TY - JOUR AU - Hussein, Rada AU - Gyrard, Amelie AU - Abedian, Somayeh AU - Gribbon, Philip AU - Martínez, Alabart Sara PY - 2025/4/23 TI - Interoperability Framework of the European Health Data Space for the Secondary Use of Data: Interactive European Interoperability Framework?Based Standards Compliance Toolkit for AI-Driven Projects JO - J Med Internet Res SP - e69813 VL - 27 KW - artificial intelligence KW - European Health Data Space KW - European interoperability framework KW - healthcare standards interoperability KW - secondary use of health data UR - https://www.jmir.org/2025/1/e69813 UR - http://dx.doi.org/10.2196/69813 UR - http://www.ncbi.nlm.nih.gov/pubmed/40266673 ID - info:doi/10.2196/69813 ER - TY - JOUR AU - An, Doyeon AU - Lim, Minsik AU - Lee, Suehyun PY - 2025/4/23 TI - Challenges for Data Quality in the Clinical Data Life Cycle: Systematic Review JO - J Med Internet Res SP - e60709 VL - 27 KW - clinical research informatics KW - data quality KW - data accuracy KW - electronic health records KW - frameworks KW - quality of health care N2 - Background: Electronic health record (EHR) data are anticipated to inform the development of health policy systems across countries and furnish valuable insights for the advancement of health and medical technology. As the current paradigm of clinical research is shifting toward data centricity, the utilization of health care data is increasingly emphasized. Objective: We aimed to review the literature on clinical data quality management and define a process for ensuring the quality management of clinical data, especially in the secondary utilization of data. Methods: A systematic review of PubMed articles from 2010 to October 2023 was conducted. A total of 82,346 articles were retrieved and screened based on the inclusion and exclusion criteria, narrowing the number of articles to 851 after title and abstract review. Articles focusing on clinical data quality management life cycles, assessment methods, and tools were selected. Results: We reviewed 105 papers describing the clinical data quality management process. This process is based on a 4-stage life cycle: planning, construction, operation, and utilization. The most frequently used dimensions were completeness, plausibility, concordance, security, currency, and interoperability. Conclusions: Given the importance of the secondary use of EHR data, standardized quality control methods and automation are necessary. This study proposes a process to standardize data quality management and develop a data quality assessment system. UR - https://www.jmir.org/2025/1/e60709 UR - http://dx.doi.org/10.2196/60709 UR - http://www.ncbi.nlm.nih.gov/pubmed/40266662 ID - info:doi/10.2196/60709 ER - TY - JOUR AU - Goh, Huat Kim AU - Yeow, Kwang Adrian Yong AU - Wang, Le AU - Poh, Hermione AU - Ng, Hui Hannah Jia AU - Tan, Gamaliel AU - Wee, Khai Soon AU - Lim, Luen Er AU - D?Souza, Andre Jared Louis PY - 2025/4/22 TI - The Benefits of Integrating Electronic Medical Record Systems Between Primary and Specialist Care Institutions: Mixed Methods Cohort Study JO - J Med Internet Res SP - e49363 VL - 27 KW - EMR integration KW - primary care KW - specialist care KW - medical neighborhood KW - efficiency N2 - Background: The benefits of a fully integrated electronic medical record (EMR) system across primary and specialist care institutions have yet to be formally established. Integrating the EMR systems between primary and specialist care is the first step in building a medical neighborhood. A medical neighborhood is a set of policies and procedures implemented through integrated systems and processes that support the joint management of patient care across primary care physicians, specialist physicians, and other health care providers. Objective: This study aims to quantify the impacts of integrating the EMR systems of primary and specialist care institutions in the process of developing a medical neighborhood. The impacts are operationalized in both quantitative and qualitative measures, measuring the benefits of such an integration in 3 specific areas, namely, patient diagnosis tracking, patient care management, and patient coordination. Methods: A comprehensive, mixed methods examination was conducted using 3 different data sources (EMR consultation data, clinician survey data, and in-depth interviews). The EMR data consist of patient encounters referred to a specialist clinic from 6 primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,404 specialist consultation referrals to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. A cohort empirical investigation was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted with the clinicians 18 months post integration. The clinicians? perceptions of the integration were measured to triangulate the empirical observation from the patient encounters, and the postimplementation perception survey was analyzed to triangulate the empirical investigation of consultation instances of the earlier cohort. Concurrently, a total of 30 interviews were conducted between March 16, 2021, and July 28, 2021, with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration, which further informed our quantitative findings. Results: The integration of EMR systems between primary and specialist care institutions was associated with benefits in patient diagnosis tracking, patient care management, and patient coordination. Specifically, it was found that the integration resulted in a decrease in wait time for specialist appointments of an average of 16.5 days (P<.001). Patients were also subjected to fewer repeated procedures and tests; the number of procedures (P=.006), radiographies (P=.02), and overall bill sizes (P=.004) all decreased by between 4.08% and 39.7%, resulting in reduced health care resource wastage while maintaining similar medical outcomes (P=.37). Conclusions: Our study?s results are among the first instances of empirical evidence to show that the integration and sharing of data between primary and specialist care institutions promote continuity in health care delivery and joint patient management in a medical neighborhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature. UR - https://www.jmir.org/2025/1/e49363 UR - http://dx.doi.org/10.2196/49363 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49363 ER - TY - JOUR AU - Xing, Yiqing AU - Liu, Xuejiao AU - Zhang, Liang AU - He, Ruibo PY - 2025/4/17 TI - The Association Between Internet Use and Co-occurring Health Care Needs: Cross-Sectional Study in China JO - J Med Internet Res SP - e67484 VL - 27 KW - internet use KW - co-occurring health care needs KW - physical exercise KW - health status KW - Chinese residents N2 - Background: The need for health care underpins health care service provision and serves as the foundation for enhancing service capacity and allocating resources. Health care needs are influenced by health, social, and economic conditions and may exhibit different characteristics over time. However, previous studies have primarily focused on specific populations or types of needs, overlooking the diversity and complexity of residents? health care requirements. Furthermore, as informatization becomes a defining aspect of modern social development, the impact of internet utilization on the co-occurrence of health care needs remains unclear. Objective: This study aims to determine the co-occurrence of health care needs among residents in China, explore the relationship between internet use frequency and co-occurring health care needs, and analyze the potential pathways of influence. Methods: Data were obtained from the ?Survey on Chinese Residents? Health Services Needs in the New Era,? conducted from July to August 2018, yielding a sample of 12,513 individuals. An association rule learning algorithm was used to analyze the characteristics of co-occurring health care needs among Chinese residents, while a generalized linear model was used to examine the relationship between internet use frequency and co-occurring health care needs. Additionally, physical exercise and health status were selected as mediating variables, and their mediating effects were assessed using a path analysis model. Results: A substantial proportion of the surveyed population (8601/12,513, 68.74%) had 2 or more co-occurring health care needs, with a lower percentage among rural residents (4045/6053, 66.83%) compared with urban residents (4556/6460, 70.53%). Frequent internet users tended to have more co-occurring health care needs (?=.895, SE 0.019, P<.001). The results indicated a positive relationship between internet use frequency and both improved physical exercise (?=.121, P<.001) and health status (?=.026, P<.001). Notably, a high level of physical exercise was associated with an increase in co-occurring health care needs (?=.087, P<.001). By contrast, a significant negative correlation was observed between health status and co-occurring health care needs (?=-.787, P<.001), indicating that these needs decreased as health status improved. Conclusions: The findings highlight the need for health policy makers and health care providers to address evolving health care needs and the impact of information technology on these needs. Furthermore, health care providers must adapt their services and delivery methods to meet residents? co-occurring health care needs. Meanwhile, policy makers and service managers should ensure that service delivery keeps pace with residents? changing needs through resource allocation, health insurance payment reforms, and performance incentives. UR - https://www.jmir.org/2025/1/e67484 UR - http://dx.doi.org/10.2196/67484 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67484 ER - TY - JOUR AU - Riou, Christine AU - El Azzouzi, Mohamed AU - Hespel, Anne AU - Guillou, Emeric AU - Coatrieux, Gouenou AU - Cuggia, Marc PY - 2025/4/17 TI - Ensuring General Data Protection Regulation Compliance and Security in a Clinical Data Warehouse From a University Hospital: Implementation Study JO - JMIR Med Inform SP - e63754 VL - 13 KW - clinical data warehouse KW - privacy KW - personal data protection KW - legislation KW - security KW - compliance KW - personal data KW - applicability KW - experiential analysis KW - university hospitals KW - French KW - France KW - data hub KW - operational challenge N2 - Background: The European Union?s General Data Protection Regulation (GDPR) has profoundly influenced health data management, with significant implications for clinical data warehouses (CDWs). In 2021, France pioneered a national framework for GDPR-compliant CDW implementation, established by its data protection authority (Commission Nationale de l?Informatique et des Libertés). This framework provides detailed guidelines for health care institutions, offering a unique opportunity to assess practical GDPR implementation in health data management. Objective: This study evaluates the real-world applicability of France?s CDW framework through its implementation at a major university hospital. It identifies practical challenges for its implementation by health institutions and proposes adaptations relevant to regulatory authorities in order to facilitate research in secondary use data domains. Methods: A systematic assessment was conducted in May 2023 at the University Hospital of Rennes, which manages data for over 2 million patients through the eHOP CDW system. The evaluation examined 116 criteria across 13 categories using a dual-assessment approach validated by information security and data protection officers. Compliance was rated as met, unmet, or not applicable, with criteria classified as software-related (n=25) or institution-related (n=91). Results: Software-related criteria showed 60% (n=15) compliance, with 28% (n=7) noncompliant or partially compliant and 12% (n=3) not applicable. Institution-related criteria achieved 72% (n=28) compliance for security requirements. Key challenges included managing genetic data, implementing automated archiving, and controlling data exports. The findings revealed effective privacy protection measures but also highlighted areas requiring regulatory adjustments to better support research. Conclusions: This first empirical assessment of a national CDW compliance framework offers valuable insights for health care institutions implementing GDPR requirements. While the framework establishes robust privacy protections, certain provisions may overly constrain research activities. The study identifies opportunities for framework evolution, balancing data protection with research imperatives. UR - https://medinform.jmir.org/2025/1/e63754 UR - http://dx.doi.org/10.2196/63754 ID - info:doi/10.2196/63754 ER - TY - JOUR AU - Maini, Ishana AU - Gilotra, Kevin AU - Sadigh, Gelareh PY - 2025/4/3 TI - Patient Factors Associated With the Use of Online Portal Health Information in the Postpandemic Era: Cross-Sectional Analysis of a National Survey JO - J Med Internet Res SP - e60472 VL - 27 KW - patient portal KW - utilization KW - health disparity KW - post-pandemic KW - health information KW - prevalence KW - portal use KW - survey KW - health care provider KW - Americans KW - US N2 - Background: Patients? electronic access to their health information can improve long-term health outcomes. Few studies have evaluated barriers that may limit access to portal health information before the COVID-19 pandemic such as preference for in-person visits, lack of perceived need to use a patient portal system, and lack of comfort or experience with computers. With the increased use of telehealth during the pandemic, patients? comfort with portal applications and digital health literacy has improved. Objective: The purpose of this study was to assess the prevalence of portal use and factors associated with patients? portal access after the COVID-19 pandemic. Methods: This study used data from the 2022 National Cancer Institute?s Health Information National Trends Survey (HINTS 6). Adult patients (aged ?18 years) who responded to the survey question about patient portal access were included. A multivariate logistic regression analysis was performed to determine characteristics associated with portal access. Results: A total number of 5958 patients were included (weighted n=245,721,106), with a mean age of 48.2 (20.1) years and were mostly female (119,538,392/236,138,857, 50.6%) and white (167,163,482/227,232,636, 73.6%). Overall, 61.3% (150,722,178/245,721,106) of all respondents reported accessing portals over the last 12 months and 43.7% (82,620,907/188,860,031) used multiple portals. Most participants (135,011,661/150,104,795, 89.9%) reported using portals to access test results, followed by viewing clinical notes (104,541,142/149,867,276, 69.8%) downloading personal health information (47,801,548/150,017,130, 31.9%). The likelihood of portal use significantly increased by 24.9% points (95% CI 19.4-30.5) when patients were offered access to portals by health care providers or insurers compared with those not offered access or did not know if they were offered access. The likelihood of portal use also increased by 19.5% points (95% CI 15.1-23.9) among patients with a health care provider encouraging them to access portals, compared to patients who did not receive encouragement to do so. Having a college education versus education below college level and living in metropolitan areas versus nonmetropolitan regions increased the probability of portal use by 6.9% points (95% CI 3.1-10.8) and 6.9% points (95% CI 1.3-12.6), respectively. Of note, males (compared with females) and those of Hispanic background (compared with non-Hispanic individuals) were less likely to be offered portal access by 10.8% points (95% CI 6.3-15.2) and 6.9% points (95% CI 1.7-12.1), respectively. Conclusions: This study demonstrates that most Americans use patient portals, though certain patient populations such as those with less than college degree education or living in nonmetropolitan areas continue to face greater difficulty accessing them. Interventions targeted at equality in offering access to patient portals and encouraging patients to use them could advance equitable and widespread access to patient portals. UR - https://www.jmir.org/2025/1/e60472 UR - http://dx.doi.org/10.2196/60472 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60472 ER - TY - JOUR AU - Li, Lan AU - Back, Emma AU - Lee, Suna AU - Shipley, Rebecca AU - Mapitse, Néo AU - Elbe, Stefan AU - Smallman, Melanie AU - Wilson, James AU - Yasin, Ifat AU - Rees, Geraint AU - Gordon, Ben AU - Murray, Virginia AU - Roberts, L. Stephen AU - Cupani, Anna AU - Kostkova, Patty PY - 2025/3/25 TI - Balancing Risks and Opportunities: Data-Empowered-Health Ecosystems JO - J Med Internet Res SP - e57237 VL - 27 KW - health policy KW - data sharing KW - digital healthcare KW - healthcare system KW - ecosystems KW - technologies KW - decision-making KW - data privacy KW - data protection KW - social media KW - application programming interfaces UR - https://www.jmir.org/2025/1/e57237 UR - http://dx.doi.org/10.2196/57237 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57237 ER - TY - JOUR AU - Dima, Lelia Alexandra AU - Nabergoj Makovec, Urska AU - Ribaut, Janette AU - Haupenthal, Frederik AU - Barnestein-Fonseca, Pilar AU - Goetzinger, Catherine AU - Grant, Sean AU - Jácome, Cristina AU - Smits, Dins AU - Tadic, Ivana AU - van Boven, Job AU - Tsiligianni, Ioanna AU - Herdeiro, Teresa Maria AU - Roque, Fátima AU - PY - 2025/3/25 TI - Stakeholder Consensus on an Interdisciplinary Terminology to Enable the Development and Uptake of Medication Adherence Technologies Across Health Systems: Web-Based Real-Time Delphi Study JO - J Med Internet Res SP - e59738 VL - 27 KW - health technology KW - medication adherence KW - Delphi study KW - stakeholder engagement KW - digital health KW - behavioral science KW - implementation science N2 - Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) European Cooperation in Science and Technology Action (CA19132) online repository of medication adherence technologies (MATechs) aims to provide an open access, searchable knowledge management platform to facilitate innovation and support medication adherence management across health systems. To provide a solid foundation for optimal use and collaboration, the repository requires a shared interdisciplinary terminology. Objective: We consulted stakeholders on their views and level of agreement with the terminology proposed to inform the ENABLE repository structure. Methods: A real-time web-based Delphi study was conducted with stakeholders from 39 countries active in research, clinical practice, patient representation, policy making, and technology development. Participants rated terms and definitions of MATech and of 21 attribute clusters on product and provider information, medication adherence descriptors, and evaluation and implementation. Relevance, clarity, and completeness criteria were rated on 9-point scales, and free-text comments were provided interactively. Participants could reconsider their ratings based on real-time aggregated feedback and revisit the survey throughout the study period. We quantified agreement and process indicators for the complete sample and per stakeholder group and performed content analysis on comments. Consensus was considered reached for ratings with a disagreement index of <1. Median ratings guided decisions on whether attributes were considered mandatory, optional, or not relevant. We used the results to improve the terminology and repository structure. Results: Of 250 stakeholders invited, 117 (46.8%) rated the MATech definition, of whom 83 (70.9%) rated all attributes. Consensus was reached for all items. The definition was considered appropriate and clear (median ratings 7.02, IPR 6.10-7.69, and 7.26, IPR 6.73-7.90, respectively). Most attributes were considered relevant, mandatory, and sufficiently clear to remain unchanged except for ISO certification (considered optional; median relevance rating 6.34, IPR 5.50-7.24) and medication adherence phase, medication adherence measurement, and medication adherence intervention (candidates for optional changes; median clarity ratings 6.07, IPR 4.86-7.17; 6.37, IPR 4.80-6.67; and 5.67, IPR 4.66-6.61, respectively). Subgroup analyses found several attribute clusters considered moderately clear by some stakeholder groups. Results were consistent across stakeholder groups and time, yet response variation was found within some stakeholder groups for selected clusters, suggesting targets for further discussion. Comments highlighted issues for further debate and provided suggestions informing modifications to improve comprehensiveness, relevance, and clarity. Conclusions: By reaching agreement on a comprehensive MATech terminology developed following state-of-the-art methodology, this study represents a key step in the ENABLE initiative to develop an information architecture capable of structuring and facilitating the development and implementation of MATech across Europe. The debates and challenges highlighted in stakeholders? comments outline a potential road map for further development of the terminology and the ENABLE repository. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-059674 UR - https://www.jmir.org/2025/1/e59738 UR - http://dx.doi.org/10.2196/59738 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59738 ER - TY - JOUR AU - Govender, Samantha AU - Cochrane, Elizabeth Maria AU - Mogale, Mabina AU - Gordon, Reno AU - Tshephe, Tjodwapi PY - 2025/3/25 TI - Establishing a Digital Health Care Ecosystem in a Health Sciences University in South Africa: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e57821 VL - 14 KW - health sciences KW - digital ecosystem KW - curriculum KW - community engagement KW - tertiary education institutions N2 - Background: Comprehensive and formalized digital health care ecosystems in health sciences tertiary education in South Africa do not currently exist, but they have the potential to influence teaching and learning, research, and community engagement. Objective: A total of 3 key objectives underpin the study, that is, determining the health care curriculum needs and required content for the development of a formalized digital health ecosystem, determining the level of readiness of staff and students to participate in a digital health care ecosystem, and determining whether community engagement and strategic partnerships can contribute to the sustainability of a digital health care ecosystem. Methods: A multipronged approach will be used to address the objectives, with a mixed methods design being undertaken. The qualitative phases will be phenomenological in nature, and triangulation of information along with thematic analysis will be conducted on the collected data. Quantitative data will be collected prospectively and cross-sectionally and analyzed using descriptive analysis. Sampling will include subject experts for the Delphi technique, staff and students at the University, clinical training and education partners, and community leaders. This study has received ethical approval from the Sefako Makgatho Health Sciences University Research and Ethics Committee (SMUREC/H/260/2023:PG). Results: Data collection for the first phase will begin in January 2024 and conclude in December 2024. Phase 2 and 3 of the study will be conducted concurrently, with data collection starting in January 2025 and concluding in December 2026. Conclusions: The establishment of a digital health care ecosystem has the potential to benefit staff, students, and communities through stakeholder collaboration, educational opportunities, research projects, and improved service delivery. International Registered Report Identifier (IRRID): DERR1-10.2196/57821 UR - https://www.researchprotocols.org/2025/1/e57821 UR - http://dx.doi.org/10.2196/57821 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57821 ER - TY - JOUR AU - Holetzek, Tim AU - Häusler, Andreas AU - Gödde, Kathrin AU - Rapp, Michael AU - Spallek, Jacob AU - Holmberg, Christine PY - 2025/3/24 TI - The Role of the Installed Base in Information Exchange Among General Practitioners in Germany: Mixed Methods Study JO - J Med Internet Res SP - e65241 VL - 27 KW - digitalization KW - general practitioners KW - Germany KW - information and communication technologies KW - information exchange KW - primary health care KW - digital transformation KW - mixed methods study KW - digital health KW - health application KW - qualitative interview N2 - Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2%, SD 24.64), fax (n=109, 43.9%, SD 25.40), or post (n=50, 20.2%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs? communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs? practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers? perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation. UR - https://www.jmir.org/2025/1/e65241 UR - http://dx.doi.org/10.2196/65241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65241 ER - TY - JOUR AU - Reed, Julie AU - Svedberg, Petra AU - Nygren, Jens PY - 2025/3/24 TI - Enhancing the Innovation Ecosystem: Overcoming Challenges to Introducing Information-Driven Technologies in Health Care JO - J Med Internet Res SP - e56836 VL - 27 KW - artificial intelligence KW - ecosystem KW - health care KW - implementation KW - technology adoption KW - improvement KW - complex-systems UR - https://www.jmir.org/2025/1/e56836 UR - http://dx.doi.org/10.2196/56836 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56836 ER - TY - JOUR AU - Kerr, Gabriele AU - Greenfield, Geva AU - Li, Edmond AU - Beaney, Thomas AU - Hayhoe, J. Benedict W. AU - Car, Josip AU - Clavería, Ana AU - Collins, Claire AU - Gusso, Gustavo AU - Hoffman, D. Robert AU - Jimenez, Geronimo AU - Koskela, H. Tuomas AU - Laranjo, Liliana AU - Lingner, Heidrun AU - Memarian, Ensieh AU - Nessler, Katarzyna AU - Petek, Davorina AU - Tsopra, Rosy AU - Majeed, Azeem AU - Neves, Luisa Ana PY - 2025/3/19 TI - Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study JO - J Med Internet Res SP - e65147 VL - 27 KW - digital health KW - primary care KW - telemedicine KW - virtual consultation KW - healthcare delivery KW - online consultation KW - primary care physician KW - upper-middle income KW - upper-middle income countries KW - high-income countries KW - online survey KW - chi-squared test KW - remote healthcare KW - video consultation KW - chat consultation KW - telephone consultations KW - digital technology KW - virtual care KW - teleconsultation KW - telehealth KW - remote consultation N2 - Background: Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis. Objective: This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability. Methods: Primary care physicians (PCPs) from 20 upper-middle? and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V. Results: A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001). Conclusions: Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations. International Registered Report Identifier (IRRID): RR2-10.2196/30099 UR - https://www.jmir.org/2025/1/e65147 UR - http://dx.doi.org/10.2196/65147 UR - http://www.ncbi.nlm.nih.gov/pubmed/40105882 ID - info:doi/10.2196/65147 ER - TY - JOUR AU - Alturkistani, Abrar AU - Beaney, Thomas AU - Greenfield, Geva AU - Costelloe, E. Ceire PY - 2025/3/11 TI - Prescription Refill Adherence Before and After Patient Portal Registration in Among General Practice Patients in England Using the Clinical Practice Research Datalink: Longitudinal Observational Study JO - JMIR Med Inform SP - e50294 VL - 13 KW - patient portals KW - personal health records KW - general practice KW - delivery of health care KW - medication ordering KW - health care KW - medication adherence KW - clinical practice research KW - patient portal KW - England KW - longitudinal analysis KW - patient health KW - medication KW - cardiovascular disease KW - diabetes KW - chronic kidney disease N2 - Background: Patient portal use has been associated with improved patient health and improved adherence to medications, including statins. However, there is limited research on the association between patient portal registration and outcomes such as statin prescription refill adherence in the context of the National Health Service of England, where patient portals have been widely available since 2015. Objective: We aimed to explore statin prescription refill adherence among general practice patients in England. Methods: This study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee (ID: 21_000411). We used patient-level general practice data from the Clinical Practice Research Datalink in England. The data included patients with cardiovascular disease, diabetes, and chronic kidney disease, who were registered on the patient portal. The primary aim was to investigate whether statin prescription refill adherence, defined as ?80% adherence based on the medication possession ratio, improved after patient portal registration. We used a multilevel logistic regression model to compare aggregate adherence 12 months before and 12 months after patient portal registration. Results: We included 44,141 patients in the study. The analysis revealed a 16% reduction in the odds of prescription refill adherence 12 months after patient portal registration (odds ratio [OR]: 0.84, 95% CI 0.81-0.86) compared to 12 months before registration in the fully adjusted model for patient- and practice-level variables. Conclusions: This study evaluated prescription refill adherence after patient portal registration. Registering to the portal does not fully explain the mechanisms underlying the relationship between patient portal use and health-related outcomes such as medication adherence. Although a small reduction in prescription refill adherence was observed, this reduction disappeared when the follow up time was reduced to 6 months. Given the limitations of the study, reduction in prescription refill adherence cannot be entirely attributable to patient portal registration. However, there may be potential confounding factors influencing this association which should be explored through future research. UR - https://medinform.jmir.org/2025/1/e50294 UR - http://dx.doi.org/10.2196/50294 ID - info:doi/10.2196/50294 ER - TY - JOUR AU - Tawfik, Daniel AU - Rule, Adam AU - Alexanian, Aram AU - Cross, Dori AU - Holmgren, Jay A. AU - Lou, S. Sunny AU - McPeek Hinz, Eugenia AU - Rose, Christian AU - Viswanadham, N. Ratnalekha V. AU - Mishuris, G. Rebecca AU - Rodríguez-Fernández, M. Jorge AU - Ford, W. Eric AU - Florig, T. Sarah AU - Sinsky, A. Christine AU - Apathy, C. Nate PY - 2025/3/6 TI - Emerging Domains for Measuring Health Care Delivery With Electronic Health Record Metadata JO - J Med Internet Res SP - e64721 VL - 27 KW - metadata KW - health services research KW - audit logs KW - event logs KW - electronic health record data KW - health care delivery KW - patient care KW - healthcare teams KW - clinician-patient relationship KW - cognitive environment UR - https://www.jmir.org/2025/1/e64721 UR - http://dx.doi.org/10.2196/64721 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053814 ID - info:doi/10.2196/64721 ER - TY - JOUR AU - Parciak, Marcel AU - Pierlet, Noëlla AU - Peeters, M. Liesbet PY - 2025/3/4 TI - Empowering Health Care Actors to Contribute to the Implementation of Health Data Integration Platforms: Retrospective of the medEmotion Project JO - J Med Internet Res SP - e68083 VL - 27 KW - data science KW - health data integration KW - health data platform KW - real-world evidence KW - health care KW - health data KW - data KW - integration platforms KW - collaborative KW - platform KW - Belgium KW - Europe KW - personas KW - communication KW - health care providers KW - hospital-specific requirements KW - digital health UR - https://www.jmir.org/2025/1/e68083 UR - http://dx.doi.org/10.2196/68083 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053761 ID - info:doi/10.2196/68083 ER - TY - JOUR AU - Ohlsen, Tessa AU - Hofer, Viola AU - Ingenerf, Josef PY - 2025/2/28 TI - A Validation Tool (VaPCE) for Postcoordinated SNOMED CT Expressions: Development and Usability Study JO - JMIR Med Inform SP - e67984 VL - 13 KW - SNOMED CT KW - PCE KW - postcoordination KW - FHIR KW - validation KW - postcoordinated expression KW - Fast Healthcare Interoperability Resource N2 - Background: The digitalization of health care has increased the demand for efficient data exchange, emphasizing semantic interoperability. SNOMED Clinical Terms (SNOMED CT), a comprehensive terminology with over 360,000 medical concepts, supports this need. However, it cannot cover all medical scenarios, particularly in complex cases. To address this, SNOMED CT allows postcoordination, where users combine precoordinated concepts with new expressions. Despite SNOMED CT?s potential, the creation and validation of postcoordinated expressions (PCEs) remain challenging due to complex syntactic and semantic rules. Objective: This work aims to develop a tool that validates postcoordinated SNOMED CT expressions, focusing on providing users with detailed, automated correction instructions for syntactic and semantic errors. The goal is not just validation, but also offering user-friendly, actionable suggestions for improving PCEs. Methods: A tool was created using the Fast Healthcare Interoperability Resource (FHIR) service $validate-code and the terminology server Ontoserver to check the correctness of PCEs. When errors are detected, the tool processes the SNOMED CT Concept Model in JSON format and applies predefined error categories. For each error type, specific correction suggestions are generated and displayed to users. The key added value of the tool is in generating specific correction suggestions for each identified error, which are displayed to the users. The tool was integrated into a web application, where users can validate individual PCEs or bulk-upload files. The tool was tested with real existing PCEs, which were used as input and validated. In the event of errors, appropriate error messages were generated as output. Results: In the validation of 136 PCEs from 304 FHIR Questionnaires, 18 (13.2%) PCEs were invalid, with the most common errors being invalid attribute values. Additionally, 868 OncoTree codes were evaluated, resulting in 161 (20.9%) PCEs containing inactive concepts, which were successfully replaced with valid alternatives. A user survey reflects a favorable evaluation of the tool?s functionality. Participants found the error categorization and correction suggestions to be precise, offering clear guidance for addressing issues. However, there is potential for enhancement, particularly regarding the level of detail in the error messages. Conclusions: The validation tool significantly improves the accuracy of postcoordinated SNOMED CT expressions by not only identifying errors but also offering detailed correction instructions. This approach supports health care professionals in ensuring that their PCEs are syntactically and semantically valid, enhancing data quality and interoperability across systems. UR - https://medinform.jmir.org/2025/1/e67984 UR - http://dx.doi.org/10.2196/67984 ID - info:doi/10.2196/67984 ER - TY - JOUR AU - Agarwal, Payal AU - Fletcher, George Glenn AU - Ramamoorthi, Karishini AU - Yao, Xiaomei AU - Bhattacharyya, Onil PY - 2025/2/14 TI - Uses of Virtual Care in Primary Care: Scoping Review JO - J Med Internet Res SP - e55007 VL - 27 KW - primary care KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultations KW - medical informatics KW - digital health KW - digital technology KW - digital intervention KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus infections KW - PRISMA N2 - Background: The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care. Objective: This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions. Methods: We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size. Results: A total of 13,667 articles were screened, and 219 (1.6%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5%) were primary studies, and 28 (16.5%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4%), medical assessment and treatment of particular conditions (63/170, 37.1%), rehabilitation (17/170, 10%), and counseling (74/170, 43.5%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes. Conclusions: Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care. UR - https://www.jmir.org/2025/1/e55007 UR - http://dx.doi.org/10.2196/55007 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55007 ER - TY - JOUR AU - Bamgboje-Ayodele, Adeola AU - Boscolo, Adrian AU - Burger, Mitchell AU - Hutchings, Owen AU - Shaw, Miranda AU - Shaw, Tim AU - Tariq, Amina AU - Naicker, Sundresan AU - McPhail, Steven AU - Baysari, Melissa PY - 2025/2/11 TI - Health IT Implementation and the Impact of the COVID-19 Pandemic on Clinician-IT Dynamics: Qualitative Study JO - J Med Internet Res SP - e57847 VL - 27 KW - health IT KW - implementation KW - COVID-19 pandemic KW - process evaluation KW - sociotechnical factors KW - virtual hospital KW - COVID-19 N2 - Background: The COVID-19 pandemic necessitated the rapid development and implementation of health ITs to support health care delivery. Health IT implementation is difficult at the best of times, due to complex sociotechnical challenges that vary across contexts and settings; however, it is currently unclear how the pandemic impacted health IT implementation processes. The aim of this study was to explore the impact of the pandemic on health IT implementation processes, including pre- and postimplementation phases, and identify the sociotechnical factors that shaped health IT implementation during an unprecedented circumstance. Objective: This study aimed to explore the impact of the pandemic on HIT implementation processes, including pre- and postimplementation phases, and identify the socio-technical factors that shaped health IT implementation during an unprecedented circumstance. Methods: Participants were from one of two teams: (1) health care staff members (doctors, nurses, nurse unit managers, and support staff members) from a virtual hospital in Australia; and (2) IT professionals within the broader health care organization assigned to the hospital. Participants took part in an interview or focus group from July to November 2022. Participants were asked to describe the process used for rapid health IT design and implementation during the COVID-19 pandemic. Qualitative data were analyzed thematically. Results: A total of 15 participants took part in the study. Both internal and external team structures, and the communication pathways that underpinned these, were reported to influence the health IT lifecycle, which in turn impacted outcomes, particularly when perceived normal ways of working were challenged during the pandemic. Across the pre-post lifecycle, preimplementation processes were viewed to be most impacted by the COVID-19 pandemic. Participants reported that their roles and responsibilities changed during health IT implementations in the pandemic, impacting co-design processes and highlighting the need for health IT implementation processes to cater for new work and the redistribution of existing work. Conclusions: Our study uncovered the negative impact of the COVID-19 pandemic on team structures, communication pathways, and health IT preimplementation processes (project management and co-design). While health care organizations are keen to transition beyond the ways of working during the pandemic, it is imperative to learn from the health IT implementation successes and failures that occurred in the pandemic via process evaluations. Our evaluation offers learnings for research (an adapted interdisciplinary team communication framework), practice (the need for health care organizations to review their communication structures, IT staff skills, and proposed processes), and education (the need for better education and training of IT professionals working in clinical settings on health concepts) on health IT implementations as the world transitions to the ?new norm.? UR - https://www.jmir.org/2025/1/e57847 UR - http://dx.doi.org/10.2196/57847 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57847 ER - TY - JOUR AU - Lee, Hocheol PY - 2025/2/7 TI - Assessment of Digital Capabilities by 9 Countries in the Alliance for Healthy Cities Using AI: Cross-Sectional Analysis JO - JMIR Form Res SP - e62935 VL - 9 KW - digital capabilities KW - digital health cities KW - digital transformation KW - Asian Forum of Healthy Cities KW - assessment KW - digital health KW - artificial intelligence KW - AI KW - World Health Organization KW - WHO KW - healthy city KW - data KW - health management KW - digital era KW - qualitative analysis KW - cross-sectional survey KW - database KW - digital health database KW - effectiveness KW - digital literacy N2 - Background: The Alma-Ata Declaration of 1978 initiated a global focus on universal health, supported by the World Health Organization (WHO) through healthy cities policies. The concept emerged at the 1984 Toronto ?Beyond Health Care? conference, leading to WHO?s first pilot project in Lisbon in 1986. The WHO continues to support regional healthy city networks, emphasizing digital transformation and data-driven health management in the digital era. Objective: This study explored the capabilities of digital healthy cities within the framework of digital transformation, focusing on member countries of the Asian Forum of Healthy Cities. It examined the cities? preparedness and policy needs for transitioning to digital health. Methods: A cross-sectional survey was conducted of 9 countries?Australia, Cambodia, China, Japan, South Korea, Malaysia, Mongolia, the Philippines, and Vietnam?from August 1 to September 21, 2023. The 6-section SPIRIT (setting approach and sustainability; political commitment, policy, and community participation; information and innovation; resources and research; infrastructure and intersectoral; and training) checklist was modified to assess healthy cities? digital capabilities. With input from 3 healthy city experts, the checklist was revised for digital capabilities, renaming ?healthy city? to ?digital healthy city.? The revised tool comprises 8 sections with 33 items. The survey leveraged ChatGPT (version 4.0; OpenAI, Microsoft), accessed via Python (Python Software Foundation) application programming interface. The openai library was installed, and an application programming interface key was entered to use ChatGPT (version 4.0). The ?GPT-4 Turbo? model command was applied. A qualitative analysis of the collected data was conducted by 5 healthy city experts through group deep-discussions. Results: The results indicate that these countries should establish networks and committees for sustainable digital healthy cities. Cambodia showed the lowest access to electricity (70%) and significant digital infrastructure disparities. Efforts to sustain digital health initiatives varied, with countries such as Korea focusing on telemedicine, while China aimed to build a comprehensive digital health database, highlighting the need for tailored strategies in promoting digital healthy cities. Life expectancy was the highest in the Republic of Korea and Japan (both 84 y). Access to electricity was the lowest in Cambodia (70%) with the remaining countries having had 95% or higher access. The internet use rate was the highest in Malaysia (97.4%), followed by the Republic of Korea (97.2%), Australia (96.2%), and Japan (82.9%). Conclusions: This study highlights the importance of big data-driven policies and personal information protection systems. Collaborative efforts across sectors for effective implementation of digital healthy cities. The findings suggest that the effectiveness of digital healthy cities is diminished without adequate digital literacy among managers and users, suggesting the need for policies to improve digital literacy. UR - https://formative.jmir.org/2025/1/e62935 UR - http://dx.doi.org/10.2196/62935 ID - info:doi/10.2196/62935 ER - TY - JOUR AU - Choudhury, Ananya AU - Volmer, Leroy AU - Martin, Frank AU - Fijten, Rianne AU - Wee, Leonard AU - Dekker, Andre AU - Soest, van Johan PY - 2025/2/6 TI - Advancing Privacy-Preserving Health Care Analytics and Implementation of the Personal Health Train: Federated Deep Learning Study JO - JMIR AI SP - e60847 VL - 4 KW - gross tumor volume segmentation KW - federated learning infrastructure KW - privacy-preserving technology KW - cancer KW - deep learning KW - artificial intelligence KW - lung cancer KW - oncology KW - radiotherapy KW - imaging KW - data protection KW - data privacy N2 - Background: The rapid advancement of deep learning in health care presents significant opportunities for automating complex medical tasks and improving clinical workflows. However, widespread adoption is impeded by data privacy concerns and the necessity for large, diverse datasets across multiple institutions. Federated learning (FL) has emerged as a viable solution, enabling collaborative artificial intelligence model development without sharing individual patient data. To effectively implement FL in health care, robust and secure infrastructures are essential. Developing such federated deep learning frameworks is crucial to harnessing the full potential of artificial intelligence while ensuring patient data privacy and regulatory compliance. Objective: The objective is to introduce an innovative FL infrastructure called the Personal