%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24452 %T A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience %A Anyanwu,Emeka C %A Ward,R Parker %A Shah,Atman %A Arora,Vineet %A Umscheid,Craig A %+ Section of Cardiology, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 (773) 834 0343, emeka@emeka.ca %K adoption %K communication %K COVID-19 %K hospital %K inpatient %K mHealth %K mobile app %K telemedicine %D 2021 %7 23.2.2021 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number–related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team’s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. %M 33513562 %R 10.2196/24452 %U https://mhealth.jmir.org/2021/2/e24452 %U https://doi.org/10.2196/24452 %U http://www.ncbi.nlm.nih.gov/pubmed/33513562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e17672 %T Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan %A Tian,Peter George Jaminal %A Harris,Jeffrey Richard %A Seikaly,Hadi %A Chambers,Thane %A Alvarado,Sara %A Eurich,Dean %+ Department of Family Medicine, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada, 1 780 492 6306, petergeo@ualberta.ca %K telephone consultations %K teleconsultations %K remote consultations %K telemedicine %K eHealth %K environmental scan %D 2021 %7 23.2.2021 %9 Review %J JMIR Form Res %G English %X Background: Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective: As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods: We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results: The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions: Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.  %M 33620325 %R 10.2196/17672 %U https://formative.jmir.org/2021/2/e17672 %U https://doi.org/10.2196/17672 %U http://www.ncbi.nlm.nih.gov/pubmed/33620325 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22220 %T A Web-Based Self-Management Support Prototype for Adults With Chronic Kidney Disease (My Kidneys My Health): Co-Design and Usability Testing %A Donald,Maoliosa %A Beanlands,Heather %A Straus,Sharon E %A Smekal,Michelle %A Gil,Sarah %A Elliott,Meghan J %A Herrington,Gwen %A Harwood,Lori %A Waldvogel,Blair %A Delgado,Maria %A Sparkes,Dwight %A Tong,Allison %A Grill,Allan %A Novak,Marta %A James,Matthew Thomas %A Brimble,K Scott %A Samuel,Susan %A Tu,Karen %A Farragher,Janine %A Hemmelgarn,Brenda R %+ Faculty of Medicine and Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Edmonton, AB, T6G 2B7, Canada, 1 780 492 9728, Brenda.Hemmelgarn@albertahealthservices.ca %K chronic kidney disease %K knowledge-to-action framework %K integrated knowledge translation %K patient engagement %K patient-oriented research %K self-management %K web-based intervention %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those who care for them. Self-management has been shown to slow CKD progression and improve the quality of life of individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed, web-based tool for CKD self-management that can be individualized to a patient’s unique situation, priorities, and preferences. We addressed this gap using an integrated knowledge translation method and patient engagement principles. Objective: The aim of this study is to conduct systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (nondialysis and nontransplant) and their caregivers to enhance self-management support. Methods: A multistep, iterative system development cycle was used to co-design and test the My Kidneys My Health prototype. The 3-step process included creating website features and content using 2 sequential focus groups with patients with CKD and caregivers, heuristic testing using the 10 heuristic principles by Nielsen, and usability testing through in-person 60-minute interviews with patients with CKD and their caregivers. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. Results: In step 1, 18 participants (14 patients and 4 caregivers) attended one of the 2 sequential focus groups. The participants provided specific suggestions for simplifying navigation as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. A total of 5 reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Furthermore, 5 participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean system usability score of 90 out of 100. Conclusions: The My Kidneys My Health prototype is a systematically developed, multifaceted, web-based CKD self-management support tool guided by the theory and preferences of patients with CKD and their caregivers. The website is user friendly and provides features that improve user experience by tailoring the content and resources to their needs. A feasibility study will provide insights into the acceptability of and engagement with the prototype and identify preliminary patient-reported outcomes (eg, self-efficacy) as well as potential factors related to implementation. This work is relevant given the shift to virtual care during the current pandemic times and provides patients with support when in-person care is restricted. %M 33560245 %R 10.2196/22220 %U https://formative.jmir.org/2021/2/e22220 %U https://doi.org/10.2196/22220 %U http://www.ncbi.nlm.nih.gov/pubmed/33560245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26190 %T Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages %A Hull,Thomas D %A Levine,Jacob %A Bantilan,Niels %A Desai,Angel N %A Majumder,Maimuna S %+ Talkspace, 2578 Broadway #607, New York, NY, 10025, United States, 1 4802548815, tdh732@mail.harvard.edu %K digital phenotyping %K COVID-19 %K telehealth %K digital mental health %K natural language processing %K machine learning %K mental health %K phenotyping %K burden %K treatment %K symptom %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients’ pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19–related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. %M 33502999 %R 10.2196/26190 %U http://formative.jmir.org/2021/2/e26190/ %U https://doi.org/10.2196/26190 %U http://www.ncbi.nlm.nih.gov/pubmed/33502999 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e14378 %T A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial %A Depp,Colin %A Ehret,Blaire %A Villa,Jennifer %A Perivoliotis,Dimitri %A Granholm,Eric %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0603, United States, 1 858 822 4251, cdepp@ucsd.edu %K prevention %K mental health services %K psychosis %K technology %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378 %M 33555265 %R 10.2196/14378 %U https://www.researchprotocols.org/2021/2/e14378 %U https://doi.org/10.2196/14378 %U http://www.ncbi.nlm.nih.gov/pubmed/33555265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e15598 %T Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study %A O'Cathail,Micheal %A Aznar-Garcia,Luis %A Sivanandan,Ananth %A Diver,Claire %A Patel,Poulam %A Tang,Pui-Shan %A Christian,Judith %+ Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Hucknall Road, Nottingham, NG5 1PB, United Kingdom, 44 07460617317, mocathail@gmail.com %K telemedicine %K teleconsultations %K brain metastases %K stereotactic radiosurgery %K mobile phone %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. %M 33544082 %R 10.2196/15598 %U http://formative.jmir.org/2021/2/e15598/ %U https://doi.org/10.2196/15598 %U http://www.ncbi.nlm.nih.gov/pubmed/33544082 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25495 %T Leadership in Digital Health Services: Protocol for a Concept Analysis %A Laukka,Elina %A Pölkki,Tarja %A Heponiemi,Tarja %A Kaihlanen,Anu-Marja %A Kanste,Outi %+ Research Unit of Nursing Science and Health Management, University of Oulu, PL 5000, Oulu, , Finland, 358 504710834, elina.laukka@oulu.fi %K health care %K leadership %K health services %K concept analysis %K telehealth %D 2021 %7 4.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective: The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods: The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results: An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions: A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. International Registered Report Identifier (IRRID): PRR1-10.2196/25495 %M 33538702 %R 10.2196/25495 %U http://www.researchprotocols.org/2021/2/e25495/ %U https://doi.org/10.2196/25495 %U http://www.ncbi.nlm.nih.gov/pubmed/33538702 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25062 %T An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study %A Sauch Valmaña,Glòria %A Vidal-Alaball,Josep %A Garcia Furió,Victoria %A Testoni,Giorgia %A Espelt,Albert %A Exposito,Katarin %A Saigí-Rubió,Francesc %A Carré,Núria %A Sanz,Ikuska %A Vicens,Victor %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K mHealth %K telehealth %K teenager %K health promotion and sexual health %K health promotion %K sexual health %D 2021 %7 3.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients’ safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 %M 33533729 %R 10.2196/25062 %U https://www.researchprotocols.org/2021/2/e25062 %U https://doi.org/10.2196/25062 %U http://www.ncbi.nlm.nih.gov/pubmed/33533729 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23316 %T Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study) %A Jalilian Khave,Laya %A Vahidi,Mohammad %A Shirini,Dorsa %A Sanadgol,Ghazal %A Ashrafi,Farzad %A Arab-Ahmadi,Mehran %A Fatemi,Alireza %A Shabani Barzegar,Minoosh %A Hassanzadeh,Taha %A Rezaei,Behandokht %A Zali,Alireza %A Ommi,Davood %A Nohesara,Shabnam %A Jalili Khoshnood,Reza %A Abdi,Saeed %A Pirsalehi,Ali %A Masarat,Ehsan %A Shokoohi,Mostafa %A Karamouzian,Mohammad %+ Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada, 1 6048222772, karamouzian.m@alumni.ubc.ca %K cohort studies %K COVID-19 %K health care delivery %K Iran %K medical education %K telemedicine %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients’ clinical profiles. Methods: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23316 %M 33471777 %R 10.2196/23316 %U https://www.researchprotocols.org/2021/2/e23316 %U https://doi.org/10.2196/23316 %U http://www.ncbi.nlm.nih.gov/pubmed/33471777 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e25183 %T Driving Digital Transformation During a Pandemic: Case Study of Virtual Collaboration in a German Hospital %A Frick,Nicholas R J %A Möllmann,Henriette L %A Mirbabaie,Milad %A Stieglitz,Stefan %+ Department of IT-Strategy, MAINGAU Energie GmbH, Ringstraße 4, Obertshausen, 63179, Germany, 49 1711904454, nicholas.frick@maingau-energie.de %K digital transformation %K virtual collaboration %K digital health %K health care %K COVID-19 %K pandemic %K hospital %K collaboration %K virtual heath %K crisis %K case study %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has not only changed the private lives of millions of people but has significantly affected the collaboration of medical specialists throughout health care systems worldwide. Hospitals are making changes to their regular operations to slow the spread of SARS-CoV-2 while ensuring the treatment of emergency patients. These substantial changes affect the typical work setting of clinicians and require the implementation of organizational arrangements. Objective: In this study, we aim to increase our understanding of how digital transformation drives virtual collaboration among clinicians in hospitals in times of crisis, such as the COVID-19 pandemic. Methods: We present the lessons learned from an exploratory case study in which we observed the introduction of an information technology (IT) system for enhancing collaboration among clinicians in a German hospital. The results are based on 16 semistructured interviews with physicians from various departments and disciplines; the interviews were generalized to better understand and interpret the meaning of the statements. Results: Three key lessons and recommendations explain how digital transformation ensures goal-driven collaboration among clinicians. First, we found that implementing a disruptive change requires alignment of the mindsets of the stakeholders. Second, IT-enabled collaboration presupposes behavioral rules that must be followed. Third, transforming antiquated processes demands a suitable technological infrastructure. Conclusions: Digital transformation is being driven by the COVID-19 pandemic. However, the rapid introduction of IT-enabled collaboration reveals grievances concerning the digital dissemination of medical information along the patient treatment path. To avoid being caught unprepared by future crises, digital transformation must be further driven to ensure collaboration, and the diagnostic and therapeutic process must be opened to disruptive strategies. %M 33449905 %R 10.2196/25183 %U https://medinform.jmir.org/2021/2/e25183 %U https://doi.org/10.2196/25183 %U http://www.ncbi.nlm.nih.gov/pubmed/33449905 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21752 %T A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study %A Sandell,Tiffany %A Schütze,Heike %A Miller,Andrew %+ Wollongong Hospital, Loftus Street, Wollongong, 2500, Australia, 61 24222500, tiffany.sandell@health.nsw.gov.au %K radiation oncology %K general practice %K health technology %K communication %K cancer %K shared care %K follow-up %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective: The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods: This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results: Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions: Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients’ preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID): PRR1-10.2196/21752 %M 33464209 %R 10.2196/21752 %U http://www.researchprotocols.org/2021/1/e21752/ %U https://doi.org/10.2196/21752 %U http://www.ncbi.nlm.nih.gov/pubmed/33464209 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23771 %T Technology Enabled Clinical Care (TECC): Protocol for a Prospective Longitudinal Cohort Study of Smartphone-Augmented Mental Health Treatment %A Rauseo-Ricupero,Natali %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Rabb Building, Boston, MA, 02446, United States, 1 617 667 6700, jtorous@bidmc.harvard.edu %K mental health care %K access %K multi-language %K smartphone %K app %K quality improvement %K protocol %K mental health %K treatment %K acceptability %K efficacy %K COVID-19 %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision—Technology Enabled Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP. Objective: TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design. Methods: The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations. Results: The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction. Conclusions: TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations. International Registered Report Identifier (IRRID): PRR1-10.2196/23771 %M 33296869 %R 10.2196/23771 %U https://www.researchprotocols.org/2021/1/e23771 %U https://doi.org/10.2196/23771 %U http://www.ncbi.nlm.nih.gov/pubmed/33296869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22450 %T Online Pelvic Floor Group Education Program for Women With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Descriptive Feasibility Study %A Jackowich,Robyn A %A Mooney,Kayla M %A Hecht,Evelyn %A Pukall,Caroline F %+ Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON, K7L 3N6, Canada, 1 613 533 3200, caroline.pukall@queensu.ca %K persistent genital arousal disorder %K genitopelvic dysesthesia %K online program %K pelvic floor %K pilot %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants’ abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms. %M 33427673 %R 10.2196/22450 %U http://formative.jmir.org/2021/1/e22450/ %U https://doi.org/10.2196/22450 %U http://www.ncbi.nlm.nih.gov/pubmed/33427673 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20692 %T Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes %A Aminoff,Hedvig %A Meijer,Sebastiaan %A Arnelo,Urban %A Frennert,Susanne %+ Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11, Stockholm, 141 57 Huddinge, Sweden, 46 8 790 80 71, hedvigam@kth.se %K telemedicine %K telementoring %K teleconsulting %K technology acceptance model %K professional users %K specialties, surgical/education %K attitude %K clinical staff %K surgery %K framework %K surgeon %K user-centered %K interview %K survey %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective: Our objective was to gain a deeper understanding of ERCP practitioners’ attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons’ beliefs about teleguidance’s contribution to performance and factors that might interact with implementation. Results: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard “Ease of Use” items for “Compatibility and Implementation Climate.” In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05). Conclusions: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes. %M 33427670 %R 10.2196/20692 %U https://formative.jmir.org/2021/1/e20692 %U https://doi.org/10.2196/20692 %U http://www.ncbi.nlm.nih.gov/pubmed/33427670 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e25435 %T Using an Extended Technology Acceptance Model to Understand the Factors Influencing Telehealth Utilization After Flattening the COVID-19 Curve in South Korea: Cross-sectional Survey Study %A An,Min Ho %A You,Seng Chan %A Park,Rae Woong %A Lee,Seongwon %+ Department of Biomedical Informatics, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 31 219 4471, seongwon.lee.16@gmail.com %K telemedicine %K telehealth %K COVID-19 %K pandemic %K model %K South Korea %K acceptance %K anxiety %K cross-sectional %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although telehealth is considered a key component in combating the worldwide crisis caused by COVID-19, the factors that influence its acceptance by the general population after the flattening of the COVID-19 curve remain unclear. Objective: We aimed to identify factors affecting telehealth acceptance, including anxiety related to COVID-19, after the initial rapid spread of the disease in South Korea. Methods: We proposed an extended technology acceptance model (TAM) and performed a cross-sectional survey of individuals aged ≥30 years. In total, 471 usable responses were collected. Confirmatory factor analysis was used to examine the validity of measurements, and the partial least squares (PLS) method was used to investigate factors influencing telehealth acceptance and the impacts of COVID-19. Results: PLS analysis showed that increased accessibility, enhanced care, and ease of telehealth use had positive effects on its perceived usefulness (P=.002, P<.001, and P<.001, respectively). Furthermore, perceived usefulness, ease, and privacy/discomfort significantly impacted the acceptance of telehealth (P<.001, P<.001, and P<.001, respectively). However, anxiety toward COVID-19 was not associated with telehealth acceptance (P=.112), and this insignificant relationship was consistent in the cluster (n=216, 46%) of respondents with chronic diseases (P=.185). Conclusions: Increased accessibility, enhanced care, usefulness, ease of use, and privacy/discomfort are decisive variables affecting telehealth acceptance in the Korean general population, whereas anxiety about COVID-19 is not. This study may lead to a tailored promotion of telehealth after the pandemic subsides. %M 33395397 %R 10.2196/25435 %U http://medinform.jmir.org/2021/1/e25435/ %U https://doi.org/10.2196/25435 %U http://www.ncbi.nlm.nih.gov/pubmed/33395397 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e21698 %T Health Care Professionals’ Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study %A Eldh,Ann Catrine %A Sverker,Annette %A Bendtsen,Preben %A Nilsson,Evalill %+ Department of Health, Medicine and Caring Sciences, Linköping University, HMV, 511-13, Campus US, Linköping University, Linköping, 581 83, Sweden, 46 13286634, ann.catrine.eldh@liu.se %K communication %K content analysis %K eHealth %K telemedicine %K digital technology %K interviews %K primary health care %K qualitative research %D 2020 %7 14.12.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care. Objective: The objective of our study was to describe health care staff’s experience with a digital communication system intended for patient-staff encounters via a digital route in primary care. Methods: In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis. Results: While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient’s voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service—at least for a while—if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers. Conclusions: A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation. %M 33315014 %R 10.2196/21698 %U http://humanfactors.jmir.org/2020/4/e21698/ %U https://doi.org/10.2196/21698 %U http://www.ncbi.nlm.nih.gov/pubmed/33315014 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e21982 %T User Experience of a Chatbot Questionnaire Versus a Regular Computer Questionnaire: Prospective Comparative Study %A te Pas,Mariska E %A Rutten,Werner G M M %A Bouwman,R Arthur %A Buise,Marc P %+ Anesthesiology Department, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, Netherlands, 31 627624857, mariska.t.pas@catharinaziekenhuis.nl %K chatbot %K user experience %K questionnaires %K response rates %K value-based health care %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Respondent engagement of questionnaires in health care is fundamental to ensure adequate response rates for the evaluation of services and quality of care. Conventional survey designs are often perceived as dull and unengaging, resulting in negative respondent behavior. It is necessary to make completing a questionnaire attractive and motivating. Objective: The aim of this study is to compare the user experience of a chatbot questionnaire, which mimics intelligent conversation, with a regular computer questionnaire. Methods: The research took place at the preoperative outpatient clinic. Patients completed both the standard computer questionnaire and the new chatbot questionnaire. Afterward, patients gave their feedback on both questionnaires by the User Experience Questionnaire, which consists of 26 terms to score. Results: The mean age of the 40 included patients (25 [63%] women) was 49 (SD 18-79) years; 46.73% (486/1040) of all terms were scored positive for the chatbot. Patients preferred the computer for 7.98% (83/1040) of the terms and for 47.88% (498/1040) of the terms there were no differences. Completion (mean time) of the computer questionnaire took 9.00 minutes by men (SD 2.72) and 7.72 minutes by women (SD 2.60; P=.148). For the chatbot, completion by men took 8.33 minutes (SD 2.99) and by women 7.36 minutes (SD 2.61; P=.287). Conclusions: Patients preferred the chatbot questionnaire over the computer questionnaire. Time to completion of both questionnaires did not differ, though the chatbot questionnaire on a tablet felt more rapid compared to the computer questionnaire. This is an important finding because it could lead to higher response rates and to qualitatively better responses in future questionnaires. %M 33284125 %R 10.2196/21982 %U http://medinform.jmir.org/2020/12/e21982/ %U https://doi.org/10.2196/21982 %U http://www.ncbi.nlm.nih.gov/pubmed/33284125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19375 %T Barriers and Enablers in Implementing Electronic Consultations in Primary Care: Scoping Review %A Baines,Rebecca %A Tredinnick-Rowe,John %A Jones,Ray %A Chatterjee,Arunangsu %+ University of Plymouth, Room 108 I 3 Endsleigh Place, Drake Circus, Plymouth, , United Kingdom, 44 1752 586837, arunangsu.chatterjee@plymouth.ac.uk %K remote consultation %K COVID-19 %K implementation science %K primary health care %K patient participation %K referral and consultation %D 2020 %7 12.11.2020 %9 Review %J J Med Internet Res %G English %X Background: Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. Objective: With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. Methods: In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). Results: In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. Conclusions: This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care. %M 33035177 %R 10.2196/19375 %U https://www.jmir.org/2020/11/e19375 %U https://doi.org/10.2196/19375 %U http://www.ncbi.nlm.nih.gov/pubmed/33035177 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18426 %T Implementation and Application of Telemedicine in China: Cross-Sectional Study %A Cui,Fangfang %A Ma,Qianqian %A He,Xianying %A Zhai,Yunkai %A Zhao,Jie %A Chen,Baozhan %A Sun,Dongxu %A Shi,Jinming %A Cao,Mingbo %A Wang,Zhenbo %+ National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, China, 86 371 67966215, zhaojie@zzu.edu.cn %K telemedicine %K Chinese hospital %K implementation %K application %K influencing factors %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine. Objective: The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future. Methods: The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect. Results: Approximately 93.8% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3% (139/161), 57.1% (92/161), 49.7% (80/161), 37.9% (61/161), and 33.5% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education. Conclusions: A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished. %M 33095175 %R 10.2196/18426 %U http://mhealth.jmir.org/2020/10/e18426/ %U https://doi.org/10.2196/18426 %U http://www.ncbi.nlm.nih.gov/pubmed/33095175 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e23680 %T Feasibility of Asynchronous and Automated Telemedicine in Otolaryngology: Prospective Cross-Sectional Study %A Cha,Dongchul %A Shin,Seung Ho %A Kim,Jungghi %A Eo,Tae Seong %A Na,Gina %A Bae,Seonghoon %A Jung,Jinsei %A Kim,Sung Huhn %A Moon,In Seok %A Choi,Jaeyoung %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2363, yurangpark@yuhs.ac %K telemedicine %K otolaryngology %K otology %K automated diagnosis %K asynchronous %K COVID-19 %K diagnosis %K feasibility %K cross-sectional %D 2020 %7 19.