlm.nih.gov/pubmed/31298218 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 2 %P e14026 %T Facility and Regional Factors Associated With the New Adoption of Electronic Medical Records in Japan: Nationwide Longitudinal Observational Study %A Kawaguchi,Hideaki %A Koike,Soichi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 358006427, hikawaguchi-tky@umin.ac.jp %K electronic health records %K health services research %K health policy %K Bayes theorem %D 2019 %7 14.6.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: The rate of adoption of electronic medical record (EMR) systems has increased internationally, and new EMR adoption is currently a major topic in Japan. However, no study has performed a detailed analysis of longitudinal data to evaluate the changes in the EMR adoption status over time. Objective: This study aimed to evaluate the changes in the EMR adoption status over time in hospitals and clinics in Japan and to examine the facility and regional factors associated with these changes. Methods: Secondary longitudinal data were created by matching data in fiscal year (FY) 2011 and FY 2014 using reference numbers. EMR adoption status was defined as “EMR adoption,” “specified adoption schedule,” or “no adoption schedule.” Data were obtained for hospitals (n=4410) and clinics (n=67,329) that had no adoption schedule in FY 2011 and for hospitals (n=1068) and clinics (n=3132) with a specified adoption schedule in FY 2011. The EMR adoption statuses of medical institutions in FY 2014 were also examined. A multinomial logistic model was used to investigate the associations between EMR adoption status in FY 2014 and facility and regional factors in FY 2011. Considering the regional variations of these models, multilevel analyses with second levels were conducted. These models were constructed separately for hospitals and clinics, resulting in four multinomial logistic models. The odds ratio (OR) and 95% Bayesian credible interval (CI) were estimated for each variable. Results: A total of 6.9% of hospitals and 14.82% of clinics with no EMR adoption schedules in FY 2011 had adopted EMR by FY 2014, while 10.49% of hospitals and 33.65% of clinics with specified adoption schedules in FY 2011 had cancelled the scheduled adoption by FY 2014. For hospitals with no adoption schedules in FY 2011, EMR adoption/scheduled adoption was associated with practice size characteristics, such as number of outpatients (from quantile 4 to quantile 1: OR 1.67, 95% CI 1.005-2.84 and OR 2.40, 95% CI 1.80-3.21, respectively), and number of doctors (from quantile 4 to quantile 1: OR 4.20, 95% CI 2.39-7.31 and OR 2.02, 95% CI 1.52-2.64, respectively). For clinics with specified EMR adoption schedules in FY 2011, the factors negatively associated with EMR adoption/cancellation of scheduled EMR adoption were the presence of beds (quantile 4 to quantile 1: OR 0.57, 95% CI 0.45-0.72 and OR 0.74, 95% CI 0.58-0.96, respectively) and having a private establisher (quantile 4 to quantile 1: OR 0.27, 95% CI 0.13-0.55 and OR 0.43, 95% CI 0.19-0.91, respectively). No regional factors were significantly associated with the EMR adoption status of hospitals with no EMR adoption schedules; population density was positively associated with EMR adoption in clinics with no EMR adoption schedule (quantile 4 to quantile 1: OR 1.49, 95% CI 1.32-1.69). Conclusions: Different approaches are needed to promote new adoption of EMR systems in hospitals as compared to clinics. It is important to induce decision making in small- and medium-sized hospitals, and regional postdecision technical support is important to avoid cancellation of scheduled EMR adoption in clinics. %M 31199307 %R 10.2196/14026 %U http://medinform.jmir.org/2019/2/e14026/ %U https://doi.org/10.2196/14026 %U http://www.ncbi.nlm.nih.gov/pubmed/31199307 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12920 %T Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder %A Anastasiadou,Dimitra %A Folkvord,Frans %A Serrano-Troncoso,Eduardo %A Lupiañez-Villanueva,Francisco %+ Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 93 450 52 74, danastasiadou@uoc.edu %K eating disorders %K mental health %K mHealth %K mobile applications %K focus groups %D 2019 %7 31.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective: This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods: To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results: The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions: In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice. %M 31199329 %R 10.2196/12920 %U https://mhealth.jmir.org/2019/6/e12920/ %U https://doi.org/10.2196/12920 %U http://www.ncbi.nlm.nih.gov/pubmed/31199329 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13199 %T Current Knowledge and Adoption of Mobile Health Apps Among Australian General Practitioners: Survey Study %A Byambasuren,Oyungerel %A Beller,Elaine %A Glasziou,Paul %+ Centre for Research in Evidence-Based Practice, Bond University, 14 University Dr, Robina, QLD, 4226, Australia, 61 755951588, obyambas@bond.edu.au %K mobile health %K smartphone %K mobile apps %K mHealth %K smartphone apps %K general practice %D 2019 %7 3.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps can be prescribed as an effective self-management tool for patients. However, it is challenging for doctors to navigate 350,000 mHealth apps to find the right ones to recommend. Although medical professionals from many countries are using mHealth apps to varying degrees, current mHealth app use by Australian general practitioners (GPs) and the barriers and facilitators they encounter when integrating mHealth apps in their clinical practice have not been reported comprehensively. Objective: The objectives of this study were to (1) evaluate current knowledge and use of mHealth apps by GPs in Australia, (2) determine the barriers and facilitators to their use of mHealth apps in consultations, and (3) explore potential solutions to the barriers. Methods: We helped the Royal Australian College of General Practitioners (RACGP) to expand the mHealth section of their annual technology survey for 2017 based on the findings of our semistructured interviews with GPs to further explore barriers to using mHealth apps in clinical practice. The survey was distributed to the RACGP members nationwide between October 26 and December 3, 2017 using Qualtrics Web-based survey tool. Results: A total of 1014 RACGP members responded (response rate 4.6% [1014/21,884], completion rate 61.2% [621/1014]). The median years practiced was 20.7 years. Two-thirds of the GPs used apps professionally in the forms of medical calculators and point-of-care references. A little over half of the GPs recommended apps for patients either daily (12.9%, 80/621), weekly (25.9%, 161/621), or monthly (13.4%, 83/621). Mindfulness and mental health apps were recommended most often (32.5%, 337/1036), followed by diet and nutrition (13.9%, 144/1036), exercise and fitness (12.7%, 132/1036), and women’s health (10%, 104/1036) related apps. Knowledge and usage of evidence-based apps from the Handbook of Non-Drug Interventions were low. The prevailing barriers to app prescription were the lack of knowledge of effective apps (59.9%, 372/621) and the lack of trustworthy source to access them (15.5%, 96/621). GPs expressed their need for a list of safe and effective apps from a trustworthy source, such as the RACGP, to overcome these barriers. They reported a preference for online video training material or webinar to learn more about mHealth apps. Conclusions: Most GPs are using apps professionally but recommending apps to patients sparingly. The main barriers to app prescription were the lack of knowledge of effective apps and the lack of trustworthy source to access them. A curated compilation of effective mHealth apps or an app library specifically aimed at GPs and health professionals would help solve both barriers. %M 31199343 %R 10.2196/13199 %U https://mhealth.jmir.org/2019/6/e13199/ %U https://doi.org/10.2196/13199 %U http://www.ncbi.nlm.nih.gov/pubmed/31199343 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13313 %T Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era %A Colicchio,Tiago K %A Cimino,James J %A Del Fiol,Guilherme %+ Informatics Institute, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, AL, 35294, United States, 1 2059960735, tcolicchio@uabmc.edu %K meaningful use %K medical informatics applications %K adoption %D 2019 %7 03.06.2019 %9 Viewpoint %J J Med Internet Res %G English %X The US health system has recently achieved widespread adoption of electronic health record (EHR) systems, primarily driven by financial incentives provided by the Meaningful Use (MU) program. Although successful in promoting EHR adoption and use, the program, and other contributing factors, also produced important unintended consequences (UCs) with far-reaching implications for the US health system. Based on our own experiences from large health information technology (HIT) adoption projects and a collection of key studies in HIT evaluation, we discuss the most prominent UCs of MU: failed expectations, EHR market saturation, innovation vacuum, physician burnout, and data obfuscation. We identify challenges resulting from these UCs and provide recommendations for future research to empower the broader medical and informatics communities to realize the full potential of a now digitized health system. We believe that fixing these unanticipated effects will demand efforts from diverse players such as health care providers, administrators, HIT vendors, policy makers, informatics researchers, funding agencies, and outside developers; promotion of new business models; collaboration between academic medical centers and informatics research departments; and improved methods for evaluations of HIT. %M 31162125 %R 10.2196/13313 %U https://www.jmir.org/2019/6/e13313/ %U https://doi.org/10.2196/13313 %U http://www.ncbi.nlm.nih.gov/pubmed/31162125 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13679 %T Who is Tracking Health on Mobile Devices: Behavioral Logfile Analysis in Hong Kong %A Guan,Lu %A Peng,Tai-Quan %A Zhu,Jonathan JH %+ Department of Communication, Michigan State University, 404 Wilson Road, East Lansing, MI, 48824, United States, 1 5173550221, winsonpeng@gmail.com %K mobile apps %K mHealth %K circadian rhythm %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps on mobile devices provide an unprecedented opportunity for ordinary people to develop social connections revolving around health issues. With increasing penetration of mobile devices and well-recorded behavioral data on such devices, it is desirable to employ digital traces on mobile devices rather than self-reported measures to capture the behavioral patterns underlying the use of mobile health (mHealth) apps in a more direct and valid way. Objective: The objectives of this study were to (1) assess the demographic predictors of the adoption of mHealth apps; (2) investigate the temporal pattern underlying the use of mHealth apps; and (3) explore the impacts of demographic variables, temporal features, and app genres on the use of mHealth apps. Methods: Logfile data of mobile devices were collected from a representative panel of about 2500 users in Hong Kong. Users’ mHealth app activities were analyzed. We first conducted a binary logistic regression analysis to uncover demographic predictors of users’ adoption status. Then we utilized a multilevel negative binomial regression to examine the impacts of demographic characteristics, temporal features, and app genres on mHealth app use. Results: It was found that 27.5% of mobile device users in Hong Kong adopt at least one genre of mHealth app. Adopters of mHealth apps tend to be female and better educated. However, demographic characteristics did not showcase the predictive powers on the use of mHealth apps, except for the gender effect (Bfemale vs Bmale=–0.18; P=.006). The use of mHealth apps demonstrates a significant temporal pattern, which is found to be moderately active during daytime and intensifying at weekends and at night. Such temporal patterns in mHealth apps use are moderated by individuals’ demographic characteristics. Finally, demographic characteristics were also found to condition the use of different genres of mHealth apps. Conclusions: Our findings suggest the importance of dynamic perspective in understanding users’ mHealth app activities. mHealth app developers should consider more the demographic differences in temporal patterns of mHealth apps in the development of mHealth apps. Furthermore, our research also contributes to the promotion of mHealth apps by emphasizing the differences of usage needs for various groups of users. %M 31120429 %R 10.2196/13679 %U http://mhealth.jmir.org/2019/5/e13679/ %U https://doi.org/10.2196/13679 %U http://www.ncbi.nlm.nih.gov/pubmed/31120429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13131 %T Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis %A Khoong,Elaine C %A Cherian,Roy %A Matta,George Y %A Lyles,Courtney R %A Schillinger,Dean %A Ratanawongsa,Neda %+ Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, United States, 1 4152063188, elaine.khoong@ucsf.edu %K vulnerable populations %K electronic health records %K attitude to computers %K physician-patient relations %K communication barriers %D 2019 %7 22.05.2019 %9 Short Paper %J J Med Internet Res %G English %X Background: Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. Objective: The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. Methods: We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. Results: Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. Conclusions: Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients. %M 31120020 %R 10.2196/13131 %U http://www.jmir.org/2019/5/e13131/ %U https://doi.org/10.2196/13131 %U http://www.ncbi.nlm.nih.gov/pubmed/31120020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13117 %T Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review %A Harst,Lorenz %A Lantzsch,Hendrikje %A Scheibe,Madlen %+ Research Association Public Health, Center of Evidence-based Healthcare, University Clinic Carl Gustav Carus, Technische Universität Dresden, House 106, Löscherstraße 18, Dresden, 01307, Germany, 49 351 3177 ext 223, lorenz.harst@tu-dresden.de %K systematic review %K telemedicine %K technology %K patient compliance %D 2019 %7 21.05.2019 %9 Review %J J Med Internet Res %G English %X Background: Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users. Objective: The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine. Methods: An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies. Results: Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models. Conclusions: The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group’s social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development. %M 31115340 %R 10.2196/13117 %U http://www.jmir.org/2019/5/e13117/ %U https://doi.org/10.2196/13117 %U http://www.ncbi.nlm.nih.gov/pubmed/31115340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12875 %T Developing the National Usability-Focused Health Information System Scale for Physicians: Validation Study %A Hyppönen,Hannele %A Kaipio,Johanna %A Heponiemi,Tarja %A Lääveri,Tinja %A Aalto,Anna-Mari %A Vänskä,Jukka %A Elovainio,Marko %+ National Institute for Health and Welfare, PO Box 30, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K physicians %K health information systems %K questionnaire %K validation studies %D 2019 %7 16.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Problems in the usability of health information systems (HISs) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HISs. Such questionnaires are needed not only for research but also for developing usability of HISs from the viewpoint of end-user experiences. Objective: This study aimed to develop and test the validity of the questionnaire measuring the National Usability-Focused HIS-Scale (NuHISS) among a nationally representative sample of Finnish physicians. Methods: We utilized 2 cross-sectional data collected from a random sample of Finnish physicians in 2014 (N=3781; of which 2340 [61.9%] were women) and 2017 (N=4018; of which 2604 [64.8%] were women). Exploratory and confirmatory factor analyses (structural equation modeling [SEM]) were applied to test the structural validity of the NuHISS. As the concurrent validity measure, we used the self-reported overall quality of the electronic health record system (school grade) provided by the participants using marginal structural models. Results: The exploratory factor analyses with Varimax rotation suggested that the 7-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and C2=2109.83 in 2017, both P<.001). Moreover, structural equation modelling analyses, using comparative fit index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), root mean squared error of approximation (RMSEA), and Standardized Root Mean square Residual (SRMR), showed that the 7-factor solution provided an acceptable fit in both samples (CFI=0.92/0.91, TLI=0.92/0.91, NFI=0.92/0.91, RMSEA=0.048/0.049, and SRMR=0.040/0.039). In addition, concurrent validity of this solution was shown to be acceptable. Ease of use, but also all other dimensions, was especially associated with overall quality reports independent of measured confounders. The 7-factor solution included dimensions of technical quality, information quality, feedback, ease of use, benefits, internal collaboration, and cross-organizational collaboration. Conclusions: NuHISS provides a useful tool for measuring usability of HISs among physicians and offers a valid measure for monitoring the long-term development of HISs on a large scale. The relative importance of items needs to be assessed against national electronic health policy goals and complemented with items that have remained outside the NuHISS from the questionnaire when appropriate. %M 31099336 %R 10.2196/12875 %U https://www.jmir.org/2019/5/e12875/ %U https://doi.org/10.2196/12875 %U http://www.ncbi.nlm.nih.gov/pubmed/31099336 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13555 %T Clinicians’ Role in the Adoption of an Oncology Decision Support App in Europe and Its Implications for Organizational Practices: Qualitative Case Study %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, Cambridge,, United Kingdom, 41 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K cell phone %K oncologists %K electronic health record %K workflow %K workload %K workplace %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %D 2019 %7 03.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the existence of adequate technological infrastructure and clearer policies, there are situations where users, mainly physicians, resist mobile health (mHealth) solutions. This is of particular concern, bearing in mind that several studies, both in developed and developing countries, showed that clinicians’ adoption is the most influential factor in such solutions’ success. Objective: The aim of this study was to focus on understanding clinicians’ roles in the adoption of an oncology decision support app, the factors impacting this adoption, and its implications for organizational and social practices. Methods: A qualitative case study of a decision support app in oncology, called ONCOassist, was conducted. The data were collected through 17 in-depth interviews with clinicians and nurses in the United Kingdom, Ireland, France, Italy, Spain, and Portugal. Results: This case demonstrates the affordances and constraints of mHealth technology at the workplace, its implications for the organization of work, and clinicians’ role in its constant development and adoption. The research findings confirmed that factors such as app operation and stability, ease of use, usefulness, cost, and portability play a major role in the adoption decision; however, other social factors such as endorsement, neutrality of the content, attitude toward technology, existing workload, and internal organizational politics are also reported as key determinants of clinicians’ adoption. Interoperability and cultural views of mobile usage at work are the key workflow disadvantages, whereas higher efficiency and performance, sharpened practice, and location flexibility are the main workflow advantages. Conclusions: Several organizational implications emerged, suggesting the need for some actions such as fostering a work culture that embraces new technologies and the creation of new digital roles for clinicians both on the hospitals or clinics and on the development sides but also more collaboration between health care organizations and digital health providers to enable electronic medical record integration and solving of any interoperability issues. From a theoretical perspective, we also suggest the addition of a fourth step to Leonardi’s methodological guidance that accounts for user engagement; embedding the users in the continuous design and development processes ensures the understanding of user-specific affordances that can then be made more obvious to other users and increase the potential of such tools to go beyond their technological features and have a higher impact on workflow and the organizing process. %M 31066710 %R 10.2196/13555 %U https://mhealth.jmir.org/2019/5/e13555/ %U https://doi.org/10.2196/13555 %U http://www.ncbi.nlm.nih.gov/pubmed/31066710 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12192 %T Factors Influencing the Adoption of Smart Health Technologies for People With Dementia and Their Informal Caregivers: Scoping Review and Design Framework %A Guisado-Fernández,Estefanía %A Giunti,Guido %A Mackey,Laura M %A Blake,Catherine %A Caulfield,Brian Michael %+ Insight Centre for Data Analytics, University College Dublin, O'Brien Science Building East, 3rd Floor, Belfield Campus, Dublin, D4, Ireland, 353 0838345003, estefaniaguisadofernandez@gmail.com %K dementia %K informal caregiver %K smart health technologies %K user-centered design %K technology adoption %D 2019 %7 30.04.2019 %9 Review %J JMIR Aging %G English %X Background: Smart Health technologies (s-Health technologies) are being developed to support people with dementia (PwD) and their informal caregivers at home, to improve care and reduce the levels of burden and stress they experience. However, although s-Health technologies have the potential to facilitate this, the factors influencing a successful implementation in this population are still unknown. Objective: The aim of this study was to review existing literature to explore the factors influencing PwD and their informal caregivers’ adoption of s-Health technologies for home care. Methods: Following the Arksey and O’Malley methodology, this study is a scoping review providing a narrative description of the scientific literature on factors influencing s-Health technology adoption for PwD and their informal caregivers. A search was conducted using PubMed, the Cochrane library, the IEEE library, and Scopus. Publications screening was conducted by 2 researchers based on inclusion criteria, and full-text analysis was then conducted by 1 researcher. The included articles were thematically analyzed by 2 researchers to gain an insight into factors influencing adoption that PwD and their informal caregivers have to encounter when using s-Health technologies. Relevant information was identified and coded. Codes were later discussed between the researchers for developing and modifying them and for achieving a consensus, and the researchers organized the codes into broader themes. Results: Emerging themes were built in a way that said something specific and meaningful about the research question, creating a list of factors influencing the adoption of s-Health technologies for PwD and their informal caregivers, including attitudinal aspects, ethical issues, technology-related challenges, condition-related challenges, and identified gaps. A design framework was created as a guide for future research and innovation in the area of s-Health technologies for PwD and their informal caregivers: DemDesCon for s-Health Technologies. DemDesCon for s-Health Technologies addresses 4 domains to consider for the design and development of s-Health technologies for this population: cognitive decline domain, physical decline domain, social domain, and development domain. Conclusions: Although s-Health technologies have been used in health care scenarios, more work is needed for them to fully achieve their potential for use in dementia care. Researchers, businesses, and public governments need to collaborate to design and implement effective technology solutions for PwD and their informal caregivers, but the lack of clear design guidelines seems to be slowing the process. We believe that the DemDesCon framework will provide them with the guidance and assistance needed for creating meaningful devices for PwD home care and informal caregivers, filling a much-needed space in the present knowledge gap. %M 31518262 %R 10.2196/12192 %U http://aging.jmir.org/2019/1/e12192/ %U https://doi.org/10.2196/12192 %U http://www.ncbi.nlm.nih.gov/pubmed/31518262 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 2 %P e13064 %T Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study %A Poncette,Akira-Sebastian %A Spies,Claudia %A Mosch,Lina %A Schieler,Monique %A Weber-Carstens,Steffen %A Krampe,Henning %A Balzer,Felix %+ Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Charitéplatz 1, Berlin,, Germany, 49 30450 ext 651166, felix.balzer@charite.de %K patient monitoring %K digital health %K qualitative research %K intensive care unit %K intensive care medicine %K multidisciplinary %K user-centered design %K design thinking %K digital literacy %K grounded theory %D 2019 %7 30.04.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s. Objective: The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring. Methods: This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff—5 physicians, 6 nurses, and 4 respiratory therapists—were recorded, transcribed, and analyzed using the grounded theory approach. Results: Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies. Conclusions: This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk) %M 31038467 %R 10.2196/13064 %U http://medinform.jmir.org/2019/2/e13064/ %U https://doi.org/10.2196/13064 %U http://www.ncbi.nlm.nih.gov/pubmed/31038467 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e8423 %T Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical Outpatients %A Holt,Kamila Adellund %A Karnoe,Astrid %A Overgaard,Dorthe %A Nielsen,Sidse Edith %A Kayser,Lars %A Røder,Michael Einar %A From,Gustav %+ Department of Nursing, Faculty of Health, University College Copenhagen, Tagensvej 86, Copenhagen N, 2200, Denmark, 45 26822657, kamh@kp.dk %K health literacy %K computer literacy %K questionnaires %K telemedicine %K consumer health informatics %D 2019 %7 05.04.