Health Train (PHT) that includes the procedural, technical, and governance components needed to implement FL on real-world health care data, including training deep learning neural networks. The study aims to apply this federated deep learning infrastructure to the use case of gross tumor volume segmentation on chest computed tomography images of patients with lung cancer and present the results from a proof-of-concept experiment. Methods: The PHT framework addresses the challenges of data privacy when sharing data, by keeping data close to the source and instead bringing the analysis to the data. Technologically, PHT requires 3 interdependent components: ?tracks? (protected communication channels), ?trains? (containerized software apps), and ?stations? (institutional data repositories), which are supported by the open source ?Vantage6? software. The study applies this federated deep learning infrastructure to the use case of gross tumor volume segmentation on chest computed tomography images of patients with lung cancer, with the introduction of an additional component called the secure aggregation server, where the model averaging is done in a trusted and inaccessible environment. Results: We demonstrated the feasibility of executing deep learning algorithms in a federated manner using PHT and presented the results from a proof-of-concept study. The infrastructure linked 12 hospitals across 8 nations, covering 4 continents, demonstrating the scalability and global reach of the proposed approach. During the execution and training of the deep learning algorithm, no data were shared outside the hospital. Conclusions: The findings of the proof-of-concept study, as well as the implications and limitations of the infrastructure and the results, are discussed. The application of federated deep learning to unstructured medical imaging data, facilitated by the PHT framework and Vantage6 platform, represents a significant advancement in the field. The proposed infrastructure addresses the challenges of data privacy and enables collaborative model development, paving the way for the widespread adoption of deep learning?based tools in the medical domain and beyond. The introduction of the secure aggregation server implied that data leakage problems in FL can be prevented by careful design decisions of the infrastructure. Trial Registration: ClinicalTrials.gov NCT05775068; https://clinicaltrials.gov/study/NCT05775068 UR - https://ai.jmir.org/2025/1/e60847 UR - http://dx.doi.org/10.2196/60847 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60847 ER - TY - JOUR AU - Marino, Antonio Carlos AU - Diaz Paz, Claudia PY - 2025/1/31 TI - Smart Contracts and Shared Platforms in Sustainable Health Care: Systematic Review JO - JMIR Med Inform SP - e58575 VL - 13 KW - health care KW - smart contracts KW - blockchain KW - security KW - privacy KW - supply chain KW - patient centricity KW - system trust KW - stakeholders N2 - Background: The benefits of smart contracts (SCs) for sustainable health care are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentralization, immutability, and traceability introduced in health care. Nevertheless, more studies need to explore the role of SCs in this sector based on the frameworks propounded in the literature that reflect business logic that has been customized, automatized, and prioritized, as well as system trust. This study addressed this lacuna. Objective: This study aimed to provide a comprehensive understanding of SCs in health care based on reviewing the frameworks propounded in the literature. Methods: A structured literature review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. One database?Web of Science (WoS)?was selected to avoid bias generated by database differences and data wrangling. A quantitative assessment of the studies based on machine learning and data reduction methodologies was complemented with a qualitative, in-depth, detailed review of the frameworks propounded in the literature. Results: A total of 70 studies, which constituted 18.7% (70/374) of the studies on this subject, met the selection criteria and were analyzed. A multiple correspondence analysis?with 74.44% of the inertia?produced 3 factors describing the advances in the topic. Two of them referred to the leading roles of SCs: (1) health care process enhancement and (2) assurance of patients? privacy protection. The first role included 6 themes, and the second one included 3 themes. The third factor encompassed the technical features that improve system efficiency. The in-depth review of these 3 factors and the identification of stakeholders allowed us to characterize the system trust in health care SCs. We assessed the risk of coverage bias, and good percentages of overlap were obtained?66% (49/74) of PubMed articles were also in WoS, and 88.3% (181/205) of WoS articles also appeared in Scopus. Conclusions: This comprehensive review allows us to understand the relevance of SCs and the potentiality of their use in patient-centric health care that considers more than technical aspects. It also provides insights for further research based on specific stakeholders, locations, and behaviors. UR - https://medinform.jmir.org/2025/1/e58575 UR - http://dx.doi.org/10.2196/58575 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58575 ER - TY - JOUR AU - Taneja, Shipra AU - Kalia, Kamini AU - Tang, Terence AU - Wodchis, P. Walter AU - Vanderhout, Shelley PY - 2025/1/31 TI - Examining Health Care Provider Experiences With Patient Portal Implementation: Mixed Methods Study JO - J Med Internet Res SP - e65967 VL - 27 KW - patient portal KW - mixed methods KW - implementation KW - healthcare provider KW - health system KW - patient care KW - online questionnaire KW - Canada KW - descriptive statistics KW - thematic analysis N2 - Background: Health systems are increasingly offering patient portals as tools for patients to access their health information with the goal of improving engagement in care. However, understanding health care providers? perspectives on patient portal implementation is crucial. Objective: This study aimed to understand health care providers? experiences of implementing the MyChart patient portal, perspectives about its impact on patient care, clinical practice, and workload, and opportunities for improvement. Methods: Using an explanatory sequential mixed methods approach, we conducted a web-based questionnaire and semistructured individual interviews with health care providers at a large Canadian community hospital, 6 months after MyChart was first offered to patients. We explored perspectives about the impact of MyChart on clinical practice, workload, and patient care. Data were analyzed using descriptive statistics and thematic analysis. Results: In total, 261 health care providers completed the web-based questionnaire, and 15 also participated in interviews. Participants agreed that patients should have access to their health information through MyChart and identified its benefits such as patients gaining a greater understanding of their own health, which could improve patient safety (160/255, 62%). While many health care providers agreed that MyChart supported better patient care (108/258, 42%), there was limited understanding of features available to patients and expectations for integrating MyChart into clinical routines. Concerns were raised about the potential negative impacts of MyChart on patient-provider relationships because sensitive notes or results could be inappropriately interpreted (109/251, 43%), and a potential increase in workload if additional portal features were introduced. Suggested opportunities for improvement included support for both patients and health care providers to learn about MyChart and establishing guidelines for health care providers on how to communicate information available in MyChart to patients. Conclusions: While health care providers acknowledged that MyChart improved patients? access to health information, its implementation introduced some friction and concerns. To reduce the risk of these challenges, health systems can benefit from engaging health care providers early to identify effective patient portal implementation strategies. UR - https://www.jmir.org/2025/1/e65967 UR - http://dx.doi.org/10.2196/65967 UR - http://www.ncbi.nlm.nih.gov/pubmed/39888658 ID - info:doi/10.2196/65967 ER - TY - JOUR AU - Sutan, Rosnah AU - Ismail, Shahida AU - Ibrahim, Roszita PY - 2025/1/29 TI - Evaluating the Development, Reliability, and Validation of the Tele-Primary Care Oral Health Clinical Information System Questionnaire: Cross-Sectional Questionnaire Study JO - JMIR Hum Factors SP - e53630 VL - 12 KW - telehealth KW - electronic health KW - eHealth KW - public health information system KW - psychometric analysis N2 - Background: Evaluating digital health service delivery in primary health care requires a validated questionnaire to comprehensively assess users? ability to implement tasks customized to the program?s needs. Objective: This study aimed to develop, test the reliability of, and validate the Tele-Primary Care Oral Health Clinical Information System (TPC-OHCIS) questionnaire for evaluating the implementation of maternal and child digital health information systems. Methods: A cross-sectional study was conducted in 2 phases. The first phase focused on content item development and was validated by a group of 10 experts using the content validity index. The second phase was to assess its psychometric testing for reliability and validity. Results: A structured questionnaire of 65 items was constructed to assess the TPC-OHCIS delivery for primary health care use based on literature and has been validated by 10 experts, and 319 respondents answered the 65-item TPC-OHCIS questionnaire, with mean item scores ranging from 1.99 (SD 0.67) to 2.85 (SD 1.019). The content validity, reliability, and face validity showed a scale-level content validity index of 0.90, scale-level content validation ratio of 0.90, and item-level face validity index of 0.76, respectively. The internal reliability was calculated as a Cronbach ? value of 0.90, with an intraclass correlation coefficient of 0.91. Scales were determined by the scree plot with eigenvalues >1, and 13 subscales were identified based on principal component analysis. The Kaiser-Meyer-Olkin value was 0.90 (P<.049). The total variance explained was 76.07%, and factor loading scores for all variables were >0.7. The Bartlett test of sphericity, determining construct validity, was found to be significant (P<.049). Conclusions: The TPC-OHCIS questionnaire is valid to be used at the primary health care level to evaluate the TPC-OHCIS implementation. It can assess health care workers? work performance and job acceptance and improve the quality of care. UR - https://humanfactors.jmir.org/2025/1/e53630 UR - http://dx.doi.org/10.2196/53630 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53630 ER - TY - JOUR AU - Alharbi, A. Abdullah AU - Aljerian, A. Nawfal AU - Binhotan, S. Meshary AU - Alghamdi, A. Hani AU - Alsultan, K. Ali AU - Arafat, S. Mohammed AU - Aldhabib, Abdulrahman AU - Alaska, A. Yasser AU - Alwahbi, B. Eid AU - Muaddi, A. Mohammed AU - Alqassim, Y. Ahmad AU - Horner, D. Ronnie PY - 2025/1/24 TI - Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data JO - JMIR Public Health Surveill SP - e64257 VL - 11 KW - digital health KW - mental health KW - health policy KW - epidemiology KW - Saudi Arabia KW - SMARC KW - health care transformation KW - e-referral KW - Saudi Medical Appointments and Referrals Centre N2 - Background: Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia?s novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020?2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18?44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. ?Unavailable subspecialty? was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems. UR - https://publichealth.jmir.org/2025/1/e64257 UR - http://dx.doi.org/10.2196/64257 ID - info:doi/10.2196/64257 ER - TY - JOUR AU - Seth, Mattias AU - Jalo, Hoor AU - Högstedt, Åsa AU - Medin, Otto AU - Sjöqvist, Arne Bengt AU - Candefjord, Stefan PY - 2025/1/23 TI - Technologies for Interoperable Internet of Medical Things Platforms to Manage Medical Emergencies in Home and Prehospital Care: Scoping Review JO - J Med Internet Res SP - e54470 VL - 27 KW - Internet of Medical Things KW - enabling technologies KW - standards KW - cross-domain interoperability KW - scoping review KW - technology KW - medical emergency KW - internet KW - prehospital care KW - gerontology KW - global population KW - chronic disease KW - multimorbidity KW - health care system KW - home-based care KW - innovation KW - digital health KW - health informatics KW - telehealth KW - artificial intelligence N2 - Background: The aging global population and the rising prevalence of chronic disease and multimorbidity have strained health care systems, driving the need for expanded health care resources. Transitioning to home-based care (HBC) may offer a sustainable solution, supported by technological innovations such as Internet of Medical Things (IoMT) platforms. However, the full potential of IoMT platforms to streamline health care delivery is often limited by interoperability challenges that hinder communication and pose risks to patient safety. Gaining more knowledge about addressing higher levels of interoperability issues is essential to unlock the full potential of IoMT platforms. Objective: This scoping review aims to summarize best practices and technologies to overcome interoperability issues in IoMT platform development for prehospital care and HBC. Methods: This review adheres to a protocol published in 2022. Our literature search followed a dual search strategy and was conducted up to August 2023 across 6 electronic databases: IEEE Xplore, PubMed, Scopus, ACM Digital Library, Sage Journals, and ScienceDirect. After the title, abstract, and full-text screening performed by 2 reviewers, 158 articles were selected for inclusion. To answer our 2 research questions, we used 2 models defined in the protocol: a 6-level interoperability model and a 5-level IoMT reference model. Data extraction and synthesis were conducted through thematic analysis using Dedoose. The findings, including commonly used technologies and standards, are presented through narrative descriptions and graphical representations. Results: The primary technologies and standards reported for interoperable IoMT platforms in prehospital care and HBC included cloud computing (19/30, 63%), representational state transfer application programming interfaces (REST APIs; 17/30, 57%), Wi-Fi (17/30, 57%), gateways (15/30, 50%), and JSON (14/30, 47%). Message queuing telemetry transport (MQTT; 7/30, 23%) and WebSocket (7/30, 23%) were commonly used for real-time emergency alerts, while fog and edge computing were often combined with cloud computing for enhanced processing power and reduced latencies. By contrast, technologies associated with higher interoperability levels, such as blockchain (2/30, 7%), Kubernetes (3/30, 10%), and openEHR (2/30, 7%), were less frequently reported, indicating a focus on lower level of interoperability in most of the included studies (17/30, 57%). Conclusions: IoMT platforms that support higher levels of interoperability have the potential to deliver personalized patient care, enhance overall patient experience, enable early disease detection, and minimize time delays. However, our findings highlight a prevailing emphasis on lower levels of interoperability within the IoMT research community. While blockchain, microservices, Docker, and openEHR are described as suitable solutions in the literature, these technologies seem to be seldom used in IoMT platforms for prehospital care and HBC. Recognizing the evident benefit of cross-domain interoperability, we advocate a stronger focus on collaborative initiatives and technologies to achieve higher levels of interoperability. International Registered Report Identifier (IRRID): RR2-10.2196/40243 UR - https://www.jmir.org/2025/1/e54470 UR - http://dx.doi.org/10.2196/54470 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54470 ER - TY - JOUR AU - Kim, Hoon Ji AU - Kim, Joung Min AU - Kim, Chang Hyeon AU - Kim, Yan Ha AU - Sung, Min Ji AU - Chang, Hyuk-Jae PY - 2025/1/23 TI - A Novel Artificial Intelligence?Enhanced Digital Network for Prehospital Emergency Support: Community Intervention Study JO - J Med Internet Res SP - e58177 VL - 27 KW - emergency patient transport KW - transport time KW - artificial intelligence KW - smartphone KW - mobile phone N2 - Background: Efficient emergency patient transport systems, which are crucial for delivering timely medical care to individuals in critical situations, face certain challenges. To address this, CONNECT-AI (CONnected Network for EMS Comprehensive Technical-Support using Artificial Intelligence), a novel digital platform, was introduced. This artificial intelligence (AI)?based network provides comprehensive technical support for the real-time sharing of medical information at the prehospital stage. Objective: This study aimed to evaluate the effectiveness of this system in reducing patient transport delays. Methods: The CONNECT-AI system provided 3 key AI services to prehospital care providers by collecting real-time patient data from the scene and hospital resource information, such as bed occupancy and the availability of emergency surgeries or procedures, using 5G communication technology and internet of things devices. These services included guidance on first aid, prediction of critically ill patients, and recommendation of the optimal transfer hospital. In addition, the platform offered emergency department medical staff real-time clinical information, including live video of patients during transport to the hospital. This community-based, nonrandomized controlled intervention study was designed to evaluate the effectiveness of the CONNECT-AI system in 2 regions of South Korea, each of which operated an intervention and a control period, each lasting 16 weeks. The impact of the system was assessed based on the proportion of patients experiencing transfer delays. Results: A total of 14,853 patients transported by public ambulance were finally selected for analysis. Overall, the median transport time was 10 (IQR 7-14) minutes in the intervention group and 9 (IQR 6-13) minutes in the control group. When comparing the incidence of transport time outliers (>75%), which was the primary outcome of this study, the rate was higher in the intervention group in region 1, but significantly reduced in region 2, with the overall outlier rate being higher in the intervention group (27.5%-29.7%, P=.04). However, for patients with fever or respiratory symptoms, the group using the system showed a statistically significant reduction in outlier cases (36.5%-30.1%, P=.01). For patients who received real-time acceptance signals from the hospital, the reduction in the percentage of 75% outliers was statistically significant compared with those without the system (27.5%-19.6%, P=.02). As a result of emergency department treatment, 1.5% of patients in the control group and 1.1% in the intervention group died (P=.14). In the system-guided optimal hospital transfer group, the mortality rate was significantly lower than in the control group (1.54%-0.64%, P=.01). Conclusions: The present digital emergency medical system platform offers a novel approach to enhancing emergency patient transport by leveraging AI, real-time information sharing, and decision support. While the system demonstrated improvements for certain patient groups facing transfer challenges, further research and modifications are necessary to fully realize its benefits in diverse health care contexts. Trial Registration: ClinicalTrials.gov NCT04829279; https://clinicaltrials.gov/study/NCT04829279 UR - https://www.jmir.org/2025/1/e58177 UR - http://dx.doi.org/10.2196/58177 UR - http://www.ncbi.nlm.nih.gov/pubmed/39847421 ID - info:doi/10.2196/58177 ER - TY - JOUR AU - Wei, Dongle AU - Gao, Pan AU - Zhai, Yunkai PY - 2025/1/22 TI - The Impact of Data Control and Delayed Discounting on the Public?s Willingness to Share Different Types of Health Care Data: Empirical Study JO - JMIR Med Inform SP - e66444 VL - 13 KW - health data control KW - delay discounting rate KW - mental accounting KW - health data KW - data sharing KW - willingness KW - patient-generated data KW - clinical medical data KW - disease prevention KW - precision medicine KW - health care KW - portability KW - accountability KW - app KW - web-based survey KW - data security KW - data privacy KW - mobile phone N2 - Background: Health data typically include patient-generated data and clinical medical data. Different types of data contribute to disease prevention, precision medicine, and the overall improvement of health care. With the introduction of regulations such as the Health Insurance Portability and Accountability Act (HIPAA), individuals play a key role in the sharing and application of personal health data. Objective: This study aims to explore the impact of different types of health data on users? willingness to share. Additionally, it analyzes the effect of data control and delay discounting rate on this process. Methods: The results of a web-based survey were analyzed to examine individuals? perceptions of sharing different types of health data and how data control and delay discounting rates influenced their decisions. We recruited participants for our study through the web-based platform ?Wenjuanxing.? After screening, we obtained 257 valid responses. Regression analysis was used to investigate the impact of data control, delayed discounting, and mental accounting on the public?s willingness to share different types of health care data. Results: Our findings indicate that the type of health data does not significantly affect the perceived benefits of data sharing. Instead, it negatively influences willingness to share by indirectly affecting data acquisition costs and perceived risks. Our results also show that data control reduces the perceived risks associated with sharing, while higher delay discounting rates lead to an overestimation of data acquisition costs and perceived risks. Conclusions: Individuals? willingness to share data is primarily influenced by costs. To promote the acquisition and development of personal health data, stakeholders should strengthen individuals? control over their data or provide direct short-term incentives. UR - https://medinform.jmir.org/2025/1/e66444 UR - http://dx.doi.org/10.2196/66444 ID - info:doi/10.2196/66444 ER - TY - JOUR AU - Sang, Ling AU - Zheng, Bixin AU - Zeng, Xianzheng AU - Liu, Huizhen AU - Jiang, Qing AU - Liu, Maotong AU - Zhu, Chenyu AU - Wang, Maoying AU - Yi, Zengwei AU - Song, Keyu AU - Song, Li PY - 2024/12/30 TI - Effectiveness of Outpatient Chronic Pain Management for Middle-Aged Patients by Internet Hospitals: Retrospective Cohort Study JO - JMIR Med Inform SP - e54975 VL - 12 KW - chronic pain management KW - internet hospital KW - physical hospital KW - quality of life KW - outpatient care KW - telemedicine KW - digital health N2 - Background: Chronic pain is widespread and carries a heavy disease burden, and there is a lack of effective outpatient pain management. As an emerging internet medical platform in China, internet hospitals have been successfully applied for the management of chronic diseases. There are also a certain number of patients with chronic pain that use internet hospitals for pain management. However, no studies have investigated the effectiveness of pain management via internet hospitals. Objective: The aim of this retrospective cohort study was to explore the effectiveness of chronic pain management by internet hospitals and their advantages and disadvantages compared to traditional physical hospital visits. Methods: This was a retrospective cohort study. Demographic information such as the patient?s sex, age, and number of visits was obtained from the IT center. During the first and last patient visits, information on outcome variables such as the Brief Pain Inventory (BPI), medical satisfaction, medical costs, and adverse drug events was obtained through a telephone follow-up. All patients with chronic pain who had 3 or more visits (internet or offline) between September 2021, and February 2023, were included. The patients were divided into an internet hospital group and a physical hospital group, according to whether they had web-based or in-person consultations, respectively. To control for confounding variables, propensity score matching was used to match the two groups. Matching variables included age, sex, diagnosis, and number of clinic visits. Results: A total of 122 people in the internet hospital group and 739 people in the physical hospital group met the inclusion criteria. After propensity score matching, 77 patients in each of the two groups were included in the analysis. There was not a significant difference in the quality of life (QOL; QOL assessment was part of the BPI scale) between the internet hospital group and the physical hospital group (P=.80), but the QOL of both groups of patients improved after pain management (internet hospital group: P<.001; physical hospital group: P=.001). There were no significant differences in the pain relief rate (P=.25) or the incidence of adverse events (P=.60) between the two groups. The total cost (P<.001) and treatment-related cost (P<.001) of the physical hospital group were higher than those of the internet hospital group. In addition, the degree of satisfaction in the internet hospital group was greater than that in the physical hospital group (P=.01). Conclusions: Internet hospitals are an effective way of managing chronic pain. They can improve patients? QOL and satisfaction, reduce treatment costs, and can be used as part of a multimodal strategy for chronic pain self-management. UR - https://medinform.jmir.org/2024/1/e54975 UR - http://dx.doi.org/10.2196/54975 ID - info:doi/10.2196/54975 ER - TY - JOUR AU - Backman, Chantal AU - Papp, Rosie AU - Tonjock Kolle, Aurelie AU - Papp, Steve AU - Visintini, Sarah AU - Schaefer Ferreira de Mello, Lúcia Ana AU - de Melo Lanzoni, Marcellino Gabriela AU - Harley, Anne PY - 2024/12/30 TI - Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review JO - J Med Internet Res SP - e55753 VL - 26 KW - platform based KW - patient-clinician KW - digital health intervention KW - care transition KW - mobile phone N2 - Background: Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients. Objective: The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs. Methods: A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods. Results: We screened 8322 articles, of which 97 (1.17%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61%), a web-based platform (28/97, 29%), or a combination of both (10/97, 10%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23%) and stroke (11/97, 11%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13%) and time constraints to use the DHIs (10/97, 10%), and the top 2 enablers were the ability to use the DHIs (17/97, 18%) and their ease of use (11/97, 11%). The main conflicting theme was access (enabler; 28/97, 29%) or limited access (barrier; 15/97, 15%) to technology or the internet. Conclusions: Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes. UR - https://www.jmir.org/2024/1/e55753 UR - http://dx.doi.org/10.2196/55753 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55753 ER - TY - JOUR AU - Declerck, Jens AU - Vandenberk, Bert AU - Deschepper, Mieke AU - Colpaert, Kirsten AU - Cool, Lieselot AU - Goemaere, Jens AU - Bové, Mona AU - Staelens, Frank AU - De Meester, Koen AU - Verbeke, Eva AU - Smits, Elke AU - De Decker, Cami AU - Van Der Vekens, Nicky AU - Pauwels, Elin AU - Vander Stichele, Robert AU - Kalra, Dipak AU - Coorevits, Pascal PY - 2024/12/20 TI - Building a Foundation for High-Quality Health Data: Multihospital Case Study in Belgium JO - JMIR Med Inform SP - e60244 VL - 12 KW - EHR KW - electronic health records KW - health data KW - data quality dimensions KW - data quality assessment KW - secondary use KW - data quality framework KW - fit for purpose KW - Belgium KW - data quality KW - framework KW - case study KW - hospital KW - variability N2 - Background: Data quality is fundamental to maintaining the trust and reliability of health data for both primary and secondary purposes. However, before the secondary use of health data, it is essential to assess the quality at the source and to develop systematic methods for the assessment of important data quality dimensions. Objective: This case study aims to offer a dual aim?to assess the data quality of height and weight measurements across 7 Belgian hospitals, focusing on the dimensions of completeness and consistency, and to outline the obstacles these hospitals face in sharing and improving data quality standards. Methods: Focusing on data quality dimensions completeness and consistency, this study examined height and weight data collected from 2021 to 2022 within 3 distinct departments?surgical, geriatrics, and pediatrics?in each of the 7 hospitals. Results: Variability was observed in the completeness scores for height across hospitals and departments, especially within surgical and geriatric wards. In contrast, weight data uniformly achieved high completeness scores. Notably, the consistency of height and weight data recording was uniformly high across all departments. Conclusions: A collective collaboration among Belgian hospitals, transcending network affiliations, was formed to conduct this data quality assessment. This study demonstrates the potential for improving data quality across health care organizations by sharing knowledge and good practices, establishing a foundation for future, similar research. UR - https://medinform.jmir.org/2024/1/e60244 UR - http://dx.doi.org/10.2196/60244 ID - info:doi/10.2196/60244 ER - TY - JOUR AU - Austin, A. Jodie AU - Lobo, H. Elton AU - Samadbeik, Mahnaz AU - Engstrom, Teyl AU - Philip, Reji AU - Pole, D. Jason AU - Sullivan, M. Clair PY - 2024/12/20 TI - Decades in the Making: The Evolution of Digital Health Research Infrastructure Through Synthetic Data, Common Data Models, and Federated Learning JO - J Med Internet Res SP - e58637 VL - 26 KW - real-world data KW - digital health research KW - synthetic data KW - common data models KW - federated learning KW - university-industry collaboration UR - https://www.jmir.org/2024/1/e58637 UR - http://dx.doi.org/10.2196/58637 UR - http://www.ncbi.nlm.nih.gov/pubmed/39705072 ID - info:doi/10.2196/58637 ER - TY - JOUR AU - Rådestad, Monica AU - Kanfjäll, Torkel AU - Lindström, Veronica PY - 2024/12/19 TI - Real-Time Triage, Position, and Documentation (TriPoD) During Medical Response to Major Incidents: Protocol for an Action Research Study JO - JMIR Res Protoc SP - e57819 VL - 13 KW - action research KW - decision support technique KW - information technology KW - medical response KW - major incident KW - management N2 - Background: There is a need to address the implementation of technological innovation into emergency medical services to facilitate and improve information exchange between prehospital emergency care providers, command centers, and hospitals during major incidents to enable better allocation of resources and minimize loss of life. At present, there is a lack of technology supporting real-time information sharing in managing major incidents to optimize the use of resources available. Objective: The aim of this protocol is to develop, design, and evaluate information technology innovations for use in medical response to major incidents. Methods: This study has a qualitative action research design. This research approach is suitable for developing and changing practice in health care settings since it is cyclical in nature and involves development, evaluation, redevelopment, and replanning. The qualitative data collection will include workshops, structured meetings, semistructured interviews, questionnaires, observations, and focus group interviews. This study assesses the use of a digital solution for real-time information sharing by involving 3 groups of indented users: prehospital emergency care personnel, hospital personnel, and designated duty officers with experience and specific knowledge in managing major incidents. This study will explore end users? experiences and needs, and a digital solution for prehospital and hospital settings will be developed in collaboration with technology producers. Results: The trial implementation and evaluation phase for this study is from April 2024 to May 2026. Interviews and questionnaires with end users were conducted during the planning phase. We have performed observations in connection with 2 major exercises in April 2024 and November 2024. The outcome of this analysis will form the basis for the design and development of a new information technology system. We aim to complete the observations in training sessions and exercises (phase 3) by September 2025, followed by modification of the technology solutions tested (phase 4) before dissemination in a scientific journal. Conclusions: This protocol includes several methods for data collection that will form the basis for the design and development process of a digital solution for real-time information sharing to support efficient management in major incidents based on the experiences and requirements of end users. The findings from this study will contribute to the limited research on users? perspectives and the development of digital solutions for real-time information during major incidents. International Registered Report Identifier (IRRID): PRR1-10.2196/57819 UR - https://www.researchprotocols.org/2024/1/e57819 UR - http://dx.doi.org/10.2196/57819 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57819 ER - TY - JOUR AU - Neunaber, Timo AU - Mortsiefer, Achim AU - Meister, Sven PY - 2024/12/19 TI - Dimensions and Subcategories of Digital Maturity in General Practice: Qualitative Study JO - J Med Internet Res SP - e57786 VL - 26 KW - digital health KW - eHealth KW - digital maturity KW - maturity assessment KW - primary care KW - general practice KW - general practitioner KW - qualitative research KW - expert interviews KW - interview KW - explorative KW - dimension KW - subcategory KW - expert KW - care provider KW - content analysis N2 - Background: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. Objective: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. Methods: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH). Results: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. Conclusions: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed. UR - https://www.jmir.org/2024/1/e57786 UR - http://dx.doi.org/10.2196/57786 UR - http://www.ncbi.nlm.nih.gov/pubmed/39699948 ID - info:doi/10.2196/57786 ER - TY - JOUR AU - Bikou, Georgia Alexia AU - Deligianni, Elena AU - Dermiki-Gkana, Foteini AU - Liappas, Nikolaos AU - Teriús-Padrón, Gabriel José AU - Beltrán Jaunsarás, Eugenia Maria AU - Cabrera-Umpiérrez, Fernanda Maria AU - Kontogiorgis, Christos PY - 2024/12/18 TI - Improving Participant Recruitment in Clinical Trials: Comparative Analysis of Innovative Digital Platforms JO - J Med Internet Res SP - e60504 VL - 26 KW - clinical research KW - e-recruitment KW - patient matching KW - clinical trials KW - digital platforms KW - enrollment KW - electronic consent N2 - Background: Pharmaceutical product development relies on thorough and costly clinical trials. Participant recruitment and monitoring can be challenging. The incorporation of cutting-edge technologies such as blockchain and artificial intelligence has revolutionized clinical research (particularly in the recruitment stage), enhanced secure data storage and analysis, and facilitated participant monitoring while protecting their personal information. Objective: This study aims to investigate the use of novel digital platforms and their features, such as e-recruitment, e-consent, and matching, aiming to optimize and expedite clinical research. Methods: A review with a systematic approach was conducted encompassing literature from January 2000 to October 2024. The MEDLINE, ScienceDirect, Scopus, and Google Scholar databases were examined thoroughly using a customized search string. Inclusion criteria focused on digital platforms involving clinical trial recruitment phases that were in English and had international presence, scientific validation, regulatory approval, and no geographic limitations. Literature reviews and unvalidated digital platforms were excluded. The selected studies underwent meticulous screening by the research team, ensuring a thorough analysis of novel digital platforms and their use and features for clinical trials. Results: A total of 24 digital platforms were identified that supported clinical trial recruitment phases. In general, most of them (n=22, 80%) are headquartered and operating in the United States, providing a range of functionalities including electronic consent (n=14, 60% of the platforms), participant matching, and monitoring of patients? health status. These supplementary features enhance the overall effectiveness of the platforms in facilitating the recruitment process for clinical trials. The analysis and digital platform findings refer to a specific time frame when the investigation took place, and a notable surge was observed in the adoption of these novel digital tools, particularly following the COVID-19 outbreak. Conclusions: This study underscores the vital role of the identified digital platforms in clinical trials, aiding in recruitment, enhancing patient engagement, accelerating procedures, and personalizing vital sign monitoring. Despite their impact, challenges in accessibility, compatibility, and transparency require careful consideration. Addressing these challenges is crucial for optimizing digital tool integration into clinical research, allowing researchers to harness the benefits while managing the associated risks effectively. UR - https://www.jmir.org/2024/1/e60504 UR - http://dx.doi.org/10.2196/60504 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60504 ER - TY - JOUR AU - Hasavari, Shirin AU - Esmaeilzadeh, Pouyan PY - 2024/12/13 TI - Appropriately Matching Transport Care Units to Patients in Interhospital Transport Care: Implementation Study JO - JMIR Form Res SP - e65626 VL - 8 KW - interfacility transport care KW - electronic health records KW - data sharing KW - blockchain KW - hyperledger fabric KW - privacy KW - implementation KW - EMS KW - emergency medical services N2 - Background: In interfacility transport care, a critical challenge exists in accurately matching ambulance response levels to patients? needs, often hindered by limited access to essential patient data at the time of transport requests. Existing systems cannot integrate patient data from sending hospitals? electronic health records (EHRs) into the transfer request process, primarily due to privacy concerns, interoperability challenges, and the sensitive nature of EHR data. We introduce a distributed digital health platform, Interfacility Transport Care (ITC)?InfoChain, designed to solve this problem without compromising EHR security or data privacy. Objective: This study aimed to detail the implementation of ITC-InfoChain, a secure, blockchain-based platform designed to enhance real-time data sharing without compromising data privacy or EHR security. Methods: The ITC-InfoChain platform prototype was implemented on Amazon Web Services cloud infrastructure, using Hyperledger Fabric as a permissioned blockchain. Key elements included participant registration, identity management, and patient data collection isolated from the sending hospital?s EHR system. The client program submits encrypted patient data to a distributed ledger, accessible to the receiving facility?s critical care unit at the time of transport request and emergency medical services (EMS) teams during transport through the PatienTrack web app. Performance was evaluated through key performance indicators such as data transaction times and scalability across transaction loads. Results: The ITC-InfoChain demonstrated strong performance and scalability. Data transaction times averaged 3.1 seconds for smaller volumes (1-20 transactions) and 6.4 seconds for 100 transactions. Optimized configurations improved processing times to 1.8-1.9 seconds for 400 transactions. These results confirm the platform?s capacity to handle high transaction volumes, supporting timely, real-time data access for decision-making during transport requests and patient transfers. Conclusions: The ITC-InfoChain platform addresses the challenge of matching appropriate transport units to patient needs by ensuring data privacy, integrity, and real-time data sharing, enhancing the coordination of patient care. The platform?s success suggests potential for regional pilots and broader adoption in secure health care systems. Stakeholder resistance due to blockchain unfamiliarity and data privacy concerns remains. Funding has been sought to support a pilot program to address these challenges through targeted education and engagement. UR - https://formative.jmir.org/2024/1/e65626 UR - http://dx.doi.org/10.2196/65626 UR - http://www.ncbi.nlm.nih.gov/pubmed/39540868 ID - info:doi/10.2196/65626 ER - TY - JOUR AU - Albers, W. Charlotte A. AU - Wieland-Jorna, Yvonne AU - de Bruijne, C. Martine AU - Smalbrugge, Martin AU - Joling, J. Karlijn AU - de Boer, E. Marike PY - 2024/12/13 TI - Enhancing Standardized and Structured Recording by Elderly Care Physicians for Reusing Electronic Health Record Data: Interview Study JO - JMIR Med Inform SP - e63710 VL - 12 KW - electronic health records KW - health information interoperability KW - health information exchange KW - reference standards KW - long-term care KW - nursing homes KW - medical records KW - attitude of health personnel KW - qualitative research KW - digital health N2 - Background: Elderly care physicians (ECPs) in nursing homes document patients? health, medical conditions, and the care provided in electronic health records (EHRs). However, much of these health data currently lack structure and standardization, limiting their potential for health information exchange across care providers and reuse for quality improvement, policy development, and scientific research. Enhancing this potential requires insight into the attitudes and behaviors of ECPs toward standardized and structured recording in EHRs. Objective: This study aims to answer why and how ECPs record their findings in EHRs and what factors influence them to record in a standardized and structured manner. The findings will be used to formulate recommendations aimed at enhancing standardized and structured data recording for the reuse of EHR data. Methods: Semistructured interviews were conducted with 13 ECPs working in Dutch nursing homes. We recruited participants through purposive sampling, aiming for diversity in age, gender, health care organization, and use of EHR systems. Interviews continued until we reached data saturation. Analysis was performed using inductive thematic analysis. Results: ECPs primarily use EHRs to document daily patient care, ensure continuity of care, and fulfill their obligation to record specific information for accountability purposes. The EHR serves as a record to justify their actions in the event of a complaint. In addition, some respondents also mentioned recording information for secondary purposes, such as research and quality improvement. Several factors were found to influence standardized and structured recording. At a personal level, it is crucial to experience the added value of standardized and structured recording. At the organizational level, clear internal guidelines and a focus on their implementation can have a substantial impact. At the level of the EHR system, user-friendliness, interoperability, and guidance were most frequently mentioned as being important. At a national level, the alignment of internal guidelines with overarching standards plays a pivotal role in encouraging standardized and structured recording. Conclusions: The results of our study are similar to the findings of previous research in hospital care and general practice. Therefore, long-term care can learn from solutions regarding standardized and structured recording in other health care sectors. The main motives for ECPs to record in EHRs are the daily patient care and ensuring continuity of care. Standardized and structured recording can be improved by aligning the recording method in EHRs with the primary care process. In addition, there are incentives for motivating ECPs to record in a standardized and structured way, mainly at the personal, organizational, EHR system, and national levels. UR - https://medinform.jmir.org/2024/1/e63710 UR - http://dx.doi.org/10.2196/63710 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63710 ER - TY - JOUR AU - Wang, Zhong AU - Hu, Fangru AU - Su, Jie AU - Lin, Yuyao PY - 2024/12/10 TI - Information Source Characteristics of Personal Data Leakage During the COVID-19 Pandemic in China: Observational Study JO - JMIR Med Inform SP - e51219 VL - 12 KW - public health emergency KW - privacy leakage KW - characteristics of information sources KW - COVID-19 KW - China KW - information source KW - data privacy KW - public health KW - leakage N2 - Background: During the COVID-19 pandemic, in the period of preventing and controlling the spread of the virus, a large amount of personal data was collected in China, and privacy leakage incidents occurred. Objective: We aimed to examine the information source characteristics of personal data leakage during the COVID-19 pandemic in China. Methods: We extracted information source characteristics of 40 personal data leakage cases using open coding and analyzed the data with 1D and 2D matrices. Results: In terms of organizational characteristics, data leakage cases mainly occurred in government agencies below the prefecture level, while few occurred in the medical system or in high-level government organizations. The majority of leakers were regular employees or junior staff members rather than temporary workers or senior managers. Family WeChat groups were the primary route for disclosure; the forwarding of documents was the main method of divulgence, while taking screenshots and pictures made up a comparatively smaller portion. Conclusions: We propose the following suggestions: restricting the authority of nonmedical institutions and low-level government agencies to collect data, strengthening training for low-level employees on privacy protection, and restricting the flow of data on social media through technical measures. UR - https://medinform.jmir.org/2024/1/e51219 UR - http://dx.doi.org/10.2196/51219 ID - info:doi/10.2196/51219 ER - TY - JOUR AU - AboArab, A. Mohammed AU - Potsika, T. Vassiliki AU - Theodorou, Alexis AU - Vagena, Sylvia AU - Gravanis, Miltiadis AU - Sigala, Fragiska AU - Fotiadis, I. Dimitrios PY - 2024/12/9 TI - Advancing Progressive Web Applications to Leverage Medical Imaging for Visualization of Digital Imaging and Communications in Medicine and Multiplanar Reconstruction: Software Development and Validation Study JO - JMIR Med Inform SP - e63834 VL - 12 KW - medical image visualization KW - peripheral artery computed tomography imaging KW - multiplanar reconstruction KW - progressive web applications N2 - Background: In medical imaging, 3D visualization is vital for displaying volumetric organs, enhancing diagnosis and analysis. Multiplanar reconstruction (MPR) improves visual and diagnostic capabilities by transforming 2D images from computed tomography (CT) and magnetic resonance imaging into 3D representations. Web-based Digital Imaging and Communications in Medicine (DICOM) viewers integrated into picture archiving and communication systems facilitate access to pictures and interaction with remote data. However, the adoption of progressive web applications (PWAs) for web-based DICOM and MPR visualization remains limited. This paper addresses this gap by leveraging PWAs for their offline access and enhanced performance. Objective: This study aims to evaluate the integration of DICOM and MPR visualization into the web using PWAs, addressing challenges related to cross-platform compatibility, integration capabilities, and high-resolution image reconstruction for medical image visualization. Methods: Our paper introduces a PWA that uses a modular design for enhancing DICOM and MPR visualization in web-based medical imaging. By integrating React.js and Cornerstone.js, the application offers seamless DICOM image processing, ensures cross-browser compatibility, and delivers a responsive user experience across multiple devices. It uses advanced interpolation techniques to make volume reconstructions more accurate. This makes MPR analysis and visualization better in a web environment, thus promising a substantial advance in medical imaging analysis. Results: In our approach, the performance of DICOM- and MPR-based PWAs for medical image visualization and reconstruction was evaluated through comprehensive experiments. The application excelled in terms of loading time and volume reconstruction, particularly in Google Chrome, whereas Firefox showed superior performance in viewing slices. This study uses a dataset comprising 22 CT scans of peripheral artery patients to demonstrate the application?s robust performance, with Google Chrome outperforming other browsers in both the local area network and wide area network settings. In addition, the application?s accuracy in MPR reconstructions was validated with an error margin of <0.05 mm and outperformed the state-of-the-art methods by 84% to 98% in loading and volume rendering time. Conclusions: This paper highlights advancements in DICOM and MPR visualization using PWAs, addressing the gaps in web-based medical imaging. By exploiting PWA features such as offline access and improved performance, we have significantly advanced medical imaging technology, focusing on cross-platform compatibility, integration efficiency, and speed. Our application outperforms existing platforms for handling complex MPR analyses and accurate analysis of medical imaging as validated through peripheral artery CT imaging. UR - https://medinform.jmir.org/2024/1/e63834 UR - http://dx.doi.org/10.2196/63834 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63834 ER - TY - JOUR AU - Chen, You AU - Lehmann, U. Christoph AU - Malin, Bradley PY - 2024/12/2 TI - Digital Information Ecosystems in Modern Care Coordination and Patient Care Pathways and the Challenges and Opportunities for AI Solutions JO - J Med Internet Res SP - e60258 VL - 26 KW - patient care pathway KW - care journey KW - care coordination KW - digital information ecosystem KW - digital technologies KW - artificial intelligence KW - information interoperability KW - information silos KW - workload KW - information retrieval KW - care transitions KW - patient-reported outcome measures KW - clinical workflow KW - usability KW - user experience workflow KW - health care information systems KW - networks of health care professionals KW - patient information flow UR - https://www.jmir.org/2024/1/e60258 UR - http://dx.doi.org/10.2196/60258 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60258 ER - TY - JOUR AU - Ware, Anna AU - Blumke, Terri AU - Hoover, Peter AU - Arreola, David PY - 2024/11/22 TI - Calculating Optimal Patient to Nursing Capacity: Comparative Analysis of Traditional and New Methods JO - JMIR Nursing SP - e59619 VL - 7 KW - nurse scheduling KW - nurse KW - patient ratio KW - nursing hours per patient day KW - NHPPD KW - nursing administration KW - workload KW - comparative analysis KW - nursing KW - staffing KW - nurse staffing KW - registered nurses KW - nurse assistants KW - staff allocation KW - patient capacity N2 - Background: Optimal nurse staffing levels have been shown to impact patients? prognoses and safety, as well as staff burnout. The predominant method for calculating staffing levels has been patient-to-nurse (P/N) ratios and nursing hours per patient day. However, both methods fall short of addressing the dynamic nature of staffing needs that often fluctuate throughout the day as patients? clinical status changes and new patients are admitted or discharged from the unit. Objective: In this evaluation, the Veterans Affairs Palo Alto Health Care System (VAPAHCS) piloted a new dynamic bed count calculation in an effort to target optimal staffing levels every hour to provide greater temporal resolution on nurse staffing levels within the Veterans Health Administration. Methods: The dynamic bed count uses elements from both the nursing hours per patient day and P/N ratio to calculate current and target staffing levels, every hour, while balancing across nurse types (registered nurses to nurse assistants) to provide improved temporal insight into staff allocation. The dynamic bed count was compared with traditional P/N ratio methods of calculating patient capacity at the VAPAHCS, to assess optimal patient capacity within their acute care ward from January 1, 2023, through May 25, 2023. Descriptive statistics summarized patient capacity variables across the intensive care unit (ICU), medical-surgical ICU, and 3 acute care units. Student t tests (2-tailed) were used to analyze differences between patient capacity measures. Results: Hourly analysis of patient capacity information displayed how the dynamic bed count provided improved temporal resolution on patient capacity. Comparing the dynamic bed count to the P/N ratio, we found the patient capacity, as determined by the P/N ratio, was, on average, higher than that of the dynamic bed count across VAPAHCS acute care units and the medical-surgical ICU (P<.001). For example, in acute care unit 3C, the average dynamic bed count was 21.6 (SD 4.2) compared with a P/N ratio of 28.6 (SD 3.2). This suggests that calculating patient capacity using P/N ratios alone could lead to units taking on more patients than what the dynamic bed count suggests the unit can optimally handle. Conclusions: As a new patient capacity calculation, the dynamic bed count provided additional details and timely information about clinical staffing levels, patient acuity, and patient turnover. Implementing this calculation into the management process has the potential to empower departments to further optimize staffing and patient care. UR - https://nursing.jmir.org/2024/1/e59619 UR - http://dx.doi.org/10.2196/59619 ID - info:doi/10.2196/59619 ER - TY - JOUR AU - Nadav, Janna AU - Kaihlanen, Anu-Marja AU - Kujala, Sari AU - Keskimäki, Ilmo AU - Viitanen, Johanna AU - Salovaara, Samuel AU - Saukkonen, Petra AU - Vänskä, Jukka AU - Vehko, Tuulikki AU - Heponiemi, Tarja PY - 2024/11/21 TI - Factors Contributing to Successful Information System Implementation and Employee Well-Being in Health Care and Social Welfare Professionals: Comparative Cross-Sectional Study JO - JMIR Med Inform SP - e52817 VL - 12 KW - implementation KW - health information systems KW - client information systems KW - stress KW - healthcare professionals KW - social welfare professionals KW - clinician well-being KW - workplace stress N2 - Background: The integration of information systems in health care and social welfare organizations has brought significant changes in patient and client care. This integration is expected to offer numerous benefits, but simultaneously the implementation of health information systems and client information systems can also introduce added stress due to the increased time and effort required by professionals. Objective: This study aimed to examine whether professional groups and the factors that contribute to successful implementation (participation in information systems development and satisfaction with software providers? development work) are associated with the well-being of health care and social welfare professionals. Methods: Data were obtained from 3 national cross-sectional surveys (n=9240), which were carried out among Finnish health care and social welfare professionals (registered nurses, physicians, and social welfare professionals) in 2020?2021. Self-rated stress and stress related to information systems were used as indicators of well-being. Analyses were conducted using linear and logistic regression analysis. Results: Registered nurses were more likely to experience self-rated stress than physicians (odds ratio [OR] ?0.47; P>.001) and social welfare professionals (OR ?0.68; P<.001). They also had a higher likelihood of stress related to information systems than physicians (b=?.11; P<.001). Stress related to information systems was less prevalent among professionals who did not participate in information systems development work (b=?.14; P<.001). Higher satisfaction with software providers? development work was associated with a lower likelihood of self-rated stress (OR ?0.23; P<.001) and stress related to information systems (b=?.36 P<.001). When comparing the professional groups, we found that physicians who were satisfied with software providers? development work had a significantly lower likelihood of stress related to information systems (b=?.12; P<.001) compared with registered nurses and social welfare professionals. Conclusions: Organizations can enhance the well-being of professionals and improve the successful implementation of information systems by actively soliciting and incorporating professional feedback, dedicating time for information systems development, fostering collaboration with software providers, and addressing the unique needs of different professional groups. UR - https://medinform.jmir.org/2024/1/e52817 UR - http://dx.doi.org/10.2196/52817 ID - info:doi/10.2196/52817 ER - TY - JOUR AU - Kang, Ye Ji AU - Jung, Weon AU - Kim, Ji Hyun AU - An, Hyun Ji AU - Yoon, Hee AU - Kim, Taerim AU - Chang, Hansol AU - Hwang, Yeon Sung AU - Park, Eun Jong AU - Lee, Tak Gun AU - Cha, Chul Won AU - Heo, Sejin AU - Lee, Uk Se PY - 2024/11/20 TI - Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data JO - JMIR Public Health Surveill SP - e59138 VL - 10 KW - telemedicine KW - public health KW - medication adherence KW - COVID-19 KW - chronic diseases N2 - Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. UR - https://publichealth.jmir.org/2024/1/e59138 UR - http://dx.doi.org/10.2196/59138 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59138 ER - TY - JOUR AU - Piera-Jiménez, Jordi AU - Carot-Sans, Gerard AU - Ramiro-Pareta, Marina AU - Nogueras, Mercedes Maria AU - Folguera-Profitós, Júlia AU - Ródenas, Pepi AU - Jiménez-Rueda, Alba AU - de Pando Navarro, Thais AU - Mira Palacios, Antoni Josep AU - Fajardo, Carles Joan AU - Ustrell Campillo, Joan AU - Vela, Emili AU - Monterde, David AU - Valero-Bover, Damià AU - Bonet, Tara AU - Tarrasó-Urios, Guillermo AU - Cantenys-Sabà, Roser AU - Fabregat-Fabregat, Pau AU - Gómez Oliveros, Beatriz AU - Berdún, Jesús AU - Michelena, Xabier AU - Cano, Isaac AU - González-Colom, Rubèn AU - Roca, Josep AU - Solans, Oscar AU - Pontes, Caridad AU - Pérez-Sust, Pol PY - 2024/11/18 TI - A 25-Year Retrospective of Health IT Infrastructure Building: The Example of the Catalonia Region JO - J Med Internet Res SP - e58933 VL - 26 KW - health ITs KW - eHealth KW - integrated care KW - open platforms KW - interoperability KW - Catalonia KW - digitalization KW - health care structure KW - health care delivery KW - integrated pathway KW - integrated treatment plan KW - process management UR - https://www.jmir.org/2024/1/e58933 UR - http://dx.doi.org/10.2196/58933 UR - http://www.ncbi.nlm.nih.gov/pubmed/39556831 ID - info:doi/10.2196/58933 ER - TY - JOUR AU - Zhou, Zhiheng AU - Jin, Danian AU - He, Jinghua AU - Zhou, Shengqing AU - Wu, Jiang AU - Wang, Shuangxi AU - Zhang, Yang AU - Feng, Tianyuan PY - 2024/11/18 TI - Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study JO - J Med Internet Res SP - e50959 VL - 26 KW - information platform KW - active health KW - chronic disease management KW - effectiveness KW - community KW - digital health KW - health literacy KW - cardio-cerebrovascular disease KW - China N2 - Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents? self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the ?i Active Health? applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents? risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents? health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients? BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. UR - https://www.jmir.org/2024/1/e50959 UR - http://dx.doi.org/10.2196/50959 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50959 ER - TY - JOUR AU - Liao, Wenmin AU - He, Rong AU - He, Zhonglian AU - Shi, Nan AU - Li, Dan AU - Zhuang, Aihua AU - Gan, Feng AU - Sun, Ying AU - Li, Chaofeng PY - 2024/11/12 TI - Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study JO - J Med Internet Res SP - e51412 VL - 26 KW - process reengineering KW - blood sampling KW - hospital administration KW - medical informatics KW - digital health KW - patient experience N2 - Background: Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. Objective: This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Methods: Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. Results: BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients? waiting time by an average of 26.1 (SD 3.8; 95% CI ?33.64 to ?18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (?=1.13, 95% CI 0.91-1.36). Conclusions: BSSPR implementation for outpatients not only reduced waiting time and improved patients? experience but also augmented the hospital?s capacity to provide medical services. This study?s findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services. UR - https://www.jmir.org/2024/1/e51412 UR - http://dx.doi.org/10.2196/51412 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51412 ER - TY - JOUR AU - Liu, Yayuan AU - Jin, Haofeng AU - Yu, Zhuoyuan AU - Tong, Yu PY - 2024/11/11 TI - Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study JO - J Med Internet Res SP - e57609 VL - 26 KW - internet hospital KW - online consultation KW - telehealth KW - outpatient visits KW - outpatient expenses KW - urban-rural healthcare disparity N2 - Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients? offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients? adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients? adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and the associated expenses by 15.5% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients? residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients? adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients? urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. UR - https://www.jmir.org/2024/1/e57609 UR - http://dx.doi.org/10.2196/57609 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57609 ER - TY - JOUR AU - Cho, Jaeso AU - Han, Yeon Ji AU - Cho, Anna AU - Yoo, Sooyoung AU - Lee, Ho-Young AU - Kim, Hunmin PY - 2024/11/8 TI - Enhancing Clinical History Taking Through the Implementation of a Streamlined Electronic Questionnaire System at a Pediatric Headache Clinic: Development and Evaluation Study JO - JMIR Med Inform SP - e54415 VL - 12 KW - electronic questionnaire system KW - electronic questionnaire KW - history taking KW - medical history KW - headache KW - migraine KW - neuralgia KW - pediatric KW - paediatric KW - infant KW - neonatal KW - toddler KW - child KW - youth KW - adolescent N2 - Background: Accurate history taking is essential for diagnosis, treatment, and patient care, yet miscommunications and time constraints often lead to incomplete information. Consequently, there has been a pressing need to establish a system whereby the questionnaire is duly completed before the medical appointment, entered into the electronic health record (EHR), and stored in a structured format within a database. Objective: This study aimed to develop and evaluate a streamlined electronic questionnaire system, BEST-Survey (Bundang Hospital Electronic System for Total Care-Survey), integrated with the EHR, to enhance history taking and data management for patients with pediatric headaches. Methods: An electronic questionnaire system was developed at Seoul National University Bundang Hospital, allowing patients to complete previsit questionnaires on a tablet PC. The information is automatically integrated into the EHR and stored in a structured database for further analysis. A retrospective analysis compared clinical information acquired from patients aged <18 years visiting the pediatric neurology outpatient clinic for headaches, before and after implementing the BEST-Survey system. The study included 365 patients before and 452 patients after system implementation. Answer rates and positive rates of key headache characteristics were compared between the 2 groups to evaluate the system?s clinical utility. Results: Implementation of the BEST-Survey system significantly increased the mean data acquisition rate from 54.6% to 99.3% (P<.001). Essential clinical features such as onset, location, duration, severity, nature, and frequency were obtained in over 98.7% (>446/452) of patients after implementation, compared to from 53.7% (196/365) to 85.2% (311/365) before. The electronic system facilitated comprehensive data collection, enabling detailed analysis of headache characteristics in the patient population. Most patients (280/452, 61.9%) reported headache onset less than 1 year prior, with the temporal region being the most common pain location (261/703, 37.1%). Over half (232/452, 51.3%) experienced headaches lasting less than 2 hours, with nausea and vomiting as the most commonly associated symptoms (231/1036, 22.3%). Conclusions: The BEST-Survey system markedly improved the completeness and accuracy of essential history items for patients with pediatric headaches. The system also streamlined data extraction and analysis for clinical and research purposes. While the electronic questionnaire cannot replace physician-led history taking, it serves as a valuable adjunctive tool to enhance patient care. UR - https://medinform.jmir.org/2024/1/e54415 UR - http://dx.doi.org/10.2196/54415 ID - info:doi/10.2196/54415 ER - TY - JOUR AU - Han, Tao AU - Wei, Qinpeng AU - Wang, Ruike AU - Cai, Yijin AU - Zhu, Hongyi AU - Chen, Jiani AU - Zhang, Zhiruo AU - Li, Sisi PY - 2024/11/8 TI - Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire JO - J Med Internet Res SP - e55140 VL - 26 KW - service quality KW - SERVQUAL KW - Service Quality Questionnaire KW - internet hospital KW - e-hospital KW - digital medical care KW - health care professionals KW - Chinese digital health care N2 - Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients? use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients? expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients? overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients? familiarity with and willingness to use these services. UR - https://www.jmir.org/2024/1/e55140 UR - http://dx.doi.org/10.2196/55140 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55140 ER - TY - JOUR AU - Zhang, Guang-Wei AU - Li, Bin AU - Gu, Zheng-Min AU - Yang, Wei-Feng AU - Wang, Yi-Ran AU - Li, Hui-Jun AU - Zheng, Han-Bing AU - Yue, Ying-Xu AU - Wang, Kui-Zhong AU - Gong, Mengchun AU - Gong, Da-Xin PY - 2024/11/8 TI - In-Depth Examination of the Functionality and Performance of the Internet Hospital Information Platform: Development and Usability Study JO - J Med Internet Res SP - e54018 VL - 26 KW - internet hospital KW - smart hospital KW - mobile applications KW - operational data KW - information system KW - online service KW - patient service KW - management tool KW - electronic prescriptions KW - medical education KW - integration N2 - Background: Internet hospitals (IHs) have rapidly developed as a promising strategy to address supply-demand imbalances in China?s medical industry, with their capabilities directly dependent on information platform functionality. Furthermore, a novel theory of ?Trinity? smart hospital has provided advanced guidelines on IH constructions. Objective: This study aimed to explore the construction experience, construction models, and development prospects based on operational data from IHs. Methods: Based on existing information systems and internet service functionalities, our hospital has built a ?Smart Hospital Internet Information Platform (SHIIP)? for IH operations, actively to expand online services, digitalize traditional health care, and explore health care services modes throughout the entire process and lifecycle. This article encompasses the platform architecture design, technological applications, patient service content and processes, health care professional support features, administrative management tools, and associated operational data. Results: Our platform has presented a set of data, including 82,279,669 visits, 420,120 online medical consultations, 124,422 electronic prescriptions, 92,285 medication deliveries, 6,965,566 prediagnosis triages, 4,995,824 offline outpatient appointments, 2025 medical education articles with a total of 15,148,310 views, and so on. These data demonstrate the significant role of IH as an indispensable component of our physical hospital services, with deep integration between online and offline health care systems. Conclusions: The upward trends in various data metrics indicate that our IH has gained significant recognition and usage among both the public and healthcare workers, and may have promising development prospects. Additionally, the platform construction approach, which prioritizes comprehensive service digitization and the 'Trinity' of the public, healthcare workers, and managers, serves as an effective means of promoting the development of Internet Hospitals. Such insights may prove invaluable in guiding the development of IH and facilitating the continued evolution of the Internet healthcare sector. UR - https://www.jmir.org/2024/1/e54018 UR - http://dx.doi.org/10.2196/54018 UR - http://www.ncbi.nlm.nih.gov/pubmed/39168813 ID - info:doi/10.2196/54018 ER - TY - JOUR AU - Nowels, Aideen Molly AU - McDarby, Meghan AU - Brody, Lilla AU - Kleiman, Evan AU - Sagui Henson, Sara AU - Castro Sweet, Cynthia AU - Kozlov, Elissa PY - 2024/11/7 TI - Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study JO - J Med Internet Res SP - e48696 VL - 26 KW - digital health KW - mental health KW - health care benefit KW - prediction KW - technology KW - digital mental health KW - employer-based KW - teletherapy KW - coaching KW - utilization KW - mobile phone N2 - Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming ?super users? of all resources. UR - https://www.jmir.org/2024/1/e48696 UR - http://dx.doi.org/10.2196/48696 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48696 ER - TY - JOUR AU - Brehmer, Alexander AU - Sauer, Martin Christopher AU - Salazar Rodríguez, Jayson AU - Herrmann, Kelsey AU - Kim, Moon AU - Keyl, Julius AU - Bahnsen, Hendrik Fin AU - Frank, Benedikt AU - Köhrmann, Martin AU - Rassaf, Tienush AU - Mahabadi, Amir-Abbas AU - Hadaschik, Boris AU - Darr, Christopher AU - Herrmann, Ken AU - Tan, Susanne AU - Buer, Jan AU - Brenner, Thorsten AU - Reinhardt, Christian Hans AU - Nensa, Felix AU - Gertz, Michael AU - Egger, Jan AU - Kleesiek, Jens PY - 2024/10/31 TI - Establishing Medical Intelligence?Leveraging Fast Healthcare Interoperability Resources to Improve Clinical Management: Retrospective Cohort and Clinical Implementation Study JO - J Med Internet Res SP - e55148 VL - 26 KW - clinical informatics KW - FHIR KW - real-world evidence KW - medical intelligence KW - interoperability KW - data exchange KW - clinical management KW - clinical decision-making KW - electronic health records KW - quality of care KW - quality improvement N2 - Background: FHIR (Fast Healthcare Interoperability Resources) has been proposed to enable health data interoperability. So far, its applicability has been demonstrated for selected research projects with limited data. Objective: This study aimed to design and implement a conceptual medical intelligence framework to leverage real-world care data for clinical decision-making. Methods: A Python package for the use of multimodal FHIR data (FHIRPACK [FHIR Python Analysis Conversion Kit]) was developed and pioneered in 5 real-world clinical use cases, that is, myocardial infarction, stroke, diabetes, sepsis, and prostate cancer. Patients were identified based on the ICD-10 (International Classification of Diseases, Tenth Revision) codes, and outcomes were derived from laboratory tests, prescriptions, procedures, and diagnostic reports. Results were provided as browser-based dashboards. Results: For 2022, a total of 1,302,988 patient encounters were analyzed. (1) Myocardial infarction: in 72.7% (261/359) of cases, medication regimens fulfilled guideline recommendations. (2) Stroke: out of 1277 patients, 165 received thrombolysis and 108 thrombectomy. (3) Diabetes: in 443,866 serum glucose and 16,180 glycated hemoglobin A1c measurements from 35,494 unique patients, the prevalence of dysglycemic findings was 39% (13,887/35,494). Among those with dysglycemia, diagnosis was coded in 44.2% (6138/13,887) of the patients. (4) Sepsis: In 1803 patients, Staphylococcus epidermidis was the primarily isolated pathogen (773/2672, 28.9%) and piperacillin and tazobactam was the primarily prescribed antibiotic (593/1593, 37.2%). (5) PC: out of 54, three patients who received radical prostatectomy were identified as cases with prostate-specific antigen persistence or biochemical recurrence. Conclusions: Leveraging FHIR data through large-scale analytics can enhance health care quality and improve patient outcomes across 5 clinical specialties. We identified (1) patients with sepsis requiring less broad antibiotic therapy, (2) patients with myocardial infarction who could benefit from statin and antiplatelet therapy, (3) patients who had a stroke with longer than recommended times to intervention, (4) patients with hyperglycemia who could benefit from specialist referral, and (5) patients with PC with early increases in cancer markers. UR - https://www.jmir.org/2024/1/e55148 UR - http://dx.doi.org/10.2196/55148 UR - http://www.ncbi.nlm.nih.gov/pubmed/39240144 ID - info:doi/10.2196/55148 ER - TY - JOUR AU - Bardhan, Jayetri AU - Roberts, Kirk AU - Wang, Zhe Daisy PY - 2024/10/30 TI - Question Answering for Electronic Health Records: Scoping Review of Datasets and Models JO - J Med Internet Res SP - e53636 VL - 26 KW - medical question answering KW - electronic health record KW - EHR KW - electronic medical records KW - EMR KW - relational database KW - knowledge graph N2 - Background: Question answering (QA) systems for patient-related data can assist both clinicians and patients. They can, for example, assist clinicians in decision-making and enable patients to have a better understanding of their medical history. Substantial amounts of patient data are stored in electronic health records (EHRs), making EHR QA an important research area. Because of the differences in data format and modality, this differs greatly from other medical QA tasks that use medical websites or scientific papers to retrieve answers, making it critical to research EHR QA. Objective: This study aims to provide a methodological review of existing works on QA for EHRs. The objectives of this study were to identify the existing EHR QA datasets and analyze them, study the state-of-the-art methodologies used in this task, compare the different evaluation metrics used by these state-of-the-art models, and finally elicit the various challenges and the ongoing issues in EHR QA. Methods: We searched for articles from January 1, 2005, to September 30, 2023, in 4 digital sources, including Google Scholar, ACL Anthology, ACM Digital Library, and PubMed, to collect relevant publications on EHR QA. Our systematic screening process followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4111 papers were identified for our study, and after screening based on our inclusion criteria, we obtained 47 papers for further study. The selected studies were then classified into 2 non?mutually exclusive categories depending on their scope: ?EHR QA datasets? and ?EHR QA models.? Results: A systematic screening process obtained 47 papers on EHR QA for final review. Out of the 47 papers, 53% (n=25) were about EHR QA datasets, and 79% (n=37) papers were about EHR QA models. It was observed that QA on EHRs is relatively new and unexplored. Most of the works are fairly recent. In addition, it was observed that emrQA is by far the most popular EHR QA dataset, both in terms of citations and usage in other papers. We have classified the EHR QA datasets based on their modality, and we have inferred that Medical Information Mart for Intensive Care (MIMIC-III) and the National Natural Language Processing Clinical Challenges datasets (ie, n2c2 datasets) are the most popular EHR databases and corpuses used in EHR QA. Furthermore, we identified the different models used in EHR QA along with the evaluation metrics used for these models. Conclusions: EHR QA research faces multiple challenges, such as the limited availability of clinical annotations, concept normalization in EHR QA, and challenges faced in generating realistic EHR QA datasets. There are still many gaps in research that motivate further work. This study will assist future researchers in focusing on areas of EHR QA that have possible future research directions. UR - https://www.jmir.org/2024/1/e53636 UR - http://dx.doi.org/10.2196/53636 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53636 ER - TY - JOUR AU - Mustafa, Khairiyah Noor AU - Ibrahim, Roszita AU - Aizuddin, Noor Azimatun AU - Aljunid, Mohamed Syed AU - Awang, Zainudin PY - 2024/10/29 TI - Critical Success Factors and Acceptance of the Casemix System Implementation Within the Total Hospital Information System: Exploratory Factor Analysis of a Pilot Study JO - JMIR Form Res SP - e56898 VL - 8 KW - critical success factors KW - exploratory factor analysis KW - Casemix system KW - acceptance KW - Total Hospital Information System N2 - Background: The health care landscape is evolving rapidly due to rising costs, an aging population, and the increasing prevalence of diseases. To address these challenges, the Ministry of Health of Malaysia implemented transformation strategies such as the Casemix system and hospital information system to enhance health care quality, resource allocation, and cost-effectiveness. However, successful implementation relies not just on the technology itself but on the acceptance and engagement of the users involved. Objective: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health?s Total Hospital Information System (THIS). Methods: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study?s minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach ? assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp). Results: This study obtained 106 valid responses, equivalent to an 84.8% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P<.001). Principal component analysis identified 9 components explaining 84.07% of the total variance, surpassing the minimum requirement of 60%. In total, 9 unique slopes indicated the identification of 9 components through EFA. While no new components emerged from the other 7 constructs, only the organizational factors construct was divided into 2 components, later named organizational structure and organizational environment. In total, 98% (41/42) of the items had factor loadings of >0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach ? ranged from 0.914 to 0.969, demonstrating high reliability. Conclusions: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals. UR - https://formative.jmir.org/2024/1/e56898 UR - http://dx.doi.org/10.2196/56898 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470697 ID - info:doi/10.2196/56898 ER - TY - JOUR AU - van Maurik, S. I. AU - Doodeman, J. H. AU - Veeger-Nuijens, W. B. AU - Möhringer, M. R. P. AU - Sudiono, R. D. AU - Jongbloed, W. AU - van Soelen, E. PY - 2024/10/24 TI - Targeted Development and Validation of Clinical Prediction Models in Secondary Care Settings: Opportunities and Challenges for Electronic Health Record Data JO - JMIR Med Inform SP - e57035 VL - 12 KW - clinical prediction model KW - electronic health record KW - targeted validation KW - EHR KW - EMR KW - prediction models KW - validation KW - CPM KW - secondary care KW - machine learning KW - artificial intelligence KW - AI UR - https://medinform.jmir.org/2024/1/e57035 UR - http://dx.doi.org/10.2196/57035 ID - info:doi/10.2196/57035 ER - TY - JOUR AU - Chen, Baozhan AU - Shi, Xiaobing AU - Feng, Tianyi AU - Jiang, Shuai AU - Zhai, Yunkai AU - Ren, Mingxing AU - Liu, Dongqing AU - Wang, Chengzeng AU - Gao, Jinghong PY - 2024/10/24 TI - Construction and Application of a Private 5G Standalone Medical Network in a Smart Health Environment: Exploratory Practice From China JO - J Med Internet Res SP - e52404 VL - 26 KW - 5G KW - medical private network KW - construction KW - application KW - performance test N2 - Background: To date, the differentiated requirements for network performance in various health care service scenarios?within, outside, and between hospitals?remain a key challenge that restricts the development and implementation of digital medical services. Objective: This study aims to construct and implement a private 5G (the 5th generation mobile communication technology) standalone (SA) medical network in a smart health environment to meet the diverse needs of various medical services. Methods: Based on an analysis of network differentiation requirements in medical applications, the system architecture and functional positioning of the proposed private 5G SA medical network are designed and implemented. The system architecture includes the development of exclusive and preferential channels for medical use, as well as an ordinary user channel. A 3-layer network function architecture is designed, encompassing resource, control, and intelligent operation layers to facilitate management arrangements and provide network open services. Core technologies, including edge cloud collaboration; service awareness; and slicing of access, bearer, and core networks, are employed in the construction and application of the 5G SA network. Results: The construction of the private 5G SA medical network primarily involves system architecture, standards, and security measures. The system, featuring exclusive, preferential, and common channels, supports a variety of medical applications. Relevant standards are adhered to in order to ensure the interaction and sharing of medical service information. Security is achieved through mechanisms such as authentication, abnormal behavior analysis, and dynamic access control. Three typical medical applications that rely on the 5G network in intrahospital, interhospital, and out-of-hospital scenarios?namely, mobile ward rounds, remote first aid, and remote ultrasound?were conducted. Testing of the 5G-enabled mobile ward rounds showed an average download rate of 790 Mbps and an average upload rate of 91 Mbps. Compared with 4G, the 5G network more effectively meets the diverse requirements of various business applications in prehospital emergency scenarios. For remote ultrasound, the average downlink rate of the 5G network is 4.82 Mbps, and the average uplink rate is 2 Mbps, with an average fluctuation of approximately 8 ms. The bandwidth, performance, and delay of the 5G SA network were also examined and confirmed to be effective. Conclusions: The proposed 5G SA medical network demonstrates strong performance in typical medical applications. Its construction and application could lead to the development of new medical service models and provide valuable references for the further advancement and implementation of 5G networks in other industries, both in China and globally. UR - https://www.jmir.org/2024/1/e52404 UR - http://dx.doi.org/10.2196/52404 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446419 ID - info:doi/10.2196/52404 ER - TY - JOUR AU - Rashid, Zulqarnain AU - Folarin, A. Amos AU - Zhang, Yuezhou AU - Ranjan, Yatharth AU - Conde, Pauline AU - Sankesara, Heet AU - Sun, Shaoxiong AU - Stewart, Callum AU - Laiou, Petroula AU - Dobson, B. Richard J. PY - 2024/10/23 TI - Digital Phenotyping of Mental and Physical Conditions: Remote Monitoring of Patients Through RADAR-Base Platform JO - JMIR Ment Health SP - e51259 VL - 11 KW - digital biomarkers KW - mHealth KW - mobile apps KW - Internet of Things KW - remote data collection KW - wearables KW - real-time monitoring KW - platform KW - biomarkers KW - wearable KW - smartphone KW - data collection KW - open-source platform KW - RADAR-base KW - phenotyping KW - mobile phone KW - IoT N2 - Background: The use of digital biomarkers through remote patient monitoring offers valuable and timely insights into a patient?s condition, including aspects such as disease progression and treatment response. This serves as a complementary resource to traditional health care settings leveraging mobile technology to improve scale and lower latency, cost, and burden. Objective: Smartphones with embedded and connected sensors have immense potential for improving health care through various apps and mobile health (mHealth) platforms. This capability could enable the development of reliable digital biomarkers from long-term longitudinal data collected remotely from patients. Methods: We built an open-source platform, RADAR-base, to support large-scale data collection in remote monitoring studies. RADAR-base is a modern remote data collection platform built around Confluent?s Apache Kafka to support scalability, extensibility, security, privacy, and quality of data. It provides support for study design and setup and active (eg, patient-reported outcome measures) and passive (eg, phone sensors, wearable devices, and Internet of Things) remote data collection capabilities with feature generation (eg, behavioral, environmental, and physiological markers). The back end enables secure data transmission and scalable solutions for data storage, management, and data access. Results: The platform has been used to successfully collect longitudinal data for various cohorts in a number of disease areas including multiple sclerosis, depression, epilepsy, attention-deficit/hyperactivity disorder, Alzheimer disease, autism, and lung diseases. Digital biomarkers developed through collected data are providing useful insights into different diseases. Conclusions: RADAR-base offers a contemporary, open-source solution driven by the community for remotely monitoring, collecting data, and digitally characterizing both physical and mental health conditions. Clinicians have the ability to enhance their insight through the use of digital biomarkers, enabling improved prevention, personalization, and early intervention in the context of disease management. UR - https://mental.jmir.org/2024/1/e51259 UR - http://dx.doi.org/10.2196/51259 ID - info:doi/10.2196/51259 ER - TY - JOUR AU - Wang, Kun AU - Zou, Wenxin AU - Lai, Yingsi AU - Hao, Chun AU - Liu, Ning AU - Ling, Xiang AU - Liu, Xiaohan AU - Liu, Ting AU - Yang, Xin AU - Zu, Chenxi AU - Wu, Shaolong PY - 2024/10/21 TI - Accessibility, Cost, and Quality of an Online Regular Follow-Up Visit Service at an Internet Hospital in China: Mixed Methods Study JO - J Med Internet Res SP - e54902 VL - 26 KW - internet hospital KW - medical service KW - accessibility KW - cost KW - quality KW - regular follow-up N2 - Background: Telemedicine provides remote health care services to overcome constraints of time and space in accessing medical care. Similarly, internet hospitals in China support and provide remote health care services. Due to the COVID-19 pandemic, there has been a proliferation of internet hospitals. Many new services, including online consultations and regular online follow-up visit services, can now be accessed via internet hospitals in China. However, the accessibility, cost, and quality advantages of regular online follow-up visit services remain unclear. Objective: This study aimed to evaluate the accessibility, costs, and quality of an online regular follow-up visit service provided by an internet hospital in China. By analyzing the accessibility, costs, and quality of this service from the supply and demand sides, we can summarize the practical and theoretical experiences. Methods: A mixed methods study was conducted using clinical records from 18,473 patients receiving 39,239 online regular follow-up visit services at an internet hospital in 2021, as well as interviews with 7 physicians, 2 head nurses, and 3 administrative staff members. The quantitative analysis examined patient demographics, diagnoses, prescriptions, geographic distribution, physician characteristics, accessibility (travel time and costs), and service hours. The qualitative analysis elucidated physician perspectives on ensuring the quality of online health care. Results: Patients were predominantly middle-aged men with chronic diseases like viral hepatitis who were located near the hospital. The vast majority were from Guangdong province where the hospital is based, especially concentrated in Guangzhou city. The online regular follow-up visit service reduced travel time by 1 hour to 9 hours and costs by ¥6 to ¥991 (US $0.86-$141.32) depending on proximity, with greater savings for patients farther from the hospital. Consultation times were roughly equivalent between online and in-person visits. Physicians provided most online services during lunch breaks (12 PM to 2 PM) or after work hours (7 PM to 11 PM), indicating increased workload. The top departments providing online regular follow-up visit services were Infectious Diseases, Rheumatology, and Dermatology. The most commonly prescribed medications aligned with the prevalent chronic diagnoses. To ensure quality, physicians conducted initial in-person consultations to fully evaluate patients before allowing online regular follow-up visits, during which they communicated with patients to assess conditions and determine if in-person care was warranted. They also periodically reminded patients to come in person for more comprehensive evaluations. However, they acknowledged online visits cannot fully replace face-to-face care. Conclusions: Telemedicine services such as online regular follow-up visit services provided by internet hospitals must strictly adhere to fundamental medical principles of diagnosis, prescription, and treatment. For patients with chronic diseases, online regular follow-up visit services improve accessibility and reduce cost but cannot fully replace in-person evaluations. Physicians leverage various strategies to ensure the quality of online care. UR - https://www.jmir.org/2024/1/e54902 UR - http://dx.doi.org/10.2196/54902 UR - http://www.ncbi.nlm.nih.gov/pubmed/39432365 ID - info:doi/10.2196/54902 ER - TY - JOUR AU - Fernando, Manasha AU - Abell, Bridget AU - McPhail, M. Steven AU - Tyack, Zephanie AU - Tariq, Amina AU - Naicker, Sundresan PY - 2024/10/17 TI - Applying the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability Framework Across Implementation Stages to Identify Key Strategies to Facilitate Clinical Decision Support System Integration Within a Large Metropolitan Health Service: Interview and Focus Group Study JO - JMIR Med Inform SP - e60402 VL - 12 KW - medical informatics KW - adoption and implementation KW - behavior KW - health systems N2 - Background: Computerized clinical decision support systems (CDSSs) enhance patient care through real-time, evidence-based guidance for health care professionals. Despite this, the effective implementation of these systems for health services presents multifaceted challenges, leading to inappropriate use and abandonment over the course of time. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework, this qualitative study examined CDSS adoption in a metropolitan health service, identifying determinants across implementation stages to optimize CDSS integration into health care practice. Objective: This study aims to identify the theory-informed (NASSS) determinants, which included multiple CDSS interventions across a 2-year period, both at the health-service level and at the individual hospital setting, that either facilitate or hinder the application of CDSSs within a metropolitan health service. In addition, this study aimed to map these determinants onto specific stages of the implementation process, thereby developing a system-level understanding of CDSS application across implementation stages. Methods: Participants involved in various stages of the implementation process were recruited (N=30). Participants took part in interviews and focus groups. We used a hybrid inductive-deductive qualitative content analysis and a framework mapping approach to categorize findings into barriers, enablers, or neutral determinants aligned to NASSS framework domains. These determinants were also mapped to implementation stages using the Active Implementation Framework stages approach. Results: Participants comprised clinical adopters (14/30, 47%), organizational champions (5/30, 16%), and those with roles in organizational clinical informatics (5/30, 16%). Most determinants were mapped to the organization level, technology, and adopter subdomains. However, the study findings also demonstrated a relative lack of long-term implementation planning. Consequently, determinants were not uniformly distributed across the stages of implementation, with 61.1% (77/126) identified in the exploration stage, 30.9% (39/126) in the full implementation stage, and 4.7% (6/126) in the installation stages. Stakeholders engaged in more preimplementation and full-scale implementation activities, with fewer cycles of monitoring and iteration activities identified. Conclusions: These findings addressed a substantial knowledge gap in the literature using systems thinking principles to identify the interdependent dynamics of CDSS implementation. A lack of sustained implementation strategies (ie, training and longer-term, adopter-level championing) weakened the sociotechnical network between developers and adopters, leading to communication barriers. More rigorous implementation planning, encompassing all 4 implementation stages, may, in a way, help in addressing the barriers identified and enhancing enablers. UR - https://medinform.jmir.org/2024/1/e60402 UR - http://dx.doi.org/10.2196/60402 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60402 ER - TY - JOUR AU - Chimbo, Bester AU - Motsi, Lovemore PY - 2024/10/16 TI - The Effects of Electronic Health Records on Medical Error Reduction: Extension of the DeLone and McLean Information System Success Model JO - JMIR Med Inform SP - e54572 VL - 12 KW - medication error KW - patient safety KW - information system KW - information systems KW - electronic health record KW - service quality N2 - Background: Medical errors are becoming a major problem for health care providers and those who design health policies. These errors cause patients? illnesses to worsen over time and can make recovery impossible. For the benefit of patients and the welfare of health care providers, a decrease in these errors is required to maintain safe, high-quality patient care. Objective: This study aimed to improve the ability of health care professionals to diagnose diseases and reduce medical errors. Methods: Data collection was performed at Dr George Mukhari Academic Hospital using convenience sampling. In total, 300 health care professionals were given a self-administered questionnaire, including doctors, dentists, pharmacists, physiologists, and nurses. To test the study hypotheses, multiple linear regression was used to evaluate empirical data. Results: In the sample of 300 health care professionals, no significant correlation was found between medical error reduction (MER) and knowledge quality (KQ) (?=.043, P=.48). A nonsignificant negative relationship existed between MER and information quality (IQ) (?=?.080, P=.19). However, a significant positive relationship was observed between MER and electronic health records (EHR; ?=.125, 95% CI 0.005-0.245, P=.042). Conclusions: Increasing patient access to medical records for health care professionals may significantly improve patient health and well-being. The effectiveness of health care organizations? operations can also be increased through better health information systems. To lower medical errors and enhance patient outcomes, policy makers should provide financing and support for EHR adoption as a top priority. Health care administrators should also concentrate on providing staff with the training they need to operate these systems efficiently. Empirical surveys in other public and private hospitals can be used to further test the validated survey instrument. UR - https://medinform.jmir.org/2024/1/e54572 UR - http://dx.doi.org/10.2196/54572 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412857 ID - info:doi/10.2196/54572 ER - TY - JOUR AU - Rosenau, Lorenz AU - Gruendner, Julian AU - Kiel, Alexander AU - Köhler, Thomas AU - Schaffer, Bastian AU - Majeed, W. Raphael PY - 2024/10/14 TI - Bridging Data Models in Health Care With a Novel Intermediate Query Format for Feasibility Queries: Mixed Methods Study JO - JMIR Med Inform SP - e58541 VL - 12 KW - feasibility KW - FHIR KW - CQL KW - eligibility criteria KW - clinical research KW - intermediate query format KW - healthcare interoperability KW - cohort definition KW - query KW - queries KW - interoperability KW - interoperable KW - informatics KW - portal KW - portals KW - implementation KW - develop KW - development KW - ontology KW - ontologies KW - JSON N2 - Background: To advance research with clinical data, it is essential to make access to the available data as fast and easy as possible for researchers, which is especially challenging for data from different source systems within and across institutions. Over the years, many research repositories and data standards have been created. One of these is the Fast Healthcare Interoperability Resources (FHIR) standard, used by the German Medical Informatics Initiative (MII) to harmonize and standardize data across university hospitals in Germany. One of the first steps to make these data available is to allow researchers to create feasibility queries to determine the data availability for a specific research question. Given the heterogeneity of different query languages to access different data across and even within standards such as FHIR (eg, CQL and FHIR Search), creating an intermediate query syntax for feasibility queries reduces the complexity of query translation and improves interoperability across different research repositories and query languages. Objective: This study describes the creation and implementation of an intermediate query syntax for feasibility queries and how it integrates into the federated German health research portal (Forschungsdatenportal Gesundheit) and the MII. Methods: We analyzed the requirements for feasibility queries and the feasibility tools that are currently available in research repositories. Based on this analysis, we developed an intermediate query syntax that can be easily translated into different research repository?specific query languages. Results: The resulting Clinical Cohort Definition Language (CCDL) for feasibility queries combines inclusion criteria in a conjunctive normal form and exclusion criteria in a disjunctive normal form, allowing for additional filters like time or numerical restrictions. The inclusion and exclusion results are combined via an expression to specify feasibility queries. We defined a JSON schema for the CCDL, generated an ontology, and demonstrated the use and translatability of the CCDL across multiple studies and real-world use cases. Conclusions: We developed and evaluated a structured query syntax for feasibility queries and demonstrated its use in a real-world example as part of a research platform across 39 German university hospitals. UR - https://medinform.jmir.org/2024/1/e58541 UR - http://dx.doi.org/10.2196/58541 ID - info:doi/10.2196/58541 ER - TY - JOUR AU - Chen, Tingting AU - Tang, Xiaofen AU - Xu, Min AU - Jiang, Yue AU - Zheng, Fengyan PY - 2024/10/14 TI - Application of Information Link Control in Surgical Specimen Near-Miss Events in a South China Hospital: Nonrandomized Controlled Study JO - JMIR Med Inform SP - e52722 VL - 12 KW - near misses KW - technical barriers KW - process barriers KW - surgical specimens KW - information N2 - Background: Information control is a promising approach for managing surgical specimens. However, there is limited research evidence on surgical near misses. This is particularly true in the closed loop of information control for each link. Objective: A new model of surgical specimen process management is further constructed, and a safe operating room nursing practice environment is created by intercepting specimen near-miss events through information safety barriers. Methods: In a large hospital in China, 84,289 surgical specimens collected in the conventional information specimen management mode from January to December 2021 were selected as the control group, and 99,998 surgical specimens collected in the information safety barrier control surgical specimen management mode from January to December 2022 were selected as the improvement group. The incidence of near misses, the qualified rate of pathological specimen fixation, and the average time required for specimen fixation were compared under the 2 management modes. The causes of 2 groups of near misses were analyzed and the near misses of information safety barrier control surgical specimens were studied. Results: Under the information-based safety barrier control surgical specimen management model, the incidence of adverse events in surgical specimens was reduced, the reporting of near-miss events in surgical specimens was improved by 100%, the quality control quality management of surgical specimens was effectively improved, the pass rate of surgical pathology specimen fixation was improved, and the meantime for surgical specimen fixation was shortened, with differences considered statistically significant at P<.05. Conclusions: Our research has developed a new mode of managing the surgical specimen process. This mode can prevent errors in approaching specimens by implementing information security barriers, thereby enhancing the quality of specimen management, ensuring the safety of medical procedures, and improving the quality of hospital services. UR - https://medinform.jmir.org/2024/1/e52722 UR - http://dx.doi.org/10.2196/52722 ID - info:doi/10.2196/52722 ER - TY - JOUR AU - Faulkenberry, Grey AU - Masizana, Audrey AU - Mosesane, Badisa AU - Ndlovu, Kagiso PY - 2024/10/9 TI - Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment JO - JMIR Res Protoc SP - e52411 VL - 13 KW - global health KW - health information systems KW - electronic health care records KW - EHRs KW - interoperability KW - data flow KW - access to information KW - health information interoperability KW - pediatric KW - pediatrics KW - infant KW - infants KW - clinical data KW - mixed method KW - Botswana KW - health care information KW - child health KW - tuberculosis KW - HIV KW - eLearning KW - survey KW - health informatics KW - communication N2 - Background: Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that ?there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level,? seconded by the Botswana National eLearning strategy (2020), which states that ?there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating.? Objective: The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. Methods: The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. Results: The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. Conclusions: This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study?s objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. International Registered Report Identifier (IRRID): DERR1-10.2196/52411 UR - https://www.researchprotocols.org/2024/1/e52411 UR - http://dx.doi.org/10.2196/52411 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52411 ER - TY - JOUR AU - Cao, Teng AU - Chen, Zhi AU - Nakayama, Masaharu PY - 2024/10/9 TI - Enhancing the Functionalities of Personal Health Record Systems: Empirical Study Based on the HL7 Personal Health Record System Functional Model Release 1 JO - JMIR Med Inform SP - e56735 VL - 12 KW - fast healthcare interoperability resources KW - logical observation identifiers names and codes KW - personal health record system functional model KW - personal health records N2 - Background: The increasing demand for personal health record (PHR) systems is driven by individuals? desire to actively manage their health care. However, the limited functionality of current PHR systems has affected users? willingness to adopt them, leading to lower-than-expected usage rates. The HL7 (Health Level Seven) PHR System Functional Model (PHR-S FM) was proposed to address this issue, outlining all possible functionalities in PHR systems. Although the PHR-S FM provides a comprehensive theoretical framework, its practical effectiveness and applicability have not been fully explored. Objective: This study aimed to design and develop a tethered PHR prototype in accordance with the guidelines of the PHR-S FM. It sought to explore the feasibility of applying the PHR-S FM in PHR systems by comparing the prototype with the results of previous research. Methods: The PHR-S FM profile was defined to meet broad clinical data management requirements based on previous research. We designed and developed a PHR prototype as a web application using the Fast Healthcare Interoperability Resources R4 (FHIR) and Logical Observation Identifiers Names and Codes (LOINC) coding system for interoperability and data consistency. We validated the prototype using the Synthea dataset, which provided realistic synthetic medical records. In addition, we compared the results produced by the prototype with those of previous studies to evaluate the feasibility and implementation of the PHR-S FM framework. Results: The PHR prototype was developed based on the PHR-S FM profile. We verified its functionality by demonstrating its ability to synchronize data with the FHIR server, effectively managing and displaying various health data types. Validation using the Synthea dataset confirmed the prototype?s accuracy, achieving 100% coverage across 1157 data items. A comparison with the findings of previous studies indicated the feasibility of implementing the PHR-S FM and highlighted areas for future research and improvements. Conclusions: The results of this study offer valuable insights into the potential for practical application and broad adoption of the PHR-S FM in real-world health care settings. UR - https://medinform.jmir.org/2024/1/e56735 UR - http://dx.doi.org/10.2196/56735 ID - info:doi/10.2196/56735 ER - TY - JOUR AU - Suzumoto, Jun AU - Mori, Yukiko AU - Kuroda, Tomohiro PY - 2024/10/9 TI - Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study JO - JMIR Med Inform SP - e56263 VL - 12 KW - health information exchange KW - audit log KW - Japan KW - HIE KW - audit KW - logs KW - usage KW - medical informatics KW - rate KW - hospitals KW - electronic health record N2 - Background: Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown. Objective: This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan. Methods: We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker?s profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type?s monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE. Results: We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470?0.487) for hospitals, 0.243 (0.230?0.247) for medical clinics, and 0.030 (0.024?0.048) for dental clinics. In 51.9% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8% (921/3434) of hospitals, it was between 1 and 10, and in 3% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487?0.529) for the most used HIE and 0.109 (0.0927?0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned. Conclusions: In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets. UR - https://medinform.jmir.org/2024/1/e56263 UR - http://dx.doi.org/10.2196/56263 ID - info:doi/10.2196/56263 ER - TY - JOUR AU - Gundler, Christopher AU - Gottfried, Karl AU - Wiederhold, Johannes Alexander AU - Ataian, Maximilian AU - Wurlitzer, Marcus AU - Gewehr, Erik Jan AU - Ückert, Frank PY - 2024/10/1 TI - Unlocking the Potential of Secondary Data for Public Health Research: Retrospective Study With a Novel Clinical Platform JO - Interact J Med Res SP - e51563 VL - 13 KW - secondary use KW - hypothesis testing KW - research platform KW - clinical data KW - Parkinson disease KW - data KW - health-related research KW - health data KW - electronic health record KW - EHR KW - tremor N2 - Background: Clinical routine data derived from university hospitals hold immense value for health-related research on large cohorts. However, using secondary data for hypothesis testing necessitates adherence to scientific, legal (such as the General Data Protection Regulation, federal and state protection legislations), technical, and administrative requirements. This process is intricate, time-consuming, and susceptible to errors. Objective: This study aims to develop a platform that enables clinicians to use current real-world data for testing research and evaluate advantages and limitations at a large university medical center (542,944 patients in 2022). Methods: We identified requirements from clinical practitioners, conceptualized and implemented a platform based on the existing components, and assessed its applicability in clinical reality quantitatively and qualitatively. Results: The proposed platform was established at the University Medical Center Hamburg-Eppendorf and made 639 forms encompassing 10,629 data elements accessible to all resident scientists and clinicians. Every day, the number of patients rises, and parts of their electronic health records are made accessible through the platform. Qualitatively, we were able to conduct a retrospective analysis of Parkinson disease over 777 patients, where we provide additional evidence for a significantly higher proportion of action tremors in patients with rest tremors (340/777, 43.8%) compared with those without rest tremors (255/777, 32.8%), as determined by a chi-square test (P<.001). Quantitatively, our findings demonstrate increased user engagement within the last 90 days, underscoring clinicians? increasing adoption of the platform in their regular research activities. Notably, the platform facilitated the retrieval of clinical data from 600,000 patients, emphasizing its substantial added value. Conclusions: This study demonstrates the feasibility of simplifying the use of clinical data to enhance exploration and sustainability in scientific research. The proposed platform emerges as a potential technological and legal framework for other medical centers, providing them with the means to unlock untapped potential within their routine data. UR - https://www.i-jmr.org/2024/1/e51563 UR - http://dx.doi.org/10.2196/51563 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51563 ER - TY - JOUR AU - Maaß, Laura AU - Hrynyschyn, Robert AU - Lange, Martin AU - Löwe, Alexandra AU - Burdenski, Kathrin AU - Butten, Kaley AU - Vorberg, Sebastian AU - Hachem, Mariam AU - Gorga, Aldo AU - Grieco, Vittorio AU - Restivo, Vincenzo AU - Vella, Giuseppe AU - Varnfield, Marlien AU - Holl, Felix PY - 2024/9/30 TI - Challenges and Alternatives to Evaluation Methods and Regulation Approaches for Medical Apps as Mobile Medical Devices: International and Multidisciplinary Focus Group Discussion JO - J Med Internet Res SP - e54814 VL - 26 KW - medical apps KW - mobile medical devices KW - evaluation methods KW - mobile medical device regulation KW - focus group study KW - alternative approaches KW - logic model KW - mobile phone N2 - Background: The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices. Objective: This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps. Methods: Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings. Results: The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a ?scientific reflex? where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users. Conclusions: It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices. UR - https://www.jmir.org/2024/1/e54814 UR - http://dx.doi.org/10.2196/54814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54814 ER - TY - JOUR AU - Hu, Zhengyong AU - Wang, Anran AU - Duan, Yifan AU - Zhou, Jiayin AU - Hu, Wanfei AU - Wu, Sizhu PY - 2024/9/30 TI - Toward Better Semantic Interoperability of Data Element Repositories in Medicine: Analysis Study JO - JMIR Med Inform SP - e60293 VL - 12 KW - data element repository KW - FAIR KW - ISO/IEC 11179 KW - metadata KW - semantic interoperability N2 - Background: Data element repositories facilitate high-quality medical data sharing by standardizing data and enhancing semantic interoperability. However, the application of repositories is confined to specific projects and institutions. Objective: This study aims to explore potential issues and promote broader application of data element repositories within the medical field by evaluating and analyzing typical repositories. Methods: Following the inclusion of 5 data element repositories through a literature review, a novel analysis framework consisting of 7 dimensions and 36 secondary indicators was constructed and used for evaluation and analysis. Results: The study?s results delineate the unique characteristics of different repositories and uncover specific issues in their construction. These issues include the absence of data reuse protocols and insufficient information regarding the application scenarios and efficacy of data elements. The repositories fully comply with only 45% (9/20) of the subprinciples for Findable and Reusable in the FAIR principle, while achieving a 90% (19/20 subprinciples) compliance rate for Accessible and 67% (10/15 subprinciples) for Interoperable. Conclusions: The recommendations proposed in this study address the issues to improve the construction and application of repositories, offering valuable insights to data managers, computer experts, and other pertinent stakeholders. UR - https://medinform.jmir.org/2024/1/e60293 UR - http://dx.doi.org/10.2196/60293 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348178 ID - info:doi/10.2196/60293 ER - TY - JOUR AU - Tabari, Parinaz AU - Costagliola, Gennaro AU - De Rosa, Mattia AU - Boeker, Martin PY - 2024/9/24 TI - State-of-the-Art Fast Healthcare Interoperability Resources (FHIR)?Based Data Model and Structure Implementations: Systematic Scoping Review JO - JMIR Med Inform SP - e58445 VL - 12 KW - data model KW - Fast Healthcare Interoperability Resources KW - FHIR KW - interoperability KW - modeling KW - PRISMA N2 - Background: Data models are crucial for clinical research as they enable researchers to fully use the vast amount of clinical data stored in medical systems. Standardized data and well-defined relationships between data points are necessary to guarantee semantic interoperability. Using the Fast Healthcare Interoperability Resources (FHIR) standard for clinical data representation would be a practical methodology to enhance and accelerate interoperability and data availability for research. Objective: This research aims to provide a comprehensive overview of the state-of-the-art and current landscape in FHIR-based data models and structures. In addition, we intend to identify and discuss the tools, resources, limitations, and other critical aspects mentioned in the selected research papers. Methods: To ensure the extraction of reliable results, we followed the instructions of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We analyzed the indexed articles in PubMed, Scopus, Web of Science, IEEE Xplore, the ACM Digital Library, and Google Scholar. After identifying, extracting, and assessing the quality and relevance of the articles, we synthesized the extracted data to identify common patterns, themes, and variations in the use of FHIR-based data models and structures across different studies. Results: On the basis of the reviewed articles, we could identify 2 main themes: dynamic (pipeline-based) and static data models. The articles were also categorized into health care use cases, including chronic diseases, COVID-19 and infectious diseases, cancer research, acute or intensive care, random and general medical notes, and other conditions. Furthermore, we summarized the important or common tools and approaches of the selected papers. These items included FHIR-based tools and frameworks, machine learning approaches, and data storage and security. The most common resource was ?Observation? followed by ?Condition? and ?Patient.? The limitations and challenges of developing data models were categorized based on the issues of data integration, interoperability, standardization, performance, and scalability or generalizability. Conclusions: FHIR serves as a highly promising interoperability standard for developing real-world health care apps. The implementation of FHIR modeling for electronic health record data facilitates the integration, transmission, and analysis of data while also advancing translational research and phenotyping. Generally, FHIR-based exports of local data repositories improve data interoperability for systems and data warehouses across different settings. However, ongoing efforts to address existing limitations and challenges are essential for the successful implementation and integration of FHIR data models. UR - https://medinform.jmir.org/2024/1/e58445 UR - http://dx.doi.org/10.2196/58445 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316433 ID - info:doi/10.2196/58445 ER - TY - JOUR AU - Ohlsen, Tessa AU - Ingenerf, Josef AU - Essenwanger, Andrea AU - Drenkhahn, Cora PY - 2024/9/17 TI - PCEtoFHIR: Decomposition of Postcoordinated SNOMED CT Expressions for Storage as HL7 FHIR Resources JO - JMIR Med Inform SP - e57853 VL - 12 KW - SNOMED CT KW - HL7 FHIR KW - TermInfo KW - postcoordination KW - semantic interoperability KW - terminology KW - OWL KW - semantic similarity N2 - Background: To ensure interoperability, both structural and semantic standards must be followed. For exchanging medical data between information systems, the structural standard FHIR (Fast Healthcare Interoperability Resources) has recently gained popularity. Regarding semantic interoperability, the reference terminology SNOMED Clinical Terms (SNOMED CT), as a semantic standard, allows for postcoordination, offering advantages over many other vocabularies. These postcoordinated expressions (PCEs) make SNOMED CT an expressive and flexible interlingua, allowing for precise coding of medical facts. However, this comes at the cost of increased complexity, as well as challenges in storage and processing. Additionally, the boundary between semantic (terminology) and structural (information model) standards becomes blurred, leading to what is known as the TermInfo problem. Although often viewed critically, the TermInfo overlap can also be explored for its potential benefits, such as enabling flexible transformation of parts of PCEs. Objective: In this paper, an alternative solution for storing PCEs is presented, which involves combining them with the FHIR data model. Ultimately, all components of a PCE should be expressible solely through precoordinated concepts that are linked to the appropriate elements of the information model. Methods: The approach involves storing PCEs decomposed into their components in alignment with FHIR resources. By utilizing the Web Ontology Language (OWL) to generate an OWL ClassExpression, and combining it with an external reasoner and semantic similarity measures, a precoordinated SNOMED CT concept that most accurately describes the PCE is identified as a Superconcept. In addition, the nonmatching attribute relationships between the Superconcept and the PCE are identified as the ?Delta.? Once SNOMED CT attributes are manually mapped to FHIR elements, FHIRPath expressions can be defined for both the Superconcept and the Delta, allowing the identified precoordinated codes to be stored within FHIR resources. Results: A web application called PCEtoFHIR was developed to implement this approach. In a validation process with 600 randomly selected precoordinated concepts, the formal correctness of the generated OWL ClassExpressions was verified. Additionally, 33 PCEs were used for two separate validation tests. Based on these validations, it was demonstrated that a previously proposed semantic similarity calculation is suitable for determining the Superconcept. Additionally, the 33 PCEs were used to confirm the correct functioning of the entire approach. Furthermore, the FHIR StructureMaps were reviewed and deemed meaningful by FHIR experts. Conclusions: PCEtoFHIR offers services to decompose PCEs for storage within FHIR resources. When creating structure mappings for specific subdomains of SNOMED CT concepts (eg, allergies) to desired FHIR profiles, the use of SNOMED CT Expression Templates has proven highly effective. Domain experts can create templates with appropriate mappings, which can then be easily reused in a constrained manner by end users. UR - https://medinform.jmir.org/2024/1/e57853 UR - http://dx.doi.org/10.2196/57853 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57853 ER - TY - JOUR AU - Ferreira, Diana AU - Neto, Cristiana AU - Hak, Francini AU - Abelha, António AU - Santos, Manuel AU - Machado, José PY - 2024/9/16 TI - Standardizing Corneal Transplantation Records Using openEHR: Case Study JO - JMIR Med Inform SP - e48407 VL - 12 KW - electronic health record KW - EHR KW - corneal transplantation KW - keratoplasty KW - openEHR KW - data representation KW - data exchange KW - templates KW - archetypes KW - forms KW - standardization N2 - Background: Corneal transplantation, also known as keratoplasty, is a widely performed surgical procedure that aims to restore vision in patients with corneal damage. The success of corneal transplantation relies on the accurate and timely management of patient information, which can be enhanced using electronic health records (EHRs). However, conventional EHRs are often fragmented and lack standardization, leading to difficulties in information access and sharing, increased medical errors, and decreased patient safety. In the wake of these problems, there is a growing demand for standardized EHRs that can ensure the accuracy and consistency of patient data across health care organizations. Objective: This paper proposes the use of openEHR structures for standardizing corneal transplantation records. The main objective of this research was to improve the quality and interoperability of EHRs in corneal transplantation, making it easier for health care providers to capture, share, and analyze clinical information. Methods: A series of sequential steps were carried out in this study to implement standardized clinical records using openEHR specifications. These specifications furnish a methodical approach that ascertains the development of high-quality clinical records. In broad terms, the methodology followed encompasses the conduction of meetings with health care professionals and the modeling of archetypes, templates, forms, decision rules, and work plans. Results: This research resulted in a tailored solution that streamlines health care delivery and meets the needs of medical professionals involved in the corneal transplantation process while seamlessly aligning with contemporary clinical practices. The proposed solution culminated in the successful integration within a Portuguese hospital of 3 key components of openEHR specifications: forms, Decision Logic Modules, and Work Plans. A statistical analysis of data collected from May 1, 2022, to March 31, 2023, allowed for the perception of the use of the new technologies within the corneal transplantation workflow. Despite the completion rate being only 63.9% (530/830), which can be explained by external factors such as patient health and availability of donor organs, there was an overall improvement in terms of task control and follow-up of the patients? clinical process. Conclusions: This study shows that the adoption of openEHR structures represents a significant step forward in the standardization and optimization of corneal transplantation records. It offers a detailed demonstration of how to implement openEHR specifications and highlights the different advantages of standardizing EHRs in the field of corneal transplantation. Furthermore, it serves as a valuable reference for researchers and practitioners who are interested in advancing and improving the exploitation of EHRs in health care. UR - https://medinform.jmir.org/2024/1/e48407 UR - http://dx.doi.org/10.2196/48407 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48407 ER - TY - JOUR AU - Mess, Veronica Elisabeth AU - Kramer, Frank AU - Krumme, Julia AU - Kanelakis, Nico AU - Teynor, Alexandra PY - 2024/9/13 TI - Use of Creative Frameworks in Health Care to Solve Data and Information Problems: Scoping Review JO - JMIR Hum Factors SP - e55182 VL - 11 KW - creative frameworks KW - data and information problems KW - data collection KW - data processing KW - data provision KW - health care KW - information visualization KW - interdisciplinary teams KW - user-centered design KW - user-centered data design KW - user-centric development N2 - Background: Digitization is vital for data management, especially in health care. However, problems still hinder health care stakeholders in their daily work while collecting, processing, and providing health data or information. Data are missing, incorrect, cannot be collected, or information is inadequately presented. These problems can be seen as data or information problems. A proven way to elicit requirements for (software) systems is by using creative frameworks (eg, user-centered design, design thinking, lean UX [user experience], or service design) or creative methods (eg, mind mapping, storyboarding, 6 thinking hats, or interaction room). However, to what extent they are used to solve data or information-related problems in health care is unclear. Objective: The primary objective of this scoping review is to investigate the use of creative frameworks in addressing data and information problems in health care. Methods: Following JBI guidelines and the PRISMA-ScR framework, this paper analyzes selected papers, answering whether creative frameworks addressed health care data or information problems. Focusing on data problems (elicitation or collection, processing) and information problems (provision or visualization), the review examined German and English papers published between 2018 and 2022 using keywords related to ?data,? ?design,? and ?user-centered.? The database SCOPUS was used. Results: Of the 898 query results, only 23 papers described a data or information problem and a creative method to solve it. These were included in the follow-up analysis and divided into different problem categories: data collection (n=7), data processing (n=1), information visualization (n=11), and mixed problems meaning data and information problem present (n=4). The analysis showed that most identified problems fall into the information visualization category. This could indicate that creative frameworks are particularly suitable for solving information or visualization problems and less for other, more abstract areas such as data problems. The results also showed that most researchers applied a creative framework after they knew what specific (data or information) problem they had (n=21). Only a minority chose a creative framework to identify a problem and realize it was a data or information problem (n=2). In response to these findings, the paper discusses the need for a new approach that addresses health care data and information challenges by promoting collaboration, iterative feedback, and user-centered development. Conclusions: Although the potential of creative frameworks is undisputed, applying these in solving data and information problems is a minority. To harness this potential, a suitable method needs to be developed to support health care system stakeholders. This method could be the User-Centered Data Approach. UR - https://humanfactors.jmir.org/2024/1/e55182 UR - http://dx.doi.org/10.2196/55182 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55182 ER - TY - JOUR AU - Staehelin, Dario AU - Dolata, Mateusz AU - Stöckli, Livia AU - Schwabe, Gerhard PY - 2024/9/10 TI - How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research JO - JMIR Med Inform SP - e57406 VL - 12 KW - patient-provider communication KW - patient-generated data KW - field study KW - chronic care KW - design science research KW - patient-centered care KW - integrated care KW - patient-provider collaboration KW - mobile phone N2 - Background: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers? workflow. Objective: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. Methods: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. Results: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. Conclusions: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care. UR - https://medinform.jmir.org/2024/1/e57406 UR - http://dx.doi.org/10.2196/57406 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57406 ER - TY - JOUR AU - Ferguson, M. Jacqueline AU - Van Campen, James AU - Slightam, Cindie AU - Greene, Liberty AU - Heyworth, Leonie AU - Zulman, M. Donna PY - 2024/9/9 TI - Evaluation of the Veterans Health Administration?s Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study JO - J Med Internet Res SP - e59089 VL - 26 KW - veterans KW - health care access KW - video-based care KW - telehealth KW - barriers to care KW - telemedicine N2 - Background: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. Objective: We sought to evaluate the reach and impact of VHA?s Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. Methods: We examined the reach of VHA?s Connected Device Program using national secondary data from VHA?s electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients? demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Results: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. Conclusions: This evaluation of VHA?s Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention. UR - https://www.jmir.org/2024/1/e59089 UR - http://dx.doi.org/10.2196/59089 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250183 ID - info:doi/10.2196/59089 ER - TY - JOUR AU - Faisal, Putra Hiro AU - Nakayama, Masaharu PY - 2024/8/28 TI - Implementation of the World Health Organization Minimum Dataset for Emergency Medical Teams to Create Disaster Profiles for the Indonesian SATUSEHAT Platform Using Fast Healthcare Interoperability Resources: Development and Validation Study JO - JMIR Med Inform SP - e59651 VL - 12 KW - WHO EMT MDS KW - FHIR KW - SATUSEHAT KW - disaster KW - implementation KW - development KW - validation KW - emergency medical team KW - disaster management KW - Indonesia KW - Fast Healthcare Interoperability Resources KW - resources KW - interoperability KW - electronic medical records KW - EMR KW - reporting KW - disaster profile KW - health data KW - health data collection KW - World Health Organization KW - EMT KW - WHO KW - MDS KW - minimum dataset N2 - Background: The National Disaster Management Agency (Badan Nasional Penanggulangan Bencana) handles disaster management in Indonesia as a health cluster by collecting, storing, and reporting information on the state of survivors and their health from various sources during disasters. Data were collected on paper and transferred to Microsoft Excel spreadsheets. These activities are challenging because there are no standards for data collection. The World Health Organization (WHO) introduced a standard for health data collection during disasters for emergency medical teams (EMTs) in the form of a minimum dataset (MDS). Meanwhile, the Ministry of Health of Indonesia launched the SATUSEHAT platform to integrate all electronic medical records in Indonesia based on Fast Healthcare Interoperability Resources (FHIR). Objective: This study aims to implement the WHO EMT MDS to create a disaster profile for the SATUSEHAT platform using FHIR. Methods: We extracted variables from 2 EMT MDS medical records?the WHO and Association of Southeast Asian Nations (ASEAN) versions?and the daily reporting form. We then performed a mapping process to match these variables with the FHIR resources and analyzed the gaps between the variables and base resources. Next, we conducted profiling to see if there were any changes in the selected resources and created extensions to fill the gap using the Forge application. Subsequently, the profile was implemented using an open-source FHIR server. Results: The total numbers of variables extracted from the WHO EMT MDS, ASEAN EMT MDS, and daily reporting forms were 30, 32, and 46, with the percentage of variables matching FHIR resources being 100% (30/30), 97% (31/32), and 85% (39/46), respectively. From the 40 resources available in the FHIR ID core, we used 10, 14, and 9 for the WHO EMT MDS, ASEAN EMT MDS, and daily reporting form, respectively. Based on the gap analysis, we found 4 variables in the daily reporting form that were not covered by the resources. Thus, we created extensions to address this gap. Conclusions: We successfully created a disaster profile that can be used as a disaster case for the SATUSEHAT platform. This profile may standardize health data collection during disasters. UR - https://medinform.jmir.org/2024/1/e59651 UR - http://dx.doi.org/10.2196/59651 ID - info:doi/10.2196/59651 ER - TY - JOUR AU - Fruchart, Mathilde AU - Quindroit, Paul AU - Jacquemont, Chloé AU - Beuscart, Jean-Baptiste AU - Calafiore, Matthieu AU - Lamer, Antoine PY - 2024/8/13 TI - Transforming Primary Care Data Into the Observational Medical Outcomes Partnership Common Data Model: Development and Usability Study JO - JMIR Med Inform SP - e49542 VL - 12 KW - data reuse KW - Observational Medical Outcomes Partnership KW - common data model KW - data warehouse KW - reproducible research KW - primary care KW - dashboard KW - electronic health record KW - patient tracking system KW - patient monitoring KW - EHR KW - primary care data N2 - Background: Patient-monitoring software generates a large amount of data that can be reused for clinical audits and scientific research. The Observational Health Data Sciences and Informatics (OHDSI) consortium developed the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to standardize electronic health record data and promote large-scale observational and longitudinal research. Objective: This study aimed to transform primary care data into the OMOP CDM format. Methods: We extracted primary care data from electronic health records at a multidisciplinary health center in Wattrelos, France. We performed structural mapping between the design of our local primary care database and the OMOP CDM tables and fields. Local French vocabularies concepts were mapped to OHDSI standard vocabularies. To validate the implementation of primary care data into the OMOP CDM format, we applied a set of queries. A practical application was achieved through the development of a dashboard. Results: Data from 18,395 patients were implemented into the OMOP CDM, corresponding to 592,226 consultations over a period of 20 years. A total of 18 OMOP CDM tables were implemented. A total of 17 local vocabularies were identified as being related to primary care and corresponded to patient characteristics (sex, location, year of birth, and race), units of measurement, biometric measures, laboratory test results, medical histories, and drug prescriptions. During semantic mapping, 10,221 primary care concepts were mapped to standard OHDSI concepts. Five queries were used to validate the OMOP CDM by comparing the results obtained after the completion of the transformations with the results obtained in the source