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 often causes respiratory symptoms, making otolaryngology offices one of the most susceptible places for community transmission of the virus. Thus, telemedicine may benefit both patients and physicians. Objective: This study aims to explore the feasibility of telemedicine for the diagnosis of all otologic disease types. Methods: A total of 177 patients were prospectively enrolled, and the patient’s clinical manifestations with otoendoscopic images were written in the electrical medical records. Asynchronous diagnoses were made for each patient to assess Top-1 and Top-2 accuracy, and we selected 20 cases to conduct a survey among four different otolaryngologists to assess the accuracy, interrater agreement, and diagnostic speed. We also constructed an experimental automated diagnosis system and assessed Top-1 accuracy and diagnostic speed. Results: Asynchronous diagnosis showed Top-1 and Top-2 accuracies of 77.40% and 86.44%, respectively. In the selected 20 cases, the Top-2 accuracy of the four otolaryngologists was on average 91.25% (SD 7.50%), with an almost perfect agreement between them (Cohen kappa=0.91). The automated diagnostic model system showed 69.50% Top-1 accuracy. Otolaryngologists could diagnose an average of 1.55 (SD 0.48) patients per minute, while the machine learning model was capable of diagnosing on average 667.90 (SD 8.3) patients per minute. Conclusions: Asynchronous telemedicine in otology is feasible owing to the reasonable Top-2 accuracy when assessed by experienced otolaryngologists. Moreover, enhanced diagnostic speed while sustaining the accuracy shows the possibility of optimizing medical resources to provide expertise in areas short of physicians. %M 33027033 %R 10.2196/23680 %U http://medinform.jmir.org/2020/10/e23680/ %U https://doi.org/10.2196/23680 %U http://www.ncbi.nlm.nih.gov/pubmed/33027033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17298 %T Determining if Telehealth Can Reduce Health System Costs: Scoping Review %A Snoswell,Centaine L %A Taylor,Monica L %A Comans,Tracy A %A Smith,Anthony C %A Gray,Leonard C %A Caffery,Liam J %+ Centre for Online Health, The University of Queensland, Building 33, Princess Alexandra Hospital, Brisbane, , Australia, 61 7 3176 7704, l.caffery@uq.edu.au %K cost-benefit analysis %K telemedicine %K review %D 2020 %7 19.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Telehealth represents an opportunity for Australia to harness the power of technology to redesign the way health care is delivered. The potential benefits of telehealth include increased accessibility to care, productivity gains for health providers and patients through reduced travel, potential for cost savings, and an opportunity to develop culturally appropriate services that are more sensitive to the needs of special populations. The uptake of telehealth has been hindered at times by clinician reluctance and policies that preclude metropolitan populations from accessing telehealth services. Objective: This study aims to investigate if telehealth reduces health system costs compared with traditional service models and to identify the scenarios in which cost savings can be realized. Methods: A scoping review was undertaken to meet the study aims. Initially, literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature in telehealth. The investigators then conducted an expert focus group to identify domains where telehealth could reduce health system costs, followed by targeted literature searches for corresponding evidence. Results: The cost analyses reviewed provided evidence that telehealth reduced costs when health system–funded travel was prevented and when telehealth mitigated the need for expensive procedural or specialist follow-up by providing competent care in a more efficient way. The expert focus group identified 4 areas of potential savings from telehealth: productivity gains, reductions in secondary care, alternate funding models, and telementoring. Telehealth demonstrated great potential for productivity gains arising from health system redesign; however, under the Australian activity-based funding, it is unlikely that these gains will result in cost savings. Secondary care use mitigation is an area of promise for telehealth; however, many studies have not demonstrated overall cost savings due to the cost of administering and monitoring telehealth systems. Alternate funding models from telehealth systems have the potential to save the health system money in situations where the consumers pay out of pocket to receive services. Telementoring has had minimal economic evaluation; however, in the long term it is likely to result in inadvertent cost savings through the upskilling of generalist and allied health clinicians. Conclusions: Health services considering implementing telehealth should be motivated by benefits other than cost reduction. The available evidence has indicated that although telehealth provides overwhelmingly positive patient benefits and increases productivity for many services, current evidence suggests that it does not routinely reduce the cost of care delivery for the health system. %M 33074157 %R 10.2196/17298 %U http://www.jmir.org/2020/10/e17298/ %U https://doi.org/10.2196/17298 %U http://www.ncbi.nlm.nih.gov/pubmed/33074157 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e20938 %T BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments %A Piera-Jiménez,Jordi %A Daugbjerg,Signe %A Stafylas,Panagiotis %A Meyer,Ingo %A Müller,Sonja %A Lewis,Leo %A da Col,Paolo %A Folkvord,Frans %A Lupiáñez-Villanueva,Francisco %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Rambla de Poblenou 156, Barcelona, 08018, Spain, 34 651041515, jpieraj@uoc.edu %K integrated care %K telemedicine %K telecare %K digital health %K cost-effectiveness %K clinical effectiveness %K chronic disease %D 2020 %7 6.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce. Objective: The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain. Methods: A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology–enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months. Results: The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI –4.51 to 4.78; P=.95) but decreased in the comparator group (mean change –3.23, 95% CI –5.34 to –1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of –0.23 (95% CI –0.44 to –0.02; P=.03) and –0.33 (95% CI –0.46 to –0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI –0.44 to 1.01, P=.44; comparator: mean change –0.29, 95% CI –0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582). Conclusions: The information and communication technology–enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved. Trial Registration: ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004 %M 33021490 %R 10.2196/20938 %U https://medinform.jmir.org/2020/10/e20938 %U https://doi.org/10.2196/20938 %U http://www.ncbi.nlm.nih.gov/pubmed/33021490 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18835 %T Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis %A Waqas,Ahmed %A Teoh,Soo Huat %A Lapão,Luís Velez %A Messina,Luiz Ary %A Correia,Jorge César %+ Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and Patient Education, Department of Medicine, Geneva University Hospitals and University of Geneva, Chemin Venel 7, Geneva, 1206, Switzerland, 41 22 372 97 22, jorgecesar.correia@hcuge.ch %K telemedicine %K scientometric analysis %K evidence synthesis %K health information technology %K research %K theme %D 2020 %7 2.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. %M 33006571 %R 10.2196/18835 %U https://www.jmir.org/2020/10/e18835 %U https://doi.org/10.2196/18835 %U http://www.ncbi.nlm.nih.gov/pubmed/33006571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17978 %T Understanding the Information Needs and Context of Trauma Handoffs to Design Automated Sensing Clinical Documentation Technologies: Qualitative Mixed-Method Study of Military and Civilian Cases %A Novak,Laurie Lovett %A Simpson,Christopher L %A Coco,Joseph %A McNaughton,Candace D %A Ehrenfeld,Jesse M %A Bloos,Sean M %A Fabbri,Daniel %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, TN, 37203, United States, 1 615 936 6497, laurie.l.novak@vumc.org %K trauma handoffs %K military field medicine %K documentation %K trauma %K health records %K hospital %K emergency %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Current methods of communication between the point of injury and receiving medical facilities rely on verbal communication, supported by brief notes and the memory of the field medic. This communication can be made more complete and reliable with technologies that automatically document the actions of field medics. However, designing state-of-the-art technology for military field personnel and civilian first responders is challenging due to the barriers researchers face in accessing the environment and understanding situated actions and cognitive models employed in the field. Objective: To identify design insights for an automated sensing clinical documentation (ASCD) system, we sought to understand what information is transferred in trauma cases between prehospital and hospital personnel, and what contextual factors influence the collection, management, and handover of information in trauma cases, in both military and civilian cases. Methods: Using a multi-method approach including video review and focus groups, we developed an understanding of the information needs of trauma handoffs and the context of field documentation to inform the design of an automated sensing documentation system that uses wearables, cameras, and environmental sensors to passively infer clinical activity and automatically produce documentation. Results: Comparing military and civilian trauma documentation and handoff, we found similarities in the types of data collected and the prioritization of information. We found that military environments involved many more contextual factors that have implications for design, such as the physical environment (eg, heat, lack of lighting, lack of power) and the potential for active combat and triage, creating additional complexity. Conclusions: An ineffectiveness of communication is evident in both the civilian and military worlds. We used multiple methods of inquiry to study the information needs of trauma care and handoff, and the context of medical work in the field. Our findings informed the design and evaluation of an automated documentation tool. The data illustrated the need for more accurate recordkeeping, specifically temporal aspects, during transportation, and characterized the environment in which field testing of the developed tool will take place. The employment of a systems perspective in this project produced design insights that our team would not have identified otherwise. These insights created exciting and interesting challenges for the technical team to resolve. %M 32975522 %R 10.2196/17978 %U http://www.jmir.org/2020/9/e17978/ %U https://doi.org/10.2196/17978 %U http://www.ncbi.nlm.nih.gov/pubmed/32975522 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e21584 %T Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study %A Khana,Rajes %A Mahinderjit Singh,Manmeet %A Damanhoori,Faten %A Mustaffa,Norlia %+ Universiti Sains Malaysia, Jalan Sungai Dua, Gelugor, Penang, 11800, Malaysia, 60 46533888, manmeet@usm.my %K trust %K trustworthiness %K multifaceted trust %K breast self-examination %K breast cancer %K health care system %K social media %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient’s personal medical data excessively with colleagues or the public. Such an act would reduce the physician’s trustworthiness from the patient’s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening. Objective: The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians. Methods: We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum. Results: Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions. Conclusions: Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient’s recommendation regarding the physician’s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty. %M 32965225 %R 10.2196/21584 %U https://medinform.jmir.org/2020/9/e21584 %U https://doi.org/10.2196/21584 %U http://www.ncbi.nlm.nih.gov/pubmed/32965225 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20786 %T Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study %A Ramaswamy,Ashwin %A Yu,Miko %A Drangsholt,Siri %A Ng,Eric %A Culligan,Patrick J %A Schlegel,Peter N %A Hu,Jim C %+ Department of Urology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, United States, 1 646 962 9600, asr9066@nyp.org %K telemedicine %K medicine %K pandemics %K patient satisfaction %K remote consultation %K disruptive technology %K medical informatics %K health care delivery %K practice patterns %K physicians %K health policy %K health services research %K health care reform %K COVID-19 %D 2020 %7 9.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre–COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE –2.05; 95% CI –2.66 to –1.22), female gender (PE –0.73; 95% CI –0.96 to –0.50), and new visit type (PE –0.75; 95% CI –1.00 to –0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. %M 32810841 %R 10.2196/20786 %U http://www.jmir.org/2020/9/e20786/ %U https://doi.org/10.2196/20786 %U http://www.ncbi.nlm.nih.gov/pubmed/32810841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20143 %T Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study %A Dhala,Atiya %A Sasangohar,Farzan %A Kash,Bita %A Ahmadi,Nima %A Masud,Faisal %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K intensive care units %K critical care %K pandemics %K SARS-CoV-2 %K telemedicine %K infection control %K COVID-19 %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective: The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods: The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results: Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions: Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients. %M 32795997 %R 10.2196/20143 %U http://www.jmir.org/2020/9/e20143/ %U https://doi.org/10.2196/20143 %U http://www.ncbi.nlm.nih.gov/pubmed/32795997 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e16521 %T A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? %A North,Frederick %A Luhman,Kristine E %A Mallmann,Eric A %A Mallmann,Toby J %A Tulledge-Scheitel,Sidna M %A North,Emily J %A Pecina,Jennifer L %+ Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 5072842511, north.frederick@mayo.edu %K patient messages %K secure messages %K patient portal %K provider messages %K electronic health records %K electronic mail %K communication %K patients %K physicians %K physician assistants %K nurse practitioners %K nurses %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. Objective: This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. Methods: We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). Results: Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. Conclusions: Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume. %M 32673238 %R 10.2196/16521 %U https://medinform.jmir.org/2020/7/e16521 %U https://doi.org/10.2196/16521 %U http://www.ncbi.nlm.nih.gov/pubmed/32673238 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17417 %T Evaluating Safety and Efficacy of Follow-up for Patients With Abdominal Pain Using Video Consultation (SAVED Study): Randomized Controlled Trial %A Gunasekeran,Dinesh Visva %A Liu,Zhenghong %A Tan,Win Jim %A Koh,Joshua %A Cheong,Chiu Peng %A Tan,Lay Hong %A Lau,Chee Siang %A Phuah,Gaik Kheng %A Manuel,Newsie Donnah A %A Chia,Che Chong %A Seng,Gek Siang %A Tong,Nancy %A Huin,May Hang %A Dulce,Suzette Villaluna %A Yap,Susan %A Ponampalam,Kishanti %A Ying,Hao %A Ong,Marcus Eng Hock %A Ponampalam,R %+ Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore, 65 6321 3497, ponampalam@singhealth.com.sg %K digital health %K teleconsultation %K video consultation %K telereview %K abdominal pain %K primary care %K emergency department %D 2020 %7 15.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. Objective: The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. Methods: The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). Results: A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups. Conclusions: The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. Trial Registration: ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556. %M 32459637 %R 10.2196/17417 %U https://www.jmir.org/2020/6/e17417 %U https://doi.org/10.2196/17417 %U http://www.ncbi.nlm.nih.gov/pubmed/32459637 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19033 %T A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development %A Schinköthe,Timo %A Gabri,Mariano Rolando %A Mitterer,Manfred %A Gouveia,Pedro %A Heinemann,Volker %A Harbeck,Nadia %A Subklewe,Marion %+ CANKADO, Eupener Sraße 165, Cologne, 50933, Germany, 49 221 429 153 00, t.schinkoethe@cankado.com %K COVID-19 %K eHealth %K connected care %K telecare %K cloud solution %K telehealth %K public health %K infectious disease %K pandemic %K outbreak %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. Objective: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. Methods: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. Results: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. Conclusions: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19. %M 32406855 %R 10.2196/19033 %U http://publichealth.jmir.org/2020/2/e19033/ %U https://doi.org/10.2196/19033 %U http://www.ncbi.nlm.nih.gov/pubmed/32406855 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e18914 %T Desirable Features of an Interdisciplinary Handoff %A Sule,Anupam Ashutosh %A Caputo,Dean %A Gohal,Jaskaren %A Dascenzo,Doug %+ Department of Internal Medicine, St Joseph Mercy Oakland, 44405 Woodward Ave, Administration Ste, Pontiac, MI, 48341, United States, 1 2488586281, anupamsule@gmail.com %K handoff %K transition %K sign-out %K electronic %K interdisciplinary %K interprofessional %K communication %K patient safety %D 2020 %7 22.5.2020 %9 Viewpoint %J JMIR Nursing %G English %X Failure of communication of critical information during handoffs is one of the leading causes of medical errors, resulting in serious, yet preventable, adverse events in hospitals across the United States. Recent studies have shown that a majority of these errors occur during patient handoffs, with notable communication gaps in interdisciplinary handoffs. We suggest some features that would improve the handoff usability and effectiveness for interdisciplinary medical and nursing teams while potentially improving patient safety. %R 10.2196/18914 %U https://nursing.jmir.org/2020/1/e18914/ %U https://doi.org/10.2196/18914 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 3 %N 1 %P e15688 %T Economic Advantages of Telehealth and Virtual Health Practitioners: Return on Investment Analysis %A Snoswell,Centaine L %A North,John B %A Caffery,Liam J %+ Centre for Online Health, The University of Queensland, Building 33, Princess Alexandra Hospital, Brisbane, 4102, Australia, 61 7 3176 5314, c.snoswell@uq.edu.au %K clinical services %K e-health %K health economics %K health funding and financing %K rural and remote health %K workforce %D 2020 %7 21.5.2020 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Telehealth is a disruptive modality that challenges the traditional model of having a clinician or patient physically present for an appointment. The benefit is that it offers the opportunity to redesign the way services are offered. For instance, a virtual health practitioner can provide videoconference consultations while being located anywhere in the world that has internet. A virtual health practitioner also obviates the issues of attracting a specialist medical workforce to rural areas, and allows the rural health service to control the specialist services that they offer. Objective: The aim of this research was to evaluate the economic effects of 3 different models of care on rural and metropolitan hospital sites. The models of care examined were patient travel, telehealth using videoconferencing, and employment of a virtual health practitioner by a rural site. Methods: Using retrospective activity data for 3 years, a return on investment (ROI) analysis was undertaken from the perspective of a rural site and metropolitan partner site using a telehealth orthopedic fracture clinic as an example. Further analysis was conducted to calculate the number of patients that would be required to attend the clinic in each model of care for the sites to break even. Results: The only service model that resulted in a positive ROI for the rural site over the 3-year period was the virtual health practitioner model. The breakeven analysis demonstrated that the rural site required the lowest number of patients to recoup costs in the virtual health practitioner model of care. The rural site was unable to recoup its costs within the travel model due to the lack of opportunity for reimbursement for services and the requirement to cover the cost of travel for patients. Conclusions: Our model demonstrated that rural health care providers can increase their ROI by employing a virtual health practitioner. %M 33393922 %R 10.2196/15688 %U http://periop.jmir.org/2020/1/e15688/ %U https://doi.org/10.2196/15688 %U http://www.ncbi.nlm.nih.gov/pubmed/33393922 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18378 %T Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction %A Shaw,Sara E %A Seuren,Lucas Martinus %A Wherton,Joseph %A Cameron,Deborah %A A'Court,Christine %A Vijayaraghavan,Shanti %A Morris,Joanne %A Bhattacharya,Satyajit %A Greenhalgh,Trisha %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865617830, sara.shaw@phc.ox.ac.uk %K delivery of health care %K physical examination %K remote consultation %K telemedicine %K health communication %K language %K nonverbal communication %K mobile phone %D 2020 %7 11.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. Objective: Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. Methods: We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). Results: Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. Conclusions: A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. International Registered Report Identifier (IRRID): RR2-10.2196/10913 %M 32391799 %R 10.2196/18378 %U http://www.jmir.org/2020/5/e18378/ %U https://doi.org/10.2196/18378 %U http://www.ncbi.nlm.nih.gov/pubmed/32391799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19577 %T Telemedicine During the COVID-19 Pandemic: Experiences From Western China %A Hong,Zhen %A Li,Nian %A Li,Dajiang %A Li,Junhua %A Li,Bing %A Xiong,Weixi %A Lu,Lu %A Li,Weimin %A Zhou,Dong %+ Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China, 86 28 8542 2893, zhoudong66@yahoo.de %K COVID-19 %K coronavirus disease %K medical education %K pandemics %K teleteaching %K tele-education %K telemedicine %D 2020 %7 8.5.2020 %9 Viewpoint %J J Med Internet Res %G English %X Disasters and pandemics pose unique challenges to health care delivery. As health care resources continue to be stretched due to the increasing burden of the coronavirus disease (COVID-19) pandemic, telemedicine, including tele-education, may be an effective way to rationally allocate medical resources. During the COVID-19 pandemic, a multimodal telemedicine network in Sichuan Province in Western China was activated immediately after the first outbreak in January 2020. The network synergizes a newly established 5G service, a smartphone app, and an existing telemedicine system. Telemedicine was demonstrated to be feasible, acceptable, and effective in Western China, and allowed for significant improvements in health care outcomes. The success of telemedicine here may be a useful reference for other parts of the world. %M 32349962 %R 10.2196/19577 %U http://www.jmir.org/2020/5/e19577/ %U https://doi.org/10.2196/19577 %U http://www.ncbi.nlm.nih.gov/pubmed/32349962 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19106 %T Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak %A Pérez Sust,Pol %A Solans,Oscar %A Fajardo,Joan Carles %A Medina Peralta,Manuel %A Rodenas,Pepi %A Gabaldà,Jordi %A Garcia Eroles,Luis %A Comella,Adrià %A Velasco Muñoz,César %A Sallent Ribes,Josuè %A Roma Monfa,Rosa %A Piera-Jimenez,Jordi %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Av del Tibidabo 39, Barcelona, 08035, Spain, 34 651041515, jpiera@bsa.cat %K digital health %K eHealth %K telemedicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K policymaking %D 2020 %7 4.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia. %M 32339998 %R 10.2196/19106 %U http://publichealth.jmir.org/2020/2/e19106/ %U https://doi.org/10.2196/19106 %U http://www.ncbi.nlm.nih.gov/pubmed/32339998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14201 %T Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study %A Chen,Sonia Chien-I %A Hu,Ridong %A McAdam,Rodney %+ Institute of Quantitative Economics, Huaqiao University, No. 668, Jimei Avenue, Jimei dist, Xiamen, 361021, China, 86 17750619886, j_rdhu@hqu.edu.cn %K connected health care %K smart health care %K health care quality %K access %K remote monitoring %K precision medicine %K self-management %D 2020 %7 28.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care’s direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. %M 32343254 %R 10.2196/14201 %U http://www.jmir.org/2020/4/e14201/ %U https://doi.org/10.2196/14201 %U http://www.ncbi.nlm.nih.gov/pubmed/32343254 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 4 %P e18094 %T Real-Time Streaming of Surgery Performance and Intraoperative Imaging Data in the Hybrid Operating Room: Development and Usability Study %A Lin,Chun-Cheng %A Chen,Yu-Pin %A Chiang,Chao-Ching %A Chang,Ming-Chau %A Lee,Oscar Kuang-Sheng %+ Department of Medical Research, Taipei Veterans General Hospital, 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan, 886 228757434 ext 9, kslee@vghtpe.gov.tw %K hybrid operating room %K real-time streaming %K surgical telementoring %K information technology infrastructure %K encoder and decoder %K real-world evidence %K information technology %K surgery %K medical imaging %K operating room %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The trend of quick evolution and increased digital data in today’s operating rooms (ORs) has led to the construction of hybrid ORs. There is often a main control room with monitors for integrating intraoperative data from multiple devices in the hybrid OR. However, there is no adequate solution for communicating the data with people outside the OR. Objective: The objective of this study was to design an intelligent operating room (iOR) system, augmented onto the existing information technology (IT) infrastructure of hybrid ORs, to stream surgery performance and intraoperative imaging data. Methods: In this study, an all-in-one device with synergetic encoder and decoder was used. The device was able to stream multiple sources to one display. The lossless video and images from specific surgical workflows were streamed outside the hybrid OR through network protocols and were further managed by a streaming server and wireless control system. The steps of this study included the following: (1) defining the requirements and feasibility of an iOR system in the hybrid OR, (2) connecting multiple sources, (3) setting up equipment across the hybrid OR and a conference room, (4) designing a video management system, and (5) real-time streaming under specific surgical workflows. Results: The wired streamed video was shown simultaneously on the display in the hybrid OR and the display in the conference room with near-zero latency. Additionally, an interactive video between the hybrid OR and the conference room was achieved through the bidirectional wireless control system. The functions of recording, archiving, and playback were successfully provided by the streaming server. The readily available hardware components and open-access programming reduced the cost required to construct this streaming system. Conclusions: This flexible and cost-effective iOR system not only provided educational benefits, but also contributed to surgical telementoring. %M 32209528 %R 10.2196/18094 %U http://medinform.jmir.org/2020/4/e18094/ %U https://doi.org/10.2196/18094 %U http://www.ncbi.nlm.nih.gov/pubmed/32209528 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16700 %T Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study %A G Bianchi,Mara %A Santos,Andre %A Cordioli,Eduardo %+ Telemedicine, Hospital Israelita Albert Einstein, Avenida Albert Einstein 627, São Paulo, Brazil, 55 11 21513381, marahgbianchi@gmail.com %K access to and use of services %K decision making %K epidemiology %K economics %K health care systems and management (telehealth) %K management %K technology %K teledermatology %K geriatric population %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective: Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods: This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results: Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions: Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses. %M 32314966 %R 10.2196/16700 %U http://www.jmir.org/2020/4/e16700/ %U https://doi.org/10.2196/16700 %U http://www.ncbi.nlm.nih.gov/pubmed/32314966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16954 %T Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study %A Verma,Rhea %A Krishnamurti,Tamar %A Ray,Kristin N %+ Department of Pediatrics, University of Pittsburgh School of Medicine, 3414 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 4126926000, kristin.ray@chp.edu %K consultation %K referral %K telemedicine %K telehealth %K child health %K child health services %D 2020 %7 9.