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective: The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods: Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results: In total, 95.1% (234/246) of the participants used their personal digital ID (NemID), 57.7% (142/246) were in contact with their GPs electronically, and 54.0% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control. The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions: Information about patients’ eHL may provide clinicians an understanding of patients’ reasons for not using digital health services, better than sociodemographic data or self-rated health. %M 30950809 %R 10.2196/ijmr.8423 %U http://www.i-jmr.org/2019/2/e8423/ %U https://doi.org/10.2196/ijmr.8423 %U http://www.ncbi.nlm.nih.gov/pubmed/30950809 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 2 %P e10949 %T Physician Use of Electronic Health Records: Survey Study Assessing Factors Associated With Provider Reported Satisfaction and Perceived Patient Impact %A Williams,Daniel Clay %A Warren,Robert W %A Ebeling,Myla %A Andrews,Annie L %A Teufel II,Ronald J %+ Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue MSC 561, Charleston, SC,, United States, 1 843 876 0794, Willidan@musc.edu %K electronic health records %K user satisfaction %K efficiency %K physician survey %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: The effect electronic health record (EHR) implementation has on physician satisfaction and patient care remains unclear. A better understanding of physician perceptions of EHRs and factors that influence those perceptions is needed to improve the physician and patient experience when using EHRs. Objective: The objective of this study was to determine provider and clinical practice factors associated with physician EHR satisfaction and perception of patient impact. Methods: We surveyed a random sample of physicians, including residents and fellows, at a US quaternary care academic hospital from February to March 2016. The survey assessed provider demographics, clinical practice factors (ie, attending, fellow, or resident), and overall EHR experience. The primary outcomes assessed were provider satisfaction and provider perceptions of impact to patient care. Responses on the satisfaction and patient impact questions were recorded on a continuous scale initially anchored at neutral (scale range 0 to 100: 0 defined as “extremely negatively” and 100 as “extremely positively”). Independent variables assessed included demographic and clinical practice factors, including perceived efficiency in using the EHR. One-way analysis of variance or the Kruskal-Wallis test was used for bivariate comparisons, and linear regression was used for multivariable modeling. Results: Of 157 physicians, 111 (70.7%) completed the survey; 51.4% (57/111) of the respondents were attending physicians, and of those, 71.9% (41/57) reported a >50% clinical full-time-equivalency and half reported supervising residents >50% of the time. A total of 50.5% (56/111) of the respondents were primary care practitioners, previous EHR experience was evenly distributed, and 12.6% (14/111) of the total sample were EHR super-users. Responses to how our current EHR affects satisfaction were rated above the neutral survey anchor point (mean 58 [SD 22]), as were their perceptions as to how the EHR impacts the patient (mean 61 [SD 18]). In bivariate comparisons, only physician age, clinical role (resident, fellow, or attending), and perceived efficiency were associated with EHR satisfaction. In the linear regression models, physicians with higher reported perceived efficiency reported higher overall satisfaction and patient impact after controlling for other variables in the model. Conclusions: Physician satisfaction with EHRs and their perception of its impact on clinical care were generally positive, but physician characteristics, greater age, and attending level were associated with worse EHR satisfaction. Perceived efficiency is the factor most associated with physician satisfaction with EHRs when controlling for other factors. Understanding physician perceptions of EHRs may allow targeting of technology resources to ensure efficiency and satisfaction with EHR system use during clinical care. %M 30946023 %R 10.2196/10949 %U https://medinform.jmir.org/2019/2/e10949/ %U https://doi.org/10.2196/10949 %U http://www.ncbi.nlm.nih.gov/pubmed/30946023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11726 %T Peer Adoption and Development of Health Innovations by Patients: National Representative Study of 6204 Citizens %A Oliveira,Pedro %A Zejnilovic,Leid %A Azevedo,Salomé %A Rodrigues,Ana Maria %A Canhão,Helena %+ Copenhagen Business School, Department of Strategy and Innovation, Kilen, Kilevej 14, DK-2000 Frederiksberg, Copenhagen, DK-2000, Denmark, 45 38152578, po.si@cbs.dk %K citizen %K patient %K innovation %K therapeutics %K health %K development %K adoption %K physician-patient relations %K social interactions %K search engine %D 2019 %7 26.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing evidence that many patients and caregivers innovate by developing new solutions to cope with their health disorders. Given the easy access to vast internet resources and peers globally, it is increasingly important to understand what may influence user innovation and its adoption in health for improving individual well-being and ensuring their safety, in particular, how interactions with peers and physicians or search behavior, along with sociodemographics, may influence the decision to develop a solution or adopt one developed by a peer. Objective: The aim of this paper was to study the development and peer-to-peer adoption of user innovations in health care and identify individual-level factors associated with these processes. Methods: Data were collected via computer-assisted phone survey from a large, random, and representative sample of adult residents in Portugal (N=6204). User innovation questions were added to 1 wave of an ongoing observational, longitudinal, population-based epidemiological study. By asking about individual innovation activity, the sample was split into 3 groups: (1) the developers of health-related solutions for own use (developers), (2) the adopters of solutions developed by other patients or caregivers (peer-to-peer adopters), and (3) the rest of the population. Within the last group, intention to adopt was measured and used as a proxy of future behavior. Regression analysis is used to test the associations. Results: In the population considered in this paper, an estimated 1.3% (75/6008) reported having developed a solution for own use and 3.3% reported to have adopted a solution developed by peers. The 3 groups (developers, adopters, and remaining population) have distinctive characteristics. Gender plays an important role in the solution development, as women are less likely to develop one (odds ratio [OR] 0.4, 95% CI 0.20-0.81; P<.05). Education is positively associated with the development activity (OR 1.13, 95% CI 1.03-1.24; P<.05) but also with the intentions to adopt a peer-developed solution. Search for health-related information is positively associated with the development, adoption, and the intentions to adopt a solution. Interactions with peers over the internet are rare, but in-person interactions are frequent and have a positive association with the dependent variables in all 3 groups. The results also suggest that trust in doctors represents an important dimension that shapes the attitudes of the population toward peer-developed solutions. Conclusions: This paper demonstrates the importance of the peer community, doctor-patient relationship, citizen’s search for information on innovation, and individual attitudes toward peer-to-peer adoption in health care. It stresses the need for a reliable Web-based health-related information and the necessity to deeper understand complex relationships between the need to improve health and fulfill the need and the perception of the health care system. %M 30912748 %R 10.2196/11726 %U http://www.jmir.org/2019/3/e11726/ %U https://doi.org/10.2196/11726 %U http://www.ncbi.nlm.nih.gov/pubmed/30912748 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 3 %N 1 %P e11951 %T Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review %A Palacholla,Ramya Sita %A Fischer,Nils %A Coleman,Amanda %A Agboola,Stephen %A Kirley,Katherine %A Felsted,Jennifer %A Katz,Chelsea %A Lloyd,Stacy %A Jethwani,Kamal %+ Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States, 1 8579199889, rpalacholla@mgh.harvard.edu %K medical informatics %K culturally appropriate technology %K hypertension %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Cardio %G English %X Background: The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management. Objective: This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators. Methods: This review followed the methodological framework developed by Arskey and O’Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies. Results: A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients. Conclusions: Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness. %M 31758771 %R 10.2196/11951 %U http://cardio.jmir.org/2019/1/e11951/ %U https://doi.org/10.2196/11951 %U http://www.ncbi.nlm.nih.gov/pubmed/31758771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11922 %T Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop %A Van Velthoven,Michelle Helena %A Cordon,Carlos %+ Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7425167828, michelle.van.velthoven@gmail.com %K adoption %K digital health %K stakeholders %K telemedicine %D 2019 %7 25.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There are various complex reasons that influence sustainable adoption of innovations in health care systems. Low adoption can be caused by a lack of support from one or more stakeholders because their needs and expectations are not always considered or aligned. Objective: This study aimed to identify stakeholders’ perceptions of barriers and facilitators toward the sustainable adoption of digital health innovations. Methods: A stakeholder workshop was attended by 12 participants with a range of backgrounds on August 25, 2017, including people representing the views from patients, carers, local hospitals, pharmacy retailers, health insurers, health services researchers, engineers, and technology and pharmaceutical companies in Switzerland. On the basis of adoption of innovation frameworks, we asked participants to interview each other about 3 factors influencing the adoption of digitally delivered health interventions: (1) Facilitators and barriers in the external system, (2) Needs and expectations of stakeholders, and (3) Safety, quality, and usability of innovations. The worksheets and videos generated from the workshop were qualitatively analyzed and summarized. Results: Facilitators for adoption mentioned were high levels of income and education, and digital health is a high priority to stakeholders. Main common interests of different stakeholders were patient satisfaction and job protection. Health care spending was a misaligned interest: although some stakeholders were keen on spending more to obtain or provide the highest quality of care, others were focused on reducing health care spending to provide cost-effective services. Switzerland’s diversity and complexity, in terms of its organization with 26 cantons (administrative divisions), were barriers as these made it harder to ensure interoperability of interventions. A culture of innovation was considered a push factor, but adoption was inhibited by persistent paper-based systems, a fear of change, and unwillingness to share data. The sustainability of interventions can be promoted by making them patient-centered, meaning that patients should be involved throughout their development. Conclusions: Promoting sustainable adoption of digital health remains challenging despite various push factors being in place. Barriers related to fragmentation, patient-centeredness, data security, privacy, trust, and job security need to be addressed. A strength is that people from a wide range of backgrounds attended the workshop. A limitation is that the findings are focused on the macro level. In-depth case studies of specific issues need to be conducted in different settings. %M 30907734 %R 10.2196/11922 %U http://www.jmir.org/2019/3/e11922/ %U https://doi.org/10.2196/11922 %U http://www.ncbi.nlm.nih.gov/pubmed/30907734 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e11211 %T European Hospitals’ Transition Toward Fully Electronic-Based Systems: Do Information Technology Security and Privacy Practices Follow? %A Uwizeyemungu,Sylvestre %A Poba-Nzaou,Placide %A Cantinotti,Michael %+ Accounting Department, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G9A 5H7, Canada, 1 819 376 5011 ext 3164, sylvestre.uwizeyemungu@uqtr.ca %K health information technology %K data security %K patient data privacy %K health services %K electronic health records %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Traditionally, health information has been mainly kept in paper-based records. This has deeply changed throughout approximately the last three decades with the widespread use of multiple health information technologies. The digitization of health care systems contributes to improving health care delivery. However, it also exposes health records to security and privacy breaches inherently related to information technology (IT). Thus, health care organizations willing to leverage IT for improved health care delivery need to put in place IT security and privacy measures consistent with their use of IT resources. Objective: In this study, 2 main objectives are pursued: (1) to assess the state of the implementation of IT security and privacy practices in European hospitals and (2) to assess to what extent these hospitals enhance their IT security and privacy practices as they move from paper-based systems toward fully electronic-based systems. Methods: Drawing on data from the European Commission electronic health survey, we performed a cluster analysis based on IT security and privacy practices implemented in 1723 European hospitals. We also developed an IT security index, a compounded measure of implemented IT security and privacy practices, and compared it with the hospitals’ level in their transition from a paper-based system toward a fully electronic-based system. Results: A total of 3 clearly distinct patterns of health IT–related security and privacy practices were unveiled. These patterns, as well as the IT security index, indicate that most of the sampled hospitals (70.2%) failed to implement basic security and privacy measures consistent with their digitization level. Conclusions: Even though, on average, the most electronically advanced hospitals display a higher IT security index than hospitals where the paper system still dominates, surprisingly, it appears that the enhancement of IT security and privacy practices as the health information digitization advances in European hospitals is neither systematic nor strong enough regarding the IT-security requirements. This study will contribute to raising awareness among hospitals’ managers as to the importance of enhancing their IT security and privacy measures so that they can keep up with the security threats inherently related to the digitization of health care organizations. %M 30907732 %R 10.2196/11211 %U http://medinform.jmir.org/2019/1/e11211/ %U https://doi.org/10.2196/11211 %U http://www.ncbi.nlm.nih.gov/pubmed/30907732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11413 %T The Role of Frontline Leaders in Building Health Professional Support for a New Patient Portal: Survey Study %A Kujala,Sari %A Hörhammer,Iiris %A Heponiemi,Tarja %A Josefsson,Kim %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo,, Finland, 358 503862768, sari.kujala@aalto.fi %K patient portal %K implementation %K expectations %K organizational readiness %K leadership %D 2019 %7 22.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective leadership and change management are thought to contribute to the successful implementation of health information technology innovations. However, limited attention has been paid to the role of frontline leaders in building health professional support for new technical innovations. Objective: First, we examined whether frontline leaders’ positive expectations of a patient portal and perceptions of its implementation were associated with their support for the portal. Second, we explored whether leaders’ positive perceptions influenced the same unit’s health professional support for the portal. Methods: Data were collected through an online survey of 2067 health professionals and 401 frontline leaders working in 44 units from 14 health organizations in Finland. The participating organizations run a joint self-care and digital value services project developing a new patient portal for self-management. The survey was conducted before the piloting and implementation of the patient portal. Results: The frontline leaders’ perception of vision clarity had the strongest association with their own support for the portal (ß=.40, P<.001). Results also showed an association between leaders’ view of organizational readiness and their support (ß=.15, P=.04). The leaders’ positive perceptions of the quality of informing about the patient portal was associated with both leaders’ own (ß=.16, P=.02) and subordinate health professionals’ support for the portal (ß=.08, P<.001). Furthermore, professional participation in the planning of the portal was positively associated with their support (ß=.57, P<.001). Conclusions: Findings suggest that assuring good informing, communicating a clear vision to frontline leaders, and acknowledging organizational readiness for change can increase health professional support for electronic health (eHealth) services in the pre-implementation phase. Results highlight the role of frontline leaders in engaging professionals in the planning and implementation of eHealth services and in building health professionals’ positive attitudes toward the implementation of eHealth services. %M 30901003 %R 10.2196/11413 %U http://www.jmir.org/2019/3/e11413/ %U https://doi.org/10.2196/11413 %U http://www.ncbi.nlm.nih.gov/pubmed/30901003 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e12350 %T Understanding Determinants of Health Care Professionals’ Perspectives on Mobile Health Continuance and Performance %A Hsiao,Ju-Ling %A Chen,Rai-Fu %+ Department of Information Management, Chia-Nan University of Pharmacy and Science, No 60, Sec 1, Erren Rd, Rende Dist, Tainan City, 71710, Taiwan, 886 6 2664911 ext 5308, rafuchen@gmail.com %K delivery of health care %K mobile health %K health information management %K health care quality, access, and evaluation %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the widespread use of mobile technologies, mobile information systems have become crucial tools in health care operations. Although the appropriate use of mobile health (mHealth) may result in major advances in expanding health care coverage (increasing decision-making speeds, managing chronic conditions, and providing suitable health care in emergencies), previous studies have argued that current mHealth research does not adequately evaluate mHealth interventions, and it does not provide sufficient evidence regarding the effects on health. Objective: The aim of this study was to facilitate the widespread use of mHealth systems; an accurate evaluation of the systems from the users’ perspective is essential after the implementation and use of the system in daily health care practices. This study extends the expectation-confirmation model by using characteristics of individuals, technology, and tasks to identify critical factors affecting mHealth continuance and performance from the perspective of health care professionals (HCPs). Methods: A questionnaire survey was used to collect data from HCPs who were experienced in using mHealth systems of a Taiwanese teaching hospital. In total, 282 questionnaires were distributed, and 201 complete and valid questionnaires were returned, thus indicating a valid response rate of 71.3% (201/282). The collected data were analyzed using WarpPLS version 5.0 (ScriptWarp Systems). Results: The results revealed that mHealth continuance (R2=0.522) was mainly affected by perceived usefulness, technology maturity, individual habits, task mobility, and user satisfaction, whereas individual performance (R2=0.492) was affected by mHealth continuance. In addition, user satisfaction (R2=0.548) was affected by confirmation and perceived usefulness of mHealth, whereas perceived usefulness (R2=0.521) was affected by confirmation. This implied that confirmation played a key role in affecting perceived usefulness and user satisfaction. Furthermore, the results showed that mHealth continuance positively affected individual performance. Conclusions: The identified critical factors influencing mHealth continuance and performance can be used as a useful assessment tool by hospitals that have implemented mHealth systems to facilitate the use and infusion of the systems. Furthermore, the results can help health care institutions that intend to introduce or develop mHealth applications to identify critical issues and effectively allocate limited resources to mHealth systems. %M 30882353 %R 10.2196/12350 %U http://medinform.jmir.org/2019/1/e12350/ %U https://doi.org/10.2196/12350 %U http://www.ncbi.nlm.nih.gov/pubmed/30882353 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e11678 %T The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation %A Lang,Alexandra %A Simmonds,Mark %A Pinchin,James %A Sharples,Sarah %A Dunn,Lorrayne %A Clarke,Susan %A Bennett,Owen %A Wood,Sally %A Swinscoe,Caron %+ Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom, 44 07921912376, alexandra.lang@nottingham.ac.uk %K health information technology %K early warning score %K mobile health %K staff workload %K clinical deterioration %K patient safety %K mixed methods %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient safety literature has long reported the need for early recognition of deteriorating patients. Early warning scores (EWSs) are commonly implemented as “track and trigger,” or rapid response systems for monitoring and early recognition of acute patient deterioration. This study presents a human factors evaluation of a hospital-wide transformation in practice, engendered by the deployment of an innovative electronic observations (eObs) and handover system. This technology enables real-time information processing at the patient’s bedside, improves visibility of patient data, and streamlines communication within clinical teams. Objective: The aim of this study was to identify improvement and deterioration in workplace efficiency and quality of care resulting from the large-scale imposition of new technology. Methods: A total of 85 hours of direct structured observations of clinical staff were carried out before and after deployment. We conducted 40 interviews with a range of clinicians. A longitudinal analysis of critical care audit and electronically recorded patient safety incident reports was conducted. The study was undertaken in a large secondary-care facility in the United Kingdom. Results: Roll-out of eObs was associated with approximately 10% reduction in total unplanned admissions to critical care units from eObs-equipped wards. Over time, staff appropriated the technology as a tool for communication, workload management, and improving awareness of team capacity. A negative factor was perceived as lack of engagement with the system by senior clinicians. Doctors spent less time in the office (68.7% to 25.6%). More time was spent at the nurses’ station (6.6% to 41.7%). Patient contact time was more than doubled (2.9% to 7.3%). Conclusions: Since deployment, clinicians have more time for patient care because of reduced time spent inputting and accessing data. The formation of a specialist clinical team to lead the roll-out was universally lauded as the reason for success. Staff valued the technology as a tool for managing workload and identified improved situational awareness as a key benefit. For future technology deployments, the staff requested more training preroll-out, in addition to engagement and support from senior clinicians. %M 30839278 %R 10.2196/11678 %U http://medinform.jmir.org/2019/1/e11678/ %U https://doi.org/10.2196/11678 %U http://www.ncbi.nlm.nih.gov/pubmed/30839278 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e12238 %T Implementation of National Health Informatization in China: Survey About the Status Quo %A Li,Chen %A Xu,Xiangdong %A Zhou,Guanghua %A He,Kai %A Qi,Tianliang %A Zhang,Wei %A Tian,Feng %A Zheng,Qinghua %A Hu,Jianping %+ Department of Information Technology, Center of Statistics and Health Informatics, National Health Commission of People’s Republic of China, No. 1, West Straight Gate South Road, Beijing,, China, 86 010 68792572, hujp@nhfpc.gov.cn %K health policy %K health informatization %K electronic health record %D 2019 %7 21.02.