software. Lastly, a prototype dashboard was developed to visualize the activity of the health center, the laboratory test results, and the drug prescription data. Conclusions: Primary care data from a French health care facility have been implemented into the OMOP CDM format. Data concerning demographics, units, measurements, and primary care consultation steps were already available in OHDSI vocabularies. Laboratory test results and drug prescription data were mapped to available vocabularies and structured in the final model. A dashboard application provided health care professionals with feedback on their practice. UR - https://medinform.jmir.org/2024/1/e49542 UR - http://dx.doi.org/10.2196/49542 ID - info:doi/10.2196/49542 ER - TY - JOUR AU - Pulantara, Wayan I. AU - Wang, Yuhan AU - Burke, E. Lora AU - Sereika, M. Susan AU - Bizhanova, Zhadyra AU - Kariuki, K. Jacob AU - Cheng, Jessica AU - Beatrice, Britney AU - Loar, India AU - Cedillo, Maribel AU - Conroy, B. Molly AU - Parmanto, Bambang PY - 2024/8/7 TI - Data Collection and Management of mHealth, Wearables, and Internet of Things in Digital Behavioral Health Interventions With the Awesome Data Acquisition Method (ADAM): Development of a Novel Informatics Architecture JO - JMIR Mhealth Uhealth SP - e50043 VL - 12 KW - integrated system KW - IoT integration KW - wearable KW - mHealth Fitbit KW - Nokia KW - clinical trial management KW - research study management KW - study tracking KW - remote assessment KW - tracking KW - Fitbit KW - wearable devices KW - device KW - management KW - data analysis KW - behavioral KW - data collection KW - Internet of Things KW - IoT KW - mHealth KW - mobile health UR - https://mhealth.jmir.org/2024/1/e50043 UR - http://dx.doi.org/10.2196/50043 ID - info:doi/10.2196/50043 ER - TY - JOUR AU - Yilma, Melese Tesfahun AU - Taddese, Asefa AU - Mamuye, Adane AU - Endehabtu, Fikadie Berhanu AU - Alemayehu, Yibeltal AU - Senay, Asaye AU - Daka, Dawit AU - Abraham, Loko AU - Tadesse, Rabeal AU - Melkamu, Gemechis AU - Wendrad, Naod AU - Kaba, Oli AU - Mohammed, Mesoud AU - Denboba, Wubshet AU - Birhan, Dawit AU - Biru, Amanuel AU - Tilahun, Binyam PY - 2024/7/26 TI - Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways JO - JMIR Med Inform SP - e50375 VL - 12 KW - health information system KW - digital health system KW - District Health Information System version 2 KW - DHIS2 KW - maturity assessment KW - Stages of Continuous Improvement KW - Ethiopia N2 - Background: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. Objective: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. Methods: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. Results: The national DHIS2 implementation?s maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. Conclusions: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed. UR - https://medinform.jmir.org/2024/1/e50375 UR - http://dx.doi.org/10.2196/50375 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50375 ER - TY - JOUR AU - Rosenau, Lorenz AU - Behrend, Paul AU - Wiedekopf, Joshua AU - Gruendner, Julian AU - Ingenerf, Josef PY - 2024/7/23 TI - Uncovering Harmonization Potential in Health Care Data Through Iterative Refinement of Fast Healthcare Interoperability Resources Profiles Based on Retrospective Discrepancy Analysis: Case Study JO - JMIR Med Inform SP - e57005 VL - 12 KW - Health Level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - FHIR profiles KW - interoperability KW - data harmonization KW - discrepancy analysis KW - data quality KW - cross-institutional data exchange KW - Medical Informatics Initiative KW - federated data access challenges N2 - Background: Cross-institutional interoperability between health care providers remains a recurring challenge worldwide. The German Medical Informatics Initiative, a collaboration of 37 university hospitals in Germany, aims to enable interoperability between partner sites by defining Fast Healthcare Interoperability Resources (FHIR) profiles for the cross-institutional exchange of health care data, the Core Data Set (CDS). The current CDS and its extension modules define elements representing patients? health care records. All university hospitals in Germany have made significant progress in providing routine data in a standardized format based on the CDS. In addition, the central research platform for health, the German Portal for Medical Research Data feasibility tool, allows medical researchers to query the available CDS data items across many participating hospitals. Objective: In this study, we aimed to evaluate a novel approach of combining the current top-down generated FHIR profiles with the bottom-up generated knowledge gained by the analysis of respective instance data. This allowed us to derive options for iteratively refining FHIR profiles using the information obtained from a discrepancy analysis. Methods: We developed an FHIR validation pipeline and opted to derive more restrictive profiles from the original CDS profiles. This decision was driven by the need to align more closely with the specific assumptions and requirements of the central feasibility platform?s search ontology. While the original CDS profiles offer a generic framework adaptable for a broad spectrum of medical informatics use cases, they lack the specificity to model the nuanced criteria essential for medical researchers. A key example of this is the necessity to represent specific laboratory codings and values interdependencies accurately. The validation results allow us to identify discrepancies between the instance data at the clinical sites and the profiles specified by the feasibility platform and addressed in the future. Results: A total of 20 university hospitals participated in this study. Historical factors, lack of harmonization, a wide range of source systems, and case sensitivity of coding are some of the causes for the discrepancies identified. While in our case study, Conditions, Procedures, and Medications have a high degree of uniformity in the coding of instance data due to legislative requirements for billing in Germany, we found that laboratory values pose a significant data harmonization challenge due to their interdependency between coding and value. Conclusions: While the CDS achieves interoperability, different challenges for federated data access arise, requiring more specificity in the profiles to make assumptions on the instance data. We further argue that further harmonization of the instance data can significantly lower required retrospective harmonization efforts. We recognize that discrepancies cannot be resolved solely at the clinical site; therefore, our findings have a wide range of implications and will require action on multiple levels and by various stakeholders. UR - https://medinform.jmir.org/2024/1/e57005 UR - http://dx.doi.org/10.2196/57005 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57005 ER - TY - JOUR AU - Aisyah, Nur Dewi AU - Setiawan, Heri Agus AU - Lokopessy, Fawwaz Alfiano AU - Faradiba, Nadia AU - Setiaji, Setiaji AU - Manikam, Logan AU - Kozlakidis, Zisis PY - 2024/7/18 TI - The Information and Communication Technology Maturity Assessment at Primary Health Care Services Across 9 Provinces in Indonesia: Evaluation Study JO - JMIR Med Inform SP - e55959 VL - 12 KW - public health centers KW - Puskesmas KW - digital maturity KW - infrastructure KW - primary health care KW - district health office KW - primary care clinics KW - Asia KW - Asian KW - Indonesia KW - ICT KW - information and communication technologies KW - information and communication technology KW - maturity KW - adoption KW - readiness KW - implementation KW - eHealth KW - telehealth KW - telemedicine KW - cross sectional KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - primary care N2 - Background: Indonesia has rapidly embraced digital health, particularly during the COVID-19 pandemic, with over 15 million daily health application users. To advance its digital health vision, the government is prioritizing the development of health data and application systems into an integrated health care technology ecosystem. This initiative involves all levels of health care, from primary to tertiary, across all provinces. In particular, it aims to enhance primary health care services (as the main interface with the general population) and contribute to Indonesia?s digital health transformation. Objective: This study assesses the information and communication technology (ICT) maturity in Indonesian health care services to advance digital health initiatives. ICT maturity assessment tools, specifically designed for middle-income countries, were used to evaluate digital health capabilities in 9 provinces across 5 Indonesian islands. Methods: A cross-sectional survey was conducted from February to March 2022, in 9 provinces across Indonesia, representing the country?s diverse conditions on its major islands. Respondents included staff from public health centers (Puskesmas), primary care clinics (Klinik Pratama), and district health offices (Dinas Kesehatan Kabupaten/Kota). The survey used adapted ICT maturity assessment questionnaires, covering human resources, software and system, hardware, and infrastructure. It was administered electronically and involved 121 public health centers, 49 primary care clinics, and 67 IT staff from district health offices. Focus group discussions were held to delve deeper into the assessment results and gain more descriptive insights. Results: In this study, 237 participants represented 3 distinct categories: 121 public health centers, 67 district health offices, and 49 primary clinics. These instances were selected from a sample of 9 of the 34 provinces in Indonesia. Collected data from interviews and focus group discussions were transformed into scores on a scale of 1 to 5, with 1 indicating low ICT readiness and 5 indicating high ICT readiness. On average, the breakdown of ICT maturity scores was as follows: 2.71 for human resources? capability in ICT use and system management, 2.83 for software and information systems, 2.59 for hardware, and 2.84 for infrastructure, resulting in an overall average score of 2.74. According to the ICT maturity level pyramid, the ICT maturity of health care providers in Indonesia fell between the basic and good levels. The need to pursue best practices also emerged strongly. Further analysis of the ICT maturity scores, when examined by province, revealed regional variations. Conclusions: The maturity of ICT use is influenced by several critical components. Enhancing human resources, ensuring infrastructure, the availability of supportive hardware, and optimizing information systems are imperative to attain ICT maturity in health care services. In the context of ICT maturity assessment, significant score variations were observed across health care levels in the 9 provinces, underscoring the diversity in ICT readiness and the need for regionally customized follow-up actions. UR - https://medinform.jmir.org/2024/1/e55959 UR - http://dx.doi.org/10.2196/55959 ID - info:doi/10.2196/55959 ER - TY - JOUR AU - Lamer, Antoine AU - Saint-Dizier, Chloé AU - Paris, Nicolas AU - Chazard, Emmanuel PY - 2024/7/17 TI - Data Lake, Data Warehouse, Datamart, and Feature Store: Their Contributions to the Complete Data Reuse Pipeline JO - JMIR Med Inform SP - e54590 VL - 12 KW - data reuse KW - data lake KW - data warehouse KW - feature extraction KW - datamart KW - feature store UR - https://medinform.jmir.org/2024/1/e54590 UR - http://dx.doi.org/10.2196/54590 ID - info:doi/10.2196/54590 ER - TY - JOUR AU - Soares, Andrey AU - Schilling, M. Lisa AU - Richardson, Joshua AU - Kommadi, Bhagvan AU - Subbian, Vignesh AU - Dehnbostel, Joanne AU - Shahin, Khalid AU - Robinson, A. Karen AU - Afzal, Muhammad AU - Lehmann, P. Harold AU - Kunnamo, Ilkka AU - Alper, S. Brian PY - 2024/6/25 TI - Making Science Computable Using Evidence-Based Medicine on Fast Healthcare Interoperability Resources: Standards Development Project JO - J Med Internet Res SP - e54265 VL - 26 KW - evidence-based medicine KW - FHIR KW - Fast Healthcare Interoperability Resources KW - computable evidence KW - EBMonFHIR KW - evidence-based medicine on Fast Healthcare Interoperability Resources N2 - Background: Evidence-based medicine (EBM) has the potential to improve health outcomes, but EBM has not been widely integrated into the systems used for research or clinical decision-making. There has not been a scalable and reusable computer-readable standard for distributing research results and synthesized evidence among creators, implementers, and the ultimate users of that evidence. Evidence that is more rapidly updated, synthesized, disseminated, and implemented would improve both the delivery of EBM and evidence-based health care policy. Objective: This study aimed to introduce the EBM on Fast Healthcare Interoperability Resources (FHIR) project (EBMonFHIR), which is extending the methods and infrastructure of Health Level Seven (HL7) FHIR to provide an interoperability standard for the electronic exchange of health-related scientific knowledge. Methods: As an ongoing process, the project creates and refines FHIR resources to represent evidence from clinical studies and syntheses of those studies and develops tools to assist with the creation and visualization of FHIR resources. Results: The EBMonFHIR project created FHIR resources (ie, ArtifactAssessment, Citation, Evidence, EvidenceReport, and EvidenceVariable) for representing evidence. The COVID-19 Knowledge Accelerator (COKA) project, now Health Evidence Knowledge Accelerator (HEvKA), took this work further and created FHIR resources that express EvidenceReport, Citation, and ArtifactAssessment concepts. The group is (1) continually refining FHIR resources to support the representation of EBM; (2) developing controlled terminology related to EBM (ie, study design, statistic type, statistical model, and risk of bias); and (3) developing tools to facilitate the visualization and data entry of EBM information into FHIR resources, including human-readable interfaces and JSON viewers. Conclusions: EBMonFHIR resources in conjunction with other FHIR resources can support relaying EBM components in a manner that is interoperable and consumable by downstream tools and health information technology systems to support the users of evidence. UR - https://www.jmir.org/2024/1/e54265 UR - http://dx.doi.org/10.2196/54265 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916936 ID - info:doi/10.2196/54265 ER - TY - JOUR AU - Karakachoff, Matilde AU - Goronflot, Thomas AU - Coudol, Sandrine AU - Toublant, Delphine AU - Bazoge, Adrien AU - Constant Dit Beaufils, Pacôme AU - Varey, Emilie AU - Leux, Christophe AU - Mauduit, Nicolas AU - Wargny, Matthieu AU - Gourraud, Pierre-Antoine PY - 2024/6/24 TI - Implementing a Biomedical Data Warehouse From Blueprint to Bedside in a Regional French University Hospital Setting: Unveiling Processes, Overcoming Challenges, and Extracting Clinical Insight JO - JMIR Med Inform SP - e50194 VL - 12 KW - data warehouse KW - biomedical data warehouse KW - clinical data repository KW - electronic health records KW - data reuse KW - secondary use KW - clinical routine data KW - real-world data KW - implementation report N2 - Background: Biomedical data warehouses (BDWs) have become an essential tool to facilitate the reuse of health data for both research and decisional applications. Beyond technical issues, the implementation of BDWs requires strong institutional data governance and operational knowledge of the European and national legal framework for the management of research data access and use. Objective: In this paper, we describe the compound process of implementation and the contents of a regional university hospital BDW. Methods: We present the actions and challenges regarding organizational changes, technical architecture, and shared governance that took place to develop the Nantes BDW. We describe the process to access clinical contents, give details about patient data protection, and use examples to illustrate merging clinical insights. Implementation (Results): More than 68 million textual documents and 543 million pieces of coded information concerning approximately 1.5 million patients admitted to CHUN between 2002 and 2022 can be queried and transformed to be made available to investigators. Since its creation in 2018, 269 projects have benefited from the Nantes BDW. Access to data is organized according to data use and regulatory requirements. Conclusions: Data use is entirely determined by the scientific question posed. It is the vector of legitimacy of data access for secondary use. Enabling access to a BDW is a game changer for research and all operational situations in need of data. Finally, data governance must prevail over technical issues in institution data strategy vis-à-vis care professionals and patients alike. UR - https://medinform.jmir.org/2024/1/e50194 UR - http://dx.doi.org/10.2196/50194 ID - info:doi/10.2196/50194 ER - TY - JOUR AU - Jiang, Jiayi AU - Zheng, Zexing PY - 2024/6/21 TI - Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis JO - JMIR Mhealth Uhealth SP - e55061 VL - 12 KW - hospital apps KW - privacy policy KW - personal information protection KW - policy evaluation KW - content analysis N2 - Background: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. Objective: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. Methods: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. Results: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users? explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%). Conclusions: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps? privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages. UR - https://mhealth.jmir.org/2024/1/e55061 UR - http://dx.doi.org/10.2196/55061 UR - http://www.ncbi.nlm.nih.gov/pubmed/38904994 ID - info:doi/10.2196/55061 ER - TY - JOUR AU - Casella Jean-Baptiste, Meredith AU - Vital Julmiste, Monide Thamar AU - Ball, Ellen PY - 2024/6/14 TI - Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study JO - JMIR Form Res SP - e55000 VL - 8 KW - maternal health KW - health informatics KW - quality improvement KW - Plan-Do-Study-Act KW - PDSA KW - maternal KW - neonatal KW - data collection KW - prenatal KW - outpatient KW - electronic data KW - nursing KW - nursing staff KW - nursing leadership N2 - Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. UR - https://formative.jmir.org/2024/1/e55000 UR - http://dx.doi.org/10.2196/55000 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875702 ID - info:doi/10.2196/55000 ER - TY - JOUR AU - Shau, Wen-Yi AU - Santoso, Handoko AU - Jip, Vincent AU - Setia, Sajita PY - 2024/6/11 TI - Integrated Real-World Data Warehouses Across 7 Evolving Asian Health Care Systems: Scoping Review JO - J Med Internet Res SP - e56686 VL - 26 KW - Asia KW - health care databases KW - cross-country comparison KW - electronic health records KW - electronic medical records KW - data warehousing KW - information storage and retrieval KW - real-world data KW - real-world evidence KW - registries KW - scoping review N2 - Background: Asia consists of diverse nations with extremely variable health care systems. Integrated real-world data (RWD) research warehouses provide vast interconnected data sets that uphold statistical rigor. Yet, their intricate details remain underexplored, restricting their broader applications. Objective: Building on our previous research that analyzed integrated RWD warehouses in India, Thailand, and Taiwan, this study extends the research to 7 distinct health care systems: Hong Kong, Indonesia, Malaysia, Pakistan, the Philippines, Singapore, and Vietnam. We aimed to map the evolving landscape of RWD, preferences for methodologies, and database use and archetype the health systems based on existing intrinsic capability for RWD generation. Methods: A systematic scoping review methodology was used, centering on contemporary English literature on PubMed (search date: May 9, 2023). Rigorous screening as defined by eligibility criteria identified RWD studies from multiple health care facilities in at least 1 of the 7 target Asian nations. Point estimates and their associated errors were determined for the data collected from eligible studies. Results: Of the 1483 real-world evidence citations identified on May 9, 2023, a total of 369 (24.9%) fulfilled the requirements for data extraction and subsequent analysis. Singapore, Hong Kong, and Malaysia contributed to ?100 publications, with each country marked by a higher proportion of single-country studies at 51% (80/157), 66.2% (86/130), and 50% (50/100), respectively, and were classified as solo scholars. Indonesia, Pakistan, Vietnam, and the Philippines had fewer publications and a higher proportion of cross-country collaboration studies (CCCSs) at 79% (26/33), 58% (18/31), 74% (20/27), and 86% (19/22), respectively, and were classified as global collaborators. Collaboration with countries outside the 7 target nations appeared in 84.2% to 97.7% of the CCCSs of each nation. Among target nations, Singapore and Malaysia emerged as preferred research partners for other nations. From 2018 to 2023, most nations showed an increasing trend in study numbers, with Vietnam (24.5%) and Pakistan (21.2%) leading the growth; the only exception was the Philippines, which declined by ?14.5%. Clinical registry databases were predominant across all CCCSs from every target nation. For single-country studies, Indonesia, Malaysia, and the Philippines favored clinical registries; Singapore had a balanced use of clinical registries and electronic medical or health records, whereas Hong Kong, Pakistan, and Vietnam leaned toward electronic medical or health records. Overall, 89.9% (310/345) of the studies took >2 years from completion to publication. Conclusions: The observed variations in contemporary RWD publications across the 7 nations in Asia exemplify distinct research landscapes across nations that are partially explained by their diverse economic, clinical, and research settings. Nevertheless, recognizing these variations is pivotal for fostering tailored, synergistic strategies that amplify RWD?s potential in guiding future health care research and policy decisions. International Registered Report Identifier (IRRID): RR2-10.2196/43741 UR - https://www.jmir.org/2024/1/e56686 UR - http://dx.doi.org/10.2196/56686 UR - http://www.ncbi.nlm.nih.gov/pubmed/38749399 ID - info:doi/10.2196/56686 ER - TY - JOUR AU - Zheng, Di AU - Shang, Yanhong AU - Ni, Jian AU - Peng, Ling AU - Tan, Xiaoming AU - Dai, Zhaoxia AU - Zhao, Yizhuo AU - Gu, Aiqin AU - Wang, Jiying AU - Song, Yanyan AU - Li, Xiaofeng AU - Zhang, Junping AU - Heng, Wei AU - Zhang, Cuiying AU - Liu, Chunling AU - Li, Hui AU - Du, Yingying AU - Xu, Jianfang AU - Wu, Dan AU - Cai, Xuwei AU - Meng, Rui AU - Dong, Xiaorong AU - Ruan, Yaoping AU - Jiang, Liyan PY - 2024/6/5 TI - Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study JO - JMIR Cancer SP - e45331 VL - 10 KW - telehealth KW - real-world data KW - patient engagement KW - lung carcinoma KW - patient-reported outcomes N2 - Background: Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. Objective: The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician?s perspective. Methods: A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform?s registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. Results: Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. Conclusions: This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions. UR - https://cancer.jmir.org/2024/1/e45331 UR - http://dx.doi.org/10.2196/45331 UR - http://www.ncbi.nlm.nih.gov/pubmed/38838304 ID - info:doi/10.2196/45331 ER - TY - JOUR AU - Yoon, Dukyong AU - Han, Changho AU - Kim, Won Dong AU - Kim, Songsoo AU - Bae, SungA AU - Ryu, An Jee AU - Choi, Yujin PY - 2024/5/31 TI - Redefining Health Care Data Interoperability: Empirical Exploration of Large Language Models in Information Exchange JO - J Med Internet Res SP - e56614 VL - 26 KW - health care interoperability KW - large language models KW - medical data transformation KW - data standardization KW - text-based N2 - Background: Efficient data exchange and health care interoperability are impeded by medical records often being in nonstandardized or unstructured natural language format. Advanced language models, such as large language models (LLMs), may help overcome current challenges in information exchange. Objective: This study aims to evaluate the capability of LLMs in transforming and transferring health care data to support interoperability. Methods: Using data from the Medical Information Mart for Intensive Care III and UK Biobank, the study conducted 3 experiments. Experiment 1 assessed the accuracy of transforming structured laboratory results into unstructured format. Experiment 2 explored the conversion of diagnostic codes between the coding frameworks of the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), and Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) using a traditional mapping table and a text-based approach facilitated by the LLM ChatGPT. Experiment 3 focused on extracting targeted information from unstructured records that included comprehensive clinical information (discharge notes). Results: The text-based approach showed a high conversion accuracy in transforming laboratory results (experiment 1) and an enhanced consistency in diagnostic code conversion, particularly for frequently used diagnostic names, compared with the traditional mapping approach (experiment 2). In experiment 3, the LLM showed a positive predictive value of 87.2% in extracting generic drug names. Conclusions: This study highlighted the potential role of LLMs in significantly improving health care data interoperability, demonstrated by their high accuracy and efficiency in data transformation and exchange. The LLMs hold vast potential for enhancing medical data exchange without complex standardization for medical terms and data structure. UR - https://www.jmir.org/2024/1/e56614 UR - http://dx.doi.org/10.2196/56614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819879 ID - info:doi/10.2196/56614 ER - TY - JOUR AU - Claggett, Jennifer AU - Petter, Stacie AU - Joshi, Amol AU - Ponzio, Todd AU - Kirkendall, Eric PY - 2024/5/30 TI - An Infrastructure Framework for Remote Patient Monitoring Interventions and Research JO - J Med Internet Res SP - e51234 VL - 26 KW - remote patient monitoring KW - eHealth KW - telehealth KW - telemonitoring KW - telemedicine KW - digital infrastructure KW - clinical decision-making UR - https://www.jmir.org/2024/1/e51234 UR - http://dx.doi.org/10.2196/51234 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815263 ID - info:doi/10.2196/51234 ER - TY - JOUR AU - Paatela, Satu AU - Kyytsönen, Maiju AU - Saranto, Kaija AU - Kinnunen, Ulla-Mari AU - Vehko, Tuulikki PY - 2024/5/29 TI - Experiences of Electronic Health Records? and Client Information Systems? Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study JO - J Med Internet Res SP - e46954 VL - 26 KW - practical nurse KW - information and communication technology KW - electronic health record KW - client information system KW - documentation KW - mobile technology N2 - Background: The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today?s era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients? homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities. Objective: This study aims to analyze practical nurses? experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device. Methods: A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings. Results: The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses? office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not. Conclusions: To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use. UR - https://www.jmir.org/2024/1/e46954 UR - http://dx.doi.org/10.2196/46954 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809583 ID - info:doi/10.2196/46954 ER - TY - JOUR AU - Bozorgmehr, Arezoo AU - Thiem, Simon-Konstantin AU - Wild, Dorothea AU - Reinsdorff, Melanie AU - Vollmar, Christian Horst AU - Kappernagel, Annika AU - Schloessler, Kathrin AU - Weissbach, Sabine AU - Pentzek, Michael AU - Dehnen, Dorothea AU - Drexler, Julia AU - Mueller, Sigrid Beate AU - Pilic, Larisa AU - Lehmann, Lion AU - Loescher, Susanne AU - Hohmann, Darinka Elena AU - Frank, Friederike AU - Ates, Gülay AU - Kersten, Susanne AU - Mortsiefer, Achim AU - Aretz, Benjamin AU - Weltermann, Birgitta PY - 2024/5/20 TI - Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study JO - JMIR Form Res SP - e53206 VL - 8 KW - primary care KW - general practice research network KW - physicians KW - feasibility study KW - IT infrastructure KW - usability KW - FallAkte KW - FallAkte Plus system KW - mixed methods usability study KW - North Rhine-Westphalian general practice research network KW - NRW-GPRN KW - Germany KW - German KW - universities KW - survey KW - questionnaire KW - participants N2 - Background: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. Objective: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany?s largest state. Methods: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. Results: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system?s emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. Conclusions: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI. UR - https://formative.jmir.org/2024/1/e53206 UR - http://dx.doi.org/10.2196/53206 UR - http://www.ncbi.nlm.nih.gov/pubmed/38767942 ID - info:doi/10.2196/53206 ER - TY - JOUR AU - Palojoki, Sari AU - Lehtonen, Lasse AU - Vuokko, Riikka PY - 2024/4/25 TI - Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability JO - JMIR Med Inform SP - e53535 VL - 12 KW - electronic health record KW - health records KW - EHR KW - EHRs KW - semantic KW - health care data KW - semantic interoperability KW - interoperability KW - standardize KW - standardized KW - standardization KW - cross-border data exchange KW - systematic review KW - synthesis KW - syntheses KW - review methods KW - review methodology KW - search KW - searches KW - searching KW - systematic KW - data exchange KW - information sharing KW - ontology KW - ontologies KW - terminology KW - terminologies KW - standard KW - standards KW - classification KW - PRISMA KW - data sharing KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: Semantic interoperability facilitates the exchange of and access to health data that are being documented in electronic health records (EHRs) with various semantic features. The main goals of semantic interoperability development entail patient data availability and use in diverse EHRs without a loss of meaning. Internationally, current initiatives aim to enhance semantic development of EHR data and, consequently, the availability of patient data. Interoperability between health information systems is among the core goals of the European Health Data Space regulation proposal and the World Health Organization?s Global Strategy on Digital Health 2020-2025. Objective: To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on semantic interoperability development, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development? Methods: Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits of these choices in the context of EHRs. Therefore, we performed a systematic literature review in PubMed by defining our study framework based on previous research. Results: Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases (eg, registers). Conclusions: When heading toward semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual model or multimodel approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes. UR - https://medinform.jmir.org/2024/1/e53535 UR - http://dx.doi.org/10.2196/53535 ID - info:doi/10.2196/53535 ER - TY - JOUR AU - Richards, Angerhofer Julie AU - Kuo, Elena AU - Stewart, Christine AU - Shulman, Lisa AU - Parrish, Rebecca AU - Whiteside, Ursula AU - Boggs, M. Jennifer AU - Simon, E. Gregory AU - Rowhani-Rahbar, Ali AU - Betz, E. Marian PY - 2024/4/22 TI - Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based ?Lock to Live? Decision Aid in Routine Health Care Encounters JO - JMIR Med Inform SP - e48007 VL - 12 KW - suicide prevention KW - firearm KW - internet KW - implementation KW - suicide KW - prevention KW - decision aid KW - risk KW - feasible KW - support KW - evaluation KW - mental health KW - electronic health record KW - tool N2 - Background: ?Lock to Live? (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. Objective: The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. Methods: The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)?a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model?Reach, Adoption, and Implementation?were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide. Results: The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) ?have an open conversation,? (2) ?validate their situation,? (3) ?share what to expect,? (4) ?make it accessible and memorable,? and (5) ?walk through the tool.? Clinicians? interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians. Conclusions: Understanding the value of L2L from users? perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide. UR - https://medinform.jmir.org/2024/1/e48007 UR - http://dx.doi.org/10.2196/48007 ID - info:doi/10.2196/48007 ER - TY - JOUR AU - Ndlovu, Kagiso AU - Mauco, Leonard Kabelo AU - Makhura, Onalenna AU - Hu, Robin AU - Motlogelwa, Peace Nkwebi AU - Masizana, Audrey AU - Lo, Emily AU - Mphoyakgosi, Thongbotho AU - Moyo, Sikhulile PY - 2024/4/16 TI - Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study JO - JMIR Form Res SP - e50897 VL - 8 KW - REDCap KW - DHIS2 KW - COVID-19 KW - National Health Laboratory KW - eHealth KW - interoperability KW - data management KW - Botswana N2 - Background: The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). Objective: This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. Methods: A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants? requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. Results: Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap?s capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. Conclusions: Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries. UR - https://formative.jmir.org/2024/1/e50897 UR - http://dx.doi.org/10.2196/50897 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625736 ID - info:doi/10.2196/50897 ER - TY - JOUR AU - O'Brien, Niki AU - Fernandez Crespo, Roberto AU - O'Driscoll, Fiona AU - Prendergast, Mabel AU - Chana, Deeph AU - Darzi, Ara AU - Ghafur, Saira PY - 2024/4/11 TI - Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study JO - JMIR Form Res SP - e50968 VL - 8 KW - acceptability KW - cross sectional KW - cybersecurity KW - digital health KW - digital transformation KW - education KW - feasibility KW - framework KW - frameworks KW - global health KW - health systems KW - implementation KW - organization KW - organizational KW - organizations KW - patient safety KW - SWOT KW - TAM KW - usability N2 - Background: Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care?specific resources to help organizations at different levels of maturity develop their cybersecurity practices. Objective: This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. Methods: A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams? networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. Results: A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. Conclusions: The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone?s responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed. UR - https://formative.jmir.org/2024/1/e50968 UR - http://dx.doi.org/10.2196/50968 UR - http://www.ncbi.nlm.nih.gov/pubmed/38603777 ID - info:doi/10.2196/50968 ER - TY - JOUR AU - Yoo, M. Richard AU - Viggiano, T. Ben AU - Pundi, N. Krishna AU - Fries, A. Jason AU - Zahedivash, Aydin AU - Podchiyska, Tanya AU - Din, Natasha AU - Shah, H. Nigam PY - 2024/4/4 TI - Scalable Approach to Consumer Wearable Postmarket Surveillance: Development and Validation Study JO - JMIR Med Inform SP - e51171 VL - 12 KW - consumer wearable devices KW - atrial fibrillation KW - postmarket surveillance KW - surveillance KW - monitoring KW - artificial intelligence KW - machine learning KW - natural language processing KW - NLP KW - wearable KW - wearables KW - labeler KW - heart KW - cardiology KW - arrhythmia KW - diagnose KW - diagnosis KW - labeling KW - classifier KW - EHR KW - electronic health record KW - electronic health records KW - consumer KW - consumers KW - device KW - devices KW - evaluation N2 - Background: With the capability to render prediagnoses, consumer wearables have the potential to affect subsequent diagnoses and the level of care in the health care delivery setting. Despite this, postmarket surveillance of consumer wearables has been hindered by the lack of codified terms in electronic health records (EHRs) to capture wearable use. Objective: We sought to develop a weak supervision?based approach to demonstrate the feasibility and efficacy of EHR-based postmarket surveillance on consumer wearables that render atrial fibrillation (AF) prediagnoses. Methods: We applied data programming, where labeling heuristics are expressed as code-based labeling functions, to detect incidents of AF prediagnoses. A labeler model was then derived from the predictions of the labeling functions using the Snorkel framework. The labeler model was applied to clinical notes to probabilistically label them, and the labeled notes were then used as a training set to fine-tune a classifier called Clinical-Longformer. The resulting classifier identified patients with an AF prediagnosis. A retrospective cohort study was conducted, where the baseline characteristics and subsequent care patterns of patients identified by the classifier were compared against those who did not receive a prediagnosis. Results: The labeler model derived from the labeling functions showed high accuracy (0.92; F1-score=0.77) on the training set. The classifier trained on the probabilistically labeled notes accurately identified patients with an AF prediagnosis (0.95; F1-score=0.83). The cohort study conducted using the constructed system carried enough statistical power to verify the key findings of the Apple Heart Study, which enrolled a much larger number of participants, where patients who received a prediagnosis tended to be older, male, and White with higher CHA2DS2-VASc (congestive heart failure, hypertension, age ?75 years, diabetes, stroke, vascular disease, age 65-74 years, sex category) scores (P<.001). We also made a novel discovery that patients with a prediagnosis were more likely to use anticoagulants (525/1037, 50.63% vs 5936/16,560, 35.85%) and have an eventual AF diagnosis (305/1037, 29.41% vs 262/16,560, 1.58%). At the index diagnosis, the existence of a prediagnosis did not distinguish patients based on clinical characteristics, but did correlate with anticoagulant prescription (P=.004 for apixaban and P=.01 for rivaroxaban). Conclusions: Our work establishes the feasibility and efficacy of an EHR-based surveillance system for consumer wearables that render AF prediagnoses. Further work is necessary to generalize these findings for patient populations at other sites. UR - https://medinform.jmir.org/2024/1/e51171 UR - http://dx.doi.org/10.2196/51171 ID - info:doi/10.2196/51171 ER - TY - JOUR AU - Choo, Mei Sim AU - Sartori, Daniele AU - Lee, Chet Sing AU - Yang, Hsuan-Chia AU - Syed-Abdul, Shabbir PY - 2024/4/3 TI - Data-Driven Identification of Factors That Influence the Quality of Adverse Event Reports: 15-Year Interpretable Machine Learning and Time-Series Analyses of VigiBase and QUEST JO - JMIR Med Inform SP - e49643 VL - 12 KW - pharmacovigilance KW - medication safety KW - big data analysis KW - feature selection KW - interpretable machine learning N2 - Background: The completeness of adverse event (AE) reports, crucial for assessing putative causal relationships, is measured using the vigiGrade completeness score in VigiBase, the World Health Organization global database of reported potential AEs. Malaysian reports have surpassed the global average score (approximately 0.44), achieving a 5-year average of 0.79 (SD 0.23) as of 2019 and approaching the benchmark for well-documented reports (0.80). However, the contributing factors to this relatively high report completeness score remain unexplored. Objective: This study aims to explore the main drivers influencing the completeness of Malaysian AE reports in VigiBase over a 15-year period using vigiGrade. A secondary objective was to understand the strategic measures taken by the Malaysian authorities leading to enhanced report completeness across different time frames. Methods: We analyzed 132,738 Malaysian reports (2005-2019) recorded in VigiBase up to February 2021 split into historical International Drug Information System (INTDIS; n=63,943, 48.17% in 2005-2016) and newer E2B (n=68,795, 51.83% in 2015-2019) format subsets. For machine learning analyses, we performed a 2-stage feature selection followed by a random forest classifier to identify the top features predicting well-documented reports. We subsequently applied tree Shapley additive explanations to examine the magnitude, prevalence, and direction of feature effects. In addition, we conducted time-series analyses to evaluate chronological trends and potential influences of key interventions on reporting quality. Results: Among the analyzed reports, 42.84% (56,877/132,738) were well documented, with an increase of 65.37% (53,929/82,497) since 2015. Over two-thirds (46,186/68,795, 67.14%) of the Malaysian E2B reports were well documented compared to INTDIS reports at 16.72% (10,691/63,943). For INTDIS reports, higher pharmacovigilance center staffing was the primary feature positively associated with being well documented. In recent E2B reports, the top positive features included reaction abated upon drug dechallenge, reaction onset or drug use duration of <1 week, dosing interval of <1 day, reports from public specialist hospitals, reports by pharmacists, and reaction duration between 1 and 6 days. In contrast, reports from product registration holders and other health care professionals and reactions involving product substitution issues negatively affected the quality of E2B reports. Multifaceted strategies and interventions comprising policy changes, continuity of education, and human resource development laid the groundwork for AE reporting in Malaysia, whereas advancements in technological infrastructure, pharmacovigilance databases, and reporting tools concurred with increases in both the quantity and quality of AE reports. Conclusions: Through interpretable machine learning and time-series analyses, this study identified key features that positively or negatively influence the completeness of Malaysian AE reports and unveiled how Malaysia has developed its pharmacovigilance capacity via multifaceted strategies and interventions. These findings will guide future work in enhancing pharmacovigilance and public health. UR - https://medinform.jmir.org/2024/1/e49643 UR - http://dx.doi.org/10.2196/49643 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568722 ID - info:doi/10.2196/49643 ER - TY - JOUR AU - Chai, Yulin AU - Yuan, Xiaoping AU - Guo, Lin AU - Chen, Zhongming PY - 2024/3/21 TI - The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy JO - J Med Internet Res SP - e53921 VL - 26 KW - broadband KW - infrastructure KW - medical resources KW - resource mismatch KW - Broadband China Policy N2 - Background: Whether the construction of broadband infrastructure can alleviate the problem of mismatched medical resources is crucial to the national information strategy, residents? well-being, and social equity. However, the academic community lacks a comprehensive theoretical analysis and rigorous empirical research on this issue. Objective: This study aims to construct a preliminary theoretical framework to scientifically assess the effects of broadband infrastructure development on the mitigation of health care resource mismatch from both theoretical and empirical perspectives, to explore the potential mechanisms of influence, and ultimately to develop several practical policy recommendations. Methods: We first used a theoretical analysis to propose testable theoretical hypotheses and establish a preliminary theoretical framework. Then, based on balanced panel data from 300 cities from 2010 to 2021, a 2-way fixed effects difference-in-differences model was used for empirical testing. Mechanism tests, robustness analyses, and heterogeneity analyses were further conducted. Results: The research findings demonstrate that the Broadband China Policy significantly reduces the degree of mismatch in medical resources by primarily using innovation effects and integration effects, resulting in a reduction of 13.2%. In addition, the heterogeneity analysis reveals that the central and eastern regions, cities with large populations, and areas with a high proportion of young people benefit more significantly. Conclusions: This study fully confirms, both theoretically and empirically, that broadband infrastructure construction can effectively reduce the mismatch of medical resources not only by expanding the existing literature on the impact of broadband on public services but also by providing valuable