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic consultations, which use store-and-forward transfer of clinical information between a primary care physician and a specialist, improve access to specialty care. Adoption of electronic consultations is beginning in pediatric health care systems, but little is known about parent perspectives, informational needs, and preferences for interaction with this new model of care. Objective: This study aimed to examine parent perspectives about electronic consultations, including perceived benefits and risks, anticipated informational needs, and preferences for parent engagement with electronic consultations. Methods: We recruited caregivers of pediatric patients (aged 0-21 years) attending visits at an academic primary care center. Caregivers were eligible if their child had ever been referred for in-person specialty care. Caregivers participated in a semistructured interview about electronic consultations, including general perspectives, desired information, and preferences for parental engagement. Interviews were transcribed and qualitatively analyzed to identify parent perspectives on electronic consultations in general, information parents would like to receive about electronic consultations, and perspectives on opportunities to enhance parent engagement with electronic consultations. Results: Interviewees (n=20) anticipated that electronic consultations would reduce the time burden of specialty care on families and that these had the potential to improve the integrity and availability of clinical information, but interviewees also expressed concern about data confidentiality. The most detailed information desired by interviewees about electronic consultations related to data security, including data confidentiality, availability, and integrity. Interviewees expressed concern that electronic consultations could exclude parents from their child’s health care decisions. Interviewees saw value in the potential ability to track the consultation status or to participate in the consultation dialogue, but they were more ambivalent about the idea of read-only access to consultation documentation. Conclusions: Parents identified the potential risks and benefits of pediatric electronic consultations, with implications for communication with families about electronic consultations and for incorporation of features to enhance parent engagement. %M 32084626 %R 10.2196/16954 %U https://www.jmir.org/2020/4/e16954 %U https://doi.org/10.2196/16954 %U http://www.ncbi.nlm.nih.gov/pubmed/32084626 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e15380 %T The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review %A O'Cathail,Micheal %A Sivanandan,M Ananth %A Diver,Claire %A Patel,Poulam %A Christian,Judith %+ Department of Oncology & Radiotherapy, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, United Kingdom, 44 01159691169 ext 72149, mocathail@gmail.com %K telehealth %K telemedicine %K teleconsultation %K scoping review %D 2020 %7 16.3.2020 %9 Review %J JMIR Med Inform %G English %X Background: The National Health Service (NHS) Long-Term Plan has set out a vision of enabling patients to access digital interactions with health care professionals within 5 years, including by video link. Objective: This review aimed to examine the extent and nature of the use of patient-facing teleconsultations within a health care setting in the United Kingdom and what outcome measures have been assessed. Methods: We conducted a systematic scoping review of teleconsultation studies following the Joanna Briggs Institute methodology. PubMed, Scopus, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched up to the end of December 2018 for publications that reported on the use of patient-facing teleconsultations in a UK health care setting. Results: The search retrieved 3132 publications, of which 101 were included for a full review. Overall, the studies were heterogeneous in design, in the specialty assessed, and reported outcome measures. The technology used for teleconsultations changed over time with earlier studies employing bespoke, often expensive, solutions. Two-thirds of the studies, conducted between 1995 and 2005, used this method. Later studies transitioned to Web-based commercial solutions such as Skype. There were five outcome measures that were assessed: (1) technical feasibility, (2) user satisfaction, (3) clinical effectiveness, (4) cost, (5) logistical and operational considerations. Due to the changing nature of technology over time, there were differing technical issues across the studies. Generally, teleconsultations were acceptable to patients, but this was less consistent among health care professionals. However, among both groups, face-to-face consultations were still seen as the gold standard. A wide range of clinical scenarios found teleconsultations to be clinically useful but potentially limited to more straightforward clinical interactions. Due to the wide array of study types and changes in technology over time, it is difficult to draw definitive conclusions on the cost involved. However, cost savings for health care providers have been demonstrated by the goal-directed implementation of teleconsultations. The integration of technology into routine practice represents a complex problem with barriers identified in funding and hospital reimbursement, information technologies infrastructure, and integration into clinicians’ workflow. Conclusions: Teleconsultations appear to be safe and effective in the correct clinical situations. Where offered, it is likely that patients will be keen to engage, although teleconsultations should only be offered as an option to support traditional care models rather than replace them outright. Health care staff should be encouraged and supported in using teleconsultations to diversify their practice. Health care organizations need to consider developing a digital technology strategy and implementation groups to assist health care staff to integrate digitally enabled care into routine practice. The introduction of new technologies should be assessed after a set period with service evaluations, including feedback from key stakeholders. %M 32175911 %R 10.2196/15380 %U http://medinform.jmir.org/2020/3/e15380/ %U https://doi.org/10.2196/15380 %U http://www.ncbi.nlm.nih.gov/pubmed/32175911 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e14379 %T Expedited Safety Reporting Through an Alert System for Clinical Trial Management at an Academic Medical Center: Retrospective Design Study %A Park,Yu Rang %A Koo,HaYeong %A Yoon,Young-Kwang %A Park,Sumi %A Lim,Young-Suk %A Baek,Seunghee %A Kim,Hae Reong %A Kim,Tae Won %+ Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 3910, twkimmd@amc.seoul.kr %K clinical trial %K adverse event %K early detection %K patient safety %D 2020 %7 27.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Early detection or notification of adverse event (AE) occurrences during clinical trials is essential to ensure patient safety. Clinical trials take advantage of innovative strategies, clinical designs, and state-of-the-art technologies to evaluate efficacy and safety, however, early awareness of AE occurrences by investigators still needs to be systematically improved. Objective: This study aimed to build a system to promptly inform investigators when clinical trial participants make unscheduled visits to the emergency room or other departments within the hospital. Methods: We developed the Adverse Event Awareness System (AEAS), which promptly informs investigators and study coordinators of AE occurrences by automatically sending text messages when study participants make unscheduled visits to the emergency department or other clinics at our center. We established the AEAS in July 2015 in the clinical trial management system. We compared the AE reporting timeline data of 305 AE occurrences from 74 clinical trials between the preinitiative period (December 2014-June 2015) and the postinitiative period (July 2015-June 2016) in terms of three AE awareness performance indicators: onset to awareness, awareness to reporting, and onset to reporting. Results: A total of 305 initial AE reports from 74 clinical trials were included. All three AE awareness performance indicators were significantly lower in the postinitiative period. Specifically, the onset-to-reporting times were significantly shorter in the postinitiative period (median 1 day [IQR 0-1], mean rank 140.04 [SD 75.35]) than in the preinitiative period (median 1 day [IQR 0-4], mean rank 173.82 [SD 91.07], P≤.001). In the phase subgroup analysis, the awareness-to-reporting and onset-to-reporting indicators of phase 1 studies were significantly lower in the postinitiative than in the preinitiative period (preinitiative: median 1 day, mean rank of awareness to reporting 47.94, vs postinitiative: median 0 days, mean rank of awareness to reporting 35.75, P=.01; and preinitiative: median 1 day, mean rank of onset to reporting 47.4, vs postinitiative: median 1 day, mean rank of onset to reporting 35.99, P=.03). The risk-level subgroup analysis found that the onset-to-reporting time for low- and high-risk studies significantly decreased postinitiative (preinitiative: median 4 days, mean rank of low-risk studies 18.73, vs postinitiative: median 1 day, mean rank of low-risk studies 11.76, P=.02; and preinitiative: median 1 day, mean rank of high-risk studies 117.36, vs postinitiative: median 1 day, mean rank of high-risk studies 97.27, P=.01). In particular, onset to reporting was reduced more in the low-risk trial than in the high-risk trial (low-risk: median 4-0 days, vs high-risk: median 1-1 day). Conclusions: We demonstrated that a real-time automatic alert system can effectively improve safety reporting timelines. The improvements were prominent in phase 1 and in low- and high-risk clinical trials. These findings suggest that an information technology-driven automatic alert system effectively improves safety reporting timelines, which may enhance patient safety. %R 10.2196/14379 %U http://medinform.jmir.org/2020/2/e14379/ %U https://doi.org/10.2196/14379 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e16765 %T Analysis of Massive Online Medical Consultation Service Data to Understand Physicians’ Economic Return: Observational Data Mining Study %A Jiang,Jinglu %A Cameron,Ann-Frances %A Yang,Ming %+ Binghamton University, 4400 Vestal Pkwy E, Binghamton, NY, 13902, United States, 1 6077773016, jingluj@binghamton.edu %K Web-based health services %K remote consultation %K machine learning %K data mining %K decision tree %K patient involvement %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Online health care consultation has become increasingly popular and is considered a potential solution to health care resource shortages and inefficient resource distribution. However, many online medical consultation platforms are struggling to attract and retain patients who are willing to pay, and health care providers on the platform have the additional challenge of standing out in a crowd of physicians who can provide comparable services. Objective: This study used machine learning (ML) approaches to mine massive service data to (1) identify the important features that are associated with patient payment, as opposed to free trial–only appointments; (2) explore the relative importance of these features; and (3) understand how these features interact, linearly or nonlinearly, in relation to payment. Methods: The dataset is from the largest China-based online medical consultation platform, which covers 1,582,564 consultation records between patient-physician pairs from 2009 to 2018. ML techniques (ie, hyperparameter tuning, model training, and validation) were applied with four classifiers—logistic regression, decision tree (DT), random forest, and gradient boost—to identify the most important features and their relative importance for predicting paid vs free-only appointments. Results: After applying the ML feature selection procedures, we identified 11 key features on the platform, which are potentially useful to predict payment. For the binary ML classification task (paid vs free services), the 11 features as a whole system achieved very good prediction performance across all four classifiers. DT analysis further identified five distinct subgroups of patients delineated by five top-ranked features: previous offline connection, total dialog, physician response rate, patient privacy concern, and social return. These subgroups interact with the physician differently, resulting in different payment outcomes. Conclusions: The results show that, compared with features related to physician reputation, service-related features, such as service delivery quality (eg, consultation dialog intensity and physician response rate), patient source (eg, online vs offline returning patients), and patient involvement (eg, provide social returns and reveal previous treatment), appear to contribute more to the patient’s payment decision. Promoting multiple timely responses in patient-provider interactions is essential to encourage payment. %M 32069213 %R 10.2196/16765 %U http://medinform.jmir.org/2020/2/e16765/ %U https://doi.org/10.2196/16765 %U http://www.ncbi.nlm.nih.gov/pubmed/32069213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14487 %T Frequent Mobile Electronic Medical Records Users Respond More Quickly to Emergency Department Consultation Requests: Retrospective Quantitative Study %A Jung,Kwang Yul %A Kim,SuJin %A Kim,Kihyung %A Lee,Eun Ju %A Kim,Kyunga %A Lee,Jeanhyoung %A Choi,Jong Soo %A Kang,Mira %A Chang,Dong Kyung %A Cha,Won Chul %+ Department of Emergency Medicine, Samsung Medical Center, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 1053866597, wc.cha@samsung.com %K electronic medical record %K emergency department %K mobile health %K time efficiency %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Specialty consultation is a critical aspect of emergency department (ED) practice, and a delay in providing consultation might have a significant clinical effect and worsen ED overcrowding. Although mobile electronic medical records (EMR) are being increasingly used and are known to improve the workflow of health care providers, limited studies have evaluated their effectiveness in real-life clinical scenarios. Objective: For this study, we aimed to determine the association between response duration to an ED specialty consultation request and the frequency of mobile EMR use. Methods: This retrospective study was conducted in an academic ED in Seoul, South Korea. We analyzed EMR and mobile EMR data from May 2018 to December 2018. Timestamps of ED consultation requests were retrieved from a PC-based EMR, and the response interval was calculated. Doctors’ log frequencies were obtained from the mobile EMR, and we merged data using doctors’ deidentification numbers. Pearson’s product-moment correlation was performed to identify this association. The primary outcome was the relationship between the frequency of mobile EMR usage and the time interval from ED request to consultation completion by specialty doctors. The secondary outcome was the relationship between the frequency of specialty doctors’ mobile EMR usage and the response time to consultation requests. Results: A total of 25,454 consultations requests were made for 15,555 patients, and 252 specialty doctors provided ED specialty consultations. Of the 742 doctors who used the mobile EMR, 208 doctors used it for the specialty consultation process. After excluding the cases lacking essential information, 21,885 consultations with 208 doctors were included for analysis. According to the mobile EMR usage pattern, the average usage frequency of all users was 13.3 logs/day, and the average duration of the completion of the specialty consultation was 51.7 minutes. There was a significant inverse relationship between the frequency of mobile EMR usage and time interval from ED request to consultation completion by specialty doctors (coefficient=–0.19; 95% CI –0.32 to –0.06; P=.005). Secondary analysis with the response time was done. There was also a significant inverse relationship between the frequency of specialty doctors’ mobile EMR usage and the response time to consultation requests (coefficient=–0.18; 95% CI –0.30 to –0.04; P=.009). Conclusions: Our findings suggest that frequent mobile EMR usage is associated with quicker response time to ED consultation requests. %M 32130157 %R 10.2196/14487 %U http://mhealth.jmir.org/2020/2/e14487/ %U https://doi.org/10.2196/14487 %U http://www.ncbi.nlm.nih.gov/pubmed/32130157 %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 %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13563 %T Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study %A Lo,Yu-Sheng %A Yang,Cheng-Yi %A Chien,Hsiung-Fei %A Chang,Shy-Shin %A Lu,Chung-Ying %A Chen,Ray-Jade %+ Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan, 886 27361661, rayjchen@tmu.edu.tw %K medical referral %K electronic referral system %K blockchain %K decentralized application %K electronic medical records %K electronic health records %K interoperability %D 2019 %7 4.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Medical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. Objective: To eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA’s NMR referral data to build an alliance-based medical referral service connecting health care facilities. Methods: We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA’s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients’ behavior and investigate the acceptance of our personal authorization-controlled framework. Results: The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. Conclusions: This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption. %M 31799935 %R 10.2196/13563 %U https://www.jmir.org/2019/12/e13563 %U https://doi.org/10.2196/13563 %U http://www.ncbi.nlm.nih.gov/pubmed/31799935 %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 %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13382 %T Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians %A Hoffmann,Mariell %A Hartmann,Mechthild %A Wensing,Michel %A Friederich,Hans-Christoph %A Haun,Markus W %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, , Germany, 49 622156 ext 8774, markus.haun@med.uni-heidelberg.de %K video consultations %K videoconferencing %K integrated behavioral health %K primary care %K health services research %K mental health %D 2019 %7 19.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective: This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods: In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results: Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions: By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487 %M 31429419 %R 10.2196/13382 %U http://www.jmir.org/2019/8/e13382/ %U https://doi.org/10.2196/13382 %U http://www.ncbi.nlm.nih.gov/pubmed/31429419 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14587 %T Evaluation of a Mobile Telesimulation Unit to Train Rural and Remote Practitioners on High-Acuity Low-Occurrence Procedures: Pilot Randomized Controlled Trial %A Jewer,Jennifer %A Parsons,Michael H %A Dunne,Cody %A Smith,Andrew %A Dubrowski,Adam %+ Faculty of Business, Memorial University, 300 Prince Phillip Drive, St John's, NL, A1B 3X5, Canada, 1 709 864 3094, jenniferj@mun.ca %K medical education %K distributed medical education %K simulation training %K emergency medicine %K rural health %K remote-facilitation %K assessment %K chest tubes %D 2019 %7 6.8.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The provision of acute medical care in rural and remote areas presents unique challenges for practitioners. Therefore, a tailored approach to training providers would prove beneficial. Although simulation-based medical education (SBME) has been shown to be effective, access to such training can be difficult and costly in rural and remote areas. Objective: The aim of this study was to evaluate the educational efficacy of simulation-based training of an acute care procedure delivered remotely, using a portable, self-contained unit outfitted with off-the-shelf and low-cost telecommunications equipment (mobile telesimulation unit, MTU), versus the traditional face-to-face approach. A conceptual framework based on a combination of Kirkpatrick’s Learning Evaluation Model and Miller’s Clinical Assessment Framework was used. Methods: A written procedural skills test was used to assess Miller’s learning level— knows —at 3 points in time: preinstruction, immediately postinstruction, and 1 week later. To assess procedural performance (shows how), participants were video recorded performing chest tube insertion before and after hands-on supervised training. A modified Objective Structured Assessment of Technical Skills (OSATS) checklist and a Global Rating Scale (GRS) of operative performance were used by a blinded rater to assess participants’ performance. Kirkpatrick’s reaction was measured through subject completion of a survey on satisfaction with the learning experiences and an evaluation of training. Results: A total of 69 medical students participated in the study. Students were randomly assigned to 1 of the following 3 groups: comparison (25/69, 36%), intervention (23/69, 33%), or control (21/69, 31%). For knows, as expected, no significant differences were found between the groups on written knowledge (posttest, P=.13). For shows how, no significant differences were found between the comparison and intervention groups on the procedural skills learning outcomes immediately after the training (OSATS checklist and GRS, P=1.00). However, significant differences were found for the control versus comparison groups (OSATS checklist, P<.001; GRS, P=.02) and the control versus intervention groups (OSATS checklist, P<.001; GRS, P=.01) on the pre- and postprocedural performance. For reaction, there were no statistically significant differences between the intervention and comparison groups on the satisfaction with learning items (P=.65 and P=.79) or the evaluation of the training (P=.79, P=.45, and P=.31). Conclusions: Our results demonstrate that simulation-based training delivered remotely, applying our MTU concept, can be an effective way to teach procedural skills. Participants trained remotely in the MTU had comparable learning outcomes (shows how) to those trained face-to-face. Both groups received statistically significant higher procedural performance scores than those in the control group. Participants in both instruction groups were equally satisfied with their learning and training (reaction). We believe that mobile telesimulation could be an effective way of providing expert mentorship and overcoming a number of barriers to delivering SBME in rural and remote locations. %R 10.2196/14587 %U http://www.jmir.org/2019/8/e14587/ %U https://doi.org/10.2196/14587 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e11722 %T Implementation of a Heart Failure Telemonitoring System in Home Care Nursing: Feasibility Study %A Seto,Emily %A Morita,Plinio Pelegrini %A Tomkun,Jonathan %A Lee,Theresa M %A Ross,Heather %A Reid-Haughian,Cheryl %A Kaboff,Andrew %A Mulholland,Deb %A Cafazzo,Joseph A %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, plinio.morita@uwaterloo.ca %K patient monitoring %K home care services %K heart failure %K mobile phone %K feasibility studies %D 2019 %7 26.07.