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: The National Health and Family Planning Commission (NHFPC) in China organized a nationwide survey to investigate the informatization in hospitals and regional Health and Family Planning Commissions (HFPCs) in 2017. The survey obtained valid results from 79.69% (2021/2536) of major hospitals and 81% (26/32) of provincial and 73.1% (307/420) of municipal HFPCs. The investigated topics covered hardware infrastructure, information resources, applications, systems, and organizations in health informatics. Objective: This study aimed to provide evidence collected from the survey regarding China’s health informatization and assist policy making regarding health informatics in the 13th Five-Year Plan of China. Methods: Based on the survey, the paper presented the status quo of China’s health informatization and analyzed the progress and potential problems in terms of the country’s health information development policies. Results: Related policies have helped to construct 4-level information platforms and start converging the regional data to the 3 centralized databases. The principle of informatics has been transiting from finance-centered to people-centered. Alternatively, the quality, usability, and interoperability of the data still need to be improved. Conclusions: The nationwide survey shows that China’s health informatization is rapidly developing. Current information platforms and databases technically support data exchanging between all provinces and cities. As China is continuing to improve the infrastructure, more advanced applications are being developed upon it. %M 30789350 %R 10.2196/12238 %U http://medinform.jmir.org/2019/1/e12238/ %U https://doi.org/10.2196/12238 %U http://www.ncbi.nlm.nih.gov/pubmed/30789350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12376 %T Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals %A Vis,Christiaan %A Ruwaard,Jeroen %A Finch,Tracy %A Rapley,Tim %A de Beurs,Derek %A van Stel,Henk %A van Lettow,Britt %A Mol,Mayke %A Kleiboer,Annet %A Riper,Heleen %A Smit,Jan %+ Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 646098094, p.d.c.vis@vu.nl %K implementation science %K eHealth %K psychometrics %K eMental health %K normalization process theory %K implementation assessment %D 2019 %7 20.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective: The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods: Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results: A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62≤alpha≤.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, χ22=22.5, P≤.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (λCA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47≤r≤.54, P≤.05). Conclusions: NoMAD’s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices. %M 30785402 %R 10.2196/12376 %U http://www.jmir.org/2019/2/e12376/ %U https://doi.org/10.2196/12376 %U http://www.ncbi.nlm.nih.gov/pubmed/30785402 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e10245 %T Improving Provider Adoption With Adaptive Clinical Decision Support Surveillance: An Observational Study %A Khan,Sundas %A Richardson,Safiya %A Liu,Andrew %A Mechery,Vinodh %A McCullagh,Lauren %A Schachter,Andy %A Pardo,Salvatore %A McGinn,Thomas %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 600 Community Drive, Manhasset, NY, 11030, United States, 1 516 600 1419, skhan31@northwell.edu %K pulmonary embolism %K clinical decision support %K evidence-based medicine %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Successful clinical decision support (CDS) tools can help use evidence-based medicine to effectively improve patient outcomes. However, the impact of these tools has been limited by low provider adoption due to overtriggering, leading to alert fatigue. We developed a tracking mechanism for monitoring trigger (percent of total visits for which the tool triggers) and adoption (percent of completed tools) rates of a complex CDS tool based on the Wells criteria for pulmonary embolism (PE). Objective: We aimed to monitor and evaluate the adoption and trigger rates of the tool and assess whether ongoing tool modifications would improve adoption rates. Methods: As part of a larger clinical trial, a CDS tool was developed using the Wells criteria to calculate pretest probability for PE at 2 tertiary centers’ emergency departments (EDs). The tool had multiple triggers: any order for D-dimer, computed tomography (CT) of the chest with intravenous contrast, CT pulmonary angiography (CTPA), ventilation-perfusion scan, or lower extremity Doppler ultrasound. A tracking dashboard was developed using Tableau to monitor real-time trigger and adoption rates. Based on initial low provider adoption rates of the tool, we conducted small focus groups with key ED providers to elicit barriers to tool use. We identified overtriggering of the tool for non-PE-related evaluations and inability to order CT testing for intermediate-risk patients. Thus, the tool was modified to allow CT testing for the intermediate-risk group and not to trigger for CT chest with intravenous contrast orders. A dialogue box, “Are you considering PE for this patient?” was added before the tool triggered to account for CTPAs ordered for aortic dissection evaluation. Results: In the ED of tertiary center 1, 95,295 patients visited during the academic year. The tool triggered for an average of 509 patients per month (average trigger rate 2036/30,234, 6.73%) before the modifications, reducing to 423 patients per month (average trigger rate 1629/31,361, 5.22%). In the ED of tertiary center 2, 88,956 patients visited during the academic year, with the tool triggering for about 473 patients per month (average trigger rate 1892/29,706, 6.37%) before the modifications and for about 400 per month (average trigger rate 1534/30,006, 5.12%) afterward. The modifications resulted in a significant 4.5- and 3-fold increase in provider adoption rates in tertiary centers 1 and 2, respectively. The modifications increased the average monthly adoption rate from 23.20/360 (6.5%) tools to 81.60/280.20 (29.3%) tools and 46.60/318.80 (14.7%) tools to 111.20/263.40 (42.6%) tools in centers 1 and 2, respectively. Conclusions: Close postimplementation monitoring of CDS tools may help improve provider adoption. Adaptive modifications based on user feedback may increase targeted CDS with lower trigger rates, reducing alert fatigue and increasing provider adoption. Iterative improvements and a postimplementation monitoring dashboard can significantly improve adoption rates. %M 30785410 %R 10.2196/10245 %U http://humanfactors.jmir.org/2019/1/e10245/ %U https://doi.org/10.2196/10245 %U http://www.ncbi.nlm.nih.gov/pubmed/30785410 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10377 %T Development of the Multidimensional Readiness and Enablement Index for Health Technology (READHY) Tool to Measure Individuals’ Health Technology Readiness: Initial Testing in a Cancer Rehabilitation Setting %A Kayser,Lars %A Rossen,Sine %A Karnoe,Astrid %A Elsworth,Gerald %A Vibe-Petersen,Jette %A Christensen,Jesper Frank %A Ried-Larsen,Mathias %A Osborne,Richard H %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, DK-1014, Denmark, 45 28757291, lk@sund.ku.dk %K health technology readiness %K questionnaire %K eHealth literacy, enablement %D 2019 %7 12.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing digitization of health care services with enhanced access to fast internet connections, along with wide use of smartphones, offers the opportunity to get health advice or treatment remotely. For service providers, it is important to consider how consumers can take full advantage of available services and how this can create an enabling environment. However, it is important to consider the digital context and the attributes of current and future users, such as their readiness (ie, knowledge, skills, and attitudes, including trust and motivation). Objective: The objective of this study was to evaluate how the eHealth Literacy Questionnaire (eHLQ) combined with selected dimensions from the Health Education Impact Questionnaire (heiQ) and the Health Literacy Questionnaire (HLQ) can be used together as an instrument to characterize an individual’s level of health technology readiness and explore how the generated data can be used to create health technology readiness profiles of potential users of health technologies and digital health services. Methods: We administered the instrument and sociodemographic questions to a population of 305 patients with a recent cancer diagnosis referred to rehabilitation in a setting that plans to introduce various technologies to assist the individuals. We evaluated properties of the Readiness and Enablement Index for Health Technology (READHY) instrument using confirmatory factor analysis, convergent and discriminant validity analysis, and exploratory factor analysis. To identify different health technology readiness profiles in the population, we further analyzed the data using hierarchical and k-means cluster analysis. Results: The confirmatory factor analysis found a suitable fit for the 13 factors with only 1 cross-loading of 1 item between 2 dimensions. The convergent and discriminant validity analysis revealed many factor correlations, suggesting that, in this population, a more parsimonious model might be achieved. Exploratory factor analysis pointed to 5 to 6 constructs based on aggregates of the existing dimensions. The results were not satisfactory, so we performed an 8-factor confirmatory factor analysis, resulting in a good fit with only 1 item cross-loading between 2 dimensions. Cluster analysis showed that data from the READHY instrument can be clustered to create meaningful health technology readiness profiles of users. Conclusions: The 13 dimensions from heiQ, HLQ, and eHLQ can be used in combination to describe a user’s health technology readiness level and degree of enablement. Further studies in other populations are needed to understand whether the associations between dimensions are consistent and the number of dimensions can be reduced. %M 30747717 %R 10.2196/10377 %U http://www.jmir.org/2019/2/e10377/ %U https://doi.org/10.2196/10377 %U http://www.ncbi.nlm.nih.gov/pubmed/30747717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10362 %T Health Care Professionals’ Perceptions of Home Telemonitoring in Heart Failure Care: Cross-Sectional Survey %A Aamodt,Ina Thon %A Lycholip,Edita %A Celutkiene,Jelena %A Strömberg,Anna %A Atar,Dan %A Falk,Ragnhild Sørum %A von Lueder,Thomas %A Hellesø,Ragnhild %A Jaarsma,Tiny %A Lie,Irene %+ Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, Building 63, Box 4956 Nydalen and Postboks 1130 Blindern, 0318, Oslo,, Norway, 47 48090883, inamarieaamodt@gmail.com %K nurses %K physicians %K perception %K telemedicine %K heart failure %K self-care %D 2019 %7 06.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Noninvasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary health care utilization, and decrease health care costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care, and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim of this study was to describe health care professionals’ (HCPs) perception of and presumed experience with noninvasive TM in daily HF patient care, perspectives of the relevance of and reasons for applying noninvasive TM, and barriers to the use of noninvasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43 items with close- and open-ended questions. In Norway, the response rate was 68.7% (226/329), with 57 of 60 hospitals participating, whereas the response rate was 68.1% (310/455) in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics, and the open-ended questions were analyzed using summative content analysis. Results: This study showed that noninvasive TM is not part of the current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with noninvasive TM in HF care in Norway (48/226, 21.2%) and Lithuania (64/310, 20.6%). Approximately half of the HCPs in both countries perceived noninvasive TM to be relevant in follow-up of HF patients in Norway (131/226, 58.0%) and Lithuania (172/310, 55.5%). For physicians in both countries and nurses in Norway, the 3 most mentioned reasons for introducing noninvasive TM were to improve self-care, to reduce hospitalizations, and to provide high-quality care, whereas the Lithuanian nurses described ability to treat more patients and to reduce their workload as reasons for introducing noninvasive TM. The main barriers to implement noninvasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive that HF patients themselves could represent barriers because of their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently nonusers of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients’ condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond. %M 30724744 %R 10.2196/10362 %U http://www.jmir.org/2019/2/e10362/ %U https://doi.org/10.2196/10362 %U http://www.ncbi.nlm.nih.gov/pubmed/30724744 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11885 %T Factors for Supporting Primary Care Physician Engagement With Patient Apps for Type 2 Diabetes Self-Management That Link to Primary Care: Interview Study %A Ayre,Julie %A Bonner,Carissa %A Bramwell,Sian %A McClelland,Sharon %A Jayaballa,Rajini %A Maberly,Glen %A McCaffery,Kirsten %+ Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), The University of Sydney, Sydney,, Australia, 61 293517220, kirsten.mccaffery@sydney.edu.au %K diabetes mellitus, type 2 %K electronic health records %K telemedicine %K mobile apps %K general practitioners %K physicians, primary care %K self-management %K qualitative research %K translational medical research %D 2019 %7 16.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The health burden of type 2 diabetes can be mitigated by engaging patients in two key aspects of diabetes care: self-management and regular contact with health professionals. There is a clear benefit to integrating these aspects of care into a single clinical tool, and as mobile phone ownership increases, apps become a more feasible platform. However, the effectiveness of online health interventions is contingent on uptake by health care providers, which is typically low. There has been little research that focuses specifically on barriers and facilitators to health care provider uptake for interventions that link self-management apps to the user’s primary care physician (PCP). Objective: This study aimed to explore PCP perspectives on proposed features for a self-management app for patients with diabetes that would link to primary care services. Methods: Researchers conducted 25 semistructured interviews. The interviewer discussed potential features that would link in with the patient’s primary care services. Interviews were audio-recorded, transcribed, and coded. Framework analysis and the Consolidated Criteria for Reporting Qualitative Research checklist were employed to ensure rigor. Results: Our analysis indicated that PCP attitudes toward proposed features for an app were underpinned by perceived roles of (1) diabetes self-management, (2) face-to-face care, and (3) the anticipated burden of new technologies on their practice. Theme 1 explored PCP perceptions about how an app could foster patient independence for self-management behaviors but could also increase responsibility and liability for the PCP. Theme 2 identified beliefs underpinning a commonly expressed preference for face-to-face care. PCPs perceived information was more motivating, better understood, and presented with greater empathy when delivered face to face rather than online. Theme 3 described how most PCPs anticipated an initial increase in workload while they learned to use a new clinical tool. Some PCPs accepted this burden on the basis that the change was inevitable as health care became more integrated. Others reported potential benefits were outweighed by effort to implement an app. This study also identified how app features can be positively framed, highlighting potential benefits for PCPs to maximize PCP engagement, buy-in, and uptake. For example, PCPs were more positive when they perceived that an app could facilitate communication and motivation between consultations, focus on building capacity for patient independence, and reinforce rather than replace in-person care. They were also more positive about app features that were automated, integrated with existing software, flexible for different patients, and included secondary benefits such as improved documentation. Conclusions: This study provided insight into PCP perspectives on a diabetes app integrated with primary care services. This was observed as more than a technological change; PCPs were concerned about changes in workload, their role in self-management, and the nature of consultations. Our research highlighted potential facilitators and barriers to engaging PCPs in the implementation process. %M 30664468 %R 10.2196/11885 %U http://mhealth.jmir.org/2019/1/e11885/ %U https://doi.org/10.2196/11885 %U http://www.ncbi.nlm.nih.gov/pubmed/30664468 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e12465 %T Improving Digital Hospital Transformation: Development of an Outcomes-Based Infrastructure Maturity Assessment Framework %A Williams,Patricia AH %A Lovelock,Brendan %A Cabarrus,Tony %A Harvey,Marlon %+ Flinders Digital Health Research Centre, College of Science and Engineering, Flinders University, Flinders at Tonsley, GPO Box 2100, Adelaide, SA 5001, Australia, 61 82012023, trish.williams@flinders.edu.au %K medical informatics %K information infrastructures %K digital hospitals %K eHealth %K implementation %K capability maturity modelling %K security %D 2019 %7 11.01.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Digital transformation in health care is being driven by the need to improve quality, reduce costs, and enhance the patient experience of health care delivery. It does this through both the direct intervention of technology to create new diagnostic and treatment opportunities and also through the improved use of information to create more engaging and efficient care processes. Objective: In a modern digital hospital, improved clinical and business processes are often driven through enhancing the information flows that support them. To understand an organization’s ability to transform their information flows requires a clear understanding of the capabilities of an organization’s information technology infrastructure. To date, hospital facilities have been challenged by the absence of uniform ways of describing this infrastructure that would enable them to benchmark where they are and create a vision of where they would like to be. While there is an industry assessment measure for electronic medical record (EMR) adoption using the Healthcare Information and Management Systems Society Analytics EMR Adoption Model, there is no equivalent for assessing the infrastructure and associated technology capabilities for digital hospitals. Our aim is to fill this gap, as hospital administrators and clinicians need to know how and why to invest in information infrastructure to support health information technology that benefits patient safety and care. Methods: Based on an operational framework for the Capability Maturity Model, devised specifically for health care, we applied information use characteristics to define eight information systems maturity levels and associated technology infrastructure capabilities. These levels are mapped to user experiences to create a linkage between technology infrastructure and experience outcomes. Subsequently, specific technology capabilities are deconstructed to identify the technology features required to meet each maturity level. Results: The resulting assessment framework clearly defines 164 individual capabilities across the five technology domains and eight maturity levels for hospital infrastructure. These level-dependent capabilities characterize the ability of the hospital’s information infrastructure to support the business of digital hospitals including clinical and administrative requirements. Further, it allows the addition of a scoring calculation for each capability, domain, and the overall infrastructure, and it identifies critical requirements to meet each of the maturity levels. Conclusions: This new Infrastructure Maturity Assessment framework will allow digital hospitals to assess the maturity of their infrastructure in terms of their digital transformation aligning to business outcomes and supporting the desired level of clinical and operational competency. It provides the ability to establish an international benchmark of hospital infrastructure performance, while identifying weaknesses in current infrastructure capability. Further, it provides a business case justification through increased functionality and a roadmap for subsequent digital transformation while moving from one maturity level to the next. As such, this framework will encourage and guide information-driven, digital transformation in health care. %M 30632973 %R 10.2196/12465 %U http://medinform.jmir.org/2019/1/e12465/ %U https://doi.org/10.2196/12465 %U http://www.ncbi.nlm.nih.gov/pubmed/30632973 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10240 %T Psychiatrists' Attitudes Toward Disruptive New Technologies: Mixed-Methods Study %A Bourla,Alexis %A Ferreri,Florian %A Ogorzelec,Laetitia %A Peretti,Charles-Siegfried %A Guinchard,Christian %A Mouchabac,Stephane %+ Department of Adult Psychiatry and Medical Psychology, Sorbonne Université, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, Paris, 75012, France, 33 149282628, alexis.bourla@aphp.fr %K acceptability %K clinical decision support systems %K computerized adaptive testing %K digital phenotype %K ecological momentary assessment %K machine learning %K mobile phone %K professional culture %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. Objective: The aim of this study was to explore psychiatrists’ perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. Methods: A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). Results: We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. Conclusions: This is the first study to assess psychiatrists’ views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies. %M 30552086 %R 10.2196/10240 %U http://mental.jmir.org/2018/4/e10240/ %U https://doi.org/10.2196/10240 %U http://www.ncbi.nlm.nih.gov/pubmed/30552086 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e201 %T Technology Adoption, Motivational Aspects, and Privacy Concerns of Wearables in the German Running Community: Field Study %A Wiesner,Martin %A Zowalla,Richard %A Suleder,Julian %A Westers,Maximilian %A Pobiruchin,Monika %+ Department of Medical Informatics, Heilbronn University, Max-Planck-Straße 39, Heilbronn, D-74081, Germany, 49 71315046947, martin.wiesner@hs-heilbronn.de %K athlete %K wearables %K mobile phones %K physical activity %K activity monitoring %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the availability of a great variety of consumer-oriented wearable devices, perceived usefulness, user satisfaction, and privacy concerns have not been fully investigated in the field of wearable applications. It is not clear why healthy, active citizens equip themselves with wearable technology for running activities, and what privacy and data sharing features might influence their individual decisions. Objective: The primary aim of the study was to shed light on motivational and privacy aspects of wearable technology used by healthy, active citizens. A secondary aim was to reevaluate smart technology adoption within the running community in Germany in 2017 and to compare it with the results of other studies and our own study from 2016. Methods: A questionnaire was designed to assess what wearable technology is used by runners of different ages and sex. Data on motivational factors were also collected. The survey was conducted at a regional road race event in May 2017, paperless via a self-implemented app. The demographic parameters of the sample cohort were compared with the event’s official starter list. In addition, the validation included comparison with demographic parameters of the largest German running events in Berlin, Hamburg, and Frankfurt/Main. Binary logistic regression analysis was used to investigate whether age, sex, or course distance were associated with device use. The same method was applied to analyze whether a runner’s age was predictive of privacy concerns, openness to voluntary data sharing, and level of trust in one’s own body for runners not using wearables (ie, technological assistance considered unnecessary in this group). Results: A total of 845 questionnaires were collected. Use of technology for activity monitoring during events or training was prevalent (73.0%, 617/845) in this group. Male long-distance runners and runners in younger age groups (30-39 years: odds ratio [OR] 2.357, 95% CI 1.378-4.115; 40-49 years: OR 1.485, 95% CI 0.920-2.403) were more likely to use tracking devices, with ages 16 to 29 years as the reference group (OR 1). Where wearable technology was used, 42.0% (259/617) stated that they were not concerned if data might be shared by a device vendor without their consent. By contrast, 35.0% (216/617) of the participants would not accept this. In the case of voluntary sharing, runners preferred to exchange tracked data with friends (51.7%, 319/617), family members (43.4%, 268/617), or a physician (32.3%, 199/617). A large proportion (68.0%, 155/228) of runners not using technology stated that they preferred to trust what their own body was telling them rather than trust a device or an app (50-59 years: P<.001; 60-69 years: P=.008). Conclusions: A total of 136 distinct devices by 23 vendors or manufacturers and 17 running apps were identified. Out of 4, 3 runners (76.8%, 474/617) always trusted in the data tracked by their personal device. Data privacy concerns do, however, exist in the German running community, especially for older age groups (30-39 years: OR 1.041, 95% CI 0.371-0.905; 40-49 years: OR 1.421, 95% CI 0.813-2.506; 50-59 years: OR 2.076, 95% CI 1.813-3.686; 60-69 years: OR 2.394, 95% CI 0.957-6.183). %M 30552085 %R 10.2196/mhealth.9623 %U http://mhealth.jmir.org/2018/12/e201/ %U https://doi.org/10.2196/mhealth.9623 %U http://www.ncbi.nlm.nih.gov/pubmed/30552085 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e11252 %T Most Influential Qualities in Creating Satisfaction Among the Users of Health Information Systems: Study in Seven European Union Countries %A Eivazzadeh,Shahryar %A Berglund,Johan S %A Larsson,Tobias C %A Fiedler,Markus %A Anderberg,Peter %+ Department of Health Science, Blekinge Institute of Technology, Blekinge Tekniska Högskola, Karlskrona, 371 79, Sweden, 46 455 38 50 00, shahryar.eivazzadeh@bth.se %K health information systems %K telemedicine %K evaluation studies as topic %K consumer behavior %K treatment outcome %K safety %K efficiency %K health care costs %K ontology engineering %K equation models %D 2018 %7 30.11.