opportunities for policy makers to optimize the allocation of medical resources. UR - https://www.jmir.org/2024/1/e53921 UR - http://dx.doi.org/10.2196/53921 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512327 ID - info:doi/10.2196/53921 ER - TY - JOUR AU - Declerck, Jens AU - Kalra, Dipak AU - Vander Stichele, Robert AU - Coorevits, Pascal PY - 2024/3/6 TI - Frameworks, Dimensions, Definitions of Aspects, and Assessment Methods for the Appraisal of Quality of Health Data for Secondary Use: Comprehensive Overview of Reviews JO - JMIR Med Inform SP - e51560 VL - 12 KW - data quality KW - data quality dimensions KW - data quality assessment KW - secondary use KW - data quality framework KW - fit for purpose N2 - Background: Health care has not reached the full potential of the secondary use of health data because of?among other issues?concerns about the quality of the data being used. The shift toward digital health has led to an increase in the volume of health data. However, this increase in quantity has not been matched by a proportional improvement in the quality of health data. Objective: This review aims to offer a comprehensive overview of the existing frameworks for data quality dimensions and assessment methods for the secondary use of health data. In addition, it aims to consolidate the results into a unified framework. Methods: A review of reviews was conducted including reviews describing frameworks of data quality dimensions and their assessment methods, specifically from a secondary use perspective. Reviews were excluded if they were not related to the health care ecosystem, lacked relevant information related to our research objective, and were published in languages other than English. Results: A total of 22 reviews were included, comprising 22 frameworks, with 23 different terms for dimensions, and 62 definitions of dimensions. All dimensions were mapped toward the data quality framework of the European Institute for Innovation through Health Data. In total, 8 reviews mentioned 38 different assessment methods, pertaining to 31 definitions of the dimensions. Conclusions: The findings in this review revealed a lack of consensus in the literature regarding the terminology, definitions, and assessment methods for data quality dimensions. This creates ambiguity and difficulties in developing specific assessment methods. This study goes a step further by assigning all observed definitions to a consolidated framework of 9 data quality dimensions. UR - https://medinform.jmir.org/2024/1/e51560 UR - http://dx.doi.org/10.2196/51560 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446534 ID - info:doi/10.2196/51560 ER - TY - JOUR AU - Ru, Boshu AU - Sillah, Arthur AU - Desai, Kaushal AU - Chandwani, Sheenu AU - Yao, Lixia AU - Kothari, Smita PY - 2024/3/6 TI - Real-World Data Quality Framework for Oncology Time to Treatment Discontinuation Use Case: Implementation and Evaluation Study JO - JMIR Med Inform SP - e47744 VL - 12 KW - data quality assessment KW - real-world data KW - real-world time to treatment discontinuation KW - systemic anticancer therapy KW - Use Case Specific Relevance and Quality Assessment KW - UReQA framework N2 - Background: The importance of real-world evidence is widely recognized in observational oncology studies. However, the lack of interoperable data quality standards in the fragmented health information technology landscape represents an important challenge. Therefore, adopting validated systematic methods for evaluating data quality is important for oncology outcomes research leveraging real-world data (RWD). Objective: This study aims to implement real-world time to treatment discontinuation (rwTTD) for a systemic anticancer therapy (SACT) as a new use case for the Use Case Specific Relevance and Quality Assessment, a framework linking data quality and relevance in fit-for-purpose RWD assessment. Methods: To define the rwTTD use case, we mapped the operational definition of rwTTD to RWD elements commonly available from oncology electronic health record?derived data sets. We identified 20 tasks to check the completeness and plausibility of data elements concerning SACT use, line of therapy (LOT), death date, and length of follow-up. Using descriptive statistics, we illustrated how to implement the Use Case Specific Relevance and Quality Assessment on 2 oncology databases (Data sets A and B) to estimate the rwTTD of an SACT drug (target SACT) for patients with advanced head and neck cancer diagnosed on or after January 1, 2015. Results: A total of 1200 (24.96%) of 4808 patients in Data set A and 237 (5.92%) of 4003 patients in Data set B received the target SACT, suggesting better relevance of the former in estimating the rwTTD of the target SACT. The 2 data sets differed with regard to the terminology used for SACT drugs, LOT format, and target SACT LOT distribution over time. Data set B appeared to have less complete SACT records, longer lags in incorporating the latest data, and incomplete mortality data, suggesting a lack of fitness for estimating rwTTD. Conclusions: The fit-for-purpose data quality assessment demonstrated substantial variability in the quality of the 2 real-world data sets. The data quality specifications applied for rwTTD estimation can be expanded to support a broad spectrum of oncology use cases. UR - https://medinform.jmir.org/2024/1/e47744 UR - http://dx.doi.org/10.2196/47744 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446504 ID - info:doi/10.2196/47744 ER - TY - JOUR AU - Guo, Yunyong AU - Ganti, Sudhakar AU - Wu, Yi PY - 2024/3/6 TI - Enhancing Energy Efficiency in Telehealth Internet of Things Systems Through Fog and Cloud Computing Integration: Simulation Study JO - JMIR Biomed Eng SP - e50175 VL - 9 KW - cloud computing KW - energy-efficient KW - fog computing KW - Internet of Things KW - IoT KW - telehealth N2 - Background: The increasing adoption of telehealth Internet of Things (IoT) devices in health care informatics has led to concerns about energy use and data processing efficiency. Objective: This paper introduces an innovative model that integrates telehealth IoT devices with a fog and cloud computing?based platform, aiming to enhance energy efficiency in telehealth IoT systems. Methods: The proposed model incorporates adaptive energy-saving strategies, localized fog nodes, and a hybrid cloud infrastructure. Simulation analyses were conducted to assess the model?s effectiveness in reducing energy consumption and enhancing data processing efficiency. Results: Simulation results demonstrated significant energy savings, with a 2% reduction in energy consumption achieved through adaptive energy-saving strategies. The sample size for the simulation was 10-40, providing statistical robustness to the findings. Conclusions: The proposed model successfully addresses energy and data processing challenges in telehealth IoT scenarios. By integrating fog computing for local processing and a hybrid cloud infrastructure, substantial energy savings are achieved. Ongoing research will focus on refining the energy conservation model and exploring additional functional enhancements for broader applicability in health care and industrial contexts. UR - https://biomedeng.jmir.org/2024/1/e50175 UR - http://dx.doi.org/10.2196/50175 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875671 ID - info:doi/10.2196/50175 ER - TY - JOUR AU - Hailemariam, Tesfahun AU - Atnafu, Asmamaw AU - Gezie, Lemma AU - Kaasbøll, Jens AU - Klein, Jorn AU - Tilahun, Binyam PY - 2024/3/4 TI - Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model JO - JMIR Hum Factors SP - e47081 VL - 11 KW - data capturing KW - data use KW - eCHIS KW - electronic community health information system KW - health extension worker KW - HEW KW - intention to use KW - service provision KW - Unified Theory of Acceptance and Use of Technology 2 KW - UTAUT2 model N2 - Background: IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. Objective: This study aimed to assess HEWs? intentions to use the eCHIS for health data management and service provision. Methods: A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs? intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. Results: A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (?=0.256; P=.007), self-expectancy (?=0.096; P=.04), social influence (?=0.203; P=.02), and hedonic motivation (?=0.217; P=.03) were significantly associated with HEWs? intention to use the eCHIS. Conclusions: HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management. UR - https://humanfactors.jmir.org/2024/1/e47081 UR - http://dx.doi.org/10.2196/47081 UR - http://www.ncbi.nlm.nih.gov/pubmed/38437008 ID - info:doi/10.2196/47081 ER - TY - JOUR AU - Oehm, Benedict Johannes AU - Riepenhausen, Luise Sarah AU - Storck, Michael AU - Dugas, Martin AU - Pryss, Rüdiger AU - Varghese, Julian PY - 2024/2/27 TI - Integration of Patient-Reported Outcome Data Collected Via Web Applications and Mobile Apps Into a Nation-Wide COVID-19 Research Platform Using Fast Healthcare Interoperability Resources: Development Study JO - J Med Internet Res SP - e47846 VL - 26 KW - Fast Healthcare Interoperability Resources KW - FHIR KW - FHIR Questionnaire KW - patient-reported outcome KW - mobile health KW - mHealth KW - research compatibility KW - interoperability KW - Germany KW - harmonized data collection KW - findable, accessible, interoperable, and reusable KW - FAIR data KW - mobile phone N2 - Background: The Network University Medicine projects are an important part of the German COVID-19 research infrastructure. They comprise 2 subprojects: COVID-19 Data Exchange (CODEX) and Coordination on Mobile Pandemic Apps Best Practice and Solution Sharing (COMPASS). CODEX provides a centralized and secure data storage platform for research data, whereas in COMPASS, expert panels were gathered to develop a reference app framework for capturing patient-reported outcomes (PROs) that can be used by any researcher. Objective: Our study aims to integrate the data collected with the COMPASS reference app framework into the central CODEX platform, so that they can be used by secondary researchers. Although both projects used the Fast Healthcare Interoperability Resources (FHIR) standard, it was not used in a way that data could be shared directly. Given the short time frame and the parallel developments within the CODEX platform, a pragmatic and robust solution for an interface component was required. Methods: We have developed a means to facilitate and promote the use of the German Corona Consensus (GECCO) data set, a core data set for COVID-19 research in Germany. In this way, we ensured semantic interoperability for the app-collected PRO data with the COMPASS app. We also developed an interface component to sustain syntactic interoperability. Results: The use of different FHIR types by the COMPASS reference app framework (the general-purpose FHIR Questionnaire) and the CODEX platform (eg, Patient, Condition, and Observation) was found to be the most significant obstacle. Therefore, we developed an interface component that realigns the Questionnaire items with the corresponding items in the GECCO data set and provides the correct resources for the CODEX platform. We extended the existing COMPASS questionnaire editor with an import function for GECCO items, which also tags them for the interface component. This ensures syntactic interoperability and eases the reuse of the GECCO data set for researchers. Conclusions: This paper shows how PRO data, which are collected across various studies conducted by different researchers, can be captured in a research-compatible way. This means that the data can be shared with a central research infrastructure and be reused by other researchers to gain more insights about COVID-19 and its sequelae. UR - https://www.jmir.org/2024/1/e47846 UR - http://dx.doi.org/10.2196/47846 UR - http://www.ncbi.nlm.nih.gov/pubmed/38411999 ID - info:doi/10.2196/47846 ER - TY - JOUR AU - Cheng, Hao-Shen AU - You, Weir-Chiang AU - Chen, Ni-Wei AU - Hsieh, Mu-Chih AU - Tsai, Che-Fu AU - Ho, Chia-Jing AU - Chen, Chien-Chih PY - 2024/2/23 TI - Enhancing the Efficiency of a Radiation Oncology Department Using Electronic Medical Records: Protocol for Preparing Radiotherapy JO - JMIR Res Protoc SP - e51002 VL - 13 KW - efficiency KW - electronic medical records KW - Hospital Information System KW - protocol KW - radiation oncology N2 - Background: Electronic medical records (EMRs) streamline medical processes, improve quality control, and facilitate data sharing among hospital departments. They also reduce maintenance costs and storage space needed for paper records, while saving time and providing structured data for future research. Objective: This study aimed to investigate whether the integration of the radiation oncology information system and the hospital information system enhances the efficiency of the department of radiation oncology. Methods: We held multidisciplinary discussions among physicians, physicists, medical radiation technologists, nurses, and engineers. We integrated paper records from the radiation oncology department into the existing hospital information system within the hospital. A new electronic interface was designed. A comparison was made between the time taken to retrieve information from either the paper records or the EMRs for radiation preparation. A total of 30 cases were randomly allocated in both the old paper-based system and the new EMR system. The time spent was calculated manually at every step during the process, and we performed an independent 1-tailed t test to evaluate the difference between the 2 systems. Results: Since the system was launched in August 2020, more than 1000 medical records have been entered into the system, and this figure continues to increase. The total time needed for the radiation preparation process was reduced from 286.8 minutes to 154.3 minutes (P<.001)?a reduction of 46.2%. There was no longer any need to arrange for a nurse to organize the radiotherapy paper records, saving a workload of 16 hours per month. Conclusions: The implementation of the integrated EMR system has resulted in a significant reduction in the number of steps involved in radiotherapy preparation, as well as a decrease in the amount of time required for the process. The new EMR system has provided numerous benefits for the department, including a decrease in workload, a simplified workflow, and conserving more patient data within a confined space. UR - https://www.researchprotocols.org/2024/1/e51002 UR - http://dx.doi.org/10.2196/51002 UR - http://www.ncbi.nlm.nih.gov/pubmed/38393753 ID - info:doi/10.2196/51002 ER - TY - JOUR AU - Li, Yiwen AU - Pope, Charlene AU - Damonte, Jennifer AU - Spates, Tanika AU - Maa, April AU - Chen, Suephy AU - Yeung, Howa PY - 2024/2/7 TI - Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis JO - JMIR Dermatol SP - e50352 VL - 7 KW - telemedicine KW - dermatology KW - eye KW - implementation science KW - stakeholder participation KW - veterans? health N2 - Background: Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members? engagement in telespecialty care. Objective: This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). Methods: In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. Results: In total, 3 themes were identified from participants? experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. Conclusions: This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans. UR - https://derma.jmir.org/2024/1/e50352 UR - http://dx.doi.org/10.2196/50352 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324360 ID - info:doi/10.2196/50352 ER - TY - JOUR AU - Wang, Tingting AU - Giunti, Guido AU - Goossens, Richard AU - Melles, Marijke PY - 2024/2/5 TI - Timing, Indicators, and Approaches to Digital Patient Experience Evaluation: Umbrella Systematic Review JO - J Med Internet Res SP - e46308 VL - 26 KW - digital health KW - eHealth KW - telemedicine KW - mobile health KW - mHealth KW - patient experience KW - user experience KW - evaluation timing KW - evaluation indicators KW - evaluation approaches KW - user-centered design KW - patient-centered care KW - human-computer interaction KW - mobile phone N2 - Background: The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required. Objective: This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation. Methods: This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials. Results: Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx. Conclusions: Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx. UR - https://www.jmir.org/2024/1/e46308 UR - http://dx.doi.org/10.2196/46308 UR - http://www.ncbi.nlm.nih.gov/pubmed/38315545 ID - info:doi/10.2196/46308 ER - TY - JOUR AU - Xu, Jian PY - 2024/2/5 TI - The Current Status and Promotional Strategies for Cloud Migration of Hospital Information Systems in China: Strengths, Weaknesses, Opportunities, and Threats Analysis JO - JMIR Med Inform SP - e52080 VL - 12 KW - hospital information system KW - HIS KW - cloud computing KW - cloud migration KW - Strengths, Weaknesses, Opportunities, and Threats analysis N2 - Background: In the 21st century, Chinese hospitals have witnessed innovative medical business models, such as online diagnosis and treatment, cross-regional multidepartment consultation, and real-time sharing of medical test results, that surpass traditional hospital information systems (HISs). The introduction of cloud computing provides an excellent opportunity for hospitals to address these challenges. However, there is currently no comprehensive research assessing the cloud migration of HISs in China. This lack may hinder the widespread adoption and secure implementation of cloud computing in hospitals. Objective: The objective of this study is to comprehensively assess external and internal factors influencing the cloud migration of HISs in China and propose promotional strategies. Methods: Academic articles from January 1, 2007, to February 21, 2023, on the topic were searched in PubMed and HuiyiMd databases, and relevant documents such as national policy documents, white papers, and survey reports were collected from authoritative sources for analysis. A systematic assessment of factors influencing cloud migration of HISs in China was conducted by combining a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis and literature review methods. Then, various promotional strategies based on different combinations of external and internal factors were proposed. Results: After conducting a thorough search and review, this study included 94 academic articles and 37 relevant documents. The analysis of these documents reveals the increasing application of and research on cloud computing in Chinese hospitals, and that it has expanded to 22 disciplinary domains. However, more than half (n=49, 52%) of the documents primarily focused on task-specific cloud-based systems in hospitals, while only 22% (n=21 articles) discussed integrated cloud platforms shared across the entire hospital, medical alliance, or region. The SWOT analysis showed that cloud computing adoption in Chinese hospitals benefits from policy support, capital investment, and social demand for new technology. However, it also faces threats like loss of digital sovereignty, supplier competition, cyber risks, and insufficient supervision. Factors driving cloud migration for HISs include medical big data analytics and use, interdisciplinary collaboration, health-centered medical service provision, and successful cases. Barriers include system complexity, security threats, lack of strategic planning and resource allocation, relevant personnel shortages, and inadequate investment. This study proposes 4 promotional strategies: encouraging more hospitals to migrate, enhancing hospitals? capabilities for migration, establishing a provincial-level unified medical hybrid multi-cloud platform, strengthening legal frameworks, and providing robust technical support. Conclusions: Cloud computing is an innovative technology that has gained significant attention from both the Chinese government and the global community. In order to effectively support the rapid growth of a novel, health-centered medical industry, it is imperative for Chinese health authorities and hospitals to seize this opportunity by implementing comprehensive strategies aimed at encouraging hospitals to migrate their HISs to the cloud. UR - https://medinform.jmir.org/2024/1/e52080 UR - http://dx.doi.org/10.2196/52080 UR - http://www.ncbi.nlm.nih.gov/pubmed/38315519 ID - info:doi/10.2196/52080 ER - TY - JOUR AU - Ang, Darryl Wei How AU - Lim, Grace Zhi Qi AU - Lau, Tiang Siew AU - Dong, Jie AU - Lau, Ying PY - 2024/1/31 TI - Unpacking the Experiences of Health Care Professionals About the Web-Based Building Resilience At Work Program During the COVID-19 Pandemic: Framework Analysis JO - JMIR Med Educ SP - e49551 VL - 10 KW - resilience KW - intent to stay KW - employability KW - health care professionals KW - process evaluation KW - framework analysis KW - framework KW - stress KW - mental health disorder KW - prevention KW - training KW - qualitative study KW - web-based tool KW - tool KW - sustainability N2 - Background: The COVID-19 pandemic has resulted in a greater workload in the health care system. Therefore, health care professionals (HCPs) continue to experience high levels of stress, resulting in mental health disorders. From a preventive perspective, building resilience has been associated with reduced stress and mental health disorders and promotes HCPs? intent to stay. Despite the benefits of resilience training, few studies provided an in-depth understanding of the contextual factors, implementation, and mechanisms of impact that influences the sustainability of resilience programs. Therefore, examining target users? experiences of the resilience program is important. This will provide meaningful information to refine and improve future resilience programs. Objective: This qualitative study aims to explore HCPs? experiences of participating in the web-based Building Resilience At Work (BRAW) program. In particular, this study aims to explore the contextual and implementational factors that would influence participants? interaction and outcome from the program. Methods: A descriptive qualitative approach using individual semistructured Zoom interviews was conducted with participants of the web-based resilience program. A framework analysis was conducted, and it is guided by the process evaluation framework. Results: A total of 33 HCPs participated in this qualitative study. Three themes depicting participants? experiences, interactions, and impacts from the BRAW program were elucidated from the framework analysis: learning from web-based tools, interacting with the BRAW program, and promoting participants? workforce readiness. Conclusions: Findings show that a web-based asynchronous and self-paced resilience program is an acceptable and feasible approach for HCPs. The program also led to encouraging findings on participants? resilience, intent to stay, and employability. However, continued refinements in the components of the web-based resilience program should be carried out to ensure the sustainability of this intervention. Trial Registration: ClinicalTrials.gov NCT05130879; https://clinicaltrials.gov/ct2/show/NCT05130879 UR - https://mededu.jmir.org/2024/1/e49551 UR - http://dx.doi.org/10.2196/49551 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294866 ID - info:doi/10.2196/49551 ER - TY - JOUR AU - Amar, Fouzia AU - April, Alain AU - Abran, Alain PY - 2024/1/30 TI - Electronic Health Record and Semantic Issues Using Fast Healthcare Interoperability Resources: Systematic Mapping Review JO - J Med Internet Res SP - e45209 VL - 26 KW - electronic health record KW - EHR KW - Health Level Seven International Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - interoperability, web ontology language KW - OWL KW - ontology KW - semantic KW - terminology KW - resource description framework KW - RDF KW - machine learning KW - ML KW - natural language processing KW - NLP N2 - Background: The increasing use of electronic health records and the Internet of Things has led to interoperability issues at different levels (structural and semantic). Standards are important not only for successfully exchanging data but also for appropriately interpreting them (semantic interoperability). Thus, to facilitate the semantic interoperability of data exchanged in health care, considerable resources have been deployed to improve the quality of shared clinical data by structuring and mapping them to the Fast Healthcare Interoperability Resources (FHIR) standard. Objective: The aims of this study are 2-fold: to inventory the studies on FHIR semantic interoperability resources and terminologies and to identify and classify the approaches and contributions proposed in these studies. Methods: A systematic mapping review (SMR) was conducted using 10 electronic databases as sources of information for inventory and review studies published during 2012 to 2022 on the development and improvement of semantic interoperability using the FHIR standard. Results: A total of 70 FHIR studies were selected and analyzed to identify FHIR resource types and terminologies from a semantic perspective. The proposed semantic approaches were classified into 6 categories, namely mapping (31/126, 24.6%), terminology services (18/126, 14.3%), resource description framework or web ontology language?based proposals (24/126, 19%), annotation proposals (18/126, 14.3%), machine learning (ML) and natural language processing (NLP) proposals (20/126, 15.9%), and ontology-based proposals (15/126, 11.9%). From 2012 to 2022, there has been continued research in 6 categories of approaches as well as in new and emerging annotations and ML and NLP proposals. This SMR also classifies the contributions of the selected studies into 5 categories: framework or architecture proposals, model proposals, technique proposals, comparison services, and tool proposals. The most frequent type of contribution is the proposal of a framework or architecture to enable semantic interoperability. Conclusions: This SMR provides a classification of the different solutions proposed to address semantic interoperability using FHIR at different levels: collecting, extracting and annotating data, modeling electronic health record data from legacy systems, and applying transformation and mapping to FHIR models and terminologies. The use of ML and NLP for unstructured data is promising and has been applied to specific use case scenarios. In addition, terminology services are needed to accelerate their use and adoption; furthermore, techniques and tools to automate annotation and ontology comparison should help reduce human interaction. UR - https://www.jmir.org/2024/1/e45209 UR - http://dx.doi.org/10.2196/45209 UR - http://www.ncbi.nlm.nih.gov/pubmed/38289660 ID - info:doi/10.2196/45209 ER - TY - JOUR AU - Basnet, Syaron AU - Chaiton, Michael PY - 2024/1/30 TI - Effectiveness of the Wellness Together Canada Portal as a Digital Mental Health Intervention in Canada: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e48703 VL - 13 KW - Wellness Together Portal KW - randomized trial KW - COVID-19 KW - mental health KW - digital health KW - digital intervention KW - substance use KW - portal KW - effectiveness KW - well-being N2 - Background: The Wellness Together Canada (WTC) portal is a digital mental health intervention that was developed in response to an unprecedented rise in mental health and substance use concerns due to the COVID-19 pandemic, with funding from the Government of Canada. It is a mental health and substance use website to support people across Canada providing digital interventions and services at no cost. Two million people have visited the WTC portal over the course of 1 year since launching; however, rigorous evaluation of this potential solution to access to mental health care during and after the COVID-19 pandemic is urgently required. Objective: This study aims to better understand the effectiveness of the existing digital interventions in improving population mental health in Canada. Methods: The Let?s Act on Mental Health study is designed as a longitudinal fully remote, equally randomized (1:1), double-blind, alternative intervention?controlled, parallel-group randomized controlled trial to be conducted between October 2023 and April 2024 with a prospective follow-up study period of 26 weeks. This trial will evaluate whether a digital intervention such as the WTC improves population mental health trajectories over time. Results: The study was approved by the research ethics board of CAMH (Centre for Addiction and Mental Health, Toronto, Ontario, Canada). It is ongoing and participant recruitment is underway. As of August 2023, a total of 453 participants in the age group of 18-72 years have participated, of whom 70% (n=359) are female. Conclusions: This initiative provides a unique opportunity to match people?s specific unmet mental health and substance use needs to evidence-based digital interventions. UR - https://www.researchprotocols.org/2024/1/e48703 UR - http://dx.doi.org/10.2196/48703 UR - http://www.ncbi.nlm.nih.gov/pubmed/38289642 ID - info:doi/10.2196/48703 ER - TY - JOUR AU - Guinez-Molinos, Sergio AU - Espinoza, Sonia AU - Andrade, Jose AU - Medina, Alejandro PY - 2024/1/29 TI - Design and Development of Learning Management System Huemul for Teaching Fast Healthcare Interoperability Resource: Algorithm Development and Validation Study JO - JMIR Med Educ SP - e45413 VL - 10 KW - interoperability KW - health information system KW - Health Level Seven International KW - HL7 KW - Fast Healthcare Interoperability Resource KW - FHIR KW - certification KW - training KW - interoperable KW - e-learning KW - application programming interface KW - API N2 - Background: Interoperability between health information systems is a fundamental requirement to guarantee the continuity of health care for the population. The Fast Healthcare Interoperability Resource (FHIR) is the standard that enables the design and development of interoperable systems with broad adoption worldwide. However, FHIR training curriculums need an easily administered web-based self-learning platform with modules to create scenarios and questions that the learner answers. This paper proposes a system for teaching FHIR that automatically evaluates the answers, providing the learner with continuous feedback and progress. Objective: We are designing and developing a learning management system for creating, applying, deploying, and automatically assessing FHIR web-based courses. Methods: The system requirements for teaching FHIR were collected through interviews with experts involved in academic and professional FHIR activities (universities and health institutions). The interviews were semistructured, recording and documenting each meeting. In addition, we used an ad hoc instrument to register and analyze all the needs to elicit the requirements. Finally, the information obtained was triangulated with the available evidence. This analysis was carried out with Atlas-ti software. For design purposes, the requirements were divided into functional and nonfunctional. The functional requirements were (1) a test and question manager, (2) an application programming interface (API) to orchestrate components, (3) a test evaluator that automatically evaluates the responses, and (4) a client application for students. Security and usability are essential nonfunctional requirements to design functional and secure interfaces. The software development methodology was based on the traditional spiral model. The end users of the proposed system are (1) the system administrator for all technical aspects of the server, (2) the teacher designing the courses, and (3) the students interested in learning FHIR. Results: The main result described in this work is Huemul, a learning management system for training on FHIR, which includes the following components: (1) Huemul Admin: a web application to create users, tests, and questions and define scores; (2) Huemul API: module for communication between different software components (FHIR server, client, and engine); (3) Huemul Engine: component for answers evaluation to identify differences and validate the content; and (4) Huemul Client: the web application for users to show the test and questions. Huemul was successfully implemented with 416 students associated with the 10 active courses on the platform. In addition, the teachers have created 60 tests and 695 questions. Overall, the 416 students who completed their courses rated Huemul highly. Conclusions: Huemul is the first platform that allows the creation of courses, tests, and questions that enable the automatic evaluation and feedback of FHIR operations. Huemul has been implemented in multiple FHIR teaching scenarios for health care professionals. Professionals trained on FHIR with Huemul are leading successful national and international initiatives. UR - https://mededu.jmir.org/2024/1/e45413 UR - http://dx.doi.org/10.2196/45413 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285492 ID - info:doi/10.2196/45413 ER - TY - JOUR AU - Azzolini, Claudio AU - Premi, Elias AU - Donati, Simone AU - Falco, Andrea AU - Torreggiani, Aldo AU - Sicurello, Francesco AU - Baj, Andreina AU - Azzi, Lorenzo AU - Orro, Alessandro AU - Porta, Giovanni AU - Azzolini, Giovanna AU - Sorrentino, Marco AU - Melillo, Paolo AU - Testa, Francesco AU - Simonelli, Francesca AU - Giardina, Gianfranco AU - Paolucci, Umberto PY - 2024/1/26 TI - Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report JO - JMIR Med Inform SP - e42847 VL - 12 KW - telemedicine KW - ophthalmology KW - eHealth KW - informatics platform KW - health care professional KW - patient care KW - information technology KW - data warehouse N2 - Background: Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). Objective: We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. Methods: A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called ?modules? were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. Implementation (Results): Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. Conclusions: Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change. UR - https://medinform.jmir.org/2024/1/e42847 UR - http://dx.doi.org/10.2196/42847 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277199 ID - info:doi/10.2196/42847 ER - TY - JOUR AU - Modi, Shikha AU - Feldman, S. Sue AU - Berner, S. Eta AU - Schooley, Benjamin AU - Johnston, Allen PY - 2024/1/24 TI - Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study JO - JMIR Med Inform SP - e52524 VL - 12 KW - acceptance KW - admission KW - adoption KW - clinical outcome KW - cost KW - economic KW - EHR adoption KW - EHR KW - electronic health record KW - finance KW - financial outcome KW - financial KW - health outcome KW - health record KW - hospital KW - hospitalization KW - length of stay KW - margin KW - moderation analysis KW - multivariate KW - operating margin KW - operating KW - operation KW - operational KW - profit KW - project management KW - readmission rate KW - readmission KW - total margin KW - value analysis KW - value engineering KW - value management N2 - Background: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. Objective: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. Methods: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. Results: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties. Conclusions: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins. UR - https://medinform.jmir.org/2024/1/e52524 UR - http://dx.doi.org/10.2196/52524 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265848 ID - info:doi/10.2196/52524 ER - TY - JOUR AU - Zhan, Siyi AU - Ding, Liping AU - Li, Hui AU - Su, Aonan PY - 2024/1/19 TI - Application of Failure Mode and Effects Analysis to Improve the Quality of the Front Page of Electronic Medical Records in China: Cross-Sectional Data Mapping Analysis JO - JMIR Med Inform SP - e53002 VL - 12 KW - front page KW - EMR system KW - electronic medical record KW - failure mode and effects analysis KW - FMEA KW - measures N2 - Background: The completeness and accuracy of the front pages of electronic medical records (EMRs) are crucial for evaluating hospital performance and for health insurance payments to inpatients. However, the quality of the first page of EMRs in China's medical system is not satisfactory, which can be partly attributed to deficiencies in the EMR system. Failure mode and effects analysis (FMEA) is a proactive risk management tool that can be used to investigate the potential failure modes in an EMR system and analyze the possible consequences. Objective: The purpose of this study was to preemptively identify the potential failures of the EMR system in China and their causes and effects in order to prevent such failures from recurring. Further, we aimed to implement corresponding improvements to minimize system failure modes. Methods: From January 1, 2020, to May 31, 2022, 10 experts, including clinicians, engineers, administrators, and medical record coders, in Zhejiang People?s Hospital conducted FMEA to improve the quality of the front page of the EMR. The completeness and accuracy of the front page and the risk priority numbers were compared before and after the implementation of specific improvement measures. Results: We identified 2 main processes and 6 subprocesses for improving the EMR system. We found that there were 13 potential failure modes, including data messaging errors, data completion errors, incomplete quality control, and coding errors. A questionnaire survey administered to random physicians and coders showed 7 major causes for these failure modes. Therefore, we established quality control rules for medical records and embedded them in the system. We also integrated the medical insurance system and the front page of the EMR on the same interface and established a set of intelligent front pages in the EMR management system. Further, we revamped the quality management systems such as communicating with physicians regularly and conducting special training seminars. The overall accuracy and integrity rate of the front page (P<.001) of the EMR increased significantly after implementation of the improvement measures, while the risk priority number decreased. Conclusions: In this study, we were able to identify the potential failure modes in the front page of the EMR system by using the FMEA method and implement corresponding improvement measures in order to minimize recurring errors in the health care services in China. UR - https://medinform.jmir.org/2024/1/e53002 UR - http://dx.doi.org/10.2196/53002 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241064 ID - info:doi/10.2196/53002 ER - TY - JOUR AU - Wang, Ying AU - Jiang, Mengyao AU - He, Mei AU - Du, Meijie PY - 2024/1/2 TI - Design and Implementation of an Inpatient Fall Risk Management Information System JO - JMIR Med Inform SP - e46501 VL - 12 KW - fall KW - hospital information system KW - patient safety KW - quality improvement KW - management KW - implementation N2 - Background: Falls had been identified as one of the nursing-sensitive indicators for nursing care in hospitals. With technological progress, health information systems make it possible for health care professionals to manage patient care better. However, there is a dearth of research on health information systems used to manage inpatient falls. Objective: This study aimed to design and implement a novel hospital-based fall risk management information system (FRMIS) to prevent inpatient falls and improve nursing quality. Methods: This implementation was conducted at a large academic medical center in central China. We established a nurse-led multidisciplinary fall prevention team in January 2016. The hospital?s fall risk management problems were summarized by interviewing fall-related stakeholders, observing fall prevention workflow and post?fall care process, and investigating patients' satisfaction. The FRMIS was developed using an iterative design process, involving collaboration among health care professionals, software developers, and system architects. We used process indicators and outcome indicators to evaluate the implementation effect. Results: The FRMIS includes a fall risk assessment platform, a fall risk warning platform, a fall preventive strategies platform, fall incident reporting, and a tracking improvement platform. Since the implementation of the FRMIS, the inpatient fall rate was significantly lower than that before implementation (P<.05). In addition, the percentage of major fall-related injuries was significantly lower than that before implementation. The implementation rate of fall-related process indicators and the reporting rate of high risk of falls were significantly different before and after system implementation (P<.05). Conclusions: The FRMIS provides support to nursing staff in preventing falls among hospitalized patients while facilitating process control for nursing managers. UR - https://medinform.jmir.org/2024/1/e46501 UR - http://dx.doi.org/10.2196/46501 UR - http://www.ncbi.nlm.nih.gov/pubmed/38165733 ID - info:doi/10.2196/46501 ER - TY - JOUR AU - Lu, Jiao AU - Bai, Jingyan AU - Zhao, Heng AU - Zhang, Xiaoxiao PY - 2023/12/26 TI - The Effect of ?Offline-to-Online? Trust Transfer on the Utilization of Online Medical Consultation Among Chinese Rural Residents: Experimental Study JO - J Med Internet Res SP - e43430 VL - 25 KW - "offline-to-online" trust transfer KW - online medical consultation KW - health care services utilization KW - Chinese rural residents KW - direct and family spillover effects N2 - Background: Online medical consultation can serve as a valuable means for rural residents to access high-quality health care resources, thereby mitigating the geographic and economic disadvantages prevalent in rural areas. Nevertheless, due to lower cognitive abilities, rural residents often face challenges in trusting and making effective use of online medical consultations. More likely, adopting a bounded rational decision-making model that facilitates the ?offline-to-online? trust transfer could prove to be a potentially effective approach. This strategy aims to encourage less technologically experienced rural residents to trust and make use of online medical consultations. Objective: This study aims to characterize the status of ?offline-to-online? trust transfer among rural residents in the context of internet health care, and analyze its direct impact on facilitating the utilization of online medical consultation. Additionally, we investigate the family spillover effect of ?offline-to-online? trust transfer in promoting the use of online medical consultation among rural family members, considering its distributional effect across various education levels of the population. Methods: A multistage stratified random sampling method was used to survey participants in rural areas of China from July to September 2021, encompassing a total of 2597 rural residents from 960 rural households. Propensity score values were estimated using logit regression, and the propensity score matching method, using the K-nearest neighbor matching, radius matching, and kernel matching methods, was applied to create matched treatment and control samples of rural residents based on their experience of ?offline-to-online? trust transfer. Subsequently, we calculated average treatment effect scores to compare the differences in utilizing online medical consultation between the treatment and control rural samples. Results: As many as 551/960 (57.4%) rural residents experienced an ?offline-to-online? trust transfer, with a higher likelihood observed in the older population with lower levels of education and higher satisfaction with local health care services. Furthermore, rural residents who underwent ?offline-to-online? trust transfer were 37%-40% more likely to utilize online medical consultation compared with those who did not experience this trust transfer. Additionally, family members of householders who underwent ?offline-to-online? trust transfer were 25%-28% more likely to utilize online medical consultation than those whose householders did not experience this trust transfer. Notably, when compared with populations with high-level education, the ?offline-to-online? trust transfer had more significant direct and spillover effects on the utilization of online medical consultation services among rural residents with low-level education. Conclusions: To enhance the ?offline-to-online? trust transfer among rural residents and its facilitation in their utilization of online medical consultation, as well as other mobile health (mHealth) and ubiquitous health (uHealth) services, we recommend that online health care providers adopt a ?patient-oriented? service model. This approach aims to elevate rural residents? satisfaction with local health care services and harness the trust-building functions inherent in physician-patient relationships and among family members. UR - https://www.jmir.org/2023/1/e43430 UR - http://dx.doi.org/10.2196/43430 UR - http://www.ncbi.nlm.nih.gov/pubmed/38147370 ID - info:doi/10.2196/43430 ER - TY - JOUR AU - Benmessaoud, Camila AU - Pfisterer, J. Kaylen AU - De Leon, Anjelica AU - Saragadam, Ashish AU - El-Dassouki, Noor AU - Young, M. Karen G. AU - Lohani, Raima AU - Xiong, Ting AU - Pham, Quynh PY - 2023/12/25 TI - Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study JO - JMIR Hum Factors SP - e45035 VL - 10 KW - digital therapeutics KW - disease management KW - heart failure KW - informal caregivers KW - mHealth KW - mobile health KW - shared care KW - telemedicine N2 - Background: The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care ?Caretown for Medly,? which empowers ICs to concurrently expand patients? self-care abilities while acknowledging ICs? eagerness to provide greater support. Objective: We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly. Methods: We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint?s ability to quickly ?solve big problems and test new ideas,? which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the ?KTA Sprint.? Results: We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care?s synergistic benefits. Features were designed for customizability to suit the patient?s condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care. Conclusions: These disease-invariant features were designed to address ICs? needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads. UR - https://humanfactors.jmir.org/2023/1/e45035 UR - http://dx.doi.org/10.2196/45035 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145480 ID - info:doi/10.2196/45035 ER - TY - JOUR AU - Nourse, Rebecca AU - Dingler, Tilman AU - Kelly, Jaimon AU - Kwasnicka, Dominika AU - Maddison, Ralph PY - 2023/12/18 TI - The Role of a Smart Health Ecosystem in Transforming the Management of Chronic Health Conditions JO - J Med Internet Res SP - e44265 VL - 25 KW - smart home KW - health KW - chronic condition KW - chronic illness KW - digital health KW - technology KW - behavior change KW - wearable KW - smart technology KW - smart health KW - economic KW - cost KW - security KW - data storage KW - implementation UR - https://www.jmir.org/2023/1/e44265 UR - http://dx.doi.org/10.2196/44265 UR - http://www.ncbi.nlm.nih.gov/pubmed/38109188 ID - info:doi/10.2196/44265 ER - TY - JOUR AU - Siqueira do Prado, Luiza AU - Allemann, Samuel AU - Viprey, Marie AU - Schott, Anne-Marie AU - Dediu, Dan AU - Dima, Lelia Alexandra PY - 2023/12/14 TI - Toward an Interdisciplinary Approach to Constructing Care Delivery Pathways From Electronic Health Care Databases to Support Integrated Care in Chronic Conditions: Systematic Review of Quantification and Visualization Methods JO - J Med Internet Res SP - e49996 VL - 25 KW - long-term care KW - electronic health care databases KW - patient pathway KW - data visualization KW - systematic review N2 - Background: Electronic health care databases are increasingly used for informing clinical decision-making. In long-term care, linking and accessing information on health care delivered by different providers could improve coordination and health outcomes. Several methods for quantifying and visualizing this information into data-driven care delivery pathways (CDPs) have been proposed. To be integrated effectively and sustainably into routine care, these methods need to meet a range of prerequisites covering 3 broad domains: clinical, technological, and behavioral. Although advances have been made, development to date lacks a comprehensive interdisciplinary approach. As the field expands, it would benefit from developing common standards of development and reporting that integrate clinical, technological, and behavioral aspects. Objective: We aimed to describe the content and development of long-term CDP quantification and visualization methods and to propose recommendations for future work. Methods: We conducted a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. We searched peer-reviewed publications in English and reported the CDP methods by using the following data in the included studies: long-term care data and extracted data on clinical information and aims, technological development and characteristics, and user behaviors. The data are summarized in tables and presented narratively. Results: Of the 2921 records identified, 14 studies were included, of which 13 (93%) were descriptive reports and 1 (7%) was a validation study. Clinical aims focused primarily on treatment decision-making (n=6, 43%) and care coordination (n=7, 50%). Technological development followed a similar process from scope definition to tool validation, with various levels of detail in reporting. User behaviors (n=3, 21%) referred to accessing CDPs, planning care, adjusting treatment, or supporting adherence. Conclusions: The use of electronic health care databases for quantifying and visualizing CDPs in long-term care is an emerging field. Detailed and standardized reporting of clinical and technological aspects is needed. Early consideration of how CDPs would be used, validated, and implemented in clinical practice would likely facilitate further development and adoption. Trial Registration: PROSPERO CRD42019140494; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=140494 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033573 UR - https://www.jmir.org/2023/1/e49996 UR - http://dx.doi.org/10.2196/49996 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096009 ID - info:doi/10.2196/49996 ER - TY - JOUR AU - Gierend, Kerstin AU - Waltemath, Dagmar AU - Ganslandt, Thomas AU - Siegel, Fabian PY - 2023/12/7 TI - Traceable Research Data Sharing in a German Medical Data Integration Center With FAIR (Findability, Accessibility, Interoperability, and Reusability)-Geared Provenance Implementation: Proof-of-Concept Study JO - JMIR Form Res SP - e50027 VL - 7 KW - provenance KW - traceability KW - data management KW - metadata KW - data integrity KW - data integration center KW - medical informatics N2 - Background: Secondary investigations into digital health records, including electronic patient data from German medical data integration centers (DICs), pave the way for enhanced future patient care. However, only limited information is captured regarding the integrity, traceability, and quality of the (sensitive) data elements. This lack of detail diminishes trust in the validity of the collected data. From a technical standpoint, adhering to the widely accepted FAIR (Findability, Accessibility, Interoperability, and Reusability) principles for data stewardship necessitates enriching data with provenance-related metadata. Provenance offers insights into the readiness for the reuse of a data element and serves as a supplier of data governance. Objective: The primary goal of this study is to augment the reusability of clinical routine data within a medical DIC for secondary utilization in clinical research. Our aim is to establish provenance traces that underpin the status of data integrity, reliability, and consequently, trust in electronic health records, thereby enhancing the accountability of the medical DIC. We present the implementation of a proof-of-concept provenance library integrating international standards as an initial step. Methods: We adhered to a customized road map for a provenance framework, and examined the data integration steps across the ETL (extract, transform, and load) phases. Following a maturity model, we derived requirements for a provenance library. Using this research approach, we formulated a provenance model with associated metadata and implemented a proof-of-concept provenance class. Furthermore, we seamlessly incorporated the internationally recognized Word Wide Web Consortium (W3C) provenance standard, aligned the resultant provenance records with the interoperable health care standard Fast Healthcare Interoperability Resources, and presented them in various representation formats. Ultimately, we conducted a thorough assessment of provenance trace measurements. Results: This study marks the inaugural implementation of integrated provenance traces at the data element level within a German medical DIC. We devised and executed a practical method that synergizes the robustness of quality- and health standard?guided (meta)data management practices. Our measurements indicate commendable pipeline execution times, attaining notable levels of accuracy and reliability in processing clinical routine data, thereby ensuring accountability in the medical DIC. These findings should inspire the development of additional tools aimed at providing evidence-based and reliable electronic health record services for secondary use. Conclusions: The research method outlined for the proof-of-concept provenance class has been crafted to promote effective and reliable core data management practices. It aims to enhance biomedical data by imbuing it with meaningful provenance, thereby bolstering the benefits for both research and society. Additionally, it facilitates the streamlined reuse of biomedical data. As a result, the system mitigates risks, as data analysis without knowledge of the origin and quality of all data elements is rendered futile. While the approach was initially developed for the medical DIC use case, these principles can be universally applied throughout the scientific domain. UR - https://formative.jmir.org/2023/1/e50027 UR - http://dx.doi.org/10.2196/50027 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060305 ID - info:doi/10.2196/50027 ER - TY - JOUR AU - Pirmani, Ashkan AU - De Brouwer, Edward AU - Geys, Lotte AU - Parciak, Tina AU - Moreau, Yves AU - Peeters, M. Liesbet PY - 2023/11/9 TI - The Journey of Data Within a Global Data Sharing Initiative: A Federated 3-Layer Data Analysis Pipeline to Scale Up Multiple Sclerosis Research JO - JMIR Med Inform SP - e48030 VL - 11 KW - data analysis pipeline KW - federated model sharing KW - real-world data KW - evidence-based decision-making KW - end-to-end pipeline KW - multiple sclerosis KW - data analysis KW - pipeline KW - data science KW - federated KW - neurology KW - brain KW - spine KW - spinal nervous system KW - neuroscience KW - data sharing KW - rare KW - low prevalence N2 - Background: Investigating low-prevalence diseases such as multiple sclerosis is challenging because of the rather small number of individuals affected by this disease and the scattering of real-world data across numerous data sources. These obstacles impair data integration, standardization, and analysis, which negatively impact the generation of significant meaningful clinical evidence. Objective: This study aims to present a comprehensive, research question?agnostic, multistakeholder-driven end-to-end data analysis pipeline that accommodates 3 prevalent data-sharing streams: individual data sharing, core data set sharing, and federated model sharing. Methods: A demand-driven methodology is employed for standardization, followed by 3 streams of data acquisition, a data quality enhancement process, a data integration procedure, and a concluding analysis stage to fulfill real-world data-sharing requirements. This pipeline?s effectiveness was demonstrated through its successful implementation in the COVID-19 and multiple sclerosis global data sharing initiative. Results: The global data sharing initiative yielded multiple scientific publications and provided extensive worldwide guidance for the community with multiple sclerosis. The pipeline facilitated gathering pertinent data from various sources, accommodating distinct sharing streams and assimilating them into a unified data set for subsequent statistical analysis or secure data examination. This pipeline contributed to the assembly of the largest data set of people with multiple sclerosis infected with COVID-19. Conclusions: The proposed data analysis pipeline exemplifies the potential of global stakeholder collaboration and underlines the significance of evidence-based decision-making. It serves as a paradigm for how data sharing initiatives can propel advancements in health care, emphasizing its adaptability and capacity to address diverse research inquiries. UR - https://medinform.jmir.org/2023/1/e48030 UR - http://dx.doi.org/10.2196/48030 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943585 ID - info:doi/10.2196/48030 ER - TY - JOUR AU - Gierend, Kerstin AU - Freiesleben, Sherry AU - Kadioglu, Dennis AU - Siegel, Fabian AU - Ganslandt, Thomas AU - Waltemath, Dagmar PY - 2023/11/8 TI - The Status of Data Management Practices Across German Medical Data Integration Centers: Mixed Methods Study JO - J Med Internet Res SP - e48809 VL - 25 KW - data management KW - provenance KW - traceability KW - metadata KW - data integration center KW - maturity model N2 - Background: In the context of the Medical Informatics Initiative, medical data integration centers (DICs) have implemented complex data flows to transfer routine health care data into research data repositories for secondary use. Data management practices are of importance throughout these processes, and special attention should be given to provenance aspects. Insufficient knowledge can lead to validity risks and reduce the confidence and quality of the processed data. The need to implement maintainable data management practices is undisputed, but there is a great lack of clarity on the status. Objective: Our study examines the current data management practices throughout the data life cycle within the Medical Informatics in Research and Care in University Medicine (MIRACUM) consortium. We present a framework for the maturity status of data management practices and present recommendations to enable a trustful dissemination and reuse of routine health care data. Methods: In this mixed methods study, we conducted semistructured interviews with stakeholders from 10 DICs between July and September 2021. We used a self-designed questionnaire that we tailored to the MIRACUM DICs, to collect qualitative and quantitative data. Our study method is compliant with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. Results: Our study provides insights into the data management practices at the MIRACUM DICs. We identify several traceability issues that can be partially explained with a lack of contextual information within nonharmonized workflow steps, unclear responsibilities, missing or incomplete data elements, and incomplete information about the computational environment information. Based on the identified shortcomings, we suggest a data management maturity framework to reach more clarity and to help define enhanced data management strategies. Conclusions: The data management maturity framework supports the production and dissemination of accurate and provenance-enriched data for secondary use. Our work serves as a catalyst for the derivation of an overarching data management strategy, abiding data integrity and provenance characteristics as key factors. We envision that this work will lead to the generation of fairer and maintained health research data of high quality. UR - https://www.jmir.org/2023/1/e48809 UR - http://dx.doi.org/10.2196/48809 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938878 ID - info:doi/10.2196/48809 ER - TY - JOUR AU - Brommeyer, Mark AU - Liang, Zhanming AU - Whittaker, Maxine AU - Mackay, Mark PY - 2023/11/3 TI - Developing Health Management Competency for Digital Health Transformation: Protocol for a Qualitative Study JO - JMIR Res Protoc SP - e51884 VL - 12 KW - health care management KW - health service manager KW - digital health KW - health informatics KW - competency KW - workforce development KW - innovation KW - research protocol KW - informatics KW - manager KW - managers KW - service KW - services KW - delivery KW - organization KW - organizational KW - workforce KW - management KW - managerial KW - qualification KW - qualifications KW - focus group KW - focus groups KW - interview KW - interviews KW - scoping KW - review methods KW - review methodology N2 - Background: Globally, the health care system is experiencing a period of rapid and radical change. In response, innovative service models have been adopted for the delivery of high-quality care that require a health workforce with skills to support transformation and new ways of working. Objective: The aim of this research protocol is to describe research that will contribute to developing the capability of health service managers in the digital health era and enabling digital transformation within the Australian health care environment. It also explains the process of preparing and finalizing the research design and methodologies by seeking answers to the following three research questions: (1) To what extent can the existing health service management and digital health competency frameworks guide the development of competence for health service managers in understanding and managing in the digital health space? (2) What are the competencies that are necessary for health service managers to acquire in order to effectively work with and manage in the digital health context? (3) What are the key factors that enable and inhibit health service managers to develop and demonstrate digital health competence in the workplace? Methods: The study has adopted a qualitative approach, guided by the empirically validated management competency identification process, using four steps: (1) health management and digital health competency mapping, (2) scoping review of literature and policy analysis, (3) focus group discussions with health service managers, and (4) semistructured interviews with digital health leaders. The first 2 steps were to confirm the need for updating the current health service management curriculum to address changing competency requirements of health service managers in the digital health context. Results: Two initial steps have been completed confirming the significance of the study and study design. Step 1, competency mapping, found that nearly half of the digital competencies were only partially or not addressed at all by the health management competency framework. The scoping review articulated the competencies health service managers need to effectively demonstrate digital health competence in the workplace. The findings effectively support the importance of the current research and also the appropriateness of the proposed steps 3 and 4 in answering the research questions and achieving the research aim. Conclusions: This study will provide insights into the health service management workforce performance and development needs for digital health and inform credentialing and professional development requirements. This will guide health service managers in leading and managing the adoption and implementation of digital health as a contemporary tool for health care delivery. The study will develop an in-depth understanding of Australian health service managers? experiences and views. This research process could be applied in other contexts, noting that the results need contextualization to individual country jurisdictions and environments. International Registered Report Identifier (IRRID): DERR1-10.2196/51884 UR - https://www.researchprotocols.org/2023/1/e51884 UR - http://dx.doi.org/10.2196/51884 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921855 ID - info:doi/10.2196/51884 ER - TY - JOUR AU - Sant?Anna, Anita AU - Nygren, Jens PY - 2023/10/25 TI - A Pragmatic Mapping of Perceptions and Use of Digital Information Systems in Primary Care in Sweden: Survey Study JO - Interact J Med Res SP - e49973 VL - 12 KW - digital information systems KW - implementation KW - primary care KW - health care professionals KW - information system KW - information systems KW - usability KW - adoption KW - perception KW - perceptions KW - technology use KW - perspective KW - perspectives N2 - Background: Electronic health records and IT infrastructure in primary care allow for digital documentation and access to information, which can be used to guide evidence-based care and monitor patient safety and quality of care. Quality indicators specified by regulatory authorities can be automatically computed and presented to primary care staff. However, the implementation of digital information systems (DIS) in health care can be challenging, and understanding factors such as relative advantage, compatibility, complexity, trialability, and observability is needed to improve the success and rate of adoption and diffusion. Objective: This study aims to explore how DIS are used and perceived by health care professionals in primary care. Methods: This study used quantitative assessment to gather survey data on the use and potential of DIS in health care in Sweden from the perspectives of primary care personnel in various roles. The digital questionnaire was designed to be short and contained 3 sections covering respondent characteristics, current use of platforms, and perceptions of decision support tools. Data were analyzed using descriptive statistics, nonparametric hypothesis testing, ordinal coefficient ?, and confirmatory factor analysis. Results: The study collected responses from participants across 10 regions of Sweden, comprising 31.9% (n=22) from private clinics and 68.1% (n=47) from public clinics. Participants included administrators (18/69, 26.1%), a medical strategist (1/69, 1.4%), and physicians (50/69, 72.5%). Usage frequency varied as follows: 11.6% (n=8) used DIS weekly, 24.6% (n=17) monthly, 27.5% (n=19) a few times a year, 26.1% (n=18) very rarely, and 10.1% (n=7) lacked access. Administrators used DIS more frequently than physicians (P=.005). DIS use centered on quality improvement and identifying high-risk patients, with differences by role. Physicians were more inclined to use DIS out of curiosity (P=.01). Participants desired DIS for patient follow-up, lifestyle guidance, treatment suggestions, reminders, and shared decision-making. Administrators favored predictive analysis (P<.001), while physicians resisted immediate patient identification (P=.03). The 5 innovation attributes showed high internal consistency (?>.7). These factors explained 78.5% of questionnaire variance, relating to complexity, competitive advantage, compatibility, trialability, and observability. Factors 2, 3, and 4 predicted intention to use DIS, with factor 2 alone achieving the best accuracy (root-mean-square=0.513). Conclusions: Administrators and physicians exhibited role-based DIS use patterns highlighting the need for tailored approaches to promote DIS adoption. The study reveals a link between positive perceptions and intention to use DIS, emphasizing the significance of considering all factors for successful health care integration. The results suggest various directions for future studies. These include refining the trialability and observability questions for increased reliability and validity, investigating a larger sample with more specific target groups to improve generalization, and exploring the relevance of different groups? perspectives and needs in relation to decisions about and use of DIS. UR - https://www.i-jmr.org/2023/1/e49973 UR - http://dx.doi.org/10.2196/49973 UR - http://www.ncbi.nlm.nih.gov/pubmed/37878357 ID - info:doi/10.2196/49973 ER - TY - JOUR AU - Solomon, Jeffrey AU - Dauber-Decker, Katherine AU - Richardson, Safiya AU - Levy, Sera AU - Khan, Sundas AU - Coleman, Benjamin AU - Persaud, Rupert AU - Chelico, John AU - King, D'Arcy AU - Spyropoulos, Alex AU - McGinn, Thomas PY - 2023/10/19 TI - Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study JO - JMIR Form Res SP - e44065 VL - 7 KW - clinical decision support system KW - cloud based KW - decision support KW - development KW - EHR KW - electronic health record KW - evidence-based medicine KW - health information technology KW - platform KW - user-centered design N2 - Background: Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. Objective: The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. Methods: We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. Results: The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells? criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform?s flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells? criteria tool will be reported in a future publication. Conclusions: The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics ?nudges? on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint. UR - https://formative.jmir.org/2023/1/e44065 UR - http://dx.doi.org/10.2196/44065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856193 ID - info:doi/10.2196/44065 ER - TY - JOUR AU - Bediang, Georges PY - 2023/10/18 TI - Implementing Clinical Information Systems in Sub-Saharan Africa: Report and Lessons Learned From the MatLook Project in Cameroon JO - JMIR Med Inform SP - e48256 VL - 11 KW - implementation report KW - challenges KW - success factors KW - Sub-Saharan Africa KW - Cameroon KW - healthcare KW - health care KW - clinical information KW - information management KW - clinical information systems KW - hospital information systems KW - data governance N2 - Background: Yaoundé Central Hospital (YCH), located in the capital of Cameroon, is one of the leading referral hospitals in Cameroon. The hospital has several departments, including the Department of Gynecology-Obstetrics (hereinafter referred to as ?the Maternity?). This clinical department has faced numerous problems with clinical information management, including the lack of high-quality and reliable clinical information, lack of access to this information, and poor use of this information. Objective: We aim to improve the management of clinical information generated at the Maternity at YCH and to describe the challenges, success factors, and lessons learned during its implementation and use. Methods: Based on an open-source hospital information system (HIS), this intervention implemented a clinical information system (CIS) at the Maternity at YCH and was carried out using the HERMES model?the first part aimed to cover outpatient consultations, billing, and cash management of the Maternity. Geneva University Hospitals supported this project, and several outcomes were measured at the end. The following outcomes were assessed: project management, technical and organizational aspects, leadership, change management, user training, and system use. Implementation (Results): The first part of the project was completed, and the CIS was deployed in the Maternity at YCH. The main technical activities were adapting the open-source HIS to manage outpatient consultations and develop integrated billing and cash management software. In addition to technical aspects, we implemented several other activities. They consisted of the implementation of appropriate project governance or management, improvement of the organizational processes at the Maternity, promotion of the local digital health leadership and performance of change management, and implementation of the training and support of users. Despite barriers encountered during the project, the 6-month evaluation showed that the CIS was effectively used during the first 6 months. Conclusions: Implementation of the HIS or CIS is feasible in a resource-limited setting such as Cameroon. The CIS was implemented based on good practices at the Maternity at YCH. This project had successes but also many challenges. Beyond project management and technical and financial aspects, the other main problems of implementing health information systems or HISs in Africa lie in digital health leadership, governance, and change management. This digital health leadership, governance, and change management should prioritize data as a tool for improving productivity and managing health institutions, and promote a data culture among health professionals to support a change in mindset and the acquisition of information management skills. Moreover, in countries with a highly centralized political system like ours, a high-level strategic and political anchor for such projects is often necessary to guarantee their success. UR - https://medinform.jmir.org/2023/1/e48256 UR - http://dx.doi.org/10.2196/48256 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851502 ID - info:doi/10.2196/48256 ER - TY - JOUR AU - Layer, Erica AU - Slim, Salim AU - Mussa, Issa AU - Al-Mafazy, Abdul-Wahid AU - Besana, R. Giulia V. AU - Msellem, Mwinyi AU - Fulcher, Isabel AU - Hornung, Heiko AU - Lampariello, Riccardo PY - 2023/10/9 TI - The Journey of Zanzibar?s Digitally Enabled Community Health Program to National Scale: Implementation Report JO - JMIR Med Inform SP - e48097 VL - 11 KW - Zanzibar KW - digital health KW - community health KW - health systems strengthening KW - maternal health KW - child health KW - data for decision-making KW - implementation science KW - health systems KW - healthcare infrastructure KW - health care KW - implementation report N2 - Background: While high-quality primary health care services can meet 80%-90% of health needs over a person?s lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. Objective: In this implementation report, we describe the design and rollout of Zanzibar?s national, digitally enabled community health program?Jamii ni Afya. Methods: Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. Results: The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. Conclusions: Jamii ni Afya represents one of the world?s first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems. UR - https://medinform.jmir.org/2023/1/e48097 UR - http://dx.doi.org/10.2196/48097 UR - http://www.ncbi.nlm.nih.gov/pubmed/37812488 ID - info:doi/10.2196/48097 ER - TY - JOUR AU - Thomas, Verghese AU - Kalidindi, Bharat AU - Waghmare, Abijeet AU - Bhatia, Abhishek AU - Raj, Tony AU - Balsari, Satchit PY - 2023/10/2 TI - The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems JO - JMIR Form Res SP - e45250 VL - 7 KW - community health workers KW - digital health KW - focus group discussions KW - health care workers KW - human centered design KW - key informant interviews KW - LMICs KW - low- and middle-income countries KW - mHealth KW - mobile health KW - qualitative research N2 - Background: mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users? perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. Objective: To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. Methods: We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. Results: We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system?s users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system?the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. Conclusions: The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption. UR - https://formative.jmir.org/2023/1/e45250 UR - http://dx.doi.org/10.2196/45250 UR - http://www.ncbi.nlm.nih.gov/pubmed/37607881 ID - info:doi/10.2196/45250 ER - TY - JOUR AU - Li, Zhong AU - Merrell, A. Melinda AU - Eberth, M. Jan AU - Wu, Dezhi AU - Hung, Peiyin PY - 2023/9/28 TI - Successes and Barriers of Health Information Exchange Participation Across Hospitals in South Carolina From 2014 to 2020: Longitudinal Observational Study JO - JMIR Med Inform SP - e40959 VL - 11 KW - health information exchange KW - electronic health records KW - interoperability KW - meaningful use KW - hospital N2 - Background: The 2009 Health Information Technology for Economic and Clinical Health Act sets three stages of Meaningful Use requirements for the electronic health records incentive program. Health information exchange (HIE) technologies are critical in the meaningful use of electronic health records to support patient care coordination. However, HIE use trends and barriers remain unclear across hospitals in South Carolina (SC), a state with the earliest HIE implementation. Objective: This study aims to explore changes in the proportion of HIE participation and factors associated with HIE participation, and barriers to exchange and interoperability across SC hospitals. Methods: This study derived data from a longitudinal data set of the 2014-2020 American Hospital Association Information Technology Supplement for 69 SC hospitals. The primary outcome was whether a hospital participated in HIE in a year. A cross-sectional multivariable logistic regression model, clustered at the hospital level and weighted by bed size, was used to identify factors associated with HIE participation. The second outcome was barriers to sending, receiving, or finding patient health information to or from other organizations or hospital systems. The frequency of hospitals reporting each barrier related to exchange and interoperability were then calculated. Results: Hospitals in SC have been increasingly participating in HIE, improving from 43% (24/56) in 2014 to 82% (54/66) in 2020. After controlling for other hospital factors, teaching hospitals (adjusted odds ratio [AOR] 3.7, 95% CI 1.0-13.3), system-affiliated hospitals (AOR 6.6, 95% CI 3.2-13.7), and rural referral hospitals (AOR 8.0, 95% CI 1.2-53.4) had higher odds to participate in HIE than their counterparts, whereas critical access hospitals (AOR 0.1, 95% CI 0.02-0.6) were less likely to participate in HIE than their counterparts reimbursed by the prospective payment system. Hospitals with greater ratios of Medicare or Medicaid inpatient days to total inpatient days also reported higher odds of HIE participation. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, including lack of provider contacts (27/40, 68%), difficulty in finding patient health information (27/40, 68%), adapting different vendor platforms (26/40, 65%), difficulty matching or identifying same patients between systems (23/40, 58%), and providers that do not typically exchange patient data (23/40, 58%). Conclusions: HIE participation has been widely adopted in SC hospitals. Our findings highlight the need to incentivize optimization of HIE and seamless information exchange by facilitating and implementing standardization of health information across various HIE systems and by addressing other technical issues, including providing providers? addresses and training HIE stakeholders to find relevant information. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information. UR - https://medinform.jmir.org/2023/1/e40959 UR - http://dx.doi.org/10.2196/40959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768730 ID - info:doi/10.2196/40959 ER - TY - JOUR AU - Heeres, J. Tjitske AU - Tran, Mikael Tri AU - Noort, A.C. Bart PY - 2023/9/20 TI - Drivers and Barriers to Implementing the Internet of Things in the Health Care Supply Chain: Mixed Methods Multicase Study JO - J Med Internet Res SP - e48730 VL - 25 KW - digital health KW - drivers and barriers KW - healthcare logistics KW - healthcare supply chain KW - implementation KW - Internet of Things KW - supply chain management N2 - Background: Over the past 2 years, the COVID-19 pandemic has placed enormous pressure on the health care industry. There has been an increase in demand and, at the same time, a shortage of supplies. This has shown that supply chain management in the health care industry cannot be taken for granted. Furthermore, the health care industry is also facing other major challenges, such as the current labor market shortage. In the literature, the Internet of Things (IoT) is highlighted as an effective tool to build a more resilient and efficient supply chain that can manage these challenges. Although using IoT in supply chain management has been extensively examined in other types of supply chains, its use in the health care supply chain has largely been overlooked. Given that the health care supply chain, compared to others, is more complex and is under growing pressure, a more in-depth understanding of the opportunities brought by IoT is necessary. Objective: This study aims to address this research gap by identifying and ranking the drivers of and barriers to implementing IoT in the health care supply chain. Methods: We conducted a 2-stage study. In the first, exploratory stage, a total of 12 semistructured interviews were conducted to identify drivers and barriers. In the second, confirmatory stage, a total of 26 health care supply chain professionals were asked in a survey to rank the drivers and barriers. Results: The results show that there are multiple financial, operational, strategy-related, and supply chain-related drivers for implementing IoT. Similarly, there are various financial, strategy-related, supply chain-related, technology-related, and user-related barriers. The findings also show that supply chain-related drivers (eg, increased transparency, traceability, and collaboration with suppliers) are the strongest drivers, while financial barriers (eg, high implementation costs and difficulties in building a business case) are the biggest barriers to overcome. Conclusions: The findings of this study add to the limited literature regarding IoT in the health care supply chain by empirically identifying the most important drivers and barriers to IoT implementation. The ranking of drivers and barriers provides guidance for practitioners and health care provider leaders intending to implement IoT in the health care supply chain. UR - https://www.jmir.org/2023/1/e48730 UR - http://dx.doi.org/10.2196/48730 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728990 ID - info:doi/10.2196/48730 ER - TY - JOUR AU - Haque, Saira AU - DeStefano, Sydney AU - Banger, Alison AU - Rutledge, Regina AU - Romaire, Melissa PY - 2023/9/20 TI - Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation JO - JMIR Form Res SP - e49591 VL - 7 KW - telehealth KW - virtual care KW - rural health KW - critical access hospital KW - access KW - telehealth impact KW - methods evaluation KW - mixed methods KW - thematic analysis KW - cost efficiency KW - telehealth cost KW - qualitative analysis KW - claims analysis N2 - Background: Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. Objective: We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. Methods: We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. Results: CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. Conclusions: The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability. UR - https://formative.jmir.org/2023/1/e49591 UR - http://dx.doi.org/10.2196/49591 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728991 ID - info:doi/10.2196/49591 ER - TY - JOUR AU - Noort, C. Bart A. AU - Buijs, Paul AU - Roemeling, Oskar PY - 2023/9/19 TI - Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study JO - Interact J Med Res SP - e41409 VL - 12 KW - health care logistics KW - outsourcing KW - web ordering portal KW - medical devices KW - feasibility study KW - device management N2 - Background: Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively. Objective: This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users? acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention?s preliminary efficacy, thus benefiting practitioners and researchers. Methods: This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti?pressure ulcer mattresses. Results: Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti?pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (?2.7 min) and anti?pressure ulcer mattresses (?3.1 min), as well as shorter delivery times for wheelchairs (?0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful. Conclusions: This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions. UR - https://www.i-jmr.org/2023/1/e41409 UR - http://dx.doi.org/10.2196/41409 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725420 ID - info:doi/10.2196/41409 ER - TY - JOUR AU - Wu, Y. Danny T. AU - Hanauer, David AU - Murdock, Paul AU - Vydiswaran, Vinod V. G. AU - Mei, Qiaozhu AU - Zheng, Kai PY - 2023/9/15 TI - Developing a Semantically Based Query Recommendation for an Electronic Medical Record Search Engine: Query Log Analysis and Design Implications JO - JMIR Form Res SP - e45376 VL - 7 KW - electronic health records KW - information retrieval KW - user-centered evaluation KW - query recommendation KW - query log analysis KW - clinical research informatics N2 - Background: An effective and scalable information retrieval (IR) system plays a crucial role in enabling clinicians and researchers to harness the valuable information present in electronic health records. In a previous study, we developed a prototype medical IR system, which incorporated a semantically based query recommendation (SBQR) feature. The system was evaluated empirically and demonstrated high perceived performance by end users. To delve deeper into the factors contributing to this perceived performance, we conducted a follow-up study using query log analysis. Objective: One of the primary challenges faced in IR is that users often have limited knowledge regarding their specific information needs. Consequently, an IR system, particularly its user interface, needs to be thoughtfully designed to assist users through the iterative process of refining their queries as they encounter relevant documents during their search. To address these challenges, we incorporated ?query recommendation? into our Electronic Medical Record Search Engine (EMERSE), drawing inspiration from the success of similar features in modern IR systems for general purposes. Methods: The query log data analyzed in this study were collected during our previous experimental study, where we developed EMERSE with the SBQR feature. We implemented a logging mechanism to capture user query behaviors and the output of the IR system (retrieved documents). In this analysis, we compared the initial query entered by users with the query formulated with the assistance of the SBQR. By examining the results of this comparison, we could examine whether the use of SBQR helped in constructing improved queries that differed from the original ones. Results: Our findings revealed that the first query entered without SBQR and the final query with SBQR assistance were highly similar (Jaccard similarity coefficient=0.77). This suggests that the perceived positive performance of the system was primarily attributed to the automatic query expansion facilitated by the SBQR rather than users manually manipulating their queries. In addition, through entropy analysis, we observed that search results converged in scenarios of moderate difficulty, and the degree of convergence correlated strongly with the perceived system performance. Conclusions: The study demonstrated the potential contribution of the SBQR in shaping participants' positive perceptions of system performance, contingent upon the difficulty of the search scenario. Medical IR systems should therefore consider incorporating an SBQR as a user-controlled option or a semiautomated feature. Future work entails redesigning the experiment in a more controlled manner and conducting multisite studies to demonstrate the effectiveness of EMERSE with SBQR for patient cohort identification. By further exploring and validating these findings, we can enhance the usability and functionality of medical IR systems in real-world settings. UR - https://formative.jmir.org/2023/1/e45376 UR - http://dx.doi.org/10.2196/45376 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713239 ID - info:doi/10.2196/45376 ER - TY - JOUR AU - O'Brien, Niki AU - Li, Edmond AU - Chaibva, N. Cynthia AU - Gomez Bravo, Raquel AU - Kovacevic, Lana AU - Kwame Ayisi-Boateng, Nana AU - Lounsbury, Olivia AU - Nwabufo, F. Ngnedjou Francoise AU - Senkyire, Kumi Ephraim AU - Serafini, Alice AU - Surafel Abay, Eleleta AU - van de Vijver, Steven AU - Wanjala, Mercy AU - Wangari, Marie-Claire AU - Moosa, Shabir AU - Neves, Luisa Ana PY - 2023/9/7 TI - Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study JO - J Med Internet Res SP - e45224 VL - 25 KW - digital health KW - digital health technology KW - telemedicine KW - remote care KW - primary care KW - primary health carel PHC KW - COVID-19 KW - global health KW - sub-Saharan Africa KW - eHealth N2 - Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers? contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. UR - https://www.jmir.org/2023/1/e45224 UR - http://dx.doi.org/10.2196/45224 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676721 ID - info:doi/10.2196/45224 ER - TY - JOUR AU - Busch-Casler, Julia AU - Radic, Marija PY - 2023/8/30 TI - Trust and Health Information Exchanges: Qualitative Analysis of the Intent to Share Personal Health Information JO - J Med Internet Res SP - e41635 VL - 25 KW - trust KW - eHealth KW - data sharing KW - sharing personal health information KW - privacy KW - security KW - health information exchange KW - consent KW - data exchange KW - belief-attitude-intention KW - behavior formation N2 - Background: Digital health has the potential to improve the quality of care, reduce health care costs, and increase patient satisfaction. Patient acceptance and consent are a prerequisite for effective sharing of personal health information (PHI) through health information exchanges (HIEs). Patients need to form and retain trust in the system(s) they use to leverage the full potential of digital health. Germany is at the forefront of approving digital treatment options with cost coverage through statutory health insurance. However, the German population has a high level of technology skepticism and a low level of trust, providing a good basis to illuminate various facets of eHealth trust formation. Objective: In a German setting, we aimed to answer the question, How does an individual form a behavioral intent to share PHI with an HIE platform? We discussed trust and informed consent through (1) synthesizing the main influence factor models into a complex model of trust in HIE, (2) providing initial validation of influence factors based on a qualitative study with patient interviews, and (3) developing a model of trust formation for digital health apps. Methods: We developed a complex model of the formation of trust and the intent to share PHI. We provided initial validation of the influence factors through 20 qualitative, semistructured interviews in the German health care setting and used a deductive coding approach to analyze the data. Results: We found that German patients show a positive intent to share their PHI with HIEs under certain conditions. These include (perceived) information security and a noncommercial organization as the recipient of the PHI. Technology experience, age, policy and regulation, and a disposition to trust play an important role in an individual?s privacy concern, which, combined with social influence, affects trust formation on a cognitive and emotional level. We found a high level of cognitive trust in health care and noncommercial research institutions but distrust in commercial entities. We further found that in-person interactions with physicians increase trust in digital health apps and PHI sharing. Patients? emotional trust depends on disposition and social influences. To form their intent to share, patients undergo a privacy calculus. Hereby, the individual?s benefit (eg, convenience), benefits for the individual?s own health, and the benefits for public welfare often outweigh the perceived risks of sharing PHI. Conclusions: With the higher demand for timely PHI, HIE providers will need to clearly communicate the benefits of their solutions and their information security measures to health care providers (physicians, nursing and administrative staff) and patients and include them as key partners to increase trust. Offering easy access and educational measures as well as the option for specific consent may increase patients? trust and their intention to share PHI. UR - https://www.jmir.org/2023/1/e41635 UR - http://dx.doi.org/10.2196/41635 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647102 ID - info:doi/10.2196/41635 ER - TY - JOUR AU - Suleski, Tance AU - Ahmed, Mohiuddin PY - 2023/8/29 TI - A Data Taxonomy for Adaptive Multifactor Authentication in the Internet of Health Care Things JO - J Med Internet Res SP - e44114 VL - 25 KW - health care KW - authentication KW - contextual data model KW - Internet of Health Care Things KW - multifactor KW - mobile phone UR - https://www.jmir.org/2023/1/e44114 UR - http://dx.doi.org/10.2196/44114 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490633 ID - info:doi/10.2196/44114 ER - TY - JOUR AU - Inau, Thea Esther AU - Sack, Jean AU - Waltemath, Dagmar AU - Zeleke, Alamirrew Atinkut PY - 2023/8/28 TI - Initiatives, Concepts, and Implementation Practices of the Findable, Accessible, Interoperable, and Reusable Data Principles in Health Data Stewardship: Scoping Review JO - J Med Internet Res SP - e45013 VL - 25 KW - data stewardship KW - findable, accessible, interoperable, and reusable data principles KW - FAIR data principles KW - health research KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses KW - PRISMA KW - qualitative analysis KW - scoping review KW - information retrieval KW - health information exchange N2 - Background: Thorough data stewardship is a key enabler of comprehensive health research. Processes such as data collection, storage, access, sharing, and analytics require researchers to follow elaborate data management strategies properly and consistently. Studies have shown that findable, accessible, interoperable, and reusable (FAIR) data leads to improved data sharing in different scientific domains. Objective: This scoping review identifies and discusses concepts, approaches, implementation experiences, and lessons learned in FAIR initiatives in health research data. Methods: The Arksey and O?Malley stage-based methodological framework for scoping reviews was applied. PubMed, Web of Science, and Google Scholar were searched to access relevant publications. Articles written in English, published between 2014 and 2020, and addressing FAIR concepts or practices in the health domain were included. The 3 data sources were deduplicated using a reference management software. In total, 2 independent authors reviewed the eligibility of each article based on defined inclusion and exclusion criteria. A charting tool was used to extract information from the full-text papers. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A total of 2.18% (34/1561) of the screened articles were included in the final review. The authors reported FAIRification approaches, which include interpolation, inclusion of comprehensive data dictionaries, repository design, semantic interoperability, ontologies, data quality, linked data, and requirement gathering for FAIRification tools. Challenges and mitigation strategies associated with FAIRification, such as high setup costs, data politics, technical and administrative issues, privacy concerns, and difficulties encountered in sharing health data despite its sensitive nature were also reported. We found various workflows, tools, and infrastructures designed by different groups worldwide to facilitate the FAIRification of health research data. We also uncovered a wide range of problems and questions that researchers are trying to address by using the different workflows, tools, and infrastructures. Although the concept of FAIR data stewardship in the health research domain is relatively new, almost all continents have been reached by at least one network trying to achieve health data FAIRness. Documented outcomes of FAIRification efforts include peer-reviewed publications, improved data sharing, facilitated data reuse, return on investment, and new treatments. Successful FAIRification of data has informed the management and prognosis of various diseases such as cancer, cardiovascular diseases, and neurological diseases. Efforts to FAIRify data on a wider variety of diseases have been ongoing since the COVID-19 pandemic. Conclusions: This work summarises projects, tools, and workflows for the FAIRification of health research data. The comprehensive review shows that implementing the FAIR concept in health data stewardship carries the promise of improved research data management and transparency in the era of big data and open research publishing. International Registered Report Identifier (IRRID): RR2-10.2196/22505 UR - https://www.jmir.org/2023/1/e45013 UR - http://dx.doi.org/10.2196/45013 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639292 ID - info:doi/10.2196/45013 ER - TY - JOUR AU - Lehoux, Pascale AU - Rocha de Oliveira, Robson AU - Rivard, Lysanne AU - Silva, Pacifico Hudson AU - Alami, Hassane AU - Mörch, Maria Carl AU - Malas, Kathy PY - 2023/8/28 TI - A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study JO - J Med Internet Res SP - e48496 VL - 25 KW - Responsible Innovation in Health KW - digital health policy KW - artificial intelligence ethics KW - responsible research and innovation KW - mixed methods KW - e-Delphi KW - interrater agreement KW - mobile phone N2 - Background: Clinicians? scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise. Objective: To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool. Methods: We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool?s components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool. Results: The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes. Conclusions: The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care. UR - https://www.jmir.org/2023/1/e48496 UR - http://dx.doi.org/10.2196/48496 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639297 ID - info:doi/10.2196/48496 ER - TY - JOUR AU - Meier-Diedrich, Eva AU - Davidge, Gail AU - Hägglund, Maria AU - Kharko, Anna AU - Lyckblad, Camilla AU - McMillan, Brian AU - Blease, Charlotte AU - Schwarz, Julian PY - 2023/8/28 TI - Changes in Documentation Due to Patient Access to Electronic Health Records: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e46722 VL - 12 KW - electronic health record KW - patient-accessible electronic health record KW - patient portal KW - electronic portal KW - scoping review KW - patient access KW - documentation change KW - natural language processing KW - patient-clinician relationship KW - online record access KW - review method KW - library science KW - librarian N2 - Background: Internationally, patient-accessible electronic health records (PAEHRs) are increasingly being implemented. Despite reported benefits to patients, the innovation has prompted concerns among health care professionals (HCPs), including the possibility that access incurs a ?dumbing down? of clinical records. Currently, no review has investigated empirical evidence of whether and how documentation changes after introducing PAEHRs. Objective: This paper presents the protocol for a scoping review examining potential subjective and objective changes in HCPs documentation after using PAEHRs. Methods: This scoping review will be carried out based on the framework of Arksey and O?Malley. Several databases will be used to conduct a literature search (APA PsycInfo, CINAHL, PubMed, and Web of Science Core Collection). Authors will participate in screening identified papers to explore the research questions: How do PAEHRs affect HCPs? documentation practices? and What subjective and objective changes to the clinical notes arise after patient access? Only studies that relate to actual use experiences, and not merely prior expectations about PAEHRs, will be selected in the review. Data abstraction will include but will not be limited to publication type, publication year, country, sample characteristics, setting, study aim, research question, and conclusions. The Mixed Methods Appraisal Tool will be used to assess the quality of the studies included. Results: The results from this scoping review will be presented as a narrative synthesis structured along the key themes of the corpus of evidence. Additional data will be prepared in charts or tabular format. We anticipate the results to be presented in a scoping review at a later date. They will be disseminated at scientific conferences and through publication in a peer-reviewed journal. Conclusions: This is the first scoping review that considers potential change in documentation after implementation of PAEHRs. The results can potentially help affirm or refute prior opinions and expectations among various stakeholders about the use of PAEHRs and thereby help to address uncertainties. Results may help to provide guidance to clinicians in writing notes and thus have immediate practical relevance to care. In addition, the review will help to identify any substantive research gaps in this field of research. In the longer term, our findings may contribute to the development of shared documentation guidelines, which in turn are central to improving patient communication and safety. International Registered Report Identifier (IRRID): PRR1-10.2196/46722 UR - https://www.researchprotocols.org/2023/1/e46722 UR - http://dx.doi.org/10.2196/46722 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639298 ID - info:doi/10.2196/46722 ER - TY - JOUR AU - van Kessel, Robin AU - Haig, Madeleine AU - Mossialos, Elias PY - 2023/8/24 TI - Strengthening Cybersecurity for Patient Data Protection in Europe JO - J Med Internet Res SP - e48824 VL - 25 KW - cybersecurity KW - Europe KW - European Health Data Space KW - digital health KW - mHealth KW - medical informatics KW - data privacy KW - patient safety KW - privacy KW - health service UR - https://www.jmir.org/2023/1/e48824 UR - http://dx.doi.org/10.2196/48824 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616048 ID - info:doi/10.2196/48824 ER - TY - JOUR AU - Brown-Johnson, G. Cati AU - Lessios, Sophia Anna AU - Thomas, Samuel AU - Kim, Mirini AU - Fukaya, Eri AU - Wu, Siqi AU - Kling, R. Samantha M. AU - Brown, Gretchen AU - Winget, Marcy PY - 2023/8/23 TI - A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study JO - JMIR Form Res SP - e43258 VL - 7 KW - nursing KW - telehealth KW - telemedicine KW - follow-up KW - wound care KW - capacity building KW - mobile phone N2 - Background: Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective: This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods: Patients and part-time or per-diem, wound care?certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results: This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care?specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions: This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients? technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care. UR - https://formative.jmir.org/2023/1/e43258 UR - http://dx.doi.org/10.2196/43258 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610798 ID - info:doi/10.2196/43258 ER - TY - JOUR AU - Nan, Jingwen AU - Xu, Li-Qun PY - 2023/8/21 TI - Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review JO - JMIR Med Inform SP - e44842 VL - 11 KW - Health level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - interoperability KW - literature review KW - practice guideline KW - mobile phone N2 - Background: With the advent of the digital economy and the aging population, the demand for diversified health care services and innovative care delivery models has been overwhelming. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which underpins coordinated care services among tiered health care institutions, improves the quality of oversight of regulators, and provides vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. To meet this demand and facilitate the interoperability of IT systems of stakeholders, after years of preparation, Health Level 7 formally introduced, in 2014, the Fast Healthcare Interoperability Resources (FHIR) standard. It has since continued to evolve. FHIR depends on the Implementation Guide (IG) to ensure feasibility and consistency while developing an interoperable health care service. The IG defines rules with associated documentation on how FHIR resources are used to tackle a particular problem. However, a gap remains between IGs and the process of building actual services because IGs are rules without specifying concrete methods, procedures, or tools. Thus, stakeholders may feel it nontrivial to participate in the ecosystem, giving rise to the need for a more actionable practice guideline (PG) for promoting FHIR?s fast adoption. Objective: This study aimed to propose a general FHIR PG to facilitate stakeholders in the health care ecosystem to understand FHIR and quickly develop interoperable health care services. Methods: We selected a collection of FHIR-related papers about the latest studies or use cases on designing and building FHIR-based interoperable health care services and tagged each use case as belonging to 1 of the 3 dominant innovation feature groups that are also associated with practice stages, that is, data standardization, data management, and data integration. Next, we reviewed each group?s detailed process and key techniques to build respective care services and collate a complete FHIR PG. Finally, as an example, we arbitrarily selected a use case outside the scope of the reviewed papers and mapped it back to the FHIR PG to demonstrate the effectiveness and generalizability of the PG. Results: The FHIR PG includes 2 core elements: one is a practice design that defines the responsibilities of stakeholders and outlines the complete procedure from data to services, and the other is a development architecture for practice design, which lists the available tools for each practice step and provides direct and actionable recommendations. Conclusions: The FHIR PG can bridge the gap between IGs and the process of building actual services by proposing actionable methods, procedures, and tools. It assists stakeholders in identifying participants? roles, managing the scope of responsibilities, and developing relevant modules, thus helping promote FHIR-based interoperable health care services. UR - https://medinform.jmir.org/2023/1/e44842 UR - http://dx.doi.org/10.2196/44842 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603388 ID - info:doi/10.2196/44842 ER - TY - JOUR AU - Liang, Huan-Wei AU - Chu, Yuan-Chia AU - Han, Tsung-Hsien PY - 2023/8/18 TI - Fortifying Health Care Intellectual Property Transactions With Blockchain JO - J Med Internet Res SP - e44578 VL - 25 KW - intellectual property KW - open innovation KW - blockchain KW - appropriability regime KW - health care KW - mobile phone N2 - Background: Intellectual property (IP) is a substantial competitive advantage in the health care industry. However, the COVID-19 pandemic highlighted the need for open innovation and collaboration for the greater good. Despite this, the industry faces challenges with innovation owing to organizational and departmental barriers. A secure platform is necessary to facilitate IP sharing without compromising the rights of IP owners. Objective: This study proposes a blockchain-based framework to secure IP transactions in health care and bring social impact. Methods: This study reviews existing researches, publications, practical cases, firm and organization websites, and conferences related to blockchain technology, blockchain in health care, blockchain in IP management, IP pledge research, and practice of IP management blockchain. The platform architecture has 7 components: pledgers, advanced research technology (ART), IP pledge platforms, IP databases, health care research, seeking ART, and transaction condition setting. These components work together seamlessly to support the sharing and pledging of ART and knowledge, while ensuring the platform?s transparency, security, and trust. Results: The open IP pledge framework can promote technology dissemination and use, reduce research and development costs, foster collaboration, and serve the public interest. Medical organizations? leadership and support and active participation from stakeholders are necessary for success. By leveraging blockchain technology, the platform ensures tamper-proof and transparent transactions and protects the rights of IP owners. In addition, the platform offers incentive mechanisms through pledge tokens that encourage stakeholders to share their ART and contribute to the platform. Conclusions: Overall, the proposed framework can facilitate technological innovation, tackle various challenges, and secure IP transactions. It provides a secure platform for stakeholders to share their IP without compromising their rights, promoting collaboration and progress in the health care industry. The implementation of the framework has the potential to revolutionize the industry?s approach to innovation, allowing a more open and collaborative environment driven by the greater good. UR - https://www.jmir.org/2023/1/e44578 UR - http://dx.doi.org/10.2196/44578 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594787 ID - info:doi/10.2196/44578 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan AU - Mirzaei, Tala PY - 2023/8/18 TI - Role of Incentives in the Use of Blockchain-Based Platforms for Sharing Sensitive Health Data: Experimental Study JO - J Med Internet Res SP - e41805 VL - 25 KW - blockchain technology KW - data sharing KW - health data KW - clinical research KW - incentive mechanisms N2 - Background: Blockchain is an emerging technology that enables secure and decentralized approaches to reduce technical risks and governance challenges associated with sharing data. Although blockchain-based solutions have been suggested for sharing health information, it is still unclear whether a suitable incentive mechanism (intrinsic or extrinsic) can be identified to encourage individuals to share their sensitive data for research purposes. Objective: This study aimed to investigate how important extrinsic incentives are and what type of incentive is the best option in blockchain-based platforms designed for sharing sensitive health information. Methods: In this study, we conducted 3 experiments with 493 individuals to investigate the role of extrinsic incentives (ie, cryptocurrency, money, and recognition) in data sharing with research organizations. Results: The findings highlight that offering different incentives is insufficient to encourage individuals to use blockchain technology or to change their perceptions about the technology?s premise for sharing sensitive health data. The results demonstrate that individuals still attribute serious risks to blockchain-based platforms. Privacy and security concerns, trust issues, lack of knowledge about the technology, lack of public acceptance, and lack of regulations are reported as top risks. In terms of attracting people to use blockchain-based platforms for data sharing in health care, we show that the effects of extrinsic motivations (cryptoincentives, money, and status) are significantly overshadowed by inhibitors to technology use. Conclusions: We suggest that before emphasizing the use of various types of extrinsic incentives, the users must be educated about the capabilities and benefits offered by this technology. Thus, an essential first step for shifting from an institution-based data exchange to a patient-centric data exchange (using blockchain) is addressing technology inhibitors to promote patient-driven data access control. This study shows that extrinsic incentives alone are inadequate to change users? perceptions, increase their trust, or encourage them to use technology for sharing health data. UR - https://www.jmir.org/2023/1/e41805 UR - http://dx.doi.org/10.2196/41805 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594783 ID - info:doi/10.2196/41805 ER - TY - JOUR AU - Mueller, Christian AU - Herrmann, Patrick AU - Cichos, Stephan AU - Remes, Bernhard AU - Junker, Erwin AU - Hastenteufel, Tobias AU - Mundhenke, Markus PY - 2023/8/4 TI - Automated Electronic Health Record to Electronic Data Capture Transfer in Clinical Studies in the German Health Care System: Feasibility Study and Gap Analysis JO - J Med Internet Res SP - e47958 VL - 25 KW - digital transformation KW - automated data transfer KW - electronic medical record KW - electronic data capture KW - EDC KW - data transfer KW - electronic health record KW - EHR KW - digital transfer KW - barrier KW - clinical practice KW - EHR2EDC KW - health care system N2 - Background: Data transfer between electronic health records (EHRs) at the point of care and electronic data capture (EDC) systems for clinical research is still mainly carried out manually, which is error-prone as well as cost- and time-intensive. Automated digital transfer from EHRs to EDC systems (EHR2EDC) would enable more accurate and efficient data capture but has so far encountered technological barriers primarily related to data format and the technological environment: in Germany, health care data are collected at the point of care in a variety of often individualized practice management systems (PMSs), most of them not interoperable. Data quality for research purposes within EDC systems must meet the requirements of regulatory authorities for standardized submission of clinical trial data and safety reports. Objective: We aimed to develop a model for automated data transfer as part of an observational study that allows data of sufficient quality to be captured at the point of care, extracted from various PMSs, and automatically transferred to electronic case report forms in EDC systems. This required addressing aspects of data security, as well as the lack of compatibility between EHR health care data and the data quality required in EDC systems for clinical research. Methods: The SaniQ software platform (Qurasoft GmbH) is already used to extract and harmonize predefined variables from electronic medical records of different Compu Group Medical?hosted PMSs. From there, data are automatically transferred to the validated AlcedisTRIAL EDC system (Alcedis GmbH) for data collection and management. EHR2EDC synchronization occurs automatically overnight, and real-time updates can be initiated manually following each data entry in the EHR. The electronic case report form (eCRF) contains 13 forms with 274 variables. Of these, 5 forms with 185 variables contain 67 automatically transferable variables (67/274, 24% of all variables and 67/185, 36% of eligible variables). Results: This model for automated data transfer bridges the current gap between clinical practice data capture at the point of care and the data sets required by regulatory agencies; it also enables automated EHR2EDC data transfer in compliance with the General Data Protection Regulation (GDPR). It addresses feasibility, connectivity, and system compatibility of currently used PMSs in health care and clinical research and is therefore directly applicable. Conclusions: This use case demonstrates that secure, consistent, and automated end-to-end data transmission from the treating physician to the regulatory authority is feasible. Automated data transmission can be expected to reduce effort and save resources and costs while ensuring high data quality. This may facilitate the conduct of studies for both study sites and sponsors, thereby accelerating the development of new drugs. Nevertheless, the industry-wide implementation of EHR2EDC requires policy decisions that set the framework for the use of research data based on routine PMS data. UR - https://www.jmir.org/2023/1/e47958 UR - http://dx.doi.org/10.2196/47958 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540555 ID - info:doi/10.2196/47958 ER - TY - JOUR AU - Zhang, Jinghui AU - Peng, Sha AU - Hou, Jianmei AU - Ma, Guiyuan AU - Liu, Yanhui AU - Fan, Yuhua AU - Luo, Lingxia AU - Shi, Zhengkun PY - 2023/8/4 TI - Nurses? Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey JO - J Med Internet Res SP - e45602 VL - 25 KW - Internet+home care services KW - willingness KW - demand KW - clinical nurses KW - municipal hospitals N2 - Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses? willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses? willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >¥10,000 increased the likelihood of nurses? willingness to provide IHC services, by 1.187 times, compared with an income <¥5000. Nurses? total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses? demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of ¥5000 to ¥10,000 (B=0.894, P<.001) and >¥10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <¥5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses? willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. UR - https://www.jmir.org/2023/1/e45602 UR - http://dx.doi.org/10.2196/45602 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540546 ID - info:doi/10.2196/45602 ER - TY - JOUR AU - Deng, Wenhao AU - Yang, Tianan AU - Deng, Jianwei AU - Liu, Ran AU - Sun, Xueqin AU - Li, Gang AU - Wen, Xinmei PY - 2023/7/31 TI - Investigating Factors Influencing Medical Practitioners? Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study JO - J Med Internet Res SP - e46621 VL - 25 KW - internet hospital KW - conservation of resource theory KW - medical practitioner KW - Unified Theory of Acceptance and Use of Technology KW - technostress KW - resistance to change KW - behavioral intention to use N2 - Background: The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners. Objective: This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework. Methods: A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model. Results: On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (?=?.55; P<.001) and work overload (?=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms. Conclusions: This study investigated the factors that facilitate or hinder medical practitioners? resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity. UR - https://www.jmir.org/2023/1/e46621 UR - http://dx.doi.org/10.2196/46621 UR - http://www.ncbi.nlm.nih.gov/pubmed/37523226 ID - info:doi/10.2196/46621 ER - TY - JOUR AU - Shi, Jingjin AU - Yuan, Rui AU - Yan, Xueming AU - Wang, Miao AU - Qiu, Jun AU - Ji, Xinhua AU - Yu, Guangjun PY - 2023/7/6 TI - Factors Influencing the Sharing of Personal Health Data Based on the Integrated Theory of Privacy Calculus and Theory of Planned Behaviors Framework: Results of a Cross-Sectional Study of Chinese Patients in the Yangtze River Delta JO - J Med Internet Res SP - e46562 VL - 25 KW - personal health data KW - data sharing KW - influencing factor KW - privacy calculus KW - Theory of Planned Behavior N2 - Background: The health care system in China is fragmented, and the distribution of high-quality resources remains uneven and irrational. Information sharing is essential to the development of an integrated health care system and maximizing its benefits. Nevertheless, data sharing raises concerns regarding the privacy and confidentiality of personal health information, which affect the willingness of patients to share information. Objective: This study aims to investigate patients? willingness to share personal health data at different levels of maternal and child specialized hospitals in China, to propose and test a conceptual model to identify key influencing factors, and to provide countermeasures and suggestions to improve the level of data sharing. Methods: A research framework based on the Theory of Privacy Calculus and the Theory of Planned Behavior was developed and empirically tested through a cross-sectional field survey from September 2022 to October 2022 in the Yangtze River Delta region, China. A 33-item measurement instrument was developed. Descriptive statistics, chi-square tests, and logistic regression analyses were conducted to characterize the willingness of sharing personal health data and differences by sociodemographic factors. Structural equation modeling was used to assess the reliability and validity of the measurement as well as to test the research hypotheses. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist for cross-sectional studies was applied for reporting results. Results: The empirical framework had a good fit with the chi-square/degree of freedom (?2/df)=2.637, root-mean-square residual=0.032, root-mean-square error of approximation=0.048, goodness-of-fit index=0.950, and normed fit index=0.955. A total of 2060 completed questionnaires were received (response rate: 2060/2400, 85.83%). Moral motive (?=.803, P<.001), perceived benefit (?=.123, P=.04), and perceived effectiveness of government regulation (?=.110, P=.001) had a significantly positive association with sharing willingness, while perceived risk (?=?.143, P<.001) had a significant negative impact, with moral motive having the greatest impact. The estimated model explained 90.5% of the variance in sharing willingness. Conclusions: This study contributes to the literature on personal health data sharing by integrating the Theory of Privacy Calculus and the Theory of Planned Behavior. Most Chinese patients are willing to share their personal health data, which is primarily motivated by moral concerns to improve public health and assist in the diagnosis and treatment of illnesses. Patients with no prior experience with personal information disclosure and those who have tertiary hospital visits were more likely to share their health data. Practical guidelines are provided to health policy makers and health care practitioners to encourage patients to share their personal health information. UR - https://www.jmir.org/2023/1/e46562 UR - http://dx.doi.org/10.2196/46562 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410526 ID - info:doi/10.2196/46562 ER - TY - JOUR AU - Portela, Diana AU - Nogueira-Leite, Diogo AU - Almeida, Rafael AU - Cruz-Correia, Ricardo PY - 2023/6/30 TI - Economic Impact of a Hospital Cyberattack in a National Health System: Descriptive Case Study JO - JMIR Form Res SP - e41738 VL - 7 KW - cybersecurity KW - medical informatics KW - economic impact KW - economic KW - cost KW - security KW - privacy KW - cyberattack KW - data breach KW - health system N2 - Background: Over the last decade, the frequency and size of cyberattacks in the health care industry have increased, ranging from breaches of processes or networks to encryption of files that restrict access to data. These attacks may have multiple consequences for patient safety, as they can, for example, target electronic health records, access to critical information, and support for critical systems, thereby causing delays in hospital activities. The effects of cybersecurity breaches are not only a threat to patients? lives but also have financial consequences due to causing inactivity in health care systems. However, publicly available information on these incidents quantifying their impact is scarce. Objective: We aim, while using public domain data from Portugal, to (1) identify data breaches in the public national health system since 2017 and (2) measure the economic impact using a hypothesized scenario as a case study. Methods: We retrieved data from multiple national and local media sources on cybersecurity from 2017 until 2022 and built a timeline of attacks. In the absence of public information on cyberattacks, reported drops in activity were estimated using a hypothesized scenario for affected resources and percentages and duration of inactivity. Only direct costs were considered for estimates. Data for estimates were produced based on planned activity through the hospital contract program. We use sensitivity analysis to illustrate how a midlevel ransomware attack might impact health institutions? daily costs (inferring a potential range of values based on assumptions). Given the heterogeneity of our included parameters, we also provide a tool for users to distinguish such impacts of different attacks on institutions according to different contract programs, served population size, and proportion of inactivity. Results: From 2017 to 2022, we were able to identify 6 incidents in Portuguese public hospitals using public domain data (there was 1 incident each year and 2 in 2018). Financial impacts were obtained from a cost point of view, where estimated values have a minimum-to-maximum range of ?115,882.96 to ?2,317,659.11 (a currency exchange rate of ?1=US $1.0233 is applicable). Costs of this range and magnitude were inferred assuming different percentages of affected resources and with different numbers of working days while considering the costs of external consultation, hospitalization, and use of in- and outpatient clinics and emergency rooms, for a maximum of 5 working days. Conclusions: To enhance cybersecurity capabilities at hospitals, it is important to provide robust information to support decision-making. Our study provides valuable information and preliminary insights that can help health care organizations better understand the costs and risks associated with cyber threats and improve their cybersecurity strategies. Additionally, it demonstrates the importance of adopting effective preventive and reactive strategies, such as contingency plans, as well as enhanced investment in improving cybersecurity capabilities in this critical area while aiming to achieve cyber-resilience. UR - https://formative.jmir.org/2023/1/e41738 UR - http://dx.doi.org/10.2196/41738 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389934 ID - info:doi/10.2196/41738 ER - TY - JOUR AU - Grimm, Michael AU - Link, Elena AU - Albrecht, Martina AU - Czerwinski, Fabian AU - Baumann, Eva AU - Suhr, Ralf PY - 2023/6/28 TI - Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study JO - J Med Internet Res SP - e44024 VL - 25 KW - eHealth KW - mobile health KW - digital health engagement KW - health information seeking KW - self-monitoring KW - digital health care KW - mobile phone N2 - Background: Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one?s state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. Objective: This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users? perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. Methods: Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. Results: Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one?s state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care?related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). Conclusions: Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key. UR - https://www.jmir.org/2023/1/e44024 UR - http://dx.doi.org/10.2196/44024 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379058 ID - info:doi/10.2196/44024 ER - TY - JOUR AU - de Batlle, Jordi AU - Benítez, D. Ivan AU - Moncusí-Moix, Anna AU - Androutsos, Odysseas AU - Angles Barbastro, Rosana AU - Antonini, Alessio AU - Arana, Eunate AU - Cabrera-Umpierrez, Fernanda Maria AU - Cea, Gloria AU - Dafoulas, ?. George AU - Folkvord, Frans AU - Fullaondo, Ane AU - Giuliani, Francesco AU - Huang, Hsiao-Ling AU - Innominato, F. Pasquale AU - Kardas, Przemyslaw AU - Lou, Q. Vivian W. AU - Manios, Yannis AU - Matsangidou, Maria AU - Mercalli, Franco AU - Mokhtari, Mounir AU - Pagliara, Silvio AU - Schellong, Julia AU - Stieler, Lisa AU - Votis, Konstantinos AU - Currás, Paula AU - Arredondo, Teresa Maria AU - Posada, Jorge AU - Guillén, Sergio AU - Pecchia, Leandro AU - Barbé, Ferran AU - Torres, Gerard AU - Fico, Giuseppe AU - PY - 2023/6/28 TI - GATEKEEPER?s Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases JO - J Med Internet Res SP - e42187 VL - 25 KW - big data KW - chronic diseases KW - eHealth KW - healthy aging KW - integrated care KW - large-scale pilots N2 - Background: The World Health Organization?s strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europe?s geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence?based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space. UR - https://www.jmir.org/2023/1/e42187 UR - http://dx.doi.org/10.2196/42187 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379060 ID - info:doi/10.2196/42187 ER - TY - JOUR AU - Boyle, Tehnaz AU - Boggs, Krislyn AU - Gao, Jingya AU - McMahon, Maureen AU - Bedenbaugh, Rachel AU - Schmidt, Lauren AU - Zachrison, Sauser Kori AU - Goralnick, Eric AU - Biddinger, Paul AU - Camargo Jr, A. Carlos PY - 2023/6/27 TI - Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e44164 VL - 9 KW - disaster medicine KW - disaster KW - telemedicine KW - telehealth KW - eHealth KW - teleconsultation KW - remote consultation KW - health care delivery KW - e-consult KW - notification KW - alert KW - emergency KW - health system KW - hospital management N2 - Background: The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. Objective: To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response. Methods: We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability. Results: Overall, 164 (87%) hospitals and EDs responded?126 (77%) completed telephone surveys. Most (n=148, 90%) receive emergency notifications from state-based systems. Forty (24%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18%); radiation specialists, 25 (15%); and trauma specialists, 20 (12%). Among critical access hospitals (CAHs) or EDs with <10,000 annual visits (n=36), 92% received routine nondisaster telehealth services but lacked toxicologist (25%), burn (22%), and radiation (17%) specialist access. Most hospitals and EDs (n=115, 70%) require disaster credentialing of teleconsultants before system use. Among 113 hospitals and EDs with written disaster credentialing procedures, 28% expected completing disaster credentialing within 24 hours, and 55% within 25-72 hours, which varied by state. Most (n=154, 94%) reported adequate internet or cellular service for video-streaming; 81% maintained cellular service despite internet disruption. Fewer rural hospitals and EDs reported reliable internet or cellular service (19/22, 86% vs 135/142, 95%) and ability to maintain cellular service with internet disruption (11/19, 58% vs 113/135, 84%) than urban hospitals and EDs. Overall, 133 (81%) were somewhat or very likely to use a regional disaster teleconsultation system. Large-volume EDs (annual visits ?40,000) were less likely to use the service than smaller ones; all CAHs and nearly all rural hospitals or freestanding EDs were likely to use disaster consultation services. Among hospitals and EDs somewhat or very unlikely to use the system (n=26), sufficient consultant access (69%) and reluctance to use new technology or systems (27%) were common barriers. Potential delays (19%), liability (19%), privacy (15%), and hospital information system security restrictions (15%) were infrequent concerns. Conclusions: Most New England hospitals and EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. System developers should focus on ways to improve telecommunication redundancy in rural areas and use low-bandwidth technology to maintain service availability to CAHs and rural hospitals and EDs. Policies and procedures to accelerate and standardize disaster credentialing are needed for implementation across jurisdictions. UR - https://publichealth.jmir.org/2023/1/e44164 UR - http://dx.doi.org/10.2196/44164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368481 ID - info:doi/10.2196/44164 ER - TY - JOUR AU - Herranz, Carmen AU - Martín-Moreno Banegas, Laura AU - Dana Muzzio, Fernando AU - Siso-Almirall, Antoni AU - Roca, Josep AU - Cano, Isaac PY - 2023/6/14 TI - A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study JO - J Med Internet Res SP - e47672 VL - 25 KW - continuum of care management KW - innovative healthcare services KW - collaborative tools KW - digital health transformation KW - usability KW - acceptability KW - health care service KW - Health Circuit KW - health management KW - management KW - support KW - digital aid KW - aid KW - care KW - prototype KW - surgery KW - testing N2 - Background: Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. Objective: The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. Methods: From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). Results: In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients? empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Conclusions: Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. Trial Registration: ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663 UR - https://www.jmir.org/2023/1/e47672 UR - http://dx.doi.org/10.2196/47672 UR - http://www.ncbi.nlm.nih.gov/pubmed/37314850 ID - info:doi/10.2196/47672 ER - TY - JOUR AU - Jackson-Triche, Maga AU - Vetal, Don AU - Turner, Eva-Marie AU - Dahiya, Priya AU - Mangurian, Christina PY - 2023/6/8 TI - Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study JO - J Med Internet Res SP - e40635 VL - 25 KW - chatbot technology KW - health care workers KW - mental health equity KW - COVID-19 KW - mental health chatbot KW - behavioral health treatment KW - mental health screening KW - telehealth KW - psychoeducation KW - employee support N2 - Background: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. Objective: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. Methods: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. Results: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. Conclusions: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings. UR - https://www.jmir.org/2023/1/e40635 UR - http://dx.doi.org/10.2196/40635 UR - http://www.ncbi.nlm.nih.gov/pubmed/37146178 ID - info:doi/10.2196/40635 ER - TY - JOUR AU - Castillo Padrós, Ramón Manuel AU - Pastor, Nuria AU - Altarriba Paracolls, Júlia AU - Mosquera Peña, Marcelino AU - Pergolizzi, Denise AU - Salvador Vergès, Àngels PY - 2023/5/31 TI - A Smart System for Remote Monitoring of Patients in Palliative Care (HumanITcare Platform): Mixed Methods Study JO - JMIR Form Res SP - e45654 VL - 7 KW - palliative care KW - advanced illness KW - remote monitoring KW - eHealth KW - telemedicine KW - mHealth N2 - Background: Due to the complexities of advanced illnesses and their treatments, it can be difficult for patients in palliative care to maintain their quality of life. Telemedicine interventions in chronic disease management engage patients in their care, provide continuous follow-up by their health care providers, identify symptoms earlier, and allow a quick response to illness-related decline. Objective: We aimed to detail and reflect on the design of an app and evaluate its feasibility to monitor the clinical situation of patients with advanced illnesses. Methods: This study used a mixed methods design using qualitative methods to inform app development and design and quantitative methods for data collection and analysis of patient evaluations. Palliative care units in 2 Spanish university hospitals (Nuestra Señora de la Candelaria in Santa Cruz de Tenerife and University Hospital Complex of Ferrol in A Coruña) carried out a literature review, designed the study protocol, and obtained approval from the Ethics Committee from June to December 2020. In addition, focus group meetings were held, and the design and technical development of the app were elaborated on and subsequently presented in the participating palliative care units. From January to March 2021, the app was made public on the App Store and Play Store, and a pilot study with patients was carried out in April to September 2021. Results: Six focus group meetings were held that included doctors, nurses, app developers, technology consultants, and sponsors. In addition, the technology consultants presented their results 3 times in the participating palliative care units to obtain feedback. After the app?s final design, it was possible to publish it on the usual servers and begin its evaluation in patients (n=60, median age 