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Telemonitoring (TM) of heart failure (HF) patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementing TM through a home care nursing agency. Objective: This study aimed to determine the feasibility of implementing a mobile phone–based TM system through a home care nursing agency and to explore the feasibility of conducting a future effectiveness trial. Methods: A feasibility study was conducted by recruiting, through community cardiologists and family physicians, 10 to 15 HF patients who would use the TM system for 4 months by taking daily measurements of weight and blood pressure and recording symptoms. Home care nurses responded to alerts generated by the TM system through either a phone call and/or a home visit. Patients and their clinicians were interviewed poststudy to determine their perceptions and experiences of using the TM system. Results: Only one community cardiologist was recruited who was willing to refer patients to this study, even after multiple attempts were made to recruit further physicians, including family physicians. The cardiologist referred only 6 patients over a 6-month period, and half of the patients dropped out of the study. The identified barriers to implementing the TM system in home care nursing were numerous and led to the small recruitment in patients and clinicians and large dropout rate. These barriers included challenges in nurses contacting patients and physicians, issues related to retention, and challenges related to integrating the TM system into a complex home care nursing workflow. However, some potential benefits of TM through a home care nursing agency were indicated, including improved patient education, providing nurses with a better understanding of the patient’s health status, and reductions in home visits. Conclusions: Lessons learned included the need to incentivize physicians, to ensure streamlined processes for recruitment and communication, to target appropriate patient populations, and to create a core clinical group. Barriers encountered in this feasibility trial should be considered to determine their applicability when deploying innovations into different service delivery models. %M 31350841 %R 10.2196/11722 %U http://medinform.jmir.org/2019/3/e11722/ %U https://doi.org/10.2196/11722 %U http://www.ncbi.nlm.nih.gov/pubmed/31350841 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e13354 %T Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study %A Nabelsi,Véronique %A Lévesque-Chouinard,Annabelle %A Liddy,Clare %A Dumas Pilon,Maxine %+ Département des Sciences Administratives, Université du Québec en Outaouais, 101, rue St-Jean-Bosco, Gatineau, QC, J8X 3X7, Canada, 1 18195953900 ext 1915, veronique.nabelsi@uqo.ca %K primary health care %K referrals %K physicians %K specialists %K health information systems %D 2019 %7 10.07.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. Objective: The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). Methods: We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. Results: For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. Conclusions: The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority. %M 31293239 %R 10.2196/13354 %U http://medinform.jmir.org/2019/3/e13354/ %U https://doi.org/10.2196/13354 %U http://www.ncbi.nlm.nih.gov/pubmed/31293239 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e14248 %T Initial Experience of the Synchronized, Real-Time, Interactive, Remote Transthoracic Echocardiogram Consultation System in Rural China: Longitudinal Observational Study %A Liu,Luwen %A Duan,Shaobo %A Zhang,Ye %A Wu,Yuejin %A Zhang,Lianzhong %+ People's Hospital of Zhengzhou University, No. 5 Weiwu Road, Zhengzhou,, China, 86 13598896699, zlz8777@163.com %K three synchronization %K double-real-time %K interactive %K remote consultation on UCG %K dynamic image decoding %K synchronization technology %D 2019 %7 08.07.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. Objective: This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. Methods: By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People’s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. Results: This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. Conclusions: The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability. %M 31287062 %R 10.2196/14248 %U http://medinform.jmir.org/2019/3/e14248/ %U https://doi.org/10.2196/14248 %U http://www.ncbi.nlm.nih.gov/pubmed/31287062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12126 %T Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website %A Li,Yumei %A Yan,Xiangbin %A Song,Xiaolong %+ Harbin Institute of Technology, 92, Xidazhi Street, Nangang District, Harbin,, China, 86 13351288123, xbyan@hit.edu.cn %K e-consultation %K medical service %K fee %K China %D 2019 %7 03.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services. Objective: This study sought to examine doctors’ participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces. Methods: This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group. Results: There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors’ charges range from ¥20 to ¥30. Conclusions: Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China. %M 31162129 %R 10.2196/12126 %U https://www.jmir.org/2019/6/e12126/ %U https://doi.org/10.2196/12126 %U http://www.ncbi.nlm.nih.gov/pubmed/31162129 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 2 %P e11233 %T Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine %A Rademacher,Nicholas James %A Cole,Gai %A Psoter,Kevin J %A Kelen,Gabor %A Fan,Jamie Wei Zhi %A Gordon,Dennis %A Razzak,Junaid %+ Department of Emergency Medicine, The Johns Hopkins School of Medicine, 5801 Smith Ave, Ste 3220, Baltimore, MD, 21209, United States, 1 4107356400, junaid.razzak@jhu.edu %K telemedicine %K telehealth %K screening %K triage %K emergency medicine %K emergency health services %K emergency medical service %K left without being seen %K emergency room %K emergency department %K tele-medicine %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Early efforts to incorporate telemedicine into Emergency Medicine focused on connecting remote treatment clinics to larger emergency departments (EDs) and providing remote consultation services to EDs with limited resources. Owing to continued ED overcrowding, some EDs have used telemedicine to increase the number of providers during surges of patient visits and offer scheduled “home” face-to-face, on-screen encounters. In this study, we used remote on-screen telemedicine providers in the “screening-in-triage” role. Objective: This study aimed to compare the efficiency and patient safety of in-person screening and telescreening. Methods: This cohort study, matched for days and proximate hours, compared the performance of real-time remote telescreening and in-person screening at a single urban academic ED over 22 weeks in the spring and summer of 2016. The study involved 337 standard screening hours and 315 telescreening hours. The primary outcome measure was patients screened per hour. Additional outcomes were rates of patients who left without being seen, rates of analgesia ordered by the screener, and proportion of patients with chest pain receiving or prescribed a standard set of tests and medications. Results: In-person screeners evaluated 1933 patients over 337 hours (5.7 patients per hour), whereas telescreeners evaluated 1497 patients over 315 hours (4.9 patients per hour; difference=0.8; 95% CI 0.5-1.2). Split analysis revealed that for the final 3 weeks of the evaluation, the patient-per-hour rate differential was neither clinically relevant nor statistically discernable (difference=0.2; 95% CI –0.7 to 1.2). There were fewer patients who left without being seen during in-person screening than during telescreening (2.6% vs 3.8%; difference=–1.2; 95% CI –2.4 to 0.0). However, compared to prior year-, date-, and time-matched data on weekdays from 1 am to 3 am, a period previously void of provider screening, telescreening decreased the rate of patients LWBS from 25.1% to 4.5% (difference=20.7%; 95% CI 10.1-31.2). Analgesia was ordered more frequently by telescreeners than by in-person screeners (51.2% vs 31.6%; difference=19.6%; 95% CI 12.1-27.1). There was no difference in standard care received by patients with chest pain between telescreening and in-person screening (29.4% vs 22.4%; difference=7.0%; 95% CI –3.4 to 17.4). Conclusions: Although the efficiency of telescreening, as measured by the rate of patients seen per hour, was lower early in the study period, telescreening achieved the same level of efficiency as in-person screening by the end of the pilot study. Adding telescreening during 1-3 am on weekdays dramatically decreased the number of patients who left without being seen compared to historic data. Telescreening was an effective and safe way for this ED to expand the hours in which patients were screened by a health care provider in triage. %M 31066698 %R 10.2196/11233 %U http://medinform.jmir.org/2019/2/e11233/ %U https://doi.org/10.2196/11233 %U http://www.ncbi.nlm.nih.gov/pubmed/31066698 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12155 %T Anesthesiology Control Tower—Feasibility Assessment to Support Translation (ACTFAST): Mixed-Methods Study of a Novel Telemedicine-Based Support System for the Operating Room %A Murray-Torres,Teresa %A Casarella,Aparna %A Bollini,Mara %A Wallace,Frances %A Avidan,Michael S %A Politi,Mary C %+ Department of Anesthesiology, Washington University School of Medicine in St. Louis, Washington University in St. Louis, 660 S Euclid Avenue, Box 8054, St. Louis, MO,, United States, 1 314 226 8880, murrayt@wustl.edu %K clinical decision support systems %K usability %K anesthesiology %K telemedicine %D 2019 %7 23.04.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite efforts to improve patient outcomes, major morbidity and mortality remain common after surgery. Health information technologies that provide decision support for clinicians might improve perioperative and postoperative patient care. Evaluating the usability of these technologies and barriers to their implementation can facilitate their acceptance within health systems. Objective: This manuscript describes usability testing and refinement of an innovative telemedicine-based clinical support system, the Anesthesiology Control Tower (ACT). It also reports stakeholders’ perceptions of the barriers and facilitators to implementation of the intervention. Methods: Three phases of testing were conducted in an iterative manner. Phase 1 testing employed a think-aloud protocol analysis to identify surface-level usability problems with individual software components of the ACT and its structure. Phase 2 testing involved an extended qualitative and quantitative real-world usability analysis. Phase 3 sought to identify major barriers and facilitators to implementation of the ACT through semistructured interviews with key stakeholders. Results: Phase 1 and phase 2 usability testing sessions identified numerous usability problems with the software components of the ACT. The ACT platform was revised in seven iterations in response to these usability concerns. Initial satisfaction with the ACT, as measured by standardized instruments, was below commonly accepted cutoffs for these measures. Satisfaction improved to acceptable levels over the course of revision and testing. A number of barriers to implementation were also identified and addressed during the refinement of the ACT intervention. Conclusions: The ACT model can improve the standard of perioperative anesthesia care. Through our thorough and iterative usability testing process and stakeholder assessment of barriers and facilitators, we enhanced the acceptability of this novel technology and improved our ability to implement this innovation into routine practice. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-018-0233-4 %M 31012859 %R 10.2196/12155 %U http://humanfactors.jmir.org/2019/2/e12155/ %U https://doi.org/10.2196/12155 %U http://www.ncbi.nlm.nih.gov/pubmed/31012859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12156 %T Investigating the Effect of Paid and Free Feedback About Physicians' Telemedicine Services on Patients’ and Physicians’ Behaviors: Panel Data Analysis %A Yang,Hualong %A Zhang,Xiaofei %+ Business School, Nankai Univeristy, 94 Weijin Road, Tianjin, 300071, China, 86 22 23501039, xiaofeizhang@nankai.edu.cn %K telemedicine %K feedback %K physician rating %K health care quality %K decision making %K physicians’ contribution %D 2019 %7 22.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, paid online patient-physician interaction has been incorporated into the telemedicine markets. With the development of telemedicine and telemedicine services, online feedback has been widely applied, helping other patients to identify quality services. Recently, in China, a new type of service feedback has been applied to the telemedicine markets, namely, paid feedback. Patients who are satisfied with a physician’s online service can buy a virtual gift or give a tip to the physicians. This paid feedback can improve the reliability of service feedback and reduce the proportion of false information because it increases the cost for feedback providers. Paid online feedback can benefit the physicians, such as by providing them with monetary incentives; however, research on the impacts and value of such paid feedback from the physician perspective in the telemedicine markets is scant. To fill this research gap, this study was designed to understand the role of paid feedback by developing a research model based on the theories of signaling and self-determination. Objective: This study aimed to explore the effects of free and paid feedback on patients’ choice and physicians’ behaviors as well as to investigate the substitute relationship between these 2 types of feedback in the telemedicine markets. Methods: A JAVA software program was used to collect online patient-doctor interaction data over a 6-month period from a popular telemedicine market in China (Good Physician Online). This study drew on a 2-equation panel model to test the hypotheses. Both fixed and random effect models were used to estimate the combined effects of paid feedback and free feedback on patients’ choice and physicians’ contribution. Finally, the Hausman test was adopted to investigate which model is better to explain our empirical results. Results: The results of this study show that paid feedback has a stronger effect on patients’ choice (a5=0.566; t2192=9.160; P<.001) and physicians’ contribution (β4=1.332; t2193=11.067; P<.001) in telemedicine markets than free feedback. Moreover, our research also proves that paid feedback and free feedback have a substitute relationship in determining patients’ and physicians’ behaviors (a6=−0.304; t2191=−5.805; P<.001 and β5=−0.823; t2192=−8.136; P<.001). Conclusions: Our findings contribute to the extant literature on service feedback in the telemedicine markets and provide insight for relevant stakeholders into how to design an effective feedback mechanism to improve patients’ service experience and physicians’ engagement. %M 30900997 %R 10.2196/12156 %U http://www.jmir.org/2019/3/e12156/ %U https://doi.org/10.2196/12156 %U http://www.ncbi.nlm.nih.gov/pubmed/30900997 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e11496 %T Telemonitoring to Manage Chronic Obstructive Pulmonary Disease: Systematic Literature Review %A Kruse,Clemens %A Pesek,Brandon %A Anderson,Megan %A Brennan,Kacey %A Comfort,Hilary %+ School of Health Administration, Texas State University, 601 University Drive, Encino Hall, Room 250, San Marcos, TX, 78666, United States, 1 512 245 4462, scottkruse@txstate.edu %K telemedicine %K COPD %K chronic disease %D 2019 %7 20.03.2019 %9 Review %J JMIR Med Inform %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death throughout the world. Telemedicine has been utilized for many diseases and its prevalence is increasing in the United States. Telemonitoring of patients with COPD has the potential to help patients manage disease and predict exacerbations. Objective: The objective of this review is to evaluate the effectiveness of telemonitoring to manage COPD. Researchers want to determine how telemonitoring has been used to observe COPD and we are hoping this will lead to more research in telemonitoring of this disease. Methods: This review was conducted in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Authors performed a systematic review of the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to obtain relevant articles. Articles were then accepted or rejected by group consensus. Each article was read and authors identified barriers and facilitators to effectiveness of telemonitoring of COPD. Results: Results indicate that conflicting information exists for the effectiveness of telemonitoring of patients with COPD. Primarily, 13 out of 29 (45%) articles stated that patient outcomes were improved overall with telemonitoring, while 11 of 29 (38%) indicated no improvement. Authors identified the following facilitators: reduced need for in-person visits, better disease management, and bolstered patient-provider relationship. Important barriers included low-quality data, increased workload for providers, and cost. Conclusions: The high variability between the articles and the ways they provided telemonitoring services created conflicting results from the literature review. Future research should emphasize standardization of telemonitoring services and predictability of exacerbations. %M 30892276 %R 10.2196/11496 %U http://medinform.jmir.org/2019/1/e11496/ %U https://doi.org/10.2196/11496 %U http://www.ncbi.nlm.nih.gov/pubmed/30892276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11161 %T Additional Telemedicine Rounds as a Successful Performance-Improvement Strategy for Sepsis Management: Observational Multicenter Study %A Deisz,Robert %A Rademacher,Susanne %A Gilger,Katrin %A Jegen,Rudolf %A Sauerzapfe,Barbara %A Fitzner,Christina %A Stoppe,Christian %A Benstoem,Carina %A Marx,Gernot %+ Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany, 49 241 8089471, cbenstoem@ukaachen.de %K intensive care %K outcome improvement %K sepsis %K sepsis bundle compliance %K SSC %K tele-ICU %K telemedicine %D 2019 %7 15.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Sepsis is a major health care problem with high morbidity and mortality rates and affects millions of patients. Telemedicine, defined as the exchange of medical information via electronic communication, improves the outcome of patients with sepsis and decreases the mortality rate and length of stay in the intensive care unit (ICU). Additional telemedicine rounds could be an effective component of performance-improvement programs for sepsis, especially in underserved rural areas and hospitals without ready access to critical care physicians. Objective: Our aim was to evaluate the impact of additional daily telemedicine rounds on adherence to sepsis bundles. We hypothesized that additional telemedicine support may increase adherence to sepsis guidelines and improve the detection rates of sepsis and septic shock. Methods: We conducted a retrospective, observational, multicenter study between January 2014 and July 2015 with one tele-ICU center and three ICUs in Germany. We implemented telemedicine as part of standard care and collected data continuously during the study. During the daily telemedicine rounds, routine screening for sepsis was conducted and adherence to the Surviving Sepsis Campaign’s 3-hour and 6-hour sepsis bundles were evaluated. Results: In total, 1168 patients were included in this study, of which 196 were positive for severe sepsis and septic shock. We found that additional telemedicine rounds improved adherence to the 3-hour (Quarter 1, 35% vs Quarter 6, 76.2%; P=.01) and 6-hour (Quarter 1, 50% vs Quarter 6, 95.2%; P=.001) sepsis bundles. In addition, we noted an increase in adherence to the item “Administration of fluids when hypotension” (Quarter 1, 80% vs Quarter 6, 100%; P=.049) of the 3-hour bundle and the item “Remeasurement of lactate” (Quarter 1, 65% vs Quarter 6, 100%, P=.003) of the 6-hour bundle. The ICU length of stay after diagnosis of severe sepsis and septic shock remained unchanged over the observation period. Due to a higher number of patients with sepsis in Quarter 5 (N=60) than in other quarters, we observed stronger effects of the additional rounds on mortality in this quarter (Quarter 1, 50% vs Quarter 5, 23.33%, P=.046). Conclusions: Additional telemedicine rounds are an effective component of and should be included in performance-improvement programs for sepsis management. %M 30664476 %R 10.2196/11161 %U http://www.jmir.org/2019/1/e11161/ %U https://doi.org/10.2196/11161 %U http://www.ncbi.nlm.nih.gov/pubmed/30664476 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e11695 %T Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study %A Blosnich,John R %A Rodriguez,Keri L %A Hruska,Kristina L %A Kavalieratos,Dio %A Gordon,Adam J %A Matza,Alexis %A Mejia,Susan M %A Shipherd,Jillian C %A Kauth,Michael R %+ Center for Health Equity Research and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System, University Drive C (151C-U), Building 30, Pittsburgh, PA, 15240-1001, United States, 1 412 360 2138, john.blosnich@va.gov %K teleconsultation %K telemedicine %K transgender persons %K veterans %K veteran health %D 2019 %7 14.01.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2015, the Department of Veterans Affairs (VA) nationally implemented a transgender e-consultation (e-consult) program with expert clinical guidance for providers. Objective: This mixed-methods project aimed to describe providers’ program experiences, reasons for nonuse of the program, and ways to improve the program use. Methods: From January to May 2017, 15 urban and rural VA providers who submitted at least one e-consult in the last year participated in semistructured interviews about their program experiences, which were analyzed using content analysis. From November to December 2017, 53 providers who encountered transgender patients but did not utilize the program participated in a brief online survey on the reasons for nonuse of the program and the facilitators encouraging use. Results: Qualitative analysis showed that providers learned of the program through email; colleagues; the electronic health record (EHR) system; and participation in the VA Lesbian, Gay, Bisexual, and Transgender committees or educational trainings. Providers used the program to establish care plans, hormone therapy recommendations, sexual and reproductive health education, surgical treatment education, patient-provider communication guidance, and second opinions. The facilitators of program use included understandable recommendations, ease of use through the EHR system, and status as the only transgender resource for rural providers. Barriers to use included time constraints, communication-related problems with the e-consult, impractical recommendations for underresourced sites, and misunderstanding of the e-consult purpose. Suggestions for improvement included addition of concise or sectioned responses, expansion of program awareness among providers or patients, designation of a follow-up contact person, and increase in provider education about transgender veterans and related care. Quantitative analysis showed that the common reasons for nonuse of the program were no knowledge of the program (54%), no need of the program (32%), and receipt of help from a colleague outside of e-consult (24%). Common suggestions to improve the program use in quantitative analyses included provision of more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. Conclusions: The VA transgender e-consult program is useful for providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing the identified barriers and enhancing the facilitators may improve program use and quality care for transgender veterans. %M 31344672 %R 10.2196/11695 %U http://medinform.jmir.org/2019/1/e11695/ %U https://doi.org/10.2196/11695 %U http://www.ncbi.nlm.nih.gov/pubmed/31344672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11112 %T Electronic Consultation Services Worldwide: Environmental Scan %A Joschko,Justin %A Keely,Erin %A Grant,Rachel %A Moroz,Isabella %A Graveline,Matthew %A Drimer,Neil %A Liddy,Clare %+ CT Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, , Ottawa, ON,, Canada, 1 613 562 6262 ext 2928, CLiddy@bruyere.org %K electronic consultation %K interviews %K primary care %K referral-consultation process %K telemedicine %K quality of care %K specialist care %D 2018 %7 21.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many health care systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists through a secure platform to facilitate discussion of patients’ care. Objective: This study aims to examine different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different health care contexts. Methods: We conducted an environmental scan comprising 3 stages as follows: literature review; gray literature search; and targeted, semistructured key informant interviews. We searched MEDLINE and EMBASE (literature review) and Google (gray literature search). Upon completing the search, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, physicians, and decision makers. The maximum variation sampling was used to ensure sufficient breadth of participant experience. In addition, we conducted semistructured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach. Results: A total of 53 services emerged from the published and gray literature. Respondents from 10 services participated in telephonic interviews. The following 4 major themes emerged from the analysis: service structure; benefits of eConsult; implementation challenges; and implementation enablers. Conclusions: eConsult services have emerged in a variety of countries and health system contexts worldwide. Despite differences in structure, platform, and delivery of their services, respondents described similar barriers and enablers to the implementation and growth and reported improved access and high levels of satisfaction. %M 30578187 %R 10.2196/11112 %U http://www.jmir.org/2018/12/e11112/ %U https://doi.org/10.2196/11112 %U http://www.ncbi.nlm.nih.gov/pubmed/30578187 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e62 %T Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review %A Lawes-Wickwar,Sadie %A McBain,Hayley %A Mulligan,Kathleen %+ Centre for Health Services Research, School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB, United Kingdom, 44 0207 040 0876, kathleen.mulligan.1@city.ac.uk %K severe mental disorders %K telehealth %K technology %K systematic review %K mobile phone %D 2018 %7 21.11.2018 %9 Review %J JMIR Ment Health %G English %X Background: People with severe mental illness (SMI) must receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly being used to assist in health care delivery using “telehealth,” which includes telephones and mobile phones, computers, remote sensors, the internet, and other devices, to provide immediate real-time information to service users to improve the management of chronic health conditions. Some initial findings have suggested that technology could improve the quality of life of people with SMI. Objective: In this systematic review, we aimed to identify the various uses and efficacy of telehealth technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Health Technology Assessment, CINAHL Plus, and NHS Economic Evaluations Database) to identify randomized controlled trials evaluating telehealth for adults with SMI published in English. Additional literature was identified through searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: Our search identified 31 articles describing 29 trials as eligible for the review. The included studies evaluated the use of computers to deliver cognitive rehabilitation (15 trials), patient education (3 trials), and Web-based self-management interventions (2 trials) and to support consultations (1 trial). Virtual reality was used to simulate work and social situations (2 trials) and to deliver cognitive training (1 trial). Telephones were used to prompt service users to take medications (3 trials) and to report symptoms to their health care team (1 trial). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective in improving medication adherence and reducing the severity of symptoms and inpatient days. Computer-assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. The results of this review should be taken in the context of varied quality in study design, with only 5 studies demonstrating a low risk of bias. Conclusions: A growing variety of telehealth technologies are being used to support the management of SMI. Specific technology types have been found to be effective for some outcomes (eg, telephone and remote medication monitoring for adherence to treatment), while other types of telehealth technologies (eg, delivery of patient education using computers) had no benefit over traditional nurse-based methods and were less acceptable to patients. Further research is warranted to establish the full potential benefits of telehealth for improving the quality of life in people with SMI, acceptability from the service user perspective, and cost-effectiveness. The findings of this review are limited by the poor quality of many of the studies reviewed. %M 30463836 %R 10.2196/mental.8816 %U http://mental.jmir.org/2018/4/e62/ %U https://doi.org/10.2196/mental.8816 %U http://www.ncbi.nlm.nih.gov/pubmed/30463836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e287 %T Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study %A Lam,Chee Kin %A McGinnis Pilote,Kara %A Haque,Ashraful %A Burzynski,Joseph %A Chuck,Christine %A Macaraig,Michelle %+ Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN72b, WS 24-017, Long Island City, NY, 11101, United States, 1 718 310 2538, clam4@health.nyc.gov %K computer-assisted therapy %K directly observed therapy %K mobile phone %K telemedicine %K videoconferencing %D 2018 %7 20.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Since January 2013, the New York City (NYC) Health Department Tuberculosis (TB) Program has offered persons diagnosed with latent TB infection (LTBI) the 3-month, once-weekly isoniazid and rifapentine (3HP) treatment regimen. Patients on this treatment are monitored in-person under directly observed therapy (DOT). To address patient and provider barriers to in-person DOT, we piloted the use of a videoconferencing software app to remotely conduct synchronous DOT (video directly observed therapy; VDOT) for patients on 3HP. Objective: The objective of our study was to evaluate the implementation of VDOT for patients on 3HP and to assess whether treatment completion for these patients increased when they were monitored using VDOT compared with that using the standard in-person DOT. Methods: Between February and October 2015, patients diagnosed with LTBI at any of the four NYC Health Department TB clinics who met eligibility criteria for treatment with 3HP under VDOT (V3HP) were followed until 16 weeks after treatment initiation, with treatment completion defined as ingestion of 11 doses within 16 weeks. Treatment completion of patients on V3HP was compared with that of patients on 3HP under clinic-based, in-person DOT who were part of a prior study in 2013. Furthermore, outcomes of video sessions with V3HP patients were collected and analyzed. Results: During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001). A total of 360 video sessions were conducted for V3HP patients with a median of 8 (range: 1-11) sessions per patient and a median time of 4 (range: 1-59) minutes per session. Adherence issues (eg, >15 minutes late) during video sessions occurred 104 times. No major side effects were reported by V3HP patients. Conclusions: The NYC TB program observed higher treatment completion with VDOT than that previously seen with clinic DOT among patients on 3HP. Expanding the use of VDOT may improve treatment completion and corresponding outcomes for patients with LTBI. %M 30459146 %R 10.2196/jmir.9825 %U https://www.jmir.org/2018/11/e287/ %U https://doi.org/10.2196/jmir.9825 %U http://www.ncbi.nlm.nih.gov/pubmed/30459146 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e48 %T Benefits and Costs of Digital Consulting in Clinics Serving Young People With Long-Term Conditions: Mixed-Methods Approach %A Kim,Sung Wook %A Madan,Jason %A Dritsaki,Melina %A Bryce,Carol %A Forjaz,Vera %A Fraser,Joe %A Griffiths,Frances %A Hamilton,Kathryn %A Huxley,Caroline %A Sturt,Jackie %+ Division of Health Sciences, Warwick Medical School, The University of Warwick, Medical School Building, Gibett Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476 151254, s.w.kim@warwick.ac.uk %K digital consulting %K long-term conditions %K costing analysis %K young people %K mental health %K diabetes %D 2018 %7 30.10.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. Objective: This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. Methods: This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. Results: When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. Conclusions: Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting. %M 30377145 %R 10.2196/medinform.9577 %U http://medinform.jmir.org/2018/4/e48/ %U https://doi.org/10.2196/medinform.9577 %U http://www.ncbi.nlm.nih.gov/pubmed/30377145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e282 %T Clinical Videoconferencing as eHealth: A Critical-Realist Review and Qualitative Meta-Synthesis %A Ekeland,Anne Granstrøm %A Hansen,Anne Helen %A Bergmo,Trine Strand %+ Norwegian Centre for eHealth Research, University Hospital of North Norway, PO Box 35, University Hospital of North Norway, Tromsø, 9038, Norway, 47 95266791, anne.granstrom.ekeland@ehealthresearch.no %K videoconferencing %K clinical practice patterns %K realist review %K situated implications %K eHealth %K telemedicine %D 2018 %7 25.10.2018 %9 Review %J J Med Internet Res %G English %X Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted, and those used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of electronic health (eHealth) identified 51 unique definitions. In addition, the “10 E’s of eHealth” was developed. In 2015, the question “What Is eHealth: Time for an Update?” was posed. Objective: Considering videoconferencing as eHealth, the objective of the paper is twofold: to demonstrate and cluster (different) clinical videoconferencing practices and their situated implications and to suggest interpretive concepts that apply to all clusters and contribute to generative learning of eHealth by discussing the concepts as add-ons to existing descriptions of eHealth in the “10 E’s of eHealth.” Methods: We performed a literature search via the National Center for Biotechnology Information, encompassing PubMed and PubMedCentral, for quality reviews and primary studies. We used the terms “videoconferencing” and “clinical practices.” The selection process was based upon clearly defined criteria. We used an electronic form to extract data. The analysis was inspired by critical and realist review types, grounded theory, and qualitative meta-synthesis. Results: The search returned 354 reviews and primary studies. This paper considered the primary studies, and 16 were included. We identified the following 4 broad clusters: videoconferencing as a controlled technological intervention within existing health care organizations for expert advice, controlled mixed interventions with experimental organizational arrangements, videoconferencing as an emerging technosocial service involving dialogue and empowerment of patients, and videoconferencing as a controlled intervention to improve administrative efficiency. The analysis across the clusters resulted in a proposal to add the following 4 D’s to the existing 10 E’s: (inter)-dependent, differentiated across services and along temporal lines, dynamic in terms of including novel elements for meeting incremental needs, and demanding in terms of making new challenges and dual results visible and needing fresh resources to meet those challenges. For a normative discussion about what eHealth should be according to authors’ conclusions, results suggested ethical, in that users interests should be respected, and not harmful in terms of increasing symptom burden. Conclusions: Services were enacted as dynamic, differentiated concerning content and considerations of quality and adaptive along temporal lines. They were made to work from an ongoing demand for fresh resources, making them interdependent. The 4 D’s—Dynamic, Differentiated, Demanding, and (inter) Dependent—serve as pragmatic add-ons to the “10 E’s of eHealth.” Questions concerning outcome of specified balances between standardization and customization in clinical settings should be addressed in future research along with the emerging dual character of outcome: services being considered both “good” and “bad.” %M 30361197 %R 10.2196/jmir.8497 %U http://www.jmir.org/2018/10/e282/ %U https://doi.org/10.2196/jmir.8497 %U http://www.ncbi.nlm.nih.gov/pubmed/30361197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11076 %T Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study %A Klingberg,Anders %A Wallis,Lee Alan %A Hasselberg,Marie %A Yen,Po-Yin %A Fritzell,Sara Caroline %+ Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm,, Sweden, 46 733357727, anders.klingberg@ki.se %K mobile phone %K referral and consultation %K emergency medicine %K mHealth %K teleconsultations %K burns %K usability evaluation %K think-aloud %K video analysis %K South Africa %D 2018 %7 19.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. Objective: The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. Methods: A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. Results: The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. Conclusions: We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words. %M 30341047 %R 10.2196/11076 %U http://mhealth.jmir.org/2018/10/e11076/ %U https://doi.org/10.2196/11076 %U http://www.ncbi.nlm.nih.gov/pubmed/30341047 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 3 %P e24 %T Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study  %A Mercer,Kathryn %A Burns,Catherine %A Guirguis,Lisa %A Chin,Jessie %A Dogba,Maman Joyce %A Dolovich,Lisa %A Guénette,Line %A Jenkins,Laurie %A Légaré,France %A McKinnon,Annette %A McMurray,Josephine %A Waked,Khrystine %A Grindrod,Kelly A %+ School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 888 4567 ext 21358, kgrindrod@uwaterloo.ca %K shared decision-making %K electronic health records %K collaboration %K interprofessional collaboration %K medication management %D 2018 %7 25.9.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective: The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods: This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results: We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions: We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach. %M 30274959 %R 10.2196/humanfactors.9891 %U http://humanfactors.jmir.org/2018/3/e24/ %U https://doi.org/10.2196/humanfactors.9891 %U http://www.ncbi.nlm.nih.gov/pubmed/30274959 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 3 %P e10295 %T Three-Dimensional Portable Document Format (3D PDF) in Clinical Communication and Biomedical Sciences: Systematic Review of Applications, Tools, and Protocols %A Newe,Axel %A Becker,Linda %+ Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, 91058, Germany, 49 913185 ext 26720, axel.newe@fau.de %K 3D PDF %K 3D visualization %K interactive %K clinical communication %K biomedical science %K tools %K protocols %K apps %K online data sharing %K scholarly publishing %K electronic publishing %D 2018 %7 07.08.2018 %9 Review %J JMIR Med Inform %G English %X Background: The Portable Document Format (PDF) is the standard file format for the communication of biomedical information via the internet and for electronic scholarly publishing. Although PDF allows for the embedding of three-dimensional (3D) objects and although this technology has great potential for the communication of such data, it is not broadly used by the scientific community or by clinicians. Objective: The objective of this review was to provide an overview of existing publications that apply 3D PDF technology and the protocols and tools for the creation of model files and 3D PDFs for scholarly purposes to demonstrate the possibilities and the ways to use this technology. Methods: A systematic literature review was performed using PubMed and Google Scholar. Articles searched for were in English, peer-reviewed with biomedical reference, published since 2005 in a journal or presented at a conference or scientific meeting. Ineligible articles were removed after screening. The found literature was categorized into articles that (1) applied 3D PDF for visualization, (2) showed ways to use 3D PDF, and (3) provided tools or protocols for the creation of 3D PDFs or necessary models. Finally, the latter category was analyzed in detail to provide an overview of the state of the art. Results: The search retrieved a total of 902 items. Screening identified 200 in-scope publications, 13 covering the use of 3D PDF for medical purposes. Only one article described a clinical routine use case; all others were pure research articles. The disciplines that were covered beside medicine were many. In most cases, either animal or human anatomies were visualized. A method, protocol, software, library, or other tool for the creation of 3D PDFs or model files was described in 19 articles. Most of these tools required advanced programming skills and/or the installation of further software packages. Only one software application presented an all-in-one solution with a graphical user interface. Conclusions: The use of 3D PDF for visualization purposes in clinical communication and in biomedical publications is still not in common use, although both the necessary technique and suitable tools are available, and there are many arguments in favor of this technique. The potential of 3D PDF usage should be disseminated in the clinical and biomedical community. Furthermore, easy-to-use, standalone, and free-of-charge software tools for the creation of 3D PDFs should be developed. %M 30087092 %R 10.2196/10295 %U http://medinform.jmir.org/2018/3/e10295/ %U https://doi.org/10.2196/10295 %U http://www.ncbi.nlm.nih.gov/pubmed/30087092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e10913 %T Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project %A Shaw,Sara E %A Cameron,Deborah %A Wherton,Joseph %A Seuren,Lucas M %A Vijayaraghavan,Shanti %A Bhattacharya,Satyajit %A A’Court,Christine %A Morris,Joanne %A Greenhalgh,Trisha %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865 617873, sara.shaw@phc.ox.ac.uk %K remote consultations, communication, language, linguistics, cancer, diabetes mellitus, heart failure %D 2018 %7 31.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Remote videoconsulting is promoted by policy makers as a way of delivering health care efficiently to an aging population with rising rates of chronic illness. As a radically new service model, it brings operational and interactional challenges in using digital technologies. In-depth research on this dynamic is needed before remote consultations are introduced more widely. Objective: The objective of this study will be to identify and analyze the communication strategies through which remote consultations are accomplished and to guide patients and clinicians to improve the communicative quality of remote consultations. Methods: In previous research, we collected and analyzed two separate datasets of remote consultations in a National Institute for Health Research–funded study of clinics in East London using Skype and a Wellcome Trust–funded study of specialist community heart failure teams in Oxford using Skype or FaceTime. The Qualitative Analysis of Remote Consultations (QuARC) study will combine datasets and undertake detailed interactional microanalysis of up to 40 remote consultations undertaken by senior and junior doctors and nurse specialists, including consultations with adults with diabetes, women who have diabetes during pregnancy, people consulting for postoperative cancer surgery and community-based patients having routine heart failure reviews along with up to 25 comparable face-to-face consultations. Drawing on established techniques (eg, conversation analysis), analysis will examine the contextual features in remote consultations (eg, restricted visual field) combined with close analysis of different modes of communication (eg, speech, gesture, and gaze). Results: Our findings will address the current gap in knowledge about how technology shapes the fine detail of communication in remote consultations. Alongside academic outputs, findings will inform the coproduction of information and guidance about communication strategies to support successful remote consultations. Conclusions: Identifying the communication strategies through which remote consultations are accomplished and producing guidance for patients and clinicians about how to use this kind of technology successfully in consultations is an important and timely goal because roll out of remote consultations is planned across the National Health Service. Registered Report Identifier: RR1-10.2196/10913 %M 30064972 %R 10.2196/10913 %U http://www.researchprotocols.org/2018/7/e10913/ %U https://doi.org/10.2196/10913 %U http://www.ncbi.nlm.nih.gov/pubmed/30064972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e240 %T Evaluating Doctor Performance: Ordinal Regression-Based Approach %A Shi,Yong %A Li,Peijia %A Yu,Xiaodan %A Wang,Huadong %A Niu,Lingfeng %+ Research Center on Fictitious Economy and Data Science, Chinese Academy of Sciences, 80 Zhongguancun East Road, Haidian District, Beijing, 100190, China, 86 15600616246, niulf@ucas.ac.cn %K performance evaluation %K ordinal regression %K mHealth %K support vector machines %K ordinal partitioning %D 2018 %7 18.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Doctor’s performance evaluation is an important task in mobile health (mHealth), which aims to evaluate the overall quality of online diagnosis and patient outcomes so that customer satisfaction and loyalty can be attained. However, most patients tend not to rate doctors’ performance, therefore, it is imperative to develop a model to make doctor’s performance evaluation automatic. When evaluating doctors’ performance, we rate it into a score label that is as close as possible to the true one. Objective: This study aims to perform automatic doctor’s performance evaluation from online textual consultations between doctors and patients by way of a novel machine learning method. Methods: We propose a solution that models doctor’s performance evaluation as an ordinal regression problem. In doing so, a support vector machine combined with an ordinal partitioning model (SVMOP), along with an innovative predictive function will be developed to capture the hidden preferences of the ordering labels over doctor’s performance evaluation. When engineering the basic text features, eight customized features (extracted from over 70,000 medical entries) were added and further boosted by the Gradient Boosting Decision Tree algorithm. Results: Real data sets from one of the largest mobile doctor/patient communication platforms in China are used in our study. Statistically, 64% of data on mHealth platforms lack the evaluation labels from patients. Experimental results reveal that our approach can support an automatic doctor performance evaluation. Compared with other auto-evaluation models, SVMOP improves mean absolute error (MAE) by 0.1, mean square error (MSE) by 0.5, pairwise accuracy (PAcc) by 5%; the suggested customized features improve MAE by 0.1, MSE by 0.2, PAcc by 3%. After boosting, performance is further improved. Based on SVMOP, predictive features like politeness and sentiment words can be mined, which can be further applied to guide the development of mHealth platforms. Conclusions: The initial modelling of doctor performance evaluation is an ordinal regression problem. Experiments show that the performance of our proposed model with revised prediction function is better than many other machine learning methods on MAE, MSE, as well as PAcc. With this model, the mHealth platform could not only make an online auto-evaluation of physician performance, but also obtain the most effective features, thereby guiding physician performance and the development of mHealth platforms. %M 30021708 %R 10.2196/jmir.9300 %U http://www.jmir.org/2018/7/e240/ %U https://doi.org/10.2196/jmir.9300 %U http://www.ncbi.nlm.nih.gov/pubmed/30021708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e218 %T Examining the Complexity of Patient-Outpatient Care Team Secure Message Communication: Qualitative Analysis %A Lanham,Holly Jordan %A Leykum,Luci K %A Pugh,Jacqueline A %+ Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 567 7000, lanham@uthscsa.edu %K secure messaging %K patient-physician communication %K complexity science %K outpatient care %K outpatients %K confidentiality %D 2018 %7 11.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communicating both routine and nonroutine issues, and the implications of these differences in use are less well understood. Objective: The purpose of this study was to examine secure messaging use to extend current knowledge of how this tool is being used in outpatient care settings and generate new research questions to improve our understanding of the role of secure messaging in the patient-provider communication toolbox. Methods: We conducted an in-depth qualitative analysis of secure message threads in 12 US Department of Veterans Affairs outpatient clinics in south Texas. We analyzed 70 secure message threads with a total of 179 unique communications between patients and their outpatient teams for patterns in communication and secure message content. We used theories from information systems and complexity science in organizations to explain our observations. Results: Analysis identified content relating to 3 main themes: (1) information management, (2) uncertainty management, and (3) patient safety and engagement risks and opportunities. Within these themes, we identified 2 subcategories of information management (information exchange and problem solving), 2 subcategories of uncertainty management (relationship building and sensemaking), and 3 subcategories of patient safety and engagement risks and opportunities (unresolved issues, tone mismatch, and urgent medical issues). Secure messages were most often used to communicate routine issues (eg, information exchange and problem solving). However, the presence of subcategories pertaining to nonroutine issues (eg, relationship building, sensemaking, tone mismatch, urgent issues, and unresolved issues) requires attention, particularly for improving opportunities in outpatient care settings using secure messaging. Conclusions: Patients use secure messaging for both routine and nonroutine purposes. Our analysis sheds light on potentially new patient safety concerns, particularly when using secure messaging to address some of the more complex issues patients are communicating with providers. Secure messaging is an asynchronous communication information system operated by patients and providers who are often characterized as having significant differences in knowledge, experience and expectations. As such, justification for its use beyond routine purposes is limited—yet this occurs, presenting a multifaceted dilemma for health care organizations. Secure messaging use in outpatient care settings may be more nuanced, and thus more challenging to understand and manage than previously recognized. New information system designs that acknowledge the use of secure messaging for nonroutine and complex health topics are needed. %M 29997107 %R 10.2196/jmir.9269 %U http://www.jmir.org/2018/7/e218/ %U https://doi.org/10.2196/jmir.9269 %U http://www.ncbi.nlm.nih.gov/pubmed/29997107 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e230 %T Applications of Space Technologies to Global Health: Scoping Review %A Dietrich,Damien %A Dekova,Ralitza %A Davy,Stephan %A Fahrni,Guillaume %A Geissbühler,Antoine %+ Hopitaux Universitaires de Genève, eHealth and Telemedicine Division, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 22 372 62 01, Damien.Dietrich@hcuge.ch %K satellite imagery %K satellite communications %K public health %K remote sensing technology %K global positioning system %K geographic information systems %K telemedicine %K spaceflight %K space medicine %K global health %D 2018 %7 27.06.2018 %9 Review %J J Med Internet Res %G English %X Background: Space technology has an impact on many domains of activity on earth, including in the field of global health. With the recent adoption of the United Nations’ Sustainable Development Goals that highlight the need for strengthening partnerships in different domains, it is useful to better characterize the relationship between space technology and global health. Objective: The aim of this study was to identify the applications of space technologies to global health, the key stakeholders in the field, as well as gaps and challenges. Methods: We used a scoping review methodology, including a literature review and the involvement of stakeholders, via a brief self-administered, open-response questionnaire. A distinct search on several search engines was conducted for each of the four key technological domains that were previously identified by the UN Office for Outer Space Affairs’ Expert Group on Space and Global Health (Domain A: remote sensing; Domain B: global navigation satellite systems; Domain C: satellite communication; and Domain D: human space flight). Themes in which space technologies are of benefit to global health were extracted. Key stakeholders, as well as gaps, challenges, and perspectives were identified. Results: A total of 222 sources were included for Domain A, 82 sources for Domain B, 144 sources for Domain C, and 31 sources for Domain D. A total of 3 questionnaires out of 16 sent were answered. Global navigation satellite systems and geographic information systems are used for the study and forecasting of communicable and noncommunicable diseases; satellite communication and global navigation satellite systems for disaster response; satellite communication for telemedicine and tele-education; and global navigation satellite systems for autonomy improvement, access to health care, as well as for safe and efficient transportation. Various health research and technologies developed for inhabited space flights have been adapted for terrestrial use. Conclusions: Although numerous examples of space technology applications to global health exist, improved awareness, training, and collaboration of the research community is needed. %M 29950289 %R 10.2196/jmir.9458 %U http://www.jmir.org/2018/6/e230/ %U https://doi.org/10.2196/jmir.9458 %U http://www.ncbi.nlm.nih.gov/pubmed/29950289 %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 4 %P e150 %T Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study %A Greenhalgh,Trisha %A Shaw,Sara %A Wherton,Joseph %A Vijayaraghavan,Shanti %A Morris,Joanne %A Bhattacharya,Satya %A Hanson,Philippa %A Campbell-Richards,Desirée %A Ramoutar,Seendy %A Collard,Anna %A Hodkinson,Isabel %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865289293, trish.greenhalgh@phc.ox.ac.uk %K remote consultations %K diabetes mellitus %K ethnography %K interviews %K organizational case studies %K health systems %D 2018 %7 17.