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Several models suggest how the qualities of a product or service influence user satisfaction. Models such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success demonstrate those relations and have been used in the context of health information systems. Objective: This study aimed to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and whether this makes user satisfaction a proxy indicator of those qualities. Methods: The Unified eValuation using ONtology (UVON) method was used to construct an ontology of the required qualities for 7 electronic health (eHealth) apps being developed in the Future Internet Social and Technological Alignment Research (FI-STAR) project, a European Union (EU) project in electronic health (eHealth). The eHealth apps were deployed across 7 EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine apps (MAST) evaluation framework. Moreover, 2 similar questionnaires for 87 patient users and 31 health professional users were elicited from the ontology. In the questionnaires, the user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analyzed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, 2 partial least squares structural equation modeling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method. Results: Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures that reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems. Conclusions: For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, whereas professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users’ evaluation of system output and fulfillment of expectations but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple and fast way to infer if the system has improved the abovementioned qualities in treatment and care. %M 30504120 %R 10.2196/11252 %U http://medinform.jmir.org/2018/4/e11252/ %U https://doi.org/10.2196/11252 %U http://www.ncbi.nlm.nih.gov/pubmed/30504120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e11032 %T New Integrated Model Approach to Understand the Factors That Drive Electronic Health Record Portal Adoption: Cross-Sectional National Survey %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School, Universidade NOVA de Lisboa, Campus de Campolide, Lisboa, 1070 312, Portugal, 351 213 828 610, d2012072@novaims.unl.pt %K electronic health records %K adoption %K eHealth %K patients %K patient portals %D 2018 %7 19.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The future of health care delivery is becoming more patient-focused, and electronic health record (EHR) portals are gaining more attention from worldwide governments that consider this technology as a valuable asset for the future sustainability of the national health care systems. Overall, this makes the adoption of EHR portals an important field to study. Objective: The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods: We applied a new adoption model that combines 3 different theories, namely, extended unified theory of acceptance and use of technology, health belief model, and the diffusion of innovation; all the 3 theories provided relevant contributions for the understanding of EHR portals. To test the research model, we used the partial least squares causal modeling approach. We executed a national survey based on randomly generated mobile phone numbers. We collected 139 questionnaires. Results: Performance expectancy (beta=.203; t=2.699), compatibility (beta=.530; t=6.189), and habit (beta=.251; t=2.660) have a statistically significant impact on behavior intention (R2=76.0%). Habit (beta=.378; t=3.821), self-perception (beta=.233; t=2.971), and behavior intention (beta=.263; t=2.379) have a statistically significant impact on use behavior (R2=61.8%). In addition, behavior intention (beta=.747; t=10.737) has a statistically significant impact on intention to recommend (R2=69.0%), results demonstrability (beta=.403; t=2.888) and compatibility (beta=.337; t=2.243) have a statistically significant impact on effort expectancy (R2=48.3%), and compatibility (beta=.594; t=6.141) has a statistically significant impact on performance expectancy (R2=42.7%). Conclusions: Our research model yields very good results, with relevant R2 in the most important dependent variables that help explain the adoption of EHR portals, behavior intention, and use behavior. %M 30455169 %R 10.2196/11032 %U https://www.jmir.org/2018/11/e11032/ %U https://doi.org/10.2196/11032 %U http://www.ncbi.nlm.nih.gov/pubmed/30455169 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10226 %T Implementation Tells Us More Beyond Pooled Estimates: Secondary Analysis of a Multicountry mHealth Trial to Reduce Blood Pressure %A Carrillo-Larco,Rodrigo M %A Jiwani,Safia S %A Diez-Canseco,Francisco %A Kanter,Rebecca %A Beratarrechea,Andrea %A Irazola,Vilma %A Ramirez-Zea,Manuel %A Rubinstein,Adolfo %A Martinez,Homero %A Miranda,J Jaime %A , %+ INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, Guatemala, Apartado Postal 1188, Guatemala, 502 2472 3762, mramirez@incap.int %K Argentina %K behavior %K clinical trial %K Guatemala %K health risk behaviors, lifestyle risk reduction %K mHealth %K Peru %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. Objective: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country. Methods: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. Results: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants’ stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. Conclusions: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake. Trial Registration: ClinicalTrials.gov NCT01295216; http://clinicaltrials.gov/ct2/show/NCT01295216 (Archived by WebCite at http://www.webcitation.org/72tMF0B7B). %M 30389646 %R 10.2196/10226 %U http://mhealth.jmir.org/2018/11/e10226/ %U https://doi.org/10.2196/10226 %U http://www.ncbi.nlm.nih.gov/pubmed/30389646 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10237 %T Health Care Apps Reported in Newspapers: Content Analysis %A Al Bawab,Abdel Qader %A AlQahtani,Fahad %A McElnay,James %+ Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom, 44 2890975221, J.mcelnay@qub.ac.uk %K apps %K newspaper articles %K newspapers %K health %D 2018 %7 22.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Newspapers are considered one of the most viewed and influential media sources in both the United Kingdom and United States. However, information about how newspapers portray health care apps to the readers has been lacking. Objective: This study investigated the reporting on health care apps in newspapers published in the United Kingdom and United States. Methods: The Nexis UK database was used to identify and select relevant articles. Systematic content analysis of the articles that met the inclusion criteria (articles of any format that contained reference to health care apps or medical apps) within the highest circulated newspapers in the United Kingdom and United States over a period of 10 years (2006-2015) was conducted. Interrater reliability of coding was established using a 10% sample of the chosen articles. Results: A total of 220 (151 UK and 69 US) relevant newspaper articles were retrieved. Health care apps were most frequently reported on in the Daily Mail and The Guardian (UK newspapers) and in the New York Times and the Washington Post (US newspapers). An exponential rise in published scientific articles (PubMed) on health care-related apps was noted during the study period. A total of 26.4% (58/220) and 19.1% (42/220) of the retrieved newspaper articles appeared in the features and main news sections, respectively. General information about health care apps was the main theme coved by the newspapers (45.9%, 101/220). Most of the articles represented a societal point of view (72.3%, 159/220). The main focus of the articles was on general health matters (48.2%, 106/220) and specific disease matters (36.8%, 81/220). Diabetes was the most frequently mentioned disease in the articles. A high proportion (91.4%, 201/220) of the articles mentioned benefits of using health care apps mainly for personalized care, whereas 24.1% (53/220) of the articles commented on related risks such as anxiety and confidentiality issues. Almost half (45.9%, 101/220) of the articles mentioned potential facilitators to the use of apps; less than 10% (16/220) discussed barriers. Most of the articles (83.6%, 184/220) were judged as having balanced judgment on the present topic and more than half (60.0%, 132/220) of the articles were judged to be of generally low quality. Conclusions: Health care apps were not widely reported in newspaper articles in the United Kingdom and United States over the study period; however, there appeared to be much more recent interest. Characteristically, the articles focused more frequently on societal impact and on general health rather than on disease-specific apps. %M 30348632 %R 10.2196/10237 %U http://mhealth.jmir.org/2018/10/e10237/ %U https://doi.org/10.2196/10237 %U http://www.ncbi.nlm.nih.gov/pubmed/30348632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e279 %T Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners %A Torrent-Sellens,Joan %A Díaz-Chao,Ángel %A Soler-Ramos,Ivan %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Avinguda del Tibidabo 39-43, Barcelona, 08035, Spain, 34 933263622, fsaigi@uoc.edu %K internet %K eHealth %K health care %K health drivers %K health barriers %K health attitude %K health information %K health empowerment %K information and communication technologies %K structural equation modeling %K Europe %D 2018 %7 22.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The literature has noted the need to use more advanced methods and models to evaluate physicians’ outcomes in the shared health care model that electronic health (eHealth) proposes. Objective: The goal of our study was to design and evaluate a predictive multidimensional model of the outcomes of eHealth usage by European physicians. Methods: We used 2012-2013 survey data from a sample of 9196 European physicians (general practitioners). We proposed and tested two composite indicators of eHealth usage outcomes (internal practices and practices with patients) through 2-stage structural equation modeling. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage outcomes indicators were also calculated. Results: European general practitioners who were female (internal practices OR 1.15, 95% CI 1.10-1.20; practices with patients OR 1.19, 95% CI 1.14-1.24) and younger—aged <35 years (internal practices OR 1.14, 95% CI 1.02-1.26; practices with patients OR 1.32, 95% CI 1.13-1.54) and aged 36-45 years (internal practices OR 1.16, 95% CI 1.06-1.28; practices with patients OR 1.21, 95% CI 1.10-1.33)—had a greater propensity toward favorable eHealth usage outcomes in internal practices and practices with patients. European general practitioners who positively valued information and communication technology (ICT) impact on their personal working processes (internal practices OR 5.30, 95% CI 4.73-5.93; practices with patients OR 4.83, 95% CI 4.32-5.40), teamwork processes (internal practices OR 4.19, 95% CI 3.78-4.65; practices with patients OR 3.38, 95% CI 3.05-3.74), and the doctor-patient relationship (internal practices OR 3.97, 95% CI 3.60-4.37; practices with patients OR 6.02, 95% CI 5.43-6.67) had a high propensity toward favorable effects of eHealth usage on internal practices and practices with patients. More favorable eHealth outcomes were also observed for self-employed European general practitioners (internal practices OR 1.33, 95% CI 1.22-1.45; practices with patients OR 1.10, 95% CI 1.03-1.28). Finally, general practitioners who reported that the number of patients treated in the last 2 years had remained constant (internal practices OR 1.08, 95% CI 1.01-1.17) or increased (practices with patients OR 1.12, 95% CI 1.03-1.22) had a higher propensity toward favorable eHealth usage outcomes. Conclusions: We provide new evidence of predictors (sociodemographic issues, attitudes toward ICT impacts, and working conditions) that explain favorable eHealth usage outcomes. The results highlight the need to develop more specific policies for eHealth usage to address different realities. %M 30348628 %R 10.2196/jmir.9253 %U http://www.jmir.org/2018/10/e279/ %U https://doi.org/10.2196/jmir.9253 %U http://www.ncbi.nlm.nih.gov/pubmed/30348628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e265 %T Investigating the Perceptions of Primary Care Dietitians on the Potential for Information Technology in the Workplace: Qualitative Study %A Jones,Aimee %A Mitchell,Lana J %A O'Connor,Rochelle %A Rollo,Megan E %A Slater,Katherine %A Williams,Lauren T %A Ball,Lauren %+ School of Allied Health Sciences, Griffith University, G01 2.05A, Gold Coast,, Australia, 61 0413031470, l.ball@griffith.edu.au %K dietetics %K information technology %K mobile phone %K primary health care %K private practice %D 2018 %7 15.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic diseases are the leading cause of morbidity and mortality worldwide. The primary health care setting is an effective avenue for the management and prevention of chronic diseases. Dietitians working in this setting assist with the management of modifiable risk factors of chronic diseases. However, health care professionals report challenges in providing care in this setting because of time and financial constraints. Information technology offers the potential to improve health care quality, safety, efficiency, and cost-efficiency, but there exists limited understanding of dietitians’ application of technology in this setting. Objective: The objective of this study was to explore the perceptions of primary care dietitians about using information technology in their workplace. Methods: We recruited 20 Australian primary care dietitians using purposive and snowball sampling for semistructured telephonic interviews. Interview questions aimed to gain an understanding of dietitians’ perceptions about sharing patient outcomes through a national database and the benefits, disadvantages, feasibility, and barriers of using information technology. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed for emerging themes and subthemes. Finally, the technologies used by participants were collated by name and researched for their key attributes. Results: The following 4 distinct themes emerged from the data: information technology improving the efficiency of practice tasks, experiencing barriers to using information technology in practice, information technology enhancing outcomes through education and monitoring, and information technology for sharing information with others. Participants identified several advantages and disadvantages of using technology and expressed willingness to share patient outcomes using a Web-based database. Conclusions: This study suggests that information technology is perceived to have benefits to dietitians and patients in primary health care. However, to achieve the optimal benefit, support is required to overcome barriers to integrate information technology into practice better. Further development of patient management systems and standardized Web-based data collection systems are needed to support better usage by dietitians. %M 30322837 %R 10.2196/jmir.9568 %U https://www.jmir.org/2018/10/e265/ %U https://doi.org/10.2196/jmir.9568 %U http://www.ncbi.nlm.nih.gov/pubmed/30322837 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 3 %P e10184 %T Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study %A Graham,Timothy AD %A Ballermann,Mark %A Lang,Eddy %A Bullard,Michael J %A Parsons,Denise %A Mercuur,Gabriella %A San Agustin,Pat %A Ali,Samina %+ Alberta Health Services, 5th Floor, 44 Capital Boulevard, 10044-108 Street, Edmonton, AB, T5J 3S7, Canada, 1 780 431 2549, tim.graham@ahs.ca %K ambulatory care facilities %K cross-sectional studies %K electronic health records %K utilization %K hospital emergency service %K statistics and numerical data %K health information exchange %K humans %K information dissemination %K medical record linkage %K program evaluation %D 2018 %7 25.9.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The adoption and use of an electronic health record (EHR) can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable EHRs (iEHRs) to facilitate health information exchange, but the clinical use and utility of iEHRs has not been well described. Objective: The aim of this study was to describe the use of a provincial iEHR known as the Alberta Netcare Portal (ANP) in 4 urban Alberta emergency departments. The secondary objectives were to characterize the time spent using the respective electronic tools and identify the aspects that were perceived as most useful by emergency department physicians. Methods: In this study, we have included 4 emergency departments, 2 using paper-based ordering (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and 2 using a commercial vendor clinical information system (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]). Structured clinical observations of ANP use and system audit logs analysis were compared at the 4 sites from October 2014 to March 2016. Results: Observers followed 142 physicians for a total of 566 hours over 376 occasions. The median percentage of observed time spent using ANP was 8.5% at UAH (interquartile range, IQR, 3.7%-13.3%), 4.4% at GNCH (IQR 2.4%-4.4%), 4.6% at FMC (IQR 2.4%-7.6%), and 5.1% at PLC (IQR 3.0%-7.7%). By combining administrative and access audit data, the median number of ANP screens (ie, results and reports displayed on a screen) accessed per patient visit were 20 at UAH (IQR 6-67), 9 at GNCH (IQR 4-29), 7 at FMC (IQR 2-18), and 5 at PLC (IQR 2-14). When compared with the structured clinical observations, the statistical analysis of screen access data showed that ANP was used more at UAH than the other sites. Conclusions: This study shows that the iEHR is well utilized at the 4 sites studied, and the usage patterns implied clinical value. Use of the ANP was highest in a paper-based academic center and lower in the centers using a commercial emergency department clinical information system. More study about the clinical impacts of using iEHRs in the Canadian context including longer term impacts on quality of practice and safety are required. %M 30274967 %R 10.2196/10184 %U http://medinform.jmir.org/2018/3/e10184/ %U https://doi.org/10.2196/10184 %U http://www.ncbi.nlm.nih.gov/pubmed/30274967 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e262 %T Use and the Users of a Patient Portal: Cross-Sectional Study %A Hoogenbosch,Bas %A Postma,Jeroen %A de Man-van Ginkel,Janneke M %A Tiemessen,Nicole AM %A van Delden,Johannes JM %A van Os-Medendorp,Harmieke %+ Department of Dermatology and Allergology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 611619212, h.vanosmedendorp@umcutrecht.nl %K patient portals %K eHealth literacy %K Unified Theory of Acceptance and Use of Technology %D 2018 %7 17.09.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals offer patients access to their medical information and tools to communicate with health care providers. It has been shown that patient portals have the potential to positively impact health outcomes and efficiency of health care. It is therefore important that health care organizations identify the patients who use or do not use the patient portal and explore the reasons in either case. The Unified Theory of Acceptance and Use of Technology (UTAUT) is a frequently used theory for explaining the use of information technology. It consists of the following constructs: performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention to use. Objective: This study aimed to explore the prevalence of patient portal use and the characteristics of patients who use or do not use a patient portal. The main constructs of UTAUT, together with demographics and disease- and care-related characteristics, have been measured to explore the predictive factors of portal use. Methods: A cross-sectional study was conducted in the outpatient departments for adult patients of a university hospital in the Netherlands. Following outcomes were included: self-reported portal use, characteristics of users such as demographics, disease- and care-related data, eHealth literacy (modified score), and scores of UTAUT constructs. Descriptive analyses and univariate and multivariate logistic regression were also conducted. Results: In the analysis, 439 adult patients were included. Furthermore, 32.1% (141/439) identified as being a user of the patient portal; 31.2% (137/439) indicated as nonusers, but being aware of the existence of the portal; and 36.6% (161/439) as being nonusers not aware of the existence of the portal. In the entire study population, the factors of being chronically ill (odds ratio, OR 1.62, 95% CI 1.04-2.52) and eHealth literacy (modified score; OR 1.12, 95% CI 1.07-1.18) best predicted portal use. In users and nonusers who were aware of the portal, UTAUT constructs were added to the multivariate logistic regression, with chronically ill and modified eHealth literacy sum score. Effort expectancy (OR 13.02, 95% CI 5.68-29.87) and performance expectancy (OR 2.84, 95% CI 1.65-4.90) are shown to significantly influence portal use in this group. Conclusions: Approximately one-third of the patients of a university hospital self-reported using the patient portal; most expressed satisfaction. At first sight, being chronically ill and higher scores on the modified eHealth literacy scale explained portal use. Adding UTAUT constructs to the model revealed that effort expectancy (ease of use and knowledge and skills related to portal use) and performance expectancy (perceived usefulness) influenced portal use. Interventions to improve awareness of the portal and eHealth literacy skills of patients and further integration of the patient portal in usual face-to-face care are needed to increase use and potential subsequent patient benefits. %M 30224334 %R 10.2196/jmir.9418 %U http://www.jmir.org/2018/9/e262/ %U https://doi.org/10.2196/jmir.9418 %U http://www.ncbi.nlm.nih.gov/pubmed/30224334 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e172 %T What Predicts Patients’ Adoption Intention Toward mHealth Services in China: Empirical Study %A Deng,Zhaohua %A Hong,Ziying %A Ren,Cong %A Zhang,Wei %A Xiang,Fei %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13016442007, xiangfei@hust.edu.cn %K mHealth service %K perceived risk %K trust %K TAM %K Chinese patients %K mobile phone %D 2018 %7 29.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients’ willingness to use mHealth is considered critical because its success depends on the adoption of patients. Objective: The objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks. Methods: We conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling. Results: The results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients’ trust and adoption intention toward mHealth services. In addition, patients’ age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively. Conclusions: We concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients. %M 30158101 %R 10.2196/mhealth.9316 %U http://mhealth.jmir.org/2018/8/e172/ %U https://doi.org/10.2196/mhealth.9316 %U http://www.ncbi.nlm.nih.gov/pubmed/30158101 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10270 %T mHealth Self-Report Monitoring in Competitive Middle- and Long-Distance Runners: Qualitative Study of Long-Term Use Intentions Using the Technology Acceptance Model %A Rönnby,Sara %A Lundberg,Oscar %A Fagher,Kristina %A Jacobsson,Jenny %A Tillander,Bo %A Gauffin,Håkan %A Hansson,Per-Olof %A Dahlström,Örjan %A Timpka,Toomas %+ Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Hus 511-001, ingång 76, plan 14, Campus US, Linköping, 581 83, Sweden, 46 4705364357, toomas.timpka@liu.se %K running %K mHealth %K health technology %K diagnostic self-evaluation %K remote sensing technology %K self-evaluation programs %K qualitative research %D 2018 %7 13.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: International middle- and long-distance running competitions attract millions of spectators in association with city races, world championships, and Olympic Games. It is therefore a major concern that ill health and pain, as a result of sports overuse, lead to numerous hours of lost training and decreased performance in competitive runners. Despite its potential for sustenance of performance, approval of mHealth self-report monitoring (mHSM) in this group of athletes has not been investigated. Objective: The objective of our study was to explore individual and situational factors associated with the acceptance of long-term mHSM in competitive runners. Methods: The study used qualitative research methods with the Technology Acceptance Model as the theoretical foundation. The study population included 20 middle- and long-distance runners competing at national and international levels. Two mHSM apps asking for health and training data from track and marathon runners were created on a platform for web survey development (Briteback AB). Data collection for the technology acceptance analysis was performed via personal interviews before and after a 6-week monitoring period. Preuse interviews investigated experience and knowledge of mHealth monitoring and thoughts on benefits and possible side effects. The postuse interviews addressed usability and usefulness, attitudes toward nonfunctional issues, and intentions to adhere to long-term monitoring. In addition, the runners’ trustworthiness when providing mHSM data was discussed. The interview data were investigated using a deductive thematic analysis. Results: The mHSM apps were considered technically easy to use. Although the runners read the instructions and entered data effortlessly, some still perceived mHSM as problematic. Concerns were raised about the selection of items for monitoring (eg, recording training load as running distance or time) and about interpretation of concepts (eg, whether subjective well-being should encompass only the running context or daily living on the whole). Usefulness of specific mHSM apps was consequently not appraised on the same bases in different subcategories of runners. Regarding nonfunctional issues, the runners competing at the international level requested detailed control over who in their sports club and national federation should be allowed access to their data; the less competitive runners had no such issues. Notwithstanding, the runners were willing to adhere to long-term mHSM, provided the technology was adjusted to their personal routines and the output was perceived as contributing to running performance. Conclusions: Adoption of mHSM by competitive runners requires clear definitions of monitoring purpose and populations, repeated in practice tests of monitoring items and terminology, and meticulousness regarding data-sharing routines. Further naturalistic studies of mHSM use in routine sports practice settings are needed with nonfunctional ethical and legal issues included in the evaluation designs. %M 30104183 %R 10.2196/10270 %U http://mhealth.jmir.org/2018/8/e10270/ %U https://doi.org/10.2196/10270 %U http://www.ncbi.nlm.nih.gov/pubmed/30104183 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10063 %T A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study %A Grassl,Niklas %A Nees,Juliane %A Schramm,Katharina %A Spratte,Julia %A Sohn,Christof %A Schott,Timm C %A Schott,Sarah %+ Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 56 7901, sarah.schott@med.uni-heidelberg.de %K telemedicine %K obstetrics %K eHealth %K pregnancy monitoring %K job satisfaction %K sleeping problems %K night shift %K emergency consultation %D 2018 %7 08.