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. Objective: The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. Methods: A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). Results: When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2% and 22% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Conclusions: Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. %M 29625956 %R 10.2196/jmir.9897 %U http://www.jmir.org/2018/4/e150/ %U https://doi.org/10.2196/jmir.9897 %U http://www.ncbi.nlm.nih.gov/pubmed/29625956 %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 4 %P e124 %T Optimizing Electronic Consultation Between Primary Care Providers and Psychiatrists: Mixed-Methods Study %A Hensel,Jennifer M %A Yang,Rebecca %A Rai,Minnie %A Taylor,Valerie H %+ Women's College Hospital Institute for Healthcare Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6230, jennifer.hensel@wchospital.ca %K eHealth %K psychiatry %K primary care %K consultation %K health services %D 2018 %7 06.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of electronic consultation (e-consult) between primary care providers (PCPs) and psychiatrists has potential, given the high prevalence of mental health issues in primary care and problematic access to specialist care. Utilization and uptake, however, appears to be lower than would be expected. Objective: This study aimed to examine actual utilization of e-consult between PCPs and psychiatrists and investigate the perceptions of PCPs about this form of psychiatric advice to inform how to optimize the utility and thereby the uptake of this service. Methods: In this mixed-methods study, we conducted a chart review of psychiatry e-consults (N=37) over 2 platforms during early implementation in Ontario, Canada, as well as 3 group interviews and 1 individual interview with PCPs (N=10) with variable experience levels and from a range of practice settings. The chart review assessed response times and referral content including the type of request, referral attachments, and consultant responses. Interviews explored the perceptions of the PCPs about the uses and barriers of psychiatry e-consult. Thematic content analysis of interview data identified common themes as well as themes unique to different provider profiles (eg, experienced PCPs vs new PCPs and rural vs urban practice). On the basis of interpretation of the quantitative and qualitative findings, we developed recommendations for the optimization of psychiatry e-consultation services. Results: During the study period, psychiatry e-consults comprised 3.66% (49/1339) of all e-consults submitted on the studied platforms. Among the e-consults reviewed, different psychiatric diagnoses were represented: 70% of requests (26/37) queried about medication safety or side effects, whereas 59% (22/37) asked about psychiatric symptom management. Moreover, 81% (30/37) of e-consults were answered within 24 hours, and 65% (24/37) were addressed in a single exchange. Themes from the interview data included psychiatry having a complexity that differentiates it from other specialties and may limit the utility of e-consult, other than for psychopharmacology advice. Variability in awareness exists in the way e-consultation could be used in psychiatry, with new PCPs feeling unsure about the appropriateness of a question. In general, new PCPs and PCPs practicing in rural areas were more receptive to psychiatry e-consult. PCPs viewed e-consult as an opportunity to collaborate and desired that it be integrated with other available services. Recommendations include the need for appropriate specialist staffing to address a wide range of requests, adequate education to referrers regarding the use of psychiatry e-consult, and the need to integrate psychiatry e-consult with other geographically relevant services, given the complexity of psychiatric issues. Conclusions: E-consult is a viable and timely way for PCPs to get much-needed psychiatric advice. For optimizing its utility and uptake, e-consult needs to be integrated into reliable care pathways with adequate referrer and consultant preparation. %M 29625949 %R 10.2196/jmir.8943 %U http://www.jmir.org/2018/4/e124/ %U https://doi.org/10.2196/jmir.8943 %U http://www.ncbi.nlm.nih.gov/pubmed/29625949 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e18 %T Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians’ Perceptions and Attitudes %A Daniel,Fady %A Jabak,Suha %A Sasso,Roula %A Chamoun,Yara %A Tamim,Hani %+ Department of Internal Medicine, American University of Beirut Medical Center, American University of Beirut, Hamra, Cairo Street, Beirut,, Lebanon, 961 3614660, fd21@aub.edu.lb %K social media %K communication %K patient-physician communication %K technology use %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. Objective: The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. Methods: This was a cross-sectional observational study using an online survey that addressed physicians’ perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. Results: A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. Conclusions: The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality. %M 29625955 %R 10.2196/medinform.8895 %U http://medinform.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/medinform.8895 %U http://www.ncbi.nlm.nih.gov/pubmed/29625955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e117 %T Use of Social Network Sites for Communication Among Health Professionals: Systematic Review %A Chan,Windy SY %A Leung,Angela YM %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Room GH528, 5th Floor, Core G,, The Hong Kong Polytechnic University, Hung Hom, Kowloon,, China (Hong Kong), 852 27665587, angela.ym.leung@polyu.edu.hk %K social networking %K social media %K health communication %K Facebook %K WhatsApp %K professional network %K health professionals %D 2018 %7 28.03.2018 %9 Review %J J Med Internet Res %G English %X Background: Although much research has been done investigating the roles of social network sites (SNSs) in linking patients and health professionals, there is a lack of information about their uses, benefits, and limitations in connecting health professions only for professional communication. Objective: This review aimed to examine the utilization of SNSs for communication among health professionals in (1) frontline clinical practice, (2) professional networks, and (3) education and training to identify areas for future health communication research. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A systematic search of the literature published in the last 10 years (January 1, 2007, to March 1, 2017) was performed in March 2017, using the following electronic databases: MEDLINE via OvidSP, EMBASE, CINAHL Complete, and InfoSci-Journals. The searches were conducted using the following defined search terms: “social media” OR “social network” OR “social network site” OR “Facebook” OR “Twitter” OR “Linkedin” OR “Instagram” OR “Weibo” OR “Whatsapp” OR “Telegram” OR “WeChat” AND “health” OR “health profession.” Results: Of the 6977 papers retrieved, a total of 33 studies were included in this review. They were exploratory in nature, and the majority used surveys (n=25) and interviews (n=6). All retrieved studies stated that SNSs enhanced effective communication and information sharing. SNSs were used for supporting delivering of clinical services, making referrals, and sharing information. They were beneficial to network building and professional collaboration. SNSs were novel tools to enhance educational interactions among peers, students, instructors, and preceptors. The application of SNSs came with restraints in technical knowledge, concerns on data protection, privacy and liability, issues in professionalism, and data protection. Conclusions: SNSs provide platforms facilitating efficient communication, interactions, and connections among health professionals in frontline clinical practice, professional networks, education, and training with limitations identified as technical knowledge, professionalism, and risks of data protection. The evolving use of SNSs necessitates robust research to explore the full potential and the relative effectiveness of SNSs in professional communication. %M 29592845 %R 10.2196/jmir.8382 %U http://www.jmir.org/2018/3/e117/ %U https://doi.org/10.2196/jmir.8382 %U http://www.ncbi.nlm.nih.gov/pubmed/29592845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e95 %T Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study %A van Kasteren,Yasmin %A Freyne,Jill %A Hussain,M Sazzad %+ Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, GPO Box 76, Epping, NSW, 1710, Australia, 61 2 9372 4177, sazzad.hussain@csiro.au %K arthroplasty %K replacement %K osteoarthritis %K patient participation %K consumer health informatics %K technology %K telemedicine %K rehabilitation %K self-care %K exercise therapy %K human computer interaction %K wearables %D 2018 %7 20.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. Objective: The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. Methods: A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. Conclusions: Digital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity. %M 29559424 %R 10.2196/jmir.7541 %U http://www.jmir.org/2018/3/e95/ %U https://doi.org/10.2196/jmir.7541 %U http://www.ncbi.nlm.nih.gov/pubmed/29559424 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e16 %T Effect of Seasonal Variation on Clinical Outcome in Patients with Chronic Conditions: Analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial %A Argha,Ahmadreza %A Savkin,Andrey %A Liaw,Siaw-Teng %A Celler,Branko George %+ Biomedical Systems Research Laboratory, University of New South Wales, Electrical Engineering and Telecommunications, Kensington, 2052, Australia, 61 0418228297, b.celler@unsw.edu.au %K telehealth %K telemonitoring %K seasonal variation %K clinical trial %K vital signs %K chronic disease %D 2018 %7 16.03.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Seasonal variation has an impact on the hospitalization rate of patients with a range of cardiovascular diseases, including myocardial infarction and angina. This paper presents findings on the influence of seasonal variation on the results of a recently completed national trial of home telemonitoring of patients with chronic conditions, carried out at five locations along the east coast of Australia. Objective: The aim is to evaluate the effect of the seasonal timing of hospital admission and length of stay on clinical outcome of a home telemonitoring trial involving patients (age: mean 72.2, SD 9.4 years) with chronic conditions (chronic obstructive pulmonary disease coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) and to explore methods of minimizing the influence of seasonal variations in the analysis of the effect of at-home telemonitoring on the number of hospital admissions and length of stay (LOS). Methods: Patients were selected from a hospital list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. A total of 114 test patients and 173 control patients were available in this trial. However, of the 287 patients, we only considered patients who had one or more admissions in the years from 2010 to 2012. Three different groups were analyzed separately because of substantially different climates: (1) Queensland, (2) Australian Capital Territory and Victoria, and (3) Tasmania. Time series data were analyzed using linear regression for a period of 3 years before the intervention to obtain an average seasonal variation pattern. A novel method that can reduce the impact of seasonal variation on the rate of hospitalization and LOS was used in the analysis of the outcome variables of the at-home telemonitoring trial. Results: Test patients were monitored for a mean 481 (SD 77) days with 87% (53/61) of patients monitored for more than 12 months. Trends in seasonal variations were obtained from 3 years’ of hospitalization data before intervention for the Queensland, Tasmania, and Australian Capital Territory and Victoria subgroups, respectively. The maximum deviation from baseline trends for LOS was 101.7% (SD 42.2%), 60.6% (SD 36.4%), and 158.3% (SD 68.1%). However, by synchronizing outcomes to the start date of intervention, the impact of seasonal variations was minimized to a maximum of 9.5% (SD 7.7%), thus improving the accuracy of the clinical outcomes reported. Conclusions: Seasonal variations have a significant effect on the rate of hospital admission and LOS in patients with chronic conditions. However, the impact of seasonal variation on clinical outcomes (rate of admissions, number of hospital admissions, and LOS) of at-home telemonitoring can be attenuated by synchronizing the analysis of outcomes to the commencement dates for the telemonitoring of vital signs. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/ 6xLPv9QDb) %M 29549068 %R 10.2196/medinform.9680 %U http://medinform.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/medinform.9680 %U http://www.ncbi.nlm.nih.gov/pubmed/29549068 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e13 %T Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study %A Pahwa,Parika %A Lunsford,Sarah %A Livesley,Nigel %+ EnCompass LLC, 5404 Wisconsin Ave, Chevy Chase, MD, 20815, United States, 1 6177849008, ssmith@urc-chs.com %K quality improvement %K mobile apps %K communication %K patient care team %D 2018 %7 01.03.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods: Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings. %M 29496651 %R 10.2196/medinform.8154 %U http://medinform.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/medinform.8154 %U http://www.ncbi.nlm.nih.gov/pubmed/29496651 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e10 %T Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study %A Powell,Rhea E %A Stone,Danica %A Hollander,Judd E %+ Thomas Jefferson University, 1025 Walnut Street Suite 300, Philadelphia, PA, 19107, United States, 1 2155035591, judd.hollander@jefferson.edu %K telemedicine %K video visit %K primary care %K specialty %K patient satisfaction %D 2018 %7 13.02.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Real-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences. Objective: The objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system. Methods: This is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care. Results: This study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52. Conclusions: A large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences. %M 29439947 %R 10.2196/medinform.8479 %U http://medinform.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/medinform.8479 %U http://www.ncbi.nlm.nih.gov/pubmed/29439947 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e9 %T The Use of Communication Apps by Medical Staff in the Australian Health Care System: Survey Study on Prevalence and Use %A Nikolic,Amanda %A Wickramasinghe,Nilmini %A Claydon-Platt,Damian %A Balakrishnan,Vikram %A Smart,Philip %+ General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, 89 Bridge Road, Richmond, 3121, Australia, 61 294266666, nikolicamanda@gmail.com %K mobile phone %K information science %K communications media %K privacy %K interdisciplinary communication %K hospital communication systems %K communication %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor’s attitudes towards them, or what guides clinician choice of app. Objective: The objective of this study was to quantify and qualify the use of communication apps among medical staff in clinical situations, their role in patient care, and knowledge and attitudes towards safety, key benefits, potential disadvantages, and policy implications. Methods: Medical staff in hospitals across Victoria (Australia) were invited to participate in an anonymous 33-question survey. The survey collected data on respondent’s demographics, their use of communication apps in clinical settings, attitudes towards communication apps, perceptions of data “safety,” and why one communication app was chosen over others. Results: Communication apps in Victorian hospitals are in widespread use from students to consultants, with WhatsApp being the primary app used. The median number of messages shared per day was 12, encompassing a range of patient information. All respondents viewed these apps positively in quickly communicating patient information in a clinical setting; however, all had concerns about the privacy implications arising from sharing patient information in this way. In total, 67% (60/90) considered patient data “moderately safe” on these apps, and 50% (46/90) were concerned the use of these apps was inconsistent with current legislation and policy. Apps were more likely to be used if they were fast, easy to use, had an easy login process, and were already in widespread use. Conclusions: Communication app use by medical personnel in Victorian hospitals is pervasive. These apps contribute to enhanced communication between medical staff, but their use raises compliance issues, most notably with Australian privacy legislation. Development of privacy-compliant apps such as MedX needs to prioritize a user-friendly interface and market the product as a privacy-compliant comparator to apps previously adapted to health care settings. %M 29426813 %R 10.2196/medinform.9526 %U http://medinform.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/medinform.9526 %U http://www.ncbi.nlm.nih.gov/pubmed/29426813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e38 %T Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial %A Martínez,Vania %A Rojas,Graciela %A Martínez,Pablo %A Zitko,Pedro %A Irarrázaval,Matías %A Luttges,Carolina %A Araya,Ricardo %+ Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago,, Chile, 56 229788601, graciela.rojas.castillo@gmail.com %K primary health care %K depression %K adolescents %K Internet %K telemedicine %K medically underserved area %D 2018 %7 31.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results: More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). Conclusions: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) %M 29386172 %R 10.2196/jmir.8021 %U https://www.jmir.org/2018/1/e38/ %U https://doi.org/10.2196/jmir.8021 %U http://www.ncbi.nlm.nih.gov/pubmed/29386172 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e2 %T The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System %A Kurahashi,Allison M %A Stinson,Jennifer N %A van Wyk,Margaret %A Luca,Stephanie %A Jamieson,Trevor %A Weinstein,Peter %A Cafazzo,Joseph A %A Lokuge,Bhadra %A Cohen,Eyal %A Rapoport,Adam %A Husain,Amna %+ The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada, 1 416 586 4800 ext 7886, amna.husain@sinaihealthsystem.ca %K patient-centered care %K patient participation %K chronic disease %K communication %K internet communication tools %K usability testing %K interdisciplinary communication %K health communication %K continuity of patient care %K patient care team %K inventions %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system’s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users’ perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions—composing, posting, and reading messages—with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. %M 29317386 %R 10.2196/humanfactors.7882 %U http://humanfactors.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/humanfactors.7882 %U http://www.ncbi.nlm.nih.gov/pubmed/29317386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e5 %T Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review %A Armoiry,Xavier %A Sturt,Jackie %A Phelps,Emma Elizabeth %A Walker,Clare-Louise %A Court,Rachel %A Taggart,Frances %A Sutcliffe,Paul %A Griffiths,Frances %A Atherton,Helen %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476522534, f.e.griffiths@warwick.ac.uk %K digital clinical communication %K professional-family relations %K family %K caregivers %K young adult %K children %K child health %D 2018 %7 05.01.2018 %9 Review %J J Med Internet Res %G English %X Background: The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. Objective: The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. Methods: We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. Results: We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. Conclusions: This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families’ and caregivers’ involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. Trial Registration: PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU) %M 29305339 %R 10.2196/jmir.7999 %U http://www.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/jmir.7999 %U http://www.ncbi.nlm.nih.gov/pubmed/29305339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e421 %T The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients %A Tates,Kiek %A Antheunis,Marjolijn L %A Kanters,Saskia %A Nieboer,Theodoor E %A Gerritse,Maria BE %+ Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg University, Warandelaan 2, Tilburg, 5037 AB, Netherlands, 31 13 466 2971, m.l.antheunis@uvt.nl %K teleconsultation %K communication quality %K patient satisfaction %K provider satisfaction %K information exchange %K interpersonal relationship building %K shared decision making %D 2017 %7 20.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. Objective: This study aimed to examine (1) the impact of a consultation medium on doctors’ and patients’ communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors’ and patients’ communicative behavior on satisfaction with both types of consultation medium. Methods: Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. Results: With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients’ attitude toward Web-based communication (b=−.249, P=.02 and patients’ perceived time and attention (b=.271, P=.03) significantly predicted patients’ perceived interpersonal relationship building. Patients’ perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between perceived information exchange and doctors’ satisfaction with the consultation (b=.533, P<.001). Furthermore, doctors’ perceived interpersonal relationship building was positively related to doctors’ satisfaction with the consultation (b=.331, P=.003). Conclusions: In this study, the quality of doctor-patient communication, as indicated by information exchange, interpersonal relationship building, and shared decision making, did not differ significantly between Web-based and face-to-face consultations. Doctors and simulated patients were equally satisfied with both types of consultation medium, and no differences were found in the manner in which participants perceived communicative behavior during these consultations. The findings suggest that worries about a negative impact of Web-based video consultation on the quality of patient-provider consultations seem unwarranted as they offer the same interaction quality and satisfaction level as regular face-to-face consultations. %M 29263017 %R 10.2196/jmir.8033 %U http://www.jmir.org/2017/12/e421/ %U https://doi.org/10.2196/jmir.8033 %U http://www.ncbi.nlm.nih.gov/pubmed/29263017 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e52 %T A Data Model for Teleconsultation in Managing High-Risk Pregnancies: Design and Preliminary Evaluation %A Deldar,Kolsoum %A Tara,Fatemeh %A Bahaadinbeigy,Kambiz %A Khajedaluee,Mohammad %A Tara,Mahmood %+ Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Square, Mashhad,, Islamic Republic Of Iran, 98 5138002429, taram@mums.ac.ir %K remote consultation %K clinical archetype %K pregnancy %K clinical decision-making %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Teleconsultation is a guarantor for virtual supervision of clinical professors on clinical decisions made by medical residents in teaching hospitals. Type, format, volume, and quality of exchanged information have a great influence on the quality of remote clinical decisions or tele-decisions. Thus, it is necessary to develop a reliable and standard model for these clinical relationships. Objective: The goal of this study was to design and evaluate a data model for teleconsultation in the management of high-risk pregnancies. Methods: This study was implemented in three phases. In the first phase, a systematic review, a qualitative study, and a Delphi approach were done in selected teaching hospitals. Systematic extraction and localization of diagnostic items to develop the tele-decision clinical archetypes were performed as the second phase. Finally, the developed model was evaluated using predefined consultation scenarios. Results: Our review study has shown that present medical consultations have no specific structure or template for patient information exchange. Furthermore, there are many challenges in the remote medical decision-making process, and some of them are related to the lack of the mentioned structure. The evaluation phase of our research has shown that data quality (P<.001), adequacy (P<.001), organization (P<.001), confidence (P<.001), and convenience (P<.001) had more scores in archetype-based consultation scenarios compared with routine-based ones. Conclusions: Our archetype-based model could acquire better and higher scores in the data quality, adequacy, organization, confidence, and convenience dimensions than ones with routine scenarios. It is probable that the suggested archetype-based teleconsultation model may improve the quality of physician-physician remote medical consultations. %M 29242181 %R 10.2196/medinform.8393 %U http://medinform.jmir.org/2017/4/e52/ %U https://doi.org/10.2196/medinform.8393 %U http://www.ncbi.nlm.nih.gov/pubmed/29242181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e175 %T Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model %A Valenzuela Espinoza,Alexis %A Devos,Stefanie %A van Hooff,Robbert-Jan %A Fobelets,Maaike %A Dupont,Alain %A Moens,Maarten %A Hubloue,Ives %A Lauwaert,Door %A Cornu,Pieter %A Brouns,Raf %A Putman,Koen %+ Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels,, Belgium, 32 47 050 57 96, alexis.valenzuela.espinoza@vub.be %K telemedicine %K prehospital %K stroke %K cost effectiveness %D 2017 %7 24.