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The demand for fetal monitoring and constant reassurance is high in pregnant women. Consequently, pregnant women use various health apps and are more likely to visit emergency departments due to subjective but nonurgent complaints. However, electronic health (eHealth) and mobile health (mHealth) solutions are rarely used to prevent nonurgent emergency consultations. To implement modern care solutions, a better understanding of the attitudes, fears, and hopes of health care professionals toward eHealth and mHealth is needed. Objective: The aim of this study was to investigate the attitudes of health care professionals in obstetrics toward telemedicine. Methods: A quantitative Web-based survey on health care professionals in obstetrics in Germany was conducted. The participants included nurses, midwives, and physicians of all age groups and job positions working in hospitals that provide various levels of health care. The questionnaire comprised 24 questions about the characteristics of the study population, views about emergency consultations in obstetrics, attitude toward telemedicine, job satisfaction, and sleeping behavior. Results: In total, 244 health care professionals participated in the Web-based survey. In general, health care professionals were skeptical (170/233, 72.9%) about the use of telemedicine in obstetrics; however, 55.8% (130/233) recognized its potential. Moreover, 72% (62/86) of physicians were optimistic in using apps for pregnancy monitoring, whereas 36.1% (47/130) of nonphysicians (P<.001) were not. Significantly, more nonphysicians rejected such developments (75/130, 57.7% rejected) compared with physicians (24/86, 28%; P<.001). We also found that obstetricians with more than 10 years of work-experience are more skeptical; however, approximately 49% (18/37) of them believed that telemedicine could reduce nonurgent emergency consultations, whereas 73.2% (106/145) of obstetricians with less than 5 years of experience (P=.01) thought otherwise. Our survey revealed a high job satisfaction and a prevalence of regular sleeping problems of 45.9% (91/198) among health care professionals in obstetrics. Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts per month (P=.77 and P=.99, respectively). Yet, 56.6% (112/198) of the survey participants thought they would be happier with their job if they had to work fewer night shifts per month. Conclusions: Our study reveals an ambivalent attitude toward the use of telemedicine among health care professionals in obstetrics in Germany at the moment. Efforts to promote the use of telemedicine should focus on nurses and midwives because these groups are the most skeptical. By contrast, particularly young physicians recognize the potential of apps in patient care and would like to use such technology in pregnancy monitoring. %M 30089606 %R 10.2196/10063 %U http://mhealth.jmir.org/2018/8/e10063/ %U https://doi.org/10.2196/10063 %U http://www.ncbi.nlm.nih.gov/pubmed/30089606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10458 %T Forecasting the Maturation of Electronic Health Record Functions Among US Hospitals: Retrospective Analysis and Predictive Model %A Kharrazi,Hadi %A Gonzalez,Claudia P %A Lowe,Kevin B %A Huerta,Timothy R %A Ford,Eric W %+ Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Office 606, Baltimore, MD, 21205-2103, United States, 1 443 287 8264, kharrazi@jhu.edu %K electronic health records %K United States %K hospitals %K HIMSS EMRAM %K Bass diffusion model %D 2018 %7 07.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Meaningful Use (MU) program has promoted electronic health record adoption among US hospitals. Studies have shown that electronic health record adoption has been slower than desired in certain types of hospitals; but generally, the overall adoption rate has increased among hospitals. However, these studies have neither evaluated the adoption of advanced functionalities of electronic health records (beyond MU) nor forecasted electronic health record maturation over an extended period in a holistic fashion. Additional research is needed to prospectively assess US hospitals’ electronic health record technology adoption and advancement patterns. Objective: This study forecasts the maturation of electronic health record functionality adoption among US hospitals through 2035. Methods: The Healthcare Information and Management Systems Society (HIMSS) Analytics’ Electronic Medical Record Adoption Model (EMRAM) dataset was used to track historic uptakes of various electronic health record functionalities considered critical to improving health care quality and efficiency in hospitals. The Bass model was used to predict the technological diffusion rates for repeated electronic health record adoptions where upgrades undergo rapid technological improvements. The forecast used EMRAM data from 2006 to 2014 to estimate adoption levels to the year 2035. Results: In 2014, over 5400 hospitals completed HIMSS’ annual EMRAM survey (86%+ of total US hospitals). In 2006, the majority of the US hospitals were in EMRAM Stages 0, 1, and 2. By 2014, most hospitals had achieved Stages 3, 4, and 5. The overall technology diffusion model (ie, the Bass model) reached an adjusted R-squared of .91. The final forecast depicted differing trends for each of the EMRAM stages. In 2006, the first year of observation, peaks of Stages 0 and 1 were shown as electronic health record adoption predates HIMSS’ EMRAM. By 2007, Stage 2 reached its peak. Stage 3 reached its full height by 2011, while Stage 4 peaked by 2014. The first three stages created a graph that exhibits the expected “S-curve” for technology diffusion, with inflection point being the peak diffusion rate. This forecast indicates that Stage 5 should peak by 2019 and Stage 6 by 2026. Although this forecast extends to the year 2035, no peak was readily observed for Stage 7. Overall, most hospitals will achieve Stages 5, 6, or 7 of EMRAM by 2020; however, a considerable number of hospitals will not achieve Stage 7 by 2035. Conclusions: We forecasted the adoption of electronic health record capabilities from a paper-based environment (Stage 0) to an environment where only electronic information is used to document and direct care delivery (Stage 7). According to our forecasts, the majority of hospitals will not reach Stage 7 until 2035, absent major policy changes or leaps in technological capabilities. These results indicate that US hospitals are decades away from fully implementing sophisticated decision support applications and interoperability functionalities in electronic health records as defined by EMRAM’s Stage 7. %M 30087090 %R 10.2196/10458 %U http://www.jmir.org/2018/8/e10458/ %U https://doi.org/10.2196/10458 %U http://www.ncbi.nlm.nih.gov/pubmed/30087090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e162 %T Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study %A Tilahun,Binyam %A Smillie,Kirsten %A Bardosh,Kevin Louis %A Murray,Melanie %A Fitzgerald,Mark %A Cook,Victoria %A Poureslami,Iraj %A Forrest,Jamie %A Lester,Richard %+ Division of Infectious Disease, Faculty of Medicine, University of British Columbia, 10th Avenue West, Vancouver, BC, V5Z0C1, Canada, 1 604 875 4588, tilahunb@mail.ubc.ca %K mobile health %K mHealth %K text messaging %K digital health %K implementation science %K Africa %K North America %D 2018 %7 03.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although many mHealth interventions have shown efficacy in research, few have been effectively implemented and sustained in real-world health system settings. Despite this programmatic gap, there is limited conclusive evidence identifying the factors that affect the implementation and successful integration of mHealth into a health system. Objective: The aim of this study is to examine the individual, organizational, and external level factors associated with the effective implementation of WelTel, an mHealth intervention designed to support outpatient medication adherence and engagement in care in Africa and North America. Methods: We will adopt the Consolidated Framework for Implementation Research (CFIR) constructs for evaluation of mHealth implementation including a scoring and monitoring system. We will apply the adapted tool to identify facilitators and barriers to implementation of the WelTel mHealth intervention in order to determine how the technology platform is perceived, diffused, adapted, and used by different mHealth project teams and health system actors in Africa and North America. We will use a mixed-methods approach to quantitatively test whether the factors identified in the CFIR framework are associated with the successful uptake of the mHealth intervention toward implementation goals. We will triangulate these data through interviews and focus group discussion with project stakeholders, exploring factors associated with successful implementation and sustainment of these interventions. Results: The development of the customized CFIR is finalized and currently is in pilot testing. The initial results of the use of the tool in those 13 implementations will be available in 2019. Continuous conference and peer- reviewed publications will be published in the coming years. Conclusions: The results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of mHealth in different health systems and geographic contexts over time. Via the tool’s unique scoring system connected to qualitative descriptors, these data will inform the most critical implementation targets and contribute to the tailoring of strategies that will assist the health system in overcoming barriers to implementation, and ultimately, improve treatment adherence and engagement in care. Registered Report Identifier: RR1-10.2196/9633 %M 29970360 %R 10.2196/resprot.9633 %U http://www.researchprotocols.org/2018/7/e162/ %U https://doi.org/10.2196/resprot.9633 %U http://www.ncbi.nlm.nih.gov/pubmed/29970360 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e38 %T Nurses’ Experience With Health Information Technology: Longitudinal Qualitative Study %A Zadvinskis,Inga M %A Garvey Smith,Jessica %A Yen,Po-Yin %+ Institute for Informatics, Department of Medicine, Washington University, 4444 Forest Park Avenue, Suite 6318, St Louis, MO, 63108-2212, United States, 1 3142732313, yenp@wustl.edu %K health IT %K electronic health record %K barcode medication administration %K qualitative research %K adaptation %D 2018 %7 26.06.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Nurses are the largest group of health information technology (HIT) users. As such, nurses’ adaptations are critical for HIT implementation success. However, longitudinal approaches to understanding nurses’ perceptions of HIT remain underexplored. Previous studies of nurses’ perceptions demonstrate that the progress and timing for acceptance of and adaptation to HIT varies. Objective: This study aimed to explore nurses’ experience regarding implementation of HIT over time. Methods: A phenomenological approach was used for this longitudinal qualitative study to explore nurses’ perceptions of HIT implementation over time, focusing on three time points (rounds) at 3, 9, and 18 months after implementation of electronic health records and bar code medication administration. The purposive sample was comprised of clinical nurses who worked on a medical-surgical unit in an academic center. Results: Major findings were categorized into 7 main themes with 54 subthemes. Nurses reported personal-level and organizational-level factors that facilitated HIT adaptation. We also generated network graphs to illustrate the occurrence of themes. Thematic interconnectivity differed due to nurses’ concerns and satisfaction at different time points. Equipment and workflow were the most frequent themes across all three rounds. Nurses were the most dissatisfied approximately 9 months after HIT implementation. Eighteen months after HIT implementation, nurses’ perceptions appeared more balanced. Conclusions: It is recommended that organizations invest in equipment (ie, wireless barcode scanners), refine policies to reflect nursing practice, and improve systems to focus on patient safety. Future research is necessary to confirm patterns of nurses’ adaptation to HIT in other samples. %M 29945862 %R 10.2196/medinform.8734 %U http://medinform.jmir.org/2018/2/e38/ %U https://doi.org/10.2196/medinform.8734 %U http://www.ncbi.nlm.nih.gov/pubmed/29945862 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10762 %T Patient Acceptance of Remote Scribing Powered by Google Glass in Outpatient Dermatology: Cross-Sectional Study %A Odenheimer,Sandra %A Goyal,Deepika %A Jones,Veena Goel %A Rosenblum,Ruth %A Ho,Lam %A Chan,Albert S %+ Palo Alto Medical Foundation, 401 Old San Francisco Road, Sunnyvale, CA, 94086, United States, 1 4086214196, odenhes@pamf.org %K acceptance, clinician burnout, communication, Google Glass, health care provider, patient, remote scribing, trust %D 2018 %7 21.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The ubiquitous use of electronic health records (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and can disrupt patient-health care provider (HCP) nonverbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted technology (FMT), such as Google Glass, may preserve patient-HCP communication dynamics in health care settings by allowing providers to maintain direct eye contact with their patients while still having access to the patient’s relevant EHR information. The medical scribe is able to chart patient encounters in real-time working in an offsite location, document the visit directly into EHR, and free HCP to focus only on the patient. Objective: The purpose of this study was to examine patient perceptions of their interactions with an HCP who used FMT with a remote medical scribe during office visits. This includes an examination of any association between patient privacy and trust in their HCP when FMT is used in the medical office setting. Methods: For this descriptive, cross-sectional study, a convenience sample of patients was recruited from an outpatient dermatology clinic in Northern California. Participants provided demographic data and completed a 12-item questionnaire to assess their familiarity, comfort, privacy, and perceptions following routine office visits with an HCP where FMT was used to document the clinical encounter. Data were analyzed using appropriate descriptive and inferential statistics. Results: Over half of the 170 study participants were female (102/170, 59.4%), 60.0% were Caucasian (102/170), 24.1% were Asian (41/170), and 88.8% were college-educated (151/170). Age ranged between 18 and 90 years (mean 50.5, SD 17.4). The majority of participants (118/170, 69.4%) were familiar with FMT, not concerned with privacy issues (132/170, 77.6%), and stated that the use of FMT did not affect their trust in their HCP (139/170, 81.8%). Moreover, participants comfortable with the use of FMT were less likely to be concerned about privacy (P<.001) and participants who trusted their HCP were less likely to be concerned about their HCP using Google Glass (P<.009). Almost one-third of them self-identified as early technology adopters (49/170, 28.8%) and 87% (148/170) preferred their HCP using FMT if it delivered better care. Conclusions: Our study findings support the patient acceptance of Google Glass use for outpatient dermatology visits. Future research should explore the use of FMT in other areas of health care and strive to include a socioeconomically diverse patient population in study samples. %M 29929947 %R 10.2196/10762 %U http://www.jmir.org/2018/6/e10762/ %U https://doi.org/10.2196/10762 %U http://www.ncbi.nlm.nih.gov/pubmed/29929947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10474 %T Understanding the Acceptance of an eHealth Technology in the Early Stages of Development: An End-User Walkthrough Approach and Two Case Studies %A van Velsen,Lex %A Evers,Mirka %A Bara,Cristian-Dan %A Op den Akker,Harm %A Boerema,Simone %A Hermens,Hermie %+ Telemedicine Cluster, Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede,, Netherlands, 31 0880875777, l.vanvelsen@rrd.nl %K eHealth %K acceptance %K design %K walkthrough %K agile design %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Studies that focus on the acceptance of an electronic health (eHealth) technology generally make use of surveys. However, results of such studies hold little value for a redesign, as they focus only on quantifying end-user appreciation of general factors (eg, perceived usefulness). Objective: We present a method for understanding end-user acceptance of an eHealth technology, early in the development process: The eHealth End-User Walkthrough. Methods: During a walkthrough, a participant is guided by using the technology via a scenario, a persona, and a low-fidelity protoype. A participant is questioned about factors that may affect acceptance during and after the demonstration. We show the value of the method via two case studies. Results: During the case studies, participants commented on whether they intend to use a technology and why they would (not) use its main features. They also provided redesign advice or input for additional functions. Finally, the sessions provide guidance for the generation of business models and implementation plans. Conclusions: The eHealth End-User Walkthrough can aid design teams in understanding the acceptance of their eHealth application in a very early stage of the design process. Consequently, it can prevent a mismatch between technology and end-users’ needs, wishes and context. %M 30684434 %R 10.2196/10474 %U http://formative.jmir.org/2018/1/e10474/ %U https://doi.org/10.2196/10474 %U http://www.ncbi.nlm.nih.gov/pubmed/30684434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e167 %T Online Lifestyle Modification Intervention: Survey of Primary Care Providers’ Attitudes and Views %A Hanna,Reem M %A Fischer,Gary %A Conroy,Molly B %A Bryce,Cindy %A Hess,Rachel %A McTigue,Kathleen %+ Division of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, United States, 1 412 692 4843, kmm34@pitt.edu %K online intervention %K obesity %K health information technology %K referral model %D 2018 %7 08.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians’ perspectives and utilization of the referral model for an online lifestyle modification intervention. Objective: The aim was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. Methods: The PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the 1-year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the 1-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record referral processes. Attitudes toward obesity counseling among referring and nonreferring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Results: Of the 67 providers who completed the surveys, nonreferring providers (n=17) were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03) than referring providers (n=50) were. Nonreferring providers were more likely to report that their patients lacked computer skills (76%, 13/17 vs 34%, 17/50) or had less access to the Internet (65%, 11/17 vs 32%, 16/50). Conclusions: Understanding providers’ views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention. %M 29884605 %R 10.2196/jmir.8616 %U http://www.jmir.org/2018/6/e167/ %U https://doi.org/10.2196/jmir.8616 %U http://www.ncbi.nlm.nih.gov/pubmed/29884605 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e35 %T Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study %A Bashir,Ayisha %A Bastola,Dhundy R %+ Department of Clinical and Translational Science, Creighton University, 2500 California Plaza, Omaha, NE, 68178, United States, 1 4027407394, abashir@unomaha.edu %K telehealth %K survey %K telemedicine %K telenursing %D 2018 %7 25.05.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. Objective: The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Methods: Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. Results: The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. Conclusions: The responses to the interview questions and data gathered from the survey showed overall satisfaction with TNSQ. The SERVQUAL instrument was a good framework to assess TNSQ. In a nutshell, the study highlighted how the telehealth process provides daily monitoring of patient health, leading to the benefits of immediate feedback for patients, family, and caregivers as well as convenience of scheduling. %M 29802089 %R 10.2196/medinform.9080 %U http://medinform.jmir.org/2018/2/e35/ %U https://doi.org/10.2196/medinform.9080 %U http://www.ncbi.nlm.nih.gov/pubmed/29802089 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e183 %T Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study. %A Kooij,Laura %A Groen,Wim G %A van Harten,Wim H %+ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, Netherlands, 31 205122861, w.v.harten@nki.nl %K patient portals %K health information technology %K attitude of health personnel %D 2018 %7 11.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. Objective: The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Methods: Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. Results: In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators’ perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects’ positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security (eg, strict regulations). Both similarities and differences were found between stakeholder groups and hospital types. For example, managers and information technology employees mainly considered guaranteeing privacy and security as a predominant barrier. Financial difficulties were particularly mentioned by medical professionals and managers. Conclusions: Patient portal implementation is a complex process and is not only a technical process but also affects the organization and its staff. Barriers and facilitators occurred at various levels and differed among hospital types (eg, lack of accessibility) and stakeholder groups (eg, sufficient resources) in terms of several factors. Our findings underscore the importance of involving multiple stakeholders in portal implementations. We identified a set of barriers and facilitators that are likely to be useful in making strategic and efficient implementation plans. %M 29752253 %R 10.2196/jmir.8989 %U http://www.jmir.org/2018/5/e183/ %U https://doi.org/10.2196/jmir.8989 %U http://www.ncbi.nlm.nih.gov/pubmed/29752253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e10235 %T Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature %A Granja,Conceição %A Janssen,Wouter %A Johansen,Monika Alise %+ Future Journal, Norwegian Centre for E-health Research, PO Box 35, Tromsø, N-9038 Tromsø, Norway, 47 90817344, conceicao.granja@ehealthresearch.no %K telemedicine %K eHealth %K medical informatics %K systematic review %K success %K failure %D 2018 %7 01.05.2018 %9 Review %J J Med Internet Res %G English %X Background: eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Objective: Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. Methods: We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Results: Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). Conclusions: The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved. %M 29716883 %R 10.2196/10235 %U http://www.jmir.org/2018/5/e10235/ %U https://doi.org/10.2196/10235 %U http://www.ncbi.nlm.nih.gov/pubmed/29716883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e153 %T Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model %A Feijt,Milou A %A de Kort,Yvonne AW %A Bongers,Inge MB %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, IPO Building, 2nd Floor, P.O. Box 513, Eindhoven, 5600 MB, Netherlands, 31 40 247 5391, m.a.feijt@tue.nl %K eHealth %K mental health %K psychology, clinical %K diffusion of innovation %K technology %D 2018 %7 24.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. Objective: The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. Methods: The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. Results: In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. Conclusions: The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options. %M 29691215 %R 10.2196/jmir.9485 %U http://www.jmir.org/2018/4/e153/ %U https://doi.org/10.2196/jmir.9485 %U http://www.ncbi.nlm.nih.gov/pubmed/29691215 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e24 %T Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis %A Khairat,Saif %A Marc,David %A Crosby,William %A Al Sanousi,Ali %+ Carolina Health Informatics Program, University of North Carolina at Chapel Hill, 428 Carrington Hall, Chapel Hill, NC, 27514, United States, 1 9198435413, saif@unc.edu %K decision support systems, clinical %K decision making, computer-assisted %K attitude to computers %D 2018 %7 18.04.2018 %9 Review %J JMIR Med Inform %G English %X Background: Clinical decision support systems (CDSSs) are an integral component of today’s health information technologies. They assist with interpretation, diagnosis, and treatment. A CDSS can be embedded throughout the patient safety continuum providing reminders, recommendations, and alerts to health care providers. Although CDSSs have been shown to reduce medical errors and improve patient outcomes, they have fallen short of their full potential. User acceptance has been identified as one of the potential reasons for this shortfall. Objective: The purpose of this paper was to conduct a critical review and task analysis of CDSS research and to develop a new framework for CDSS design in order to achieve user acceptance. Methods: A critical review of CDSS papers was conducted with a focus on user acceptance. To gain a greater understanding of the problems associated with CDSS acceptance, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives: the machine (ie, the CDSS engine) and the user (ie, the physician). Results: Favorability of CDSSs was based on user acceptance of clinical guidelines, reminders, alerts, and diagnostic suggestions. We propose two models: (1) the user acceptance and system adaptation design model, which includes optimizing CDSS design based on user needs/expectations, and (2) the input-process-output-engagemodel, which reveals to users the processes that govern CDSS outputs. Conclusions: This research demonstrates that the incorporation of the proposed models will improve user acceptance to support the beneficial effects of CDSSs adoption. Ultimately, if a user does not accept technology, this not only poses a threat to the use of the technology but can also pose a threat to the health and well-being of patients. %M 29669706 %R 10.2196/medinform.8912 %U http://medinform.jmir.org/2018/2/e24/ %U https://doi.org/10.2196/medinform.8912 %U http://www.ncbi.nlm.nih.gov/pubmed/29669706 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e15 %T Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial %A Celler,Branko %A Argha,Ahmadreza %A Varnfield,Marlien %A Jayasena,Rajiv %+ Biomedical Systems Research Laboratory, University of New South Wales, Building G7, Anzac Parade, Sydney, New South Wales,, Australia, 61 2 9385 0746, b.celler@unsw.edu.au %K patient compliance %K vital signs %K telehealth %K telemonitoring %K clinical trial %K chronic disease %D 2018 %7 09.04.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start. Higher adherence rates have been reported for simple types of monitoring and for shorter periods of intervention. If patients do not follow the intended procedure, poorer results than expected may be achieved. Hence, analyzing factors that can influence patient adherence is of great importance. Objective: The goal of the research was to present findings on patient adherence with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organisation (CSIRO) national trial of home telemonitoring of patients (mean age 70.5 years, SD 9.3 years) with chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) carried out at 5 locations along the east coast of Australia. We investigated the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan over periods exceeding 6 months (302 days, SD 135 days) and explored different levels of adherence for different measurements as a function of age, gender, and supervisory models. Methods: In this study, 113 patients forming the test arm of a Before and After Control Intervention (BACI) home telemonitoring trial were analyzed. Patients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and comorbidities. Vital signs included noninvasive blood pressure, pulse oximetry, spirometry, electrocardiogram (ECG), blood glucose level, body temperature, and body weight. Adherence was calculated as the number of days during which at least 1 measurement was taken over all days where measurements were scheduled. Different levels of adherence for different measurements, as a function of age, gender, and supervisory models, were analyzed using linear regression and analysis of covariance for a period of 1 year after the intervention. Results: Patients were monitored on average for 302 (SD 135) days, although some continued beyond 12 months. The overall adherence rate for all measurements was 64.1% (range 59.4% to 68.8%). The adherence rates of patients monitored in hospital settings relative to those monitored in community settings were significantly higher for spirometry (69.3%, range 60.4% to 78.2%, versus 41.0%, range 33.1% to 49.0%, P<.001), body weight (64.5%, range 55.7% to 73.2%, versus 40.5%, range 32.3% to 48.7%, P<.001), and body temperature (66.8%, range 59.7% to 73.9%, versus 55.2%, range 48.4% to 61.9%, P=.03). Adherence with blood glucose measurements (58.1%, range 46.7% to 69.5%, versus 50.2%, range 42.8% to 57.6%, P=.24) was not significantly different overall. Adherence rates for blood pressure (68.5%, range 62.7% to 74.2%, versus 59.7%, range 52.1% to 67.3%, P=.04), ECG (65.6%, range 59.7% to 71.5%, versus 56.5%, range 48.7% to 64.4%, P=.047), and pulse oximetry (67.0%, range 61.4% to 72.7%, versus 56.4%, range 48.6% to 64.1%, P=.02) were significantly higher in males relative to female subjects. No statistical differences were observed between rates of adherence for the younger patient group (70 years and younger) and older patient group (older than 70 years). Conclusions: Patients with chronic conditions enrolled in the home telemonitoring trial were able to record their vital signs at home at least once every 2 days over prolonged periods of time. Male patients maintained a higher adherence than female patients over time, and patients supervised by hospital-based care coordinators reported higher levels of adherence with their measurement schedule relative to patients supervised in community settings. This was most noticeable for spirometry. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/6xPOU3DpR). %M 29631991 %R 10.2196/medinform.9200 %U http://medinform.jmir.org/2018/2/e15/ %U https://doi.org/10.2196/medinform.9200 %U http://www.ncbi.nlm.nih.gov/pubmed/29631991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e83 %T Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care %A Swinkels,Ilse Catharina Sophia %A Huygens,Martine Wilhelmina Johanna %A Schoenmakers,Tim M %A Oude Nijeweme-D'Hollosy,Wendy %A van Velsen,Lex %A Vermeulen,Joan %A Schoone-Harmsen,Marian %A Jansen,Yvonne JFM %A van Schayck,Onno CP %A Friele,Roland %A de Witte,Luc %+ Netherlands Institute for Health Services Research, PO Box 1568, Utrecht, 3500 BN, Netherlands, 31 302729771, i.swinkels@nivel.nl %K telemedicine %K primary health care %K implementation %K patient involvement %K entrepreneurship %K health personnel %K policy makers %D 2018 %7 29.03.2018 %9 Viewpoint %J J Med Internet Res %G English %X Background: Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective: This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods: Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results: The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. Conclusions: For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced. %M 29599108 %R 10.2196/jmir.9110 %U http://www.jmir.org/2018/3/e83/ %U https://doi.org/10.2196/jmir.9110 %U http://www.ncbi.nlm.nih.gov/pubmed/29599108 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e1 %T Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability %A Levesque,Deborah %A Umanzor,Cindy %A de Aguiar,Emma %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 401 360 2975, dlevesque@prochange.com %K pilot projects %K substance use disorders %K primary care %K behavioral medicine %K expert system %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients. Objective: The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions. Methods: A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items. Results: For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5). Conclusions: The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients. %M 29295811 %R 10.2196/medinform.7355 %U http://medinform.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/medinform.7355 %U http://www.ncbi.nlm.nih.gov/pubmed/29295811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e429 %T Consumer Adoption of Future MyData-Based Preventive eHealth Services: An Acceptance Model and Survey Study %A Koivumäki,Timo %A Pekkarinen,Saara %A Lappi,Minna %A Väisänen,Jere %A Juntunen,Jouni %A Pikkarainen,Minna %+ Martti Ahtisaari Institute, Oulu Business School, University of Oulu, PO Box 4600, Oulu, 90014, Finland, 358 40 5073631, timo.koivumaki@oulu.fi %K health behavior %K consumer behavior %K eHealth %K surveys and questionnaires %K personal health record %K patient-accessible health record %K adoption %K UTAUT %K PHR %D 2017 %7 22.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Constantly increasing health care costs have led countries and health care providers to the point where health care systems must be reinvented. Consequently, electronic health (eHealth) has recently received a great deal of attention in social sciences in the domain of Internet studies. However, only a fraction of these studies focuses on the acceptability of eHealth, making consumers’ subjective evaluation an understudied field. This study will address this gap by focusing on the acceptance of MyData-based preventive eHealth services from the consumer point of view. We are adopting the term "MyData", which according to a White Paper of the Finnish Ministry of Transport and Communication refers to "1) a new approach, a paradigm shift in personal data management and processing that seeks to transform the current organization centric system to a human centric system, 2) to personal data as a resource that the individual can access and control." Objective: The aim of this study was to investigate what factors influence consumers’ intentions to use a MyData-based preventive eHealth service before use. Methods: We applied a new adoption model combining Venkatesh’s unified theory of acceptance and use of technology 2 (UTAUT2) in a consumer context and three constructs from health behavior theories, namely threat appraisals, self-efficacy, and perceived barriers. To test the research model, we applied structural equation modeling (SEM) with Mplus software, version 7.4. A Web-based survey was administered. We collected 855 responses. Results: We first applied traditional SEM for the research model, which was not statistically significant. We then tested for possible heterogeneity in the data by running a mixture analysis. We found that heterogeneity was not the cause for the poor performance of the research model. Thus, we moved on to model-generating SEM and ended up with a statistically significant empirical model (root mean square error of approximation [RMSEA] 0.051, Tucker-Lewis index [TLI] 0.906, comparative fit index [CFI] 0.915, and standardized root mean square residual 0.062). According to our empirical model, the statistically significant drivers for behavioral intention were effort expectancy (beta=.191, P<.001), self-efficacy (beta=.449, P<.001), threat appraisals (beta=.416, P<.001), and perceived barriers (beta=−.212, P=.009). Conclusions: Our research highlighted the importance of health-related factors when it comes to eHealth technology adoption in the consumer context. Emphasis should especially be placed on efforts to increase consumers’ self-efficacy in eHealth technology use and in supporting healthy behavior. %M 29273574 %R 10.2196/jmir.7821 %U http://www.jmir.org/2017/12/e429/ %U https://doi.org/10.2196/jmir.7821 %U http://www.ncbi.nlm.nih.gov/pubmed/29273574 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e31 %T Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study %A Lau,Annie YS %A Piper,Kalman %A Bokor,Desmond %A Martin,Paige %A Lau,Victor SL %A Coiera,Enrico %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6/75 Talavera Rd Macquarie Park, Sydney, 2109, Australia, 61 431599890, annie.lau@mq.edu.au %K mobile application %K mobile health %K personal health record %K patients %K health services %K medical informatics %K surgery %K orthopedics %K shoulder %K rotator cuff %K rehabilitation %D 2017 %7 07.12.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective: The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians. %M 29217504 %R 10.2196/humanfactors.8096 %U http://humanfactors.jmir.org/2017/4/e31/ %U https://doi.org/10.2196/humanfactors.8096 %U http://www.ncbi.nlm.nih.gov/pubmed/29217504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e402 %T Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence %A Sieverink,Floor %A Kelders,Saskia M %A van Gemert-Pijnen,Julia EWC %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, Netherlands, 31 534896631, f.sieverink@utwente.nl %K adherence %K eHealth %K systematic review %D 2017 %7 06.12.2017 %9 Review %J J Med Internet Res %G English %X Background: In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. Objective: The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. Methods: A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. Results: In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as “the more use, the better,” whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. Conclusions: The results of this review showed that to date, justifications for intended use are often missing in evaluations of adherence. Evidently, it is not always possible to estimate the intended use of a technology. However, such measures do not meet the definition of adherence and should therefore be referred to as the actual usage of the technology. Therefore, it can be concluded that adherence to eHealth technology is an underdeveloped and often improperly used concept in the existing body of literature. When defining the intended use of a technology and selecting valid measures for adherence, the goal or the assumed working mechanisms should be leading. Adherence can then be standardized, which will improve the comparison of adherence rates to different technologies with the same goal and will provide insight into how adherence to different elements contributed to the outcomes. %M 29212630 %R 10.2196/jmir.8578 %U http://www.jmir.org/2017/12/e402/ %U https://doi.org/10.2196/jmir.8578 %U http://www.ncbi.nlm.nih.gov/pubmed/29212630 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e177 %T Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test %A Dou,Kaili %A Yu,Ping %A Deng,Ning %A Liu,Fang %A Guan,YingPing %A Li,Zhenye %A Ji,Yumeng %A Du,Ningkai %A Lu,Xudong %A Duan,Huilong %+ The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Zhejiang University, Yuquan Campus, Hangzhou, 310027, China, 86 571 2295 2693, zju.dengning@gmail.com %K smartphone %K mobile health %K patients %K hypertension %K chronic disease %K disease management %D 2017 %7 06.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients’ acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients’ actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results: The model accounted for .412 of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. Age and gender had no significant influence on patients’ acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions: This study developed a theoretical model to predict patients’ acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients’ awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. %M 29212629 %R 10.2196/mhealth.7886 %U https://mhealth.jmir.org/2017/12/e177/ %U https://doi.org/10.2196/mhealth.7886 %U http://www.ncbi.nlm.nih.gov/pubmed/29212629 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e374 %T Understanding Older Adult's Technology Adoption and Withdrawal for Elderly Care and Education: Mixed Method Analysis from National Survey %A Chiu,Ching-Ju %A Liu,Chia-Wen %+ Institute of Gerontology, College of Medicine, National Cheng Kung University, No 1, University Road, Tainan, 70101, Taiwan, 886 62353535 ext 5739, cjchiu@mail.ncku.edu.tw %K Internet adoption %K Internet withdrawal %K digital opportunity %K information literacy %K middle-aged and older adults %K Taiwan %D 2017 %7 03.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Elderly adults have comprised the fastest growing population adopting the Internet and computer technology over the past decade. However, how their experiences can shed light on elderly learning theory has not been examined much in the literature. Objective: This study investigated the factors and reasons associated with Internet adoption and withdrawal among older adults in Taiwan, and if any gender differences exist in this context. Methods: Data on participants aged 50 years and older from the nationally representative “Digital Opportunity Survey on Individuals and Households in Taiwan,” who did not use the Internet in 2005 but adopted it in 2007 (n=1548), and those who reported using Internet in 2011 but then withdrew (n=1575), were analyzed. Factors and reasons associated with Internet adoption and withdrawal were examined using both quantitative and qualitative data. Results: Education level independently predicted Internet adoption behavior. With regard to the reasons for adoption, 66% (62/94) of participants indicated they started using the Internet to meet certain “needs”; for example, “keeping up with the world” (40.4%, 38/94) was listed as the most critical reason, followed by “job needs” (25.5%, 24/94). Older adults with a positive attitude toward the Internet with regard to increasing employment opportunities (OR 2.0, 95% CI 1.0-3.9, P=.04) and the amount of information obtained (OR 0.5, 95% CI 0.3-0.9, P=.01), as well as enriching recreation and entertainment (OR 0.6, 95% CI 0.4-0.9, P=.02), were less likely to withdraw from the Internet. The most common reason for Internet withdrawal was “psychological barriers” (eg, no available time, no meaningful use, or nothing worth reading/watching; 66.3%, 193/291), followed by “health barriers” (eg, eyes or body deteriorate with Internet use; 21.0%, 61/291). Although psychological barriers were the most important factor for Internet withdrawal for both men (72.5%, 100/138) and women (62%, 93/150), women were more likely than men to be affected by health barriers (26.0%, 39/150 vs 15.9%, 22/138; P=.004) and anthropic factors or accidental barriers (7.3%, 11/150 vs 2.9%, 4/138; P=.02). Conclusions: Our findings that the need to keep up with the world associated with Internet adoption, and gender differences in reasons behind Internet withdrawal, such that women reported more health and anthropic factors or accidental barriers than man, may provide a new perspective that help health educators understand strategies that encourage older adults to keep learning, an important component of active aging. %M 29101093 %R 10.2196/jmir.7401 %U http://www.jmir.org/2017/11/e374/ %U https://doi.org/10.2196/jmir.7401 %U http://www.ncbi.nlm.nih.gov/pubmed/29101093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e367 %T Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies %A Greenhalgh,Trisha %A Wherton,Joseph %A Papoutsi,Chrysanthi %A Lynch,Jennifer %A Hughes,Gemma %A A'Court,Christine %A Hinder,Susan %A Fahy,Nick %A Procter,Rob %A Shaw,Sara %+ Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865 289294, trish.greenhalgh@phc.ox.ac.uk %K diffusion of innovation %K scale-up %K program sustainability %K implementation %K complexity of innovations %K business planning %K NASSS framework %K nonadoption, abandonment, scale-up, spread, sustainability framework %K innovation adoption %D 2017 %7 01.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Objective: Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. Methods: The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. Results: The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. Conclusions: Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures. %M 29092808 %R 10.2196/jmir.8775 %U http://www.jmir.org/2017/11/e367/ %U https://doi.org/10.2196/jmir.8775 %U http://www.ncbi.nlm.nih.gov/pubmed/29092808 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e38 %T Patient Portal Use and Experience Among Older Adults: Systematic Review %A Sakaguchi-Tang,Dawn K %A Bosold,Alyssa L %A Choi,Yong K %A Turner,Anne M %+ Department of Human Centered Design and Engineering, College of Engineering, University of Washington, 3960 Benton Lane NE, 428 Sieg Hall, Seattle, WA, 98195, United States, 1 206 543 2567, dawnsaka@uw.edu %K aged %K patient portals %K personal health records %K utilization %K usability %K user experience %D 2017 %7 16.10.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: The older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults. Objective: The aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults’ use and adoption of patient portals and ePHRs. Methods: We searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption. Results: We retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults’ experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips. Conclusions: More research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process. %M 29038093 %R 10.2196/medinform.8092 %U http://medinform.jmir.org/2017/4/e38/ %U https://doi.org/10.2196/medinform.8092 %U http://www.ncbi.nlm.nih.gov/pubmed/29038093 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e37 %T Characteristics of Innovators Adopting a National Personal Health Record in Portugal: Cross-Sectional Study %A Laranjo,Liliana %A Rodolfo,Inês %A Pereira,Ana Marta %A de Sá,Armando Brito %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera road, Sydney, 2113, Australia, 61 98502426, liliana.laranjo@gmail.com %K personal health records %K diffusion of innovation %K digital divide %K patient participation %K geographic information systems %D 2017 %7 11.10.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Personal health records (PHRs) are increasingly being deployed worldwide, but their rates of adoption by patients vary widely across countries and health systems. Five main categories of adopters are usually considered when evaluating the diffusion of innovations: innovators, early adopters, early majority, late majority, and laggards. Objective: We aimed to evaluate adoption of the Portuguese PHR 3 months after its release, as well as characterize the individuals who registered and used the system during that period (the innovators). Methods: We conducted a cross-sectional study. Users and nonusers were defined based on their input, or not, of health-related information into the PHR. Users of the PHR were compared with nonusers regarding demographic and clinical variables. Users were further characterized according to their intensity of information input: single input (one single piece of health-related information recorded) and multiple inputs. Multivariate logistic regression was used to model the probability of being in the multiple inputs group. ArcGis (ESRI, Redlands, CA, USA) was used to create maps of the proportion of PHR registrations by region and district. Results: The number of registered individuals was 109,619 (66,408/109,619, 60.58% women; mean age: 44.7 years, standard deviation [SD] 18.1 years). The highest proportion of registrations was observed for those aged between 30 and 39 years (25,810/109,619, 23.55%). Furthermore, 16.88% (18,504/109,619) of registered individuals were considered users and 83.12% (91,115/109,619) nonusers. Among PHR users, 32.18% (5955/18,504) engaged in single input and 67.82% (12,549/18,504) in multiple inputs. Younger individuals and male users had higher odds of engaging in multiple inputs (odds ratio for male individuals 1.32, CI 1.19-1.48). Geographic analysis revealed higher proportions of PHR adoption in urban centers when compared with rural noncoastal districts. Conclusions: Approximately 1% of the country’s population registered during the first 3 months of the Portuguese PHR. Registered individuals were more frequently female aged between 30 and 39 years. There is evidence of a geographic gap in the adoption of the Portuguese PHR, with higher proportions of adopters in urban centers than in rural noncoastal districts. %M 29021125 %R 10.2196/medinform.7887 %U http://medinform.jmir.org/2017/4/e37/ %U https://doi.org/10.2196/medinform.7887 %U http://www.ncbi.nlm.nih.gov/pubmed/29021125 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e24 %T Lack of Adoption of a Mobile App to Support Patient Self-Management of Diabetes and Hypertension in a Federally Qualified Health Center: Interview Analysis of Staff and Patients in a Failed Randomized Trial %A Thies,Kathleen %A Anderson,Daren %A Cramer,Benjamin %+ Community Health Center, Inc., Weitzman Institute, 631 Main St, Middletown, CT, 06457, United States, 1 603 661 9113, thiesk@chc1.com %K telehealth %K mobile health %K mHealth %K underserved patients %K HIT %K usability %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Thousands of mobile health (mHealth) apps have been developed to support patients’ management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers’ adoption of these technologies. Objective: The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) with uncontrolled diabetes and/or hypertension. Patients entered clinical data into the app, which also supported messaging between patients and providers. After a 4-month period of vigorous recruitment, the trial was suspended due to low enrollment and inconsistent use of the app by enrolled patients. The project aim was changed to understanding why the trial was unsuccessful. Methods: We used the user-task-context (eUTC) usability framework to develop a set of interview questions for patients and staff who were involved in the trial. All interviews were done by phone and lasted 20 to 30 minutes. Interviews were not recorded. Results: There was a poor fit between the app, end users, and recruitment and treatment approaches in our setting. Usability testing might have revealed this prior to launch but was not an option. There was not sufficient time during routine care for clinical staff to familiarize patients with the app or to check clinical data and messages, which are unreimbursed activities. Some patients did not use the app appropriately. The lack of integration with the electronic health record (EHR) was cited as a problem for both patients and staff who also said the app was just one more thing to attend to. Conclusions: This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users’ electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies. %M 28974481 %R 10.2196/humanfactors.7709 %U https://humanfactors.jmir.org/2017/4/e24/ %U https://doi.org/10.2196/humanfactors.7709 %U http://www.ncbi.nlm.nih.gov/pubmed/28974481 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 3 %P e31 %T System-Wide Inpatient Portal