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine. Objective: We aim to develop a first cost effectiveness model for in-ambulance telemedicine and use this model to estimate the time savings needed before in-ambulance telemedicine becomes cost effective. Methods: Current standard stroke care is compared with current standard stroke care supplemented with in-ambulance telemedicine using a cost-utility model measuring costs and quality-adjusted life-years (QALYs) from a health care perspective. We combine a decision tree with a Markov model. Data from the UZ Brussel Stroke Registry (2282 stroke patients) and linked hospital claims data at individual level are combined with literature data to populate the model. A 2-way sensitivity analysis varying both implementation costs and time gain is performed to map the different cost-effective combinations and identify the time gain needed for cost effectiveness and dominance. For several modeled time gains, the cost-effectiveness acceptability curve is calculated and mapped in 1 figure. Results: Under the base-case scenario (implementation cost of US $159,425) and taking a lifetime horizon into account, in-ambulance telemedicine is a cost-effective strategy compared to standard stroke care alone starting from a time gain of 6 minutes. After 12 minutes, in-ambulance telemedicine becomes dominant, and this results in a mean decrease of costs by US –$30 (95% CI –$32 to –$29) per patient with 0.00456 (95% CI 0.00448 to 0.00463) QALYs on average gained per patient. In over 82% of all probabilistic simulations, in-ambulance telemedicine remains under the cost-effectiveness threshold of US $47,747. Conclusions: Our model suggests that in-ambulance telemedicine can be cost effective starting from a time gain of 6 minutes and becomes a dominant strategy after approximately 15 minutes. This indicates that in-ambulance telemedicine has the potential to become a cost-effective intervention assuming time gains in clinical implementations are realized in the future. %M 29175808 %R 10.2196/mhealth.8288 %U http://mhealth.jmir.org/2017/11/e175/ %U https://doi.org/10.2196/mhealth.8288 %U http://www.ncbi.nlm.nih.gov/pubmed/29175808 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e165 %T Uses of Mobile Device Digital Photography of Dermatologic Conditions in Primary Care %A Pecina,Jennifer L %A Wyatt,Kirk D %A Comfere,Nneka I %A Bernard,Matthew E %A North,Frederick %+ Department of Family Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, United States, 1 5072840423, pecina.jennifer@mayo.edu %K telemedicine %K teledermatology %K mobile phone %K mobile applications %K primary health care %K smartphone %K remote consultation %D 2017 %7 08.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)–based mobile devices. Objective: The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes. Methods: Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant). Results: During the study period, there were 1139 photo sessions on 1059 unique patients. Of the 1139 sessions, 395 (34.68%) sessions documented dermatologist input in the EHR via dermatology curbside consultation, eConsult, and in-person dermatology consult. Clinicians utilized curbside phone consults preferentially over eConsults for TD. By clinician type, nurse practitioners (NPs) and physician assistants (PAs) were more likely to utilize the PhotoExam for TD as compared with physicians. By specialty type, pediatric clinicians were more likely to utilize the PhotoExam for TD as compared with family medicine and internal medicine clinicians. A total of 108 (9.5%) photo sessions had a biopsy performed of the photographed site. Of these, 46 biopsies (42.6%) were performed by a primary care clinician, and 27 (25.0%) biopsies were interpreted as a malignancy. Of the 27 biopsies that revealed malignant findings, 6 (22%) had a TD consultation before biopsy, and 10 (37%) of these biopsies were obtained by primary care clinicians. Conclusions: Clinicians primarily used the PhotoExam for non-TD purposes. Nurse practitioners and PAs utilized the app for TD purposes more than physicians. Primary care clinicians requested curbside dermatology consults more frequently than dermatology eConsults. %M 29117934 %R 10.2196/mhealth.8257 %U http://mhealth.jmir.org/2017/11/e165/ %U https://doi.org/10.2196/mhealth.8257 %U http://www.ncbi.nlm.nih.gov/pubmed/29117934 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e41 %T Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review %A Mileski,Michael %A Kruse,Clemens Scott %A Catalani,Justin %A Haderer,Tara %+ School of Health Administration, Texas State University, 601 University Drive, San Marcos, TX, 78666, United States, 1 832 752 4419, mileski@txstate.edu %K hypertension %K telemedicine %K eHealth %K mHealth %K disease management %D 2017 %7 24.10.2017 %9 Review %J JMIR Med Inform %G English %X Background: Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. Objective: A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Methods: Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results: Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. Conclusions: This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of hypertension. %M 29066424 %R 10.2196/medinform.6603 %U http://medinform.jmir.org/2017/4/e41/ %U https://doi.org/10.2196/medinform.6603 %U http://www.ncbi.nlm.nih.gov/pubmed/29066424 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e135 %T Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Huang,Ching-Chang %A Hung,Yu-Chien %A Hwang,Juey-Jen %A Ho,Yi-Lwun %+ Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 10002, Taiwan, 886 2 2312 3456 ext 63651, ylho@ntu.edu.tw %K atrial fibrillation %K screen %K cloud-computing algorithm %K electrocardiography %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. %M 28951384 %R 10.2196/mhealth.8290 %U https://mhealth.jmir.org/2017/9/e135/ %U https://doi.org/10.2196/mhealth.8290 %U http://www.ncbi.nlm.nih.gov/pubmed/28951384 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 3 %P e29 %T Impact of At-Home Telemonitoring on Health Services Expenditure and Hospital Admissions in Patients With Chronic Conditions: Before and After Control Intervention Analysis %A Celler,Branko %A Varnfield,Marlien %A Nepal,Surya %A Sparks,Ross %A Li,Jane %A Jayasena,Rajiv %+ Biomedical Systems Research Laboratory, University of New South Wales, Building G7, Sydney, NSW, 2052, Australia, 61 2 9385 0746, b.celler@unsw.edu.au %K telehealth %K telemonitoring %K chronic disease management %K healthcare outcomes %K BACI analysis %D 2017 %7 08.09.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Telemonitoring is becoming increasingly important for the management of patients with chronic conditions, especially in countries with large distances such as Australia. However, despite large national investments in health information technology, little policy work has been undertaken in Australia in deploying telehealth in the home as a solution to the increasing demands and costs of managing chronic disease. Objective: The objective of this trial was to evaluate the impact of introducing at-home telemonitoring to patients living with chronic conditions on health care expenditure, number of admissions to hospital, and length of stay (LOS). Methods: A before and after control intervention analysis model was adopted whereby at each location patients were selected from a list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. Test patients were supplied with a telehealth vital signs monitor and were remotely managed by a trained clinical care coordinator, while control patients continued to receive usual care. A total of 100 test patients and 137 control patients were analyzed. Primary health care benefits provided to Australian patients were investigated for the trial cohort. Time series data were analyzed using linear regression and analysis of covariance for a period of 3 years before the intervention and 1 year after. Results: There were no significant differences between test and control patients at baseline. Test patients were monitored for an average of 276 days with 75% of patients monitored for more than 6 months. Test patients 1 year after the start of their intervention showed a 46.3% reduction in rate of predicted medical expenditure, a 25.5% reduction in the rate of predicted pharmaceutical expenditure, a 53.2% reduction in the rate of predicted unscheduled admission to hospital, a 67.9% reduction in the predicted rate of LOS when admitted to hospital, and a reduction in mortality of between 41.3% and 44.5% relative to control patients. Control patients did not demonstrate any significant change in their predicted trajectory for any of the above variables. Conclusions: At-home telemonitoring of chronically ill patients showed a statistically robust positive impact increasing over time on health care expenditure, number of admissions to hospital, and LOS as well as a reduction in mortality. Trial Registration: Retrospectively registered with the Australian and New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030 (Archived by WebCite at http://www.webcitation.org/6sxqjkJHW) %M 28887294 %R 10.2196/medinform.7308 %U http://medinform.jmir.org/2017/3/e29/ %U https://doi.org/10.2196/medinform.7308 %U http://www.ncbi.nlm.nih.gov/pubmed/28887294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e279 %T Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry %A Lowenstein,Margaret %A Bamgbose,Olusinmi %A Gleason,Nathaniel %A Feldman,Mitchell D %+ University of Pennsylvania Perelman School of Medicine, National Clinician Scholars Program, Blockley Hall, 423 Guardian Drive, Philadelphia, PA,, United States, 1 215 573 3977, margaw@mail.med.upenn.edu %K mental health %K primary care %K health care delivery %K teleconsultation %K telehealth %K Internet care delivery %D 2017 %7 04.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Objective: Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. Methods: We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Results: Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. Conclusions: For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. %M 28778852 %R 10.2196/jmir.7921 %U http://www.jmir.org/2017/8/e279/ %U https://doi.org/10.2196/jmir.7921 %U http://www.ncbi.nlm.nih.gov/pubmed/28778852 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e11 %T WhatsApp Messenger as an Adjunctive Tool for Telemedicine: An Overview %A Giordano,Vincenzo %A Koch,Hilton %A Godoy-Santos,Alexandre %A Dias Belangero,William %A Esteves Santos Pires,Robinson %A Labronici,Pedro %+ Department of Orthopedics, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203, Leblon, Rio de Janeiro, 22440-040, Brazil, 55 21997516859, v_giordano@me.com %K whatsapp %K telemedicine %K smartphone %K mobile application %D 2017 %7 21.07.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The advent of telemedicine has allowed physicians to deliver medical treatment to patients from a distance. Mobile apps such as WhatsApp Messenger, an instant messaging service, came as a novel concept in all fields of social life, including medicine. The use of instant messaging services has been shown to improve communication within medical teams by providing means for quick teleconsultation, information sharing, and starting treatment as soon as possible. Objective: The aim of this study was to perform a comprehensive systematic review of present literature on the use of the WhatsApp Messenger app as an adjunctive health care tool for medical doctors. Methods: Searches were performed in PubMed, EMBASE, and the Cochrane Library using the term “whatsapp*” in articles published before January 2016. A bibliography of all relevant original articles that used the WhatsApp Messenger app was created. The level of evidence of each study was determined according to the Oxford Levels of Evidence ranking system produced by the Oxford Centre for Evidence-Based Medicine. The impact and the indications of WhatsApp Messenger are discussed in order to understand the extent to which this app currently functions as an adjunctive tool for telemedicine. Results: The database search identified a total of 30 studies in which the term “whatsapp*” was used. Each article’s list of references was evaluated item-by-item. After literature reviews, letters to the editor, and low-quality studies were excluded, a total of 10 studies were found to be eligible for inclusion. Of these studies, 9 had been published in the English language and 1 had been published in Spanish. Five were published by medical doctors. Conclusions: The pooled data presents compelling evidence that the WhatsApp Messenger app is a promising system, whether used as a communication tool between health care professionals, as a means of communication between health care professionals and the general public, or as a learning tool for providing health care information to professionals or to the general population. However, high-quality and properly evaluated research is needed, as are improvements in descriptions of the methodology and the study processes. These improvements will allow WhatsApp Messenger to be categorically defined as an effective telemedicine tool in many different fields of health care. %M 28733273 %R 10.2196/ijmr.6214 %U http://www.i-jmr.org/2017/2/e11/ %U https://doi.org/10.2196/ijmr.6214 %U http://www.ncbi.nlm.nih.gov/pubmed/28733273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e219 %T My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer %A Voruganti,Teja %A Grunfeld,Eva %A Jamieson,Trevor %A Kurahashi,Allison M %A Lokuge,Bhadra %A Krzyzanowska,Monika K %A Mamdani,Muhammad %A Moineddin,Rahim %A Husain,Amna %+ Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, 4th Floor, Box 13, 60 Murray Street, Toronto, ON,, Canada, 1 416 586 4800 ext 7884, amna.husain@tlcpc.org %K MeSH: Internet %K professional-patient relations %K interdisciplinary communication %K neoplasms %K adult %K chronic disease %K continuity of patient care %K patient care team %K communication %K outcome assessment (health care) %D 2017 %7 18.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. Objective: The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. Methods: We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ≥3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. Results: Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. Conclusions: The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. Trial Registration: ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb). %M 28720558 %R 10.2196/jmir.7421 %U http://www.jmir.org/2017/7/e219/ %U https://doi.org/10.2196/jmir.7421 %U http://www.ncbi.nlm.nih.gov/pubmed/28720558 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 3 %P e13 %T The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users %A Sieck,Cynthia J %A Hefner,Jennifer L %A Schnierle,Jeanette %A Florian,Hannah %A Agarwal,Aradhna %A Rundell,Kristen %A McAlearney,Ann Scheck %+ The Ohio State University College of Medicine, 2231 North High St, 277 Northwood-High Bldg, Columbus, OH, 43201, United States, 1 614 366 0218, cynthia.sieck@osumc.edu %K patient portals %K secure messaging %K patient-provider communication %K qualitative study %D 2017 %7 04.07.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective: Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods: This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic’s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results: Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician’s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the “rules of engagement” at portal sign-up, either in the office or through an online tutorial. Conclusions: As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing “rules of engagement” for communication via patient portals. %M 28676467 %R 10.2196/medinform.7516 %U http://medinform.jmir.org/2017/3/e13/ %U https://doi.org/10.2196/medinform.7516 %U http://www.ncbi.nlm.nih.gov/pubmed/28676467 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 2 %P e16 %T Telemedicine Services for the Arctic: A Systematic Review %A Woldaregay,Ashenafi Zebene %A Walderhaug,Ståle %A Hartvigsen,Gunnar %+ Department of Computer Science, University of Tromsø - The Arctic University of Norway, Realfagbygget Hansine Hansens vei 54 Breivika, Tromsø, 9019, Norway, 47 48682581, ashenafi.z.woldaregay@uit.no %K telemedicine %K telehealth %K health services accessibility %K extreme cold %K arctic regions %K accidents %D 2017 %7 28.06.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. Objective: The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. Methods: A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. Results: The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated another 219 papers, leaving 203 relevant papers. After a full-text assessment, 36 articles were left, which were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. Conclusions: Despite the increasing number of fishermen and other seafarers, Arctic and maritime working conditions are mainly characterized by an absence of access to health care facilities. The condition is further aggravated for fishermen and seafarers who are working in the Arctic regions. In spite of the existing barriers and challenges, some telemedicine services have recently been successfully delivered in these areas. These services include teleconsultation (9/37, 24%), teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%), telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37, 27%). However, the use of telemedicine in relation to search and rescue (SAR) services is not yet fully exploited. Therefore, we foresee that these implemented and evaluated telemedicine services will serve as underlying models for the successful implementation of future search and rescue (SAR) services. %M 28659257 %R 10.2196/medinform.6323 %U http://medinform.jmir.org/2017/2/e16/ %U https://doi.org/10.2196/medinform.6323 %U http://www.ncbi.nlm.nih.gov/pubmed/28659257 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e221 %T The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review %A Kooij,Laura %A Groen,Wim G %A van Harten,Wim H %+ The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, Amsterdam, 1066CX, Netherlands, 31 88 005 75, w.v.harten@nki.nl %K review %K integrated healthcare systems %K health information systems %K chronic disease %D 2017 %7 22.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective: Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods: PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness—in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes—were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results: The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes—for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs’ satisfaction, and confidence. Conclusions: IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods. %M 28642218 %R 10.2196/jmir.7405 %U http://www.jmir.org/2017/6/e221/ %U https://doi.org/10.2196/jmir.7405 %U http://www.ncbi.nlm.nih.gov/pubmed/28642218 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e177 %T Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study %A McGrail,Kimberlyn Marie %A Ahuja,Megan Alyssa %A Leaver,Chad Andrew %+ Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 778 998 3821, kim.mcgrail@ubc.ca %K virtual visits %K telehealth %K primary care delivery %K patient-centered care %D 2017 %7 26.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use. Objective: Descriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician. Methods: The study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs. Results: During 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2%) of respondents saying their virtual visit was of high quality and 364 (91.2%) reporting their virtual visit was “very” or “somewhat” helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can $4 per quarter (Can –$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can –$8.68, P<.001). Conclusions: Virtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems. %M 28550006 %R 10.2196/jmir.7374 %U http://www.jmir.org/2017/5/e177/ %U https://doi.org/10.2196/jmir.7374 %U http://www.ncbi.nlm.nih.gov/pubmed/28550006 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 1 %P e8 %T Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data %A Kargiannakis,Melissa %A Fitzsimmons,Deborah A %A Bentley,Claire L %A Mountain,Gail A %+ School of Nursing and Allied Health, Liverpool John Moores University, Tithebarn Building, 79 Tithebarn Street, Liverpool, L2 2ER, United Kingdom, 44 151 231 5872, D.A.Fitzsimmons@ljmu.ac.uk %K information systems %K telemedicine %K pulmonary disease %K chronic obstructive %K triggers and rules %K information integration %K decision support systems %K information retrieval %D 2017 %7 22.03.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD. Objective: The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission. Methods: A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention. Results: Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm. Conclusions: It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 68856013; http://www.isrctn.com/ISRCTN68856013 (Archived by WebCite at http://www.webcitation.org/6ofApNB2e) %M 28330829 %R 10.2196/medinform.6359 %U http://medinform.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/medinform.6359 %U http://www.ncbi.nlm.nih.gov/pubmed/28330829 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 2 %N 1 %P e22 %T Enhancing Video Chat Applications for Home Health Care %A Stutman,Steve %+ Radio Robots, LLC, PO Box 783, Sudbury, MA, 01776, United States, 1 617 901 3490, stutman@alum.mit.edu %K video chat %K patient-physician interaction %K age in place %D 2016 %7 29.12.2016 %9 Poster %J iproc %G English %X Background: Estimates show that up to 87% of seniors would like to “age in place.” Often, such people are remote from their families and health care providers. Acquisition and telemetry of data and bio-signals from personal health care instrumentation is of great value, but we feel that this does not tell the complete story, because we are dealing with humans. A brief video chat, via personal computer, can usually provide a great deal of information concerning a person’s well-being. An individual’s mood, physical status, and energy level and the state of their surroundings can frequently be determined in a one-minute video chat. While these evaluations are qualitative, they can be very useful in answering the simple, important question “Is this person OK?” A video chat can also help build constructive social bonds between patients and providers because the telecommunication is no longer “faceless.” People who are aging in place are generally not the best computer users. Even if a person is proficient with the use of computers, issues with vision and manual dexterity can present obstacles to the use of video chat applications such as Skype. We have designed and implemented a low-cost system, comprised of a small “helper” program and a wired keypad, which operates with a personal computer and obviates the difficulties experienced by many less experienced and older users. Very simply, this system makes it easier for many people to communicate with their families and healthcare providers. Objective: Our goal was to simplify the use of video chat applications. A conventional desktop is often visually cluttered or has one application window obscuring another. Navigation with a mouse or other pointing device can be difficult for people with impaired vision and those with tremors, arthritis, or other dexterity limiting factors. We designed and built a “helper” program that, in conjunction with a dedicated large symbol keypad, lets a user initiate a video chat just by pressing a couple of buttons. Methods: At present we have conducted a small pilot study (N=8) with naïve computer users who want to video chat with family members. Participants in the study were chosen because they had difficulty initiating video chats. We asked this group to use our system and measured time required to initiate a video chat. Results: All subjects were able to initiate video chats in <30 seconds. The users were all able to terminate the chats when desired. In simple terms, the naïve users were able to start and end calls when they wanted to. Users expressed satisfaction at being able to control this aspect of their computers without technical support from others and enjoyed chat interactions. Conclusions: Video chat applications can be made simpler and easier to use, empowering a person who is aging in place to engage with family and healthcare providers. %R 10.2196/iproc.6246 %U http://www.iproc.org/2016/1/e22/ %U https://doi.org/10.2196/iproc.6246 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e29 %T Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study %A Abraham,Joanna %A Kannampallil,Thomas G %A Patel,Vimla L %A Patel,Bela %A Almoosa,Khalid F %+ Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 1919 W Taylor Street, Room 204, Chicago, IL, 30047, United States, 1 3124134623, abrahamj@uic.edu %K teaching rounds %K communication %K intensive care units %D 2016 %7 09.12.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Recent research has shown evidence of disproportionate time allocation for patient communication during multidisciplinary rounds (MDRs). Studies have shown that patients discussed later during rounds receive lesser time. Objective: The aim of our study was to investigate whether disproportionate time allocation effects persist with the use of structured rounding tools. Methods: Using audio recordings of rounds (N=82 patients), we compared time allocation and communication breakdowns between a problem-based Subjective, Objective, Assessment, and Plan (SOAP) and a system-based Handoff Intervention Tool (HAND-IT) rounding tools. Results: We found no significant linear dependence of the order of patient presentation on the time spent or on communication breakdowns for both structured tools. However, for the problem-based tool, there was a significant linear relationship between the time spent on discussing a patient and the number of communication breakdowns (P<.05)––with an average of 1.04 additional breakdowns with every 120 seconds in discussion. Conclusions: The use of structured rounding tools potentially mitigates disproportionate time allocation and communication breakdowns during rounds, with the more structured HAND-IT, almost completely eliminating such effects. These results have potential implications for planning, prioritization, and training for time management during MDRs. %M 27940423 %R 10.2196/humanfactors.6642 %U http://humanfactors.jmir.org/2016/2/e29/ %U https://doi.org/10.2196/humanfactors.6642 %U http://www.ncbi.nlm.nih.gov/pubmed/27940423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e304 %T How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals %A de Jong,Catharina C %A Ros,Wynand JG %A van Leeuwen,Mia %A Schrijvers,Guus %+ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Postbus 85500, Huispostnr STR 6.131, Utrecht, 3508 GA, Netherlands, 31 623908387, cjong8@umcutrecht.nl %K eHealth %K primary care %K elderly %K email %K nurses %K general practitioners %K medical informatics %K Internet %D 2016 %7 24.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. Objective: The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. Methods: The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. Results: An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. Conclusions: An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care. %M 27884811 %R 10.2196/jmir.6332 %U http://www.jmir.org/2016/11/e304/ %U https://doi.org/10.2196/jmir.6332 %U http://www.ncbi.nlm.nih.gov/pubmed/27884811 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 4 %N 3 %P e26 %T Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors %A Choi,Iee %A Kim,Jin Kyu %A Kim,Sun Jun %A Cho,Soo Chul %A Kim,Il Nyeo %+ Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Department of Pediatrics, Chonbuk National University Hospital, 20, Gunjiro, Duckjinku, Jeonju, Korea, 561-712, Republic Of Korea, 82 63 250 1460, kyunim99@gmail.com %K social media %K personal satisfaction %K information systems %K patient transfer %D 2016 %7 04.08.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. Objective: In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. Methods: Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. Results: The number of patients transferred was reported to increase by 65% (26/40) obstetricians and 40% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72% (29/40) obstetricians and 59% (34/57) pediatricians. Satisfaction was indicated by 83% (33/40) obstetricians and 89% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). Conclusions: The users were highly satisfied and different users indicated different factors of satisfaction. This finding implies that users’ requirements should be accommodated in future developments of patient transfer information systems. %M 27492978 %R 10.2196/medinform.5984 %U http://medinform.jmir.org/2016/3/e26/ %U https://doi.org/10.2196/medinform.5984 %U http://www.ncbi.nlm.nih.gov/pubmed/27492978 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e193 %T Telemedical Education: Training Digital Natives in Telemedicine %A Pathipati,Akhilesh S %A Azad,Tej D %A Jethwani,Kamal %+ Partners HealthCare Connected Health, 25 New Chardon St., Boston, MA, 02114, United States, 1 6177242724, kjethwani@partners.org %K telemedicine %K medical education %K medical school %K curriculum reform %D 2016 %7 12.07.2016 %9 Viewpoint %J J Med Internet Res %G English %X Telemedicine plays an important role in the delivery of medical care, and will become increasingly prominent going forward. Current medical students are among the first generation of “digital natives” who are well versed in the incorporation of technology into social interaction. These students are well positioned to apply advances in communications to patient care. Even so, providers require training to effectively leverage these opportunities. Therefore, we recommend introducing telemedicine training into medical school curricula and propose a model for incorporation. %M 27405323 %R 10.2196/jmir.5534 %U http://www.jmir.org/2016/7/e193/ %U https://doi.org/10.2196/jmir.5534 %U http://www.ncbi.nlm.nih.gov/pubmed/27405323 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 2 %N 2 %P e11 %T Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies %A Bull,Tyler Preston %A Dewar,Alexis Roxanne %A Malvey,Donna M %A Szalma,James Leo %+ University of Central Florida, Department of Psychology, College of Sciences, 4000 Central Florida Blvd., Orlando, FL, 32816, United States, 1 (407)823 0920, dewar@knights.ucf.edu %K telehealth systems %K younger adults %K telehealth advantages %K telehealth disadvantages %K thematic analysis %D 2016 %7 08.07.2016 %9 Original Paper %J JMIR Med Educ %G English %X Background: While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. Objective: This study aims to examine the perceptions of telehealth systems within a large student sample. Methods: Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. Results: We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. Conclusion: By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems. %M 27731865 %R 10.2196/mededu.5392 %U http://mededu.jmir.org/2016/2/e11/ %U https://doi.org/10.2196/mededu.5392 %U http://www.ncbi.nlm.nih.gov/pubmed/27731865 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e43 %T Use of iPhones by Nurses in an Acute Care Setting to Improve Communication and Decision-Making Processes: Qualitative Analysis of Nurses’ Perspectives on iPhone Use %A Farrell,Maureen %+ University of Melbourne, Parkville, Victoria, 3010, Australia, 61 3 9035 ext 5511, maureen.farrell@unimelb.edu.au %K acute care %K clinical decision making %K communication %K iPhones %K nursing %D 2016 %7 31.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Smartphones and other mobile devices are having and will continue to have an impact on health care delivery in acute settings in Australia and overseas. Nurses, unlike physicians, have been slow to adopt these technologies and the reasons for this may relate to the status of both these professions within the hospital setting. Objective: To explore nurses’ perspectives on iPhone use within an acute care unit. We examined their experiences and views on how this device may improve communication and decision-making processes at the point of care. Methods: Two focus group discussions, using a semistructured interview, were conducted over the trial period. The discussions focused on the nurses’ experiences regarding ease of use, features, and capabilities of the device. The focus groups were recorded, transcribed, and analyzed using semistructured interview questions as a guide. Results: The positive findings indicated that the iPhones were accessible and portable at point of care with patients, enhanced communication in the workplace, particularly among the nurses, and that this technology would evolve and be embraced by all nurses in the future. The negatives were the small screen size when undertaking bedside education for the patient and the invasive nature of the device. Another issue was the perception of being viewed as unprofessional when using the device in real time with the patients and their family. Conclusions: The use of iPhones by nurses in acute care settings has the potential to enhance patient care, especially through more effective communication among nurses, and other health care professionals. To ensure that the benefits of this technology is woven into the everyday practice of the nurse, it is important that leaders in these organizations develop the agenda or policy to ensure that this occurs. %M 27246197 %R 10.2196/mhealth.5071 %U http://mhealth.jmir.org/2016/2/e43/ %U https://doi.org/10.2196/mhealth.5071 %U http://www.ncbi.nlm.nih.gov/pubmed/27246197 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e79 %T Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients %A Patel,Bhavesh %A Johnston,Maximilian %A Cookson,Natalie %A King,Dominic %A Arora,Sonal %A Darzi,Ara %+ Department of Surgery and Cancer, St Mary's Campus, Imperial College London, QEQM Building, London, W2 1NY, United Kingdom, 44 0 207 594 792, bhavesh.patel07@imperial.ac.uk %K communication %K mobile phone %K pager %K applications %K apps %K escalation of care %K simulation %D 2016 %7 06.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. Objective: The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. Methods: We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users’ satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. Results: We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100–121 versus pager median 77, range 39–104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included “enhances interprofessional efficiency,” “results in less disturbance,” “performed desired functions reliably,” and “allows me to clearly transfer information.” Conclusions: Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care. %M 27052694 %R 10.2196/jmir.4854 %U http://www.jmir.org/2016/4/e79/ %U https://doi.org/10.2196/jmir.4854 %U http://www.ncbi.nlm.nih.gov/pubmed/27052694 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 1 %P e3 %T Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance %A Cuba Gyllensten,Illapha %A Bonomi,Alberto G %A Goode,Kevin M %A Reiter,Harald %A Habetha,Joerg %A Amft,Oliver %A Cleland,John GF %+ Personal Health Solutions, Philips Research, 5.007, High Tech Campus 34, Eindhoven, 5656AE, Netherlands, 31 631926930, illapha@gmail.com %K Heart failure %K telemonitoring %K deterioration detection %K alert algorithms %K ambulatory monitoring %K impedance %D 2016 %7 18.02.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective: In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods: We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results: Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines. Conclusions: NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation. %M 26892844 %R 10.2196/medinform.4842 %U http://medinform.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/medinform.4842 %U http://www.ncbi.nlm.nih.gov/pubmed/26892844 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 1 %P e6 %T Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System %A Gupte,Gouri %A Vimalananda,Varsha %A Simon,Steven R %A DeVito,Katerina %A Clark,Justice %A Orlander,Jay D %+ School of Public Health, Department of Health Policy and Management, Boston University, Room 264, 715 Albany Street, Boston, MA, 02118, United States, 1 617 414 1426, gourig@bu.edu %K remote consultations %K clinical communication %K electronic consultation %K telehealth %K clinical information %K decision making, telemonitoring %K eHealth infrastructures %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication. Objective: The aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system. Methods: Data from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults. Results: A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e-consults reflected a request for specialist input to a generalist’s question in diagnosis or management in the ambulatory setting, we identified creative uses of e-consults, including requests for face-to-face appointments and documentation of pre-operative chart reviews; moreover, 7.00% (360/5141) of the e-consults originated from our sub-acute and chronic care inpatient units. In interviews, requesting providers reported high utility and usability. Specialists recognized the value of e-consults but expressed concerns about additional workload. Conclusions: The e-consult mechanism is frequently utilized for its initial intended purpose. It has also been adopted for unexpected clinical and administrative uses, developing into a “disruptive innovation” and highlighting existing gaps in mechanisms for provider communication. Further investigation is needed to characterize optimal utilization of e-consults within specialty and the medical center, and what features of the e-consult program, other than volume, represent valid measures of access and quality care. %M 26872820 %R 10.2196/medinform.4801 %U http://medinform.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/medinform.4801 %U http://www.ncbi.nlm.nih.gov/pubmed/26872820 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 4 %P e37 %T Resident Use of Text Messaging for Patient Care: Ease of Use or Breach of Privacy? %A Prochaska,Micah T %A Bird,Amber-Nicole %A Chadaga,Amar %A Arora,Vineet M %+ Section of Hospital Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5000, Chicago, IL, 60637, United States, 1 773 702 6988, mprochas@medicine.bsd.uchicago.edu %K in-hospital communication %K SMS text messaging %K mobile technology %D 2015 %7 26.11.2015 %9 Short Paper %J JMIR Med Inform %G English %X Background: Short message service (SMS) text messaging is an efficient form of communication and pervasive in health care, but may not securely protect patient information. It is unclear if resident providers are aware of the security concerns of SMS text messaging when communicating about patient care. Objective: We sought to compare residents’ preferences for SMS text messaging compared with other forms of in-hospital communication when considering security versus ease of use. Methods: This study was a cross-sectional multi-institutional survey of internal medicine residents. Residents ranked different communication modalities based on efficiency, ease of use, and security using a Likert scale. Communication options included telephone, email, hospital paging, and SMS text messaging. Respondents also reported whether they had received confidential patient identifiers through any of these modalities. Results: SMS text messaging was preferred by 71.7% (94/131) of respondents because of its efficiency and by 79.8% (103/129) of respondents because of its ease of use. For security, 82.5% (104/126) of respondents preferred the hospital paging system, whereas only 20.6% (26/126) of respondents preferred SMS text messaging for secure communication. In all, 70.9% (93/131) of respondents reported having received patient identifiers (first and/or last name), 81.7% (107/131) reported receiving patient initials, and 50.4% (66/131) reported receiving a patient’s medical record number through SMS text messages. Conclusions: Residents prefer in-hospital communication through SMS text messaging because of its ease of use and efficiency. Despite security concerns, the majority of residents reported receiving confidential patient information through SMS text messaging. For providers, it is possible that the benefits of improved in-hospital communication with SMS text messaging and the presumed improvement in the coordination and delivery of patient care outweigh security concerns they may have. The tension between the security and convenience of SMS text messaging may represent an educational opportunity to ensure the compliance of mobile technology in the health care setting. %M 26611620 %R 10.2196/medinform.4797 %U http://medinform.jmir.org/2015/4/e37/ %U https://doi.org/10.2196/medinform.4797 %U http://www.ncbi.nlm.nih.gov/pubmed/26611620 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e72 %T The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol %A Manojlovich,Milisa %A Adler-Milstein,Julia %A Harrod,Molly %A Sales,Anne %A Hofer,Timothy P %A Saint,Sanjay %A Krein,Sarah L %+ University of Michigan, School of Nursing, 400 N. Ingalls, room 4306, Ann Arbor, MI, 48109, United States, 1 734 936 3055, mmanojlo@umich.edu %K interdisciplinary communication %K health information technology %K computer communication networks %K hospital communication systems %D 2015 %7 11.06.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. Objective: The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. Methods: This 4-year study uses a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from aim 1 will provide a detailed assessment of health information and communication technologies in use and help identify sites with variation in health information and communication technologies for the qualitative phase of the study. In aim 2, we will conduct telephone interviews with hospital personnel in up to 8 hospitals to gather in-depth information about communication practices and work relationships on medical-surgical units. In aim 3, we will collect data in 4 hospitals (selected from telephone interview results) via observation, shadowing, focus groups, and artifacts to learn how health information and communication technologies, communication practices, and work relationships affect communication. Results: Results from aim 1 will be published in 2016. Results from aims 2 and 3 will be published in subsequent years. Conclusions: As the majority of US hospitals do not yet have HIT fully implemented, results from our study will inform future development and implementation of health information and communication technologies to support effective communication between nurses and physicians. %M 26068442 %R 10.2196/resprot.4463 %U http://www.researchprotocols.org/2015/2/e72/ %U https://doi.org/10.2196/resprot.4463 %U http://www.ncbi.nlm.nih.gov/pubmed/26068442 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 2 %P e21 %T A Telesurveillance System With Automatic Electrocardiogram Interpretation Based on Support Vector Machine and Rule-Based Processing %A Ho,Te-Wei %A Huang,Chen-Wei %A Lin,Ching-Miao %A Lai,Feipei %A Ding,Jian-Jiun %A Ho,Yi-Lwun %A Hung,Chi-Sheng %+ National Taiwan University, Graduate Institute of Communication Engineering, No. 1, Section 4, Roosevelt Road, Taipei, 10617, Taiwan, 886 233669652, jjding@ntu.edu.tw %K telehealth care %K telesurveillance system %K electrocardiogram %K ECG classification %K support vector machine %D 2015 %7 07.05.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Telehealth care is a global trend affecting clinical practice around the world. To mitigate the workload of health professionals and provide ubiquitous health care, a comprehensive surveillance system with value-added services based on information technologies must be established. Objective: We conducted this study to describe our proposed telesurveillance system designed for monitoring and classifying electrocardiogram (ECG) signals and to evaluate the performance of ECG classification. Methods: We established a telesurveillance system with an automatic ECG interpretation mechanism. The system included: (1) automatic ECG signal transmission via telecommunication, (2) ECG signal processing, including noise elimination, peak estimation, and feature extraction, (3) automatic ECG interpretation based on the support vector machine (SVM) classifier and rule-based processing, and (4) display of ECG signals and their analyzed results. We analyzed 213,420 ECG signals that were diagnosed by cardiologists as the gold standard to verify the classification performance. Results: In the clinical ECG database from the Telehealth Center of the National Taiwan University Hospital (NTUH), the experimental results showed that the ECG classifier yielded a specificity value of 96.66% for normal rhythm detection, a sensitivity value of 98.50% for disease recognition, and an accuracy value of 81.17% for noise detection. For the detection performance of specific diseases, the recognition model mainly generated sensitivity values of 92.70% for atrial fibrillation, 89.10% for pacemaker rhythm, 88.60% for atrial premature contraction, 72.98% for T-wave inversion, 62.21% for atrial flutter, and 62.57% for first-degree atrioventricular block. Conclusions: Through connected telehealth care devices, the telesurveillance system, and the automatic ECG interpretation system, this mechanism was intentionally designed for continuous decision-making support and is reliable enough to reduce the need for face-to-face diagnosis. With this value-added service, the system could widely assist physicians and other health professionals with decision making in clinical practice. The system will be very helpful for the patient who suffers from cardiac disease, but for whom it is inconvenient to go to the hospital very often. %M 25953306 %R 10.2196/medinform.4397 %U http://medinform.jmir.org/2015/2/e21/ %U https://doi.org/10.2196/medinform.4397 %U http://www.ncbi.nlm.nih.gov/pubmed/25953306 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e63 %T Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews %A Kitsiou,Spyros %A Paré,Guy %A Jaana,Mirou %+ College of Applied Health Sciences, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 1919 West Taylor Street (AHSB), Chicago, IL, 60612, United States, 1 3123553519, skitsiou@uic.edu %K home telemonitoring %K telemedicine %K telehealth %K remote monitoring %K remote consultation %K heart failure %K chronic diseases %K continuity of patient care %K physiologic monitoring %K ambulatory monitoring %K home care services %K review %K umbrella review %K systematic review %K meta-analysis %D 2015 %7 12.03.2015 %9 Review %J J Med Internet Res %G English %X Background: Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective: This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods: A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. %M 25768664 %R 10.2196/jmir.4174 %U http://www.jmir.org/2015/3/e63/ %U https://doi.org/10.2196/jmir.4174 %U http://www.ncbi.nlm.nih.gov/pubmed/25768664 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e8 %T Optimizing Inter-Professional Communications in Surgery: Protocol for a Mixed-Methods Exploratory Study %A Hallet,Julie %A Wallace,David %A El-Sedfy,Abraham %A Hall,Trevor NT %A Ahmed,Najma %A Bridge,Jennifer %A Taggar,Ru %A Smith,Andy J %A Nathens,Avery B %A Coburn,Natalie G %A Gotlib-Conn,Lesley %+ Sunnybrook Health Sciences Centre, Division of General Surgery, 2075 Bayview Avenue, T-wing, Toronto, ON, M4N 3M5, Canada, 1 416 480 6106, natalie.coburn@sunnybrook.ca %K communication %K interprofessional %K pager %K resident %K nurse %K education %K patient safety %D 2015 %7 05.03.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Effective nurse-physician communication is critical to delivering high quality patient care. Interprofessional communication between surgical nurses and surgeons, often through the use of pagers, is currently characterized by information gaps and interprofessional tensions, both sources of workflow interruption, potential medical error, impaired educational experience, and job satisfaction. Objective: This study aims to define current patterns of, and understand enablers and barriers to interprofessional communication in general surgery, in order to optimize the use of communication technologies, teamwork, provider satisfaction, and quality and safety of patient care. Methods: We will use a mixed-methods multiphasic approach. In phase 1, a quantitative and content analysis of alpha-numeric pages (ANP) received by general surgery residents will be conducted to develop a paging taxonomy. Frequency, timing (on-call vs regular duty hours), and interval between pages will be described using a 4-week sample of pages. Results will be compared between pages sent to junior and senior residents. Finally, using an inductive analysis, two independent assessors will classify ANP thematically. In Phase 2, a qualitative constructivist approach will explore stakeholders’ experiences with interprofessional communication, including paging, through interviews and shadowing of 40 residents and 40 nurses at two institutions. Finally, a survey will be developed, tested, and administered to all general surgery nurses and residents at the same two institutions, to evaluate their attitudes about the effectiveness and quality of interprofessional communication, and assess their satisfaction. Results: Describing the profile of current pages is the first step towards identifying areas and root causes of IPC inefficiency. This study will identify key contextual barriers to surgical nurse-house staff communication, and existing interprofessional knowledge and practice gaps. Conclusions: Our findings will inform the design of a guideline and tailored intervention to improve IPC in order to ensure high quality patient care, optimal educational experience, and provider satisfaction. %M 25745882 %R 10.2196/resprot.3623 %U http://www.researchprotocols.org/2015/1/e8/ %U https://doi.org/10.2196/resprot.3623 %U http://www.ncbi.nlm.nih.gov/pubmed/25745882 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e5 %T Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation %A Rodriguez,Keri L %A Burkitt,Kelly H %A Bayliss,Nichole K %A Skoko,Jennifer E %A Switzer,Galen E %A Zickmund,Susan L %A Fine,Michael J %A Macpherson,David S %+ VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Building 30, University Drive C (151C), Pittsburgh, PA, 15240-1001, United States, 1 412 360 2237, keri.rodriguez@va.gov %K access %K rural health %K referral and consultation %K patient satisfaction %K veterans %D 2015 %7 14.01.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access. Objective: The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceived facilitators and barriers to using the e-consult program. Methods: We conducted semistructured telephone interviews with veteran patients (N=15), Community Based Outpatient Clinic (CBOC) PCPs (N=15), and VA Pittsburgh specialty physicians (N=4) who used the e-consult program between December 2009 to August 2010. Participants answered questions regarding satisfaction in eight domains and identified factors contributing to their responses. Results: Most participants were white (patients=87%; PCPs=80%; specialists=75%) and male (patients=93%; PCPs=67%; specialists=75%). On average, patients had one e-consult (SD 0), PCPs initiated 6 e-consults (SD 6), and VAPHS specialists performed 17 e-consults (SD 11). Patients, PCPs, and specialty physicians were satisfied with e-consults median (range) of 5.0 (4-5) on 1-5 Likert-scale, 4.0 (3-5), and 3.5 (3-5) respectively. The most common reason why patients and specialists reported increased overall satisfaction with e-consults was improved communication, whereas improved timeliness of care was the most common reason for PCPs. Communication was the most reported perceived barrier and facilitator to e-consult use. Conclusions: Veterans and VA health care providers were satisfied with the e-consult process. Our findings suggest that while the reasons for satisfaction with e-consult differ somewhat for patients and physicians, e-consult may be a useful tool to improve VA health care system access for rural patients. %M 25589233 %R 10.2196/medinform.3725 %U http://medinform.jmir.org/2015/1/e5/ %U https://doi.org/10.2196/medinform.3725 %U http://www.ncbi.nlm.nih.gov/pubmed/25589233