 Implementation: Survey of Health Care Team Perceptions %A Hefner,Jennifer L %A Sieck,Cynthia J %A Walker,Daniel M %A Huerta,Timothy R %A McAlearney,Ann Scheck %+ Department of Family Medicine, The College of Medicine, The Ohio State University, 2231 N. High St, Columbus, OH, 43201, United States, 1 6146856322, Jennifer.Hefner@osumc.edu %K patient portals %K hospitalization %K medical informatics %K patient participation %D 2017 %7 14.09.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Inpatient portals, a new type of patient portal tailored specifically to the hospital setting, can allow patients to access up-to-date health information and exchange secure communications with their care team. As such, inpatient portals present an opportunity for patients to increase engagement in their care during a time of acute crisis that emphasizes focus on a patient’s health. While there is a large body of research on patient portals in the outpatient setting, questions are being raised specifically about inpatient portals, such as how they will be incorporated into the flow of patient care in hectic, stressed, team-based hospital settings. Objective: Our aim is to improve understanding about hospital care team members’ perceptions of the value of an interactive patient portal for admitted patients, as well as to ascertain staff orientation toward this new technology. Methods: Throughout the course of 2016, an inpatient portal, MyChart Bedside (MCB) was implemented across a five-hospital health system. The portal is a tablet-based app that includes a daily schedule, lab/test results, secure messaging with the care team, a place to take notes, and access to educational materials. Within a month of initial rollout, hospital care team members completed a 5-minute, anonymous online survey to assess attitudes and perceptions about MCB use and staff training for the new technology. Results: Throughout the health system, 686 staff members completed the survey: 193 physicians (23.6%), 439 nurses (53.7%), and 186 support staff (22.7%). Questions about the importance of MCB, self-efficacy in using MCB with patients, and feelings about sufficient training and resources showed that an average of 40-60% of respondents in each group reported a positive orientation toward the MCB technology and training received. This positive orientation was highest among support staff, lower among nurses, and lowest for physicians (all differences by staff role were statistically significant at P<.001). Additionally, 62.0% of respondents reported “not enough” training. Conclusions: Despite the robust training effort, similar to that used in previous health information technology implementations at this health system, hospital care team members reported only a moderately positive orientation toward MCB and its potential, and the majority wanted more training. We propose that due to the unique elements of the inpatient portal—interactive features used by patients and providers requiring explanation and collaboration—traditional training approaches may be insufficient. Introduction of the inpatient portal as a new collaborative tool may thus require new methods of training to support enhanced engagement between patients and their care team. %M 28912115 %R 10.2196/medinform.7707 %U http://medinform.jmir.org/2017/3/e31/ %U https://doi.org/10.2196/medinform.7707 %U http://www.ncbi.nlm.nih.gov/pubmed/28912115 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 3 %P e28 %T Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation %A Yen,Po-Yin %A McAlearney,Ann Scheck %A Sieck,Cynthia J %A Hefner,Jennifer L %A Huerta,Timothy R %+ Washington University in St Louis, Institute for Informatics, 4444 Forest Park Ave, Suite 6318, St Louis, MO,, United States, 1 314 273 2213, yenp@wustl.edu %K health information technology %K adaptation %K adoption %K acceptance %D 2017 %7 07.09.2017 %9 Viewpoint %J JMIR Med Inform %G English %X In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer. %M 28882812 %R 10.2196/medinform.7476 %U http://medinform.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/medinform.7476 %U http://www.ncbi.nlm.nih.gov/pubmed/28882812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e285 %T Web-Based Medical Service: Technology Attractiveness, Medical Creditability, Information Source, and Behavior Intention %A Wang,Shan Huei %+ Department and Graduate Institute of Business Administration, National Taiwan University, 9th Floor, Building I, College of Management, No. 85, Section 4, Roosevelt Road, Taipei,, Taiwan, 886 2 33661058, d98741001@ntu.edu.tw %K web-based medical service %K technology attractiveness %K medical creditability %K information source %K behavior intention %D 2017 %7 02.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based medical service (WBMS), a cooperative relationship between medical service and Internet technology, has been called one of the most innovative services of the 21st century. However, its business promotion and implementation in the medical industry have neither been expected nor executed. Few studies have explored this phenomenon from the viewpoint of inexperienced patients. Objective: The primary goal of this study was to explore whether technology attractiveness, medical creditability, and diversified medical information sources could increase users’ behavior intention. Methods: This study explored the effectiveness of web-based medical service by using three situations to manipulate sources of medical information. A total of 150 questionnaires were collected from people who had never used WBMS before. Hierarchical regression was used to examine the mediation and moderated-mediation effects. Results: Perceived ease of use (P=.002) and perceived usefulness (P=.001) significantly enhance behavior intentions. Medical credibility is a mediator (P=.03), but the relationship does not significantly differ under diverse manipulative information channels (P=.39). Conclusions: Medical credibility could explain the extra variation between technology attractiveness and behavior intention, but not significant under different moderating effect of medical information sources. %M 28768608 %R 10.2196/jmir.8114 %U http://www.jmir.org/2017/8/e285/ %U https://doi.org/10.2196/jmir.8114 %U http://www.ncbi.nlm.nih.gov/pubmed/28768608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e42 %T Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom %A Lennon,Marilyn R %A Bouamrane,Matt-Mouley %A Devlin,Alison M %A O'Connor,Siobhan %A O'Donnell,Catherine %A Chetty,Ula %A Agbakoba,Ruth %A Bikker,Annemieke %A Grieve,Eleanor %A Finch,Tracy %A Watson,Nicholas %A Wyke,Sally %A Mair,Frances S %+ General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Horselethill Road, University of Glasgow, Glasgow, G12 9LX, UK, United Kingdom, 44 01413308317, Frances.Mair@glasgow.ac.uk %K telemedicine %K health plan implementation %K community health services %K health services research %K electronic health records %K instrumentation %K qualitative research %K diffusion of innovation %K medical informatics %D 2017 %7 16.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results: We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale. %M 28209558 %R 10.2196/jmir.6900 %U http://www.jmir.org/2017/2/e42/ %U https://doi.org/10.2196/jmir.6900 %U http://www.ncbi.nlm.nih.gov/pubmed/28209558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e163 %T Being Human: A Qualitative Interview Study Exploring Why a Telehealth Intervention for Management of Chronic Conditions Had a Modest Effect %A O'Cathain,Alicia %A Drabble,Sarah J %A Foster,Alexis %A Horspool,Kimberley %A Edwards,Louisa %A Thomas,Clare %A Salisbury,Chris %+ Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 114 222 0770, a.ocathain@sheffield.ac.uk %K telehealth %K depression %K cardiovascular diseases %K qualitative research %K chronic disease %K randomized controlled trials %K primary health care %D 2016 %7 30.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. Objective: An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Methods: Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Results: Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients’ lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients’ lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients’ motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address their specific risk factors. Implementation was not optimal in the early part of the CVD risk trial owing to technical difficulties and the need to adapt the intervention for use in practice. For both conditions, enthusiastic and motivated staff offering continuity of intervention delivery tailored to individual patients’ needs were identified as important for patient engagement with telehealth; this was not delivered consistently, particularly in the early stages of the trials. Finally, there was a lack of active engagement from primary care. Conclusions: The conceptual model was supported and could be used to develop further telehealth interventions for chronic conditions. It may be possible to increase the effectiveness of this, and similar interventions, by attending to the human as well as the technical aspects of telehealth: offering it to patients actively wanting the intervention, ensuring continuity of delivery by enthusiastic and motivated staff, and encouraging active engagement from primary care staff. %M 27363434 %R 10.2196/jmir.5879 %U http://www.jmir.org/2016/6/e163/ %U https://doi.org/10.2196/jmir.5879 %U http://www.ncbi.nlm.nih.gov/pubmed/27363434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e172 %T Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study %A Fiks,Alexander G %A DuRivage,Nathalie %A Mayne,Stephanie L %A Finch,Stacia %A Ross,Michelle E %A Giacomini,Kelli %A Suh,Andrew %A McCarn,Banita %A Brandt,Elias %A Karavite,Dean %A Staton,Elizabeth W %A Shone,Laura P %A McGoldrick,Valerie %A Noonan,Kathleen %A Miller,Dorothy %A Lehmann,Christoph U %A Pace,Wilson D %A Grundmeier,Robert W %+ Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3535 Market Street, Rm 1546, Philadelphia, PA, 19104, United States, 1 267 426 2304, fiks@email.chop.edu %K asthma %K electronic health records %K health information technology %D 2016 %7 29.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established. Objective: We evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success. Methods: We conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework. Results: We invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success. Conclusions: Although use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term. Implementation efforts should include workflow redesign and prioritize enrollment of symptomatic children. ClinicalTrial: Clinicaltrials.gov NCT01966068; https://clinicaltrials.gov/ct2/show/NCT01966068 (Archived by WebCite at http://www.webcitation.org/6i9iSQkm3) %M 27357835 %R 10.2196/jmir.5610 %U http://www.jmir.org/2016/6/e172/ %U https://doi.org/10.2196/jmir.5610 %U http://www.ncbi.nlm.nih.gov/pubmed/27357835 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 4 %N 2 %P e21 %T Users’ Perspectives on a Picture Archiving and Communication System (PACS): An In-Depth Study in a Teaching Hospital in Kuwait %A Buabbas,Ali Jassem %A Al-Shamali,Dawood Ameer %A Sharma,Prem %A Haidar,Salwa %A Al-Shawaf,Hamza %+ Faculty of Medicine, Community Medicine and Behavioral Sciences, Kuwait University, Al-Jabreya, Hawally,, Kuwait, 965 25319504, ali.buabbas@hsc.edu.kw %K PACS evaluation %K user perspective %K IS success %K imaging informatics %K radiology %D 2016 %7 15.06.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Picture archiving and communication system (PACS) is a well-known imaging informatics application in health care organizations, specifically designed for the radiology department. Health care providers have exhibited willingness toward evaluating PACS in hospitals to ascertain the critical success and failure of the technology, considering that evaluation is a basic requirement. Objective: This study aimed at evaluating the success of a PACS in a regional teaching hospital of Kuwait, from users’ perspectives, using information systems success criteria. Methods: An in-depth study was conducted by using quantitative and qualitative methods. This mixed-method study was based on: (1) questionnaires, distributed to all radiologists and technologists and (2) interviews, conducted with PACS administrators. Results: In all, 60 questionnaires were received from the respondents. These included 39 radiologists (75% response rate) and 21 technologists (62% response rate), with the results showing almost three-quarters (74%, 44 of 59) of the respondents rating PACS positively and as user friendly. This study’s findings revealed that the demographic data, including computer experience, was an insignificant factor, having no influence on the users’ responses. The findings were further substantiated by the administrators’ interview responses, which supported the benefits of PACS, indicating the need for developing a unified policy aimed at streamlining and improving the departmental workflow. Conclusions: The PACS had a positive and productive impact on the radiologists’ and technologists’ work performance. They were endeavoring to resolve current problems while keeping abreast of advances in PACS technology, including teleradiology and mobile image viewer, which is steadily increasing in usage in the Kuwaiti health system. %M 27307046 %R 10.2196/medinform.5703 %U http://medinform.jmir.org/2016/2/e21/ %U https://doi.org/10.2196/medinform.5703 %U http://www.ncbi.nlm.nih.gov/pubmed/27307046 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 4 %N 2 %P e19 %T Adoption Factors of the Electronic Health Record: A Systematic Review %A Kruse,Clemens Scott %A Kothman,Krysta %A Anerobi,Keshia %A Abanaka,Lillian %+ Texas State University, School of Health Administration, 601 University Drive, HPB, 250, San Marcos, TX, 78230, United States, 1 210 355 4742, scottkruse@txstate.edu %K electronic health record %K information technology %K HITECH Act %K health information technology %D 2016 %7 01.06.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures. Objective: The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States. Methods: Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012–09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity. Results: Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues. Conclusions: The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite incentives in the HITECH Act. Limited financial backing and outdated technology were also common barriers frequently mentioned during data review. Future public policy should include incentives commensurate with those in the HITECH Act to maintain strong adoption rates. %M 27251559 %R 10.2196/medinform.5525 %U http://medinform.jmir.org/2016/2/e19/ %U https://doi.org/10.2196/medinform.5525 %U http://www.ncbi.nlm.nih.gov/pubmed/27251559 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 2 %P e14 %T An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence–Powered Medication Reconciliation Tool %A Long,Ju %A Yuan,Michael Juntao %A Poonawala,Robina %+ McCoy College of Business Administration, Department of Computer Information Systems and Quantitative Methods, Texas State University, 601 University Dr, San Marcos, TX, 78666, United States, 1 5123006829, jl38@txstate.edu %K medication reconciliation %K adverse drug event %K medication errors %K medication adherence %K patient medication knowledge %K decision making, shared %D 2016 %7 16.05.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Medication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap. Objective: The aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen. Methods: In this study, we developed iPad-based software tools, with AI decision support, to engage patients to “self-service” medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool’s user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool’s usability afterward. Results: All patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving. Conclusions: We have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians. %M 27185210 %R 10.2196/ijmr.5462 %U http://www.i-jmr.org/2016/2/e14/ %U https://doi.org/10.2196/ijmr.5462 %U http://www.ncbi.nlm.nih.gov/pubmed/27185210 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e13 %T Process and Effects Evaluation of a Digital Mental Health Intervention Targeted at Improving Occupational Well-Being: Lessons From an Intervention Study With Failed Adoption %A Muuraiskangas,Salla %A Harjumaa,Marja %A Kaipainen,Kirsikka %A Ermes,Miikka %+ VTT Technical Research Centre of Finland Ltd, Digital Health, Kaitoväylä 1, Oulu, 90590, Finland, 358 207222169, salla.muuraiskangas@vtt.fi %K acceptance and commitment therapy %K intervention studies %K mHealth %K cccupational health %K process assessment %K stress %K mindfulness %K attrition %K adoption %D 2016 %7 11.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Digital interventions have the potential to serve as cost-effective ways to manage occupational stress and well-being. However, little is known about the adoption of individual-level digital interventions at organizations. Objectives: The aim of this paper is to study the effects of an unguided digital mental health intervention in occupational well-being and the factors that influence the adoption of the intervention. Methods: The intervention was based on acceptance and commitment therapy (ACT) and its aim was to teach skills for stress management and mental well-being. It was delivered via a mobile and a Web-based app that were offered to employees of two information and communication technology (ICT) companies. The primary outcome measures were perceived stress and work engagement, measured by a 1-item stress questionnaire (Stress) and the Utrecht Work Engagement Scale (UWES-9). The intervention process was evaluated regarding the change mechanisms and intervention stages using mixed methods. The initial interviews were conducted face-to-face with human resource managers (n=2) of both companies in August 2013. The participants were recruited via information sessions and email invitations. The intervention period took place between November 2013 and March 2014. The participants were asked to complete online questionnaires at baseline, two months, and four months after the baseline measurement. The final phone interviews for the volunteer participants (n=17) and the human resource managers (n=2) were conducted in April to May 2014, five months after the baseline. Results: Of all the employees, only 27 (8.1%, 27/332) took the app into use, with a mean use of 4.8 (SD 4.7) different days. In the beginning, well-being was on good level in both companies and no significant changes in well-being were observed. The activities of the intervention process failed to integrate the intervention into everyday activities at the workplace. Those who took the app into use experienced many benefits such as relief in stressful situations. The app was perceived as a toolkit for personal well-being that gives concrete instructions on how mindfulness can be practiced. However, many barriers to participate in the intervention were identified at the individual level, such as lack of time, lack of perceived need, and lack of perceived benefits. Conclusions: The findings suggest that neither the setting nor the approach used in this study were successful in adopting new digital interventions at the target organizations. Barriers were faced at both the organizational as well as the individual level. At the organizational level, top management needs to be involved in the intervention planning for fitting into the organization policies, the existing technology infrastructure, and also targeting the organizational goals. At the individual level, concretizing the benefits of the preventive intervention and arranging time for app use at the workplace are likely to increase adoption. %M 27170553 %R 10.2196/mental.4465 %U http://mental.jmir.org/2016/2/e13/ %U https://doi.org/10.2196/mental.4465 %U http://www.ncbi.nlm.nih.gov/pubmed/27170553 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e75 %T A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review %A Flott,Kelsey %A Callahan,Ryan %A Darzi,Ara %A Mayer,Erik %+ Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, St Mary’s Campus, Praed Street, London, W2 1NY, United Kingdom, 44 7909248515, k.flott14@imperial.ac.uk %K digital maturity %K evaluation %K health information exchange %K patient-centered care %D 2016 %7 14.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective: The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods: We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results: We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions: The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system. Trial Registration: N/A %M 27080852 %R 10.2196/jmir.5047 %U http://www.jmir.org/2016/4/e75/ %U https://doi.org/10.2196/jmir.5047 %U http://www.ncbi.nlm.nih.gov/pubmed/27080852 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 2 %P e11 %T Use and Uptake of eHealth in General Practice: A Cross-Sectional Survey and Focus Group Study Among Health Care Users and General Practitioners %A Peeters,Jose M %A Krijgsman,Johan W %A Brabers,Anne E %A Jong,Judith D De %A Friele,Roland D %+ NIVEL, Otterstraat 118-124, Utrecht, 3513 CR, Netherlands, 31 030 2729628, j.peeters@nivel.nl %K eHealth %K technology %K GPs, general practice %K implementation %K survey %K health care users %D 2016 %7 06.04.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Policy makers promote the use of eHealth to widen access to health care services and to improve the quality and safety of care. Nevertheless, the enthusiasm among policy makers for eHealth does not match its uptake and use. eHealth is defined in this study as “health services delivered or enhanced through the Internet and related information and communication technologies.” Objective: The objective of this study was to investigate (1) the current use of eHealth in the Netherlands by general practitioners (GPs) and health care users, (2) the future plans of GPs to provide eHealth and the willingness of health care users to use eHealth services, and (3) the perceived positive effects and barriers from the perspective of GPs and health care users. Methods: A cross-sectional survey of a sample of Dutch GPs and members of the Dutch Health Care Consumer Panel was conducted in April 2014. A pre-structured questionnaire was completed by 171 GPs (12% response) and by 754 health care users (50% response). In addition, two focus groups were conducted in June 2014: one group with GPs (8 participants) and one with health care users (10 participants). Results: Three-quarters of Dutch GPs that responded to the questionnaire (67.3%, 115/171) offered patients the possibility of requesting a prescription via the Internet, and half of them offered patients the possibility of asking a question via the Internet (49.1%, 84/171). In general, they did intend to provide future eHealth services. Nonetheless, many of the GPs perceived barriers, especially concerning its innovation (eg, insufficient reliable, secure systems) and the sociopolitical context (eg, lack of financial compensation for the time spent on implementation). By contrast, health care users were generally not aware of existing eHealth services offered by their GPs. Nevertheless, half of them were willing to use eHealth services when offered by their GP. In general, health care users have positive attitudes regarding eHealth. One in five (20.6%, 148/718) health care users perceived barriers to the use of eHealth. These included concerns about the safety of health information obtained via the Internet (66.7%, 96/144) and privacy aspects (55.6%, 80/144). Conclusions: GPs and health care users have generally positive attitudes towards eHealth, which is a prerequisite for the uptake of eHealth. But, general practitioners in particular perceive barriers to using eHealth and consider the implementation of eHealth to be complex. This study shows that there is room for improving awareness of eHealth services in primary care. It will take some time before these issues are resolved and eHealth can be fully adopted. %M 27052805 %R 10.2196/medinform.4515 %U http://medinform.jmir.org/2016/2/e11/ %U https://doi.org/10.2196/medinform.4515 %U http://www.ncbi.nlm.nih.gov/pubmed/27052805 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e73 %T Personal Health Record Use in the United States: Forecasting Future Adoption Levels %A Ford,Eric W %A Hesse,Bradford W %A Huerta,Timothy R %+ Department of Health Policy and Management, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States, 1 806 787 3267, ewford@gmail.com %K personal health records %K electronic health records %K patient participation %K technology diffusion %K Bass modeling %K PHR Adoption Forecasts %D 2016 %7 30.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Personal health records (PHRs) offer a tremendous opportunity to generate consumer support in pursing the triple aim of reducing costs, increasing access, and improving care quality. Moreover, surveys in the United States indicate that consumers want Web-based access to their medical records. However, concerns that consumers’ low health information literacy levels and physicians’ resistance to sharing notes will limit PHRs’ utility to a relatively small portion of the population have reduced both the product innovation and policy imperatives. Objective: The purpose of our study was 3-fold: first, to report on US consumers’ current level of PHR activity; second, to describe the roles of imitation and innovation influence factors in determining PHR adoption rates; and third, to forecast future PHR diffusion uptake among US consumers under 3 scenarios. Methods: We used secondary data from the Health Information National Trends Survey (HINTS) of US citizens for the survey years 2008, 2011, and 2013. Applying technology diffusion theory and Bass modeling, we evaluated 3 future PHR adoption scenarios by varying the introduction dates. Results: All models displayed the characteristic diffusion S-curve indicating that the PHR technology is likely to achieve significant market penetration ahead of meaningful use goals. The best-performing model indicates that PHR adoption will exceed 75% by 2020. Therefore, the meaningful use program targets for PHR adoption are below the rates likely to occur without an intervention. Conclusions: The promise of improved care quality and cost savings through better consumer engagement prompted the US Institute of Medicine to call for universal PHR adoption in 1999. The PHR products available as of 2014 are likely to meet and exceed meaningful use stage 3 targets before 2020 without any incentive. Therefore, more ambitious uptake and functionality availability should be incorporated into future goals. %M 27030105 %R 10.2196/jmir.4973 %U http://www.jmir.org/2016/3/e73/ %U https://doi.org/10.2196/jmir.4973 %U http://www.ncbi.nlm.nih.gov/pubmed/27030105 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e49 %T Electronic Health Record Patient Portal Adoption by Health Care Consumers: An Acceptance Model and Survey %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School (IMS), Universidade Nova de Lisboa, Campus de Campolide, Lisboa, 1070-312, Portugal, 351 917330943, d2012072@novaims.unl.pt %K UTAUT2 %K technology adoption %K eHealth %K health care consumers %K electronic health records %K technology acceptance %D 2016 %7 02.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand. Objective: The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods: We applied a new adoption model using, as a starting point, Ventkatesh's Unified Theory of Acceptance and Use of Technology in a consumer context (UTAUT2) by integrating a new construct specific to health care, a new moderator, and new relationships. To test the research model, we used the partial least squares (PLS) causal modelling approach. An online questionnaire was administrated. We collected 360 valid responses. Results: The statistically significant drivers of behavioral intention are performance expectancy (beta=.200; t=3.619), effort expectancy (beta=.185; t=2.907), habit (beta=.388; t=7.320), and self-perception (beta=.098; t=2.285). The predictors of use behavior are habit (beta=0.206; t=2.752) and behavioral intention (beta=0.258; t=4.036). The model explained 49.7% of the variance in behavioral intention and 26.8% of the variance in use behavior. Conclusions: Our research helps to understand the desired technology characteristics of EHR portals. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not. The inclusion of specific constructs and relationships related to the health care consumer area also had a significant impact on understanding the adoption of EHR portals. %M 26935646 %R 10.2196/jmir.5069 %U http://www.jmir.org/2016/3/e49/ %U https://doi.org/10.2196/jmir.5069 %U http://www.ncbi.nlm.nih.gov/pubmed/26935646 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 1 %P e2 %T Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System %A Kern,Raimar %A Haase,Rocco %A Eisele,Judith Christina %A Thomas,Katja %A Ziemssen,Tjalf %+ Multiple Sclerosis Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University of Technology Dresden, Germany, Fetscherstrasse 74, Dresden, , Germany, 49 351 458 4465, Tjalf.Ziemssen@uniklinikum-dresden.de %K health information technology %K computers %K Internet %K multiple sclerosis %K eHealth %K disease management %D 2016 %7 08.01.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Objective: Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. Methods: We conducted a paper-and-pencil–based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians’ attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians’ knowledge about the Multiple Sclerosis Documentation System (3 items). Results: From 600 mailed surveys, 74 completed surveys were returned. As much as 9 of the 10 practices were already connected to the Internet (67/74), but only 49% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 43% opted for an online interface, whereas 58% decided on an offline method of data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient communication, and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 91% welcomed the opportunity of a specific clinical documentation for MS and 87% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74). Conclusions: Physicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Many aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS-specific eHealth services were highly appreciated, but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients. %M 26746977 %R 10.2196/ijmr.4549 %U http://www.i-jmr.org/2016/1/e2/ %U https://doi.org/10.2196/ijmr.4549 %U http://www.ncbi.nlm.nih.gov/pubmed/26746977 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e283 %T “Why Didn’t it Work?” Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma %A Lau,Annie YS %A Arguel,Amaël %A Dennis,Sarah %A Liaw,Siaw-Teng %A Coiera,Enrico %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6 Talavera Rd Macquarie University, Sydney, 2109, Australia, 61 431599890, annie.lau@mq.edu.au %K asthma %K self-management %K personal health record %K personally controlled health management system %K eHealth %K Internet %K intervention %K adult %D 2015 %7 15.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Personally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors. Objective: The aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma. Methods: A 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy. Results: A total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once. Conclusions: Despite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A) %M 26678294 %R 10.2196/jmir.4734 %U http://www.jmir.org/2015/12/e283/ %U https://doi.org/10.2196/jmir.4734 %U http://www.ncbi.nlm.nih.gov/pubmed/26678294 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 4 %P e21 %T Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients %A Huygens,Martine WJ %A Vermeulen,Joan %A Friele,Roland D %A van Schayck,Onno CP %A de Jong,Judith D %A de Witte,Luc P %+ School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 43 38 81 700, m.huygens@maastrichtuniversity.nl %K eHealth %K online communication %K primary care %K general practice %D 2015 %7 24.11.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective: The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods: There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results: There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. Conclusions: Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role. %M 26601596 %R 10.2196/ijmr.4245 %U http://www.i-jmr.org/2015/4/e21/ %U https://doi.org/10.2196/ijmr.4245 %U http://www.ncbi.nlm.nih.gov/pubmed/26601596 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 3 %P e30 %T Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities %A Slight,Sarah Patricia %A Berner,Eta S %A Galanter,William %A Huff,Stanley %A Lambert,Bruce L %A Lannon,Carole %A Lehmann,Christoph U %A McCourt,Brian J %A McNamara,Michael %A Menachemi,Nir %A Payne,Thomas H %A Spooner,S Andrew %A Schiff,Gordon D %A Wang,Tracy Y %A Akincigil,Ayse %A Crystal,Stephen %A Fortmann,Stephen P %A Vandermeer,Meredith L %A Bates,David W %+ The Centre for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Womens Hospital, 1620 Tremont Street, Boston, MA, MA 02120-1613, United States, 1 617 732 5650, dbates@partners.org %K medical informatics %K health policy %K electronic health records %K meaningful use %D 2015 %7 18.9.2015 %9 Original Paper %J JMIR Med Inform %G English %X 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. %R 10.2196/medinform.4457 %U http://medinform.jmir.org/2015/3/e30/ %U https://doi.org/10.2196/medinform.4457 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 2 %P e22 %T Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia %A Tilahun,Binyam %A Fritz,Fleur %+ Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, D-48149, Germany, 49 (251) 83 55262, Binyam.Tilahun@uni-muenster.de %K electronic medical record %K evaluation %K low-resource settings %K Ethiopia %K DeLone and MacLean model %D 2015 %7 25.05.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective: The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods: A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results: Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions: Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock. %M 26007237 %R 10.2196/medinform.4106 %U http://medinform.jmir.org/2015/2/e22/ %U https://doi.org/10.2196/medinform.4106 %U http://www.ncbi.nlm.nih.gov/pubmed/26007237 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e47 %T Predictors for Assessing Electronic Messaging Between Nurses and General Practitioners as a Useful Tool for Communication in Home Health Care Services: A Cross-Sectional Study %A Lyngstad,Merete %A Hofoss,Dag %A Grimsmo,Anders %A Hellesø,Ragnhild %+ Institute of Health and Society, Department of Nursing Science, University of Oslo, PO 1130 Blindern, Oslo, 0318, Norway, 47 92625044, Merete.Lyngstad@medisin.uio.no %K electronic mail %K home healthcare nursing %K collaborating %K general practitioners %D 2015 %7 17.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. Objective: The aim of this study was to explore home health care nurses’ assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. Methods: The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Results: Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). Conclusions: This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses’ assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services. %M 25691234 %R 10.2196/jmir.4056 %U http://www.jmir.org/2015/2/e47/ %U https://doi.org/10.2196/jmir.4056 %U http://www.ncbi.nlm.nih.gov/pubmed/25691234 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e7 %T Moderating Effects of Voluntariness on the Actual Use of Electronic Health Records for Allied Health Professionals %A Chiu,Teresa ML %A Ku,Benny PS %+ Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong kong, , China (Hong Kong), 852 2766 6714, teresa.ml.chiu@gmail.com %K health information technology %K technology acceptance %K user behavior %K allied health %K attitude towards technology %D 2015 %7 10.02.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Mandatory versus voluntary requirement has moderating effect on a person’s intention to use a new information technology. Studies have shown that the use of technology in health care settings is predicted by perceived ease of use, perceived usefulness, social influence, facilitating conditions, and attitude towards computer. These factors have different effects on mandatory versus voluntary environment of use. However, the degree and direction of moderating effect of voluntariness on these factors remain inconclusive. Objective: This study aimed to examine the moderating effect of voluntariness on the actual use of an electronic health record (EHR) designed for use by allied health professionals in Hong Kong. Specifically, this study explored and compared the moderating effects of voluntariness on factors organized into technology, implementation, and individual contexts. Methods: Physiotherapists who had taken part in the implementation of a new EHR were invited to complete a survey. The survey included questions that measured the levels of voluntariness, technology acceptance and use, and attitude towards technology. Multiple logistic regressions were conducted to identify factors associated with actual use of a compulsory module and a noncompulsory module of the EHR. Results: In total, there were 93 participants in the study. All of them had access to the noncompulsory module, the e-Progress Note, to record progress notes of their patients. Out of the 93 participants, 57 (62%) were required to use a compulsory module, the e-Registration, to register patient attendance. In the low voluntariness environment, Actual Use was associated with Effort Expectancy (mean score of users 3.51, SD 0.43; mean score of non-users 3.21, SD 0.31; P=.03). Effort Expectancy measured the perceived ease of use and was a variable in the technology context. The variables in the implementation and individual contexts did not show a difference between the two groups. In the high voluntariness environment, the mean score of Actual Use was associated with Performance Expectancy (P=.03), Organization Facilitating Condition (P=.02), and Interest in Internet and Computer (P=.052) in univariate analyses. The only variable left in the logistic regression model was Organization Facilitating Conditions (mean score of users 3.82, SD 0.35; mean score of non-users 3.40, SD 0.48; P=.03), a variable in the implementation context. The factors affecting actual use were different in mandatory and voluntary environments, indicating a moderating effect of voluntariness. Conclusions: The results of this study have provided preliminary supports of moderating effects of voluntariness on the use of EHR by allied health professionals. Different factors were identified to be associated with actual use: (1) Ease of Use in mandatory environment, and (2) Organization Facilitating Conditions in voluntary environment. More studies are needed to examine the direction of moderating effects. The findings of this study have potential practical implications. In sum, voluntariness can be a highly relevant and important moderating factor not to be ignored in the design and evaluation of EHR. %M 25720417 %R 10.2196/medinform.2548 %U http://medinform.jmir.org/2015/1/e7/ %U https://doi.org/10.2196/medinform.2548 %U http://www.ncbi.nlm.nih.gov/pubmed/25720417 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e4 %T Adoption of Clinical Decision Support in Multimorbidity: A Systematic Review %A Fraccaro,Paolo %A Arguello Casteleiro,Mercedes %A Ainsworth,John %A Buchan,Iain %+ Centre for Health Informatics, Institute of Population Health, The University of Manchester, Vaughan House, Portsmouth St, Manchester, M13 9GB, United Kingdom, 44 161 275 1132, paolo.fraccaro@postgrad.manchester.ac.uk %K decision support systems, management %K systematic review %K multiple chronic diseases %K multiple pathologies %K multiple medications %D 2015 %7 07.01.2015 %9 Review %J JMIR Med Inform %G English %X Background: Patients with multiple conditions have complex needs and are increasing in number as populations age. This multimorbidity is one of the greatest challenges facing health care. Having more than 1 condition generates (1) interactions between pathologies, (2) duplication of tests, (3) difficulties in adhering to often conflicting clinical practice guidelines, (4) obstacles in the continuity of care, (5) confusing self-management information, and (6) medication errors. In this context, clinical decision support (CDS) systems need to be able to handle realistic complexity and minimize iatrogenic risks. Objective: The aim of this review was to identify to what extent CDS is adopted in multimorbidity. Methods: This review followed PRISMA guidance and adopted a multidisciplinary approach. Scopus and PubMed searches were performed by combining terms from 3 different thesauri containing synonyms for (1) multimorbidity and comorbidity, (2) polypharmacy, and (3) CDS. The relevant articles were identified by examining the titles and abstracts. The full text of selected/relevant articles was analyzed in-depth. For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness. Results: A total of 50 articles were selected for the full in-depth analysis and 20 studies were included in the final review. Medication (n=10) and clinical guidance (n=8) were the predominant clinical tasks. Four studies focused on merging concurrent clinical practice guidelines. A total of 17 articles reported their CDS systems were knowledge-based. Most articles reviewed considered patients’ clinical records (n=19), clinical practice guidelines (n=12), and clinicians’ knowledge (n=10) as contextual input data. The most frequent diseases mentioned were cardiovascular (n=9) and diabetes mellitus (n=5). In all, 12 articles mentioned generalist doctor(s) as the decision maker(s). For articles reviewed, there were no studies referring to the active involvement of the patient in the decision-making process or to patient self-management. None of the articles reviewed adopted mobile technologies. There were no rigorous evaluations of usability or effectiveness of the CDS systems reported. Conclusions: This review shows that multimorbidity is underinvestigated in the informatics of supporting clinical decisions. CDS interventions that systematize clinical practice guidelines without considering the interactions of different conditions and care processes may lead to unhelpful or harmful clinical actions. To improve patient safety in multimorbidity, there is a need for more evidence about how both conditions and care processes interact. The data needed to build this evidence base exist in many electronic health record systems and are underused. %M 25785897 %R 10.2196/medinform.3503 %U http://medinform.jmir.org/2015/1/e4/ %U https://doi.org/10.2196/medinform.3503 %U http://www.ncbi.nlm.nih.gov/pubmed/25785897 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e42 %T Mobile Technologies: Expectancy, Usage, and Acceptance of Clinical Staff and Patients at a University Medical Center %A Illiger,Kristin %A Hupka,Markus %A von Jan,Ute %A Wichelhaus,Daniel %A Albrecht,Urs-Vito %+ PL Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Street 1, Hannover, 30625, Germany, 49 511 532 ext 3508, albrecht.urs-vito@mh-hannover.de %K survey %K mobile health %K mobile apps %K health care %K privacy %K data protection %K patients %K medical staff %K staff attitude %D 2014 %7 21.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users’ basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings. Objective: The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology. Methods: Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher’s exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables. Results: The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context. Conclusions: Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context. %M 25338094 %R 10.2196/mhealth.3799 %U http://mhealth.jmir.org/2014/4/e42/ %U https://doi.org/10.2196/mhealth.3799 %U http://www.ncbi.nlm.nih.gov/pubmed/25338094 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 2 %P e26 %T Barriers Over Time to Full Implementation of Health Information Exchange in the United States %A Kruse,Clemens Scott %A Regier,Verna %A Rheinboldt,Kurt T %+ School of Health Administration, College of Allied Health Professions, Texas State University, HPB, 2nd Floor, 601 University Dr, San Marcos, TX, 78666, United States, 1 210 355 4742, scottkruse@txstate.edu %K medical informatics %K electronic health record (EHR) %K electronic medical records (EMR) %K health information technology (HIT) %K quality improvement %K national health policy %K workflow %K past trends %D 2014 %7 30.09.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. Objective: The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. Methods: We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). Results: The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. Conclusions: The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows. %M 25600635 %R 10.2196/medinform.3625 %U http://medinform.jmir.org/2014/2/e26/ %U https://doi.org/10.2196/medinform.3625 %U http://www.ncbi.nlm.nih.gov/pubmed/25600635 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 2 %P e24 %T Adoption, Use, and Impact of E-Booking in Private Medical Practices: Mixed-Methods Evaluation of a Two-Year Showcase Project in Canada %A Paré,Guy %A Trudel,Marie-Claude %A Forget,Pascal %+ HEC Montreal, 3000 Chemin de la Cote-Ste-Catherine, Montreal, QC, H3T 2A7, Canada, 1 514 340 6812, guy.pare@hec.ca %K e-booking %K medical practices %K primary care %K missed appointments %K mixed-methods evaluative study %D 2014 %7 24.09.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: Managing appointments in private medical practices and ambulatory care settings is a complex process. Various strategies to reduce missed appointments can be implemented. E-booking systems, which allow patients to schedule and manage medical appointments online, represents such a strategy. To better support clinicians seeking to offer an e-booking service to their patients, health authorities in Canada recently invested in a showcase project involving six private medical clinics. Objective: The objectives pursued in this study were threefold: (1) to measure adoption and use of the e-booking system in each of the clinics over a 2-year period, (2) to assess patients’ perceptions regarding the characteristics and benefits of using the system, and (3) to measure the impact of the e-booking system on the number of missed appointments in each clinic. Methods: A mixed-methods approach was adopted in this study. We first extracted and analyzed raw data from the e-booking system deployed in each of the medical practices to monitor adoption and use of the system over time and to assess the impact of the system on the number of missed appointments. Second, we conducted a Web-based survey of patients’ perceptions in the spring of 2013. Results: The patients and physicians targeted by this showcase project showed a growing interest in the e-booking system as the number of users, time slots made available by physicians, and online appointments grew steadily over time. The great majority of patients said that they appreciated the system mainly because of the benefits they derived from it, namely, scheduling flexibility, time savings, and automated reminders that prevented forgotten appointments. Importantly, our findings suggest that the system’s automated reminders help significantly reduce the number of missed appointments. Conclusions: E-booking systems seem to represent a win-win solution for patients and physicians in private medical practices. We encourage researchers to replicate and extend our work in other primary care settings in order to test the generalizability of our findings. %M 25600414 %R 10.2196/medinform.3669 %U http://medinform.jmir.org/2014/2/e24/ %U https://doi.org/10.2196/medinform.3669 %U http://www.ncbi.nlm.nih.gov/pubmed/25600414 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 1 %P e9 %T Factors Associated With Adoption of Health Information Technology: A Conceptual Model Based on a Systematic Review %A Kruse,Clemens Scott %A DeShazo,Jonathan %A Kim,Forest %A Fulton,Lawrence %+ College of Health Professions, School of Health Administration, Texas State University, HPB, 2nd Floor, 601 University Drive, San Marcos, TX, 78666, United States, 1 210 355 4742, scottkruse@txstate.edu %K electronic health record (EHR) %K electronic medical record (EMR) %K health information technology (HIT) %K medical information systems %K computerized provider order entry (CPOE) %K adoption %D 2014 %7 23.05.2014 %9 Review %J JMIR Med Inform %G English %X 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. %M 25599673 %R 10.2196/medinform.3106 %U http://medinform.jmir.org/2014/1/e9/ %U https://doi.org/10.2196/medinform.3106 %U http://www.ncbi.nlm.nih.gov/pubmed/25599673 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 1 %N 1 %P e1 %T Factors Associated With Adoption of the Electronic Health Record System Among Primary Care Physicians %A Cheung,Clement SK %A Tong,Ellen LH %A Cheung,Ngai Tseung %A Chan,Wai Man %A Wang,Harry HX %A Kwan,Mandy WM %A Fan,Carmen KM %A Liu,Kirin QL %A Wong,Martin CS %+ School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, The Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China, Shatin, NT, Hong Kong, , China (Hong Kong), 852 22528782, drwong_martin@yahoo.com.hk %K electronic medical record %K physicians %K adoption %K associated factors %K medical informatics %D 2013 %7 26.08.2013 %9 Original Paper %J JMIR Med Inform %G English %X Background: A territory-wide Internet-based electronic patient record allows better patient care in different sectors. The engagement of private physicians is one of the major facilitators for implementation, but there is limited information about the current adoption level of electronic medical record (eMR) among private primary care physicians. Objective: This survey measured the adoption level, enabling factors, and hindering factors of eMR, among private physicians in Hong Kong. It also evaluated the key functions and the popularity of electronic systems and vendors used by these private practitioners. Methods: A central registry consisting of 4324 private practitioners was set up. Invitations for self-administered surveys and the completed questionnaires were sent and returned via fax, email, postal mail, and on-site clinic visits. Current users and non-users of eMR system were compared according to their demographic and practice characteristics. Student’s t tests and chi-square tests were used for continuous and categorical variables, respectively. Results: A total of 524 completed surveys (response rate 524/4405 11.90%) were collected. The proportion of using eMR in private clinics was 79.6% (417/524). When compared with non-users, the eMR users were younger (users: 48.4 years SD 10.6 years vs non-users: 61.7 years SD 10.2 years, P<.001); more were female physicians (users: 80/417, 19.2% vs non-users: 14/107, 13.1%, P=.013); possessed less clinical experience (with more than20 years of practice: users: 261/417, 62.6% vs non-user: 93/107, 86.9%, P<.001); fewer worked under a Health Maintenance Organization (users: 347/417, 83.2% vs non-users: 97/107, 90.7%, P<.001) and more worked with practice partners (users: 126/417, 30.2% vs non-users: 4/107, 3.7%, P<.001). Efficiency (379/417, 90.9%) and reduction of medical errors (229/417, 54.9%) were the major enabling factors, while patient-unfriendliness (58/107, 54.2%) and limited consultation time (54/107, 50.5%) were the most commonly reported hindering factors. The key functions of computer software among eMR users consisted of electronic patient registration system (376/417, 90.2%), drug dispensing system (328/417, 78.7%) and electronic drug labels (296/417, 71.0%). SoftLink Clinic Solution was the most popular vendor (160/417, 38.4%). Conclusions: These findings identified several physician groups who should be targeted for more assistance on eMR installation and its adoption. Future studies should address the barriers of using Internet-based eMR to enhance its adoption. %M 25599989 %R 10.2196/medinform.2766 %U http://medinform.jmir.org/2013/1/e1/ %U https://doi.org/10.2196/medinform.2766 %U http://www.ncbi.nlm.nih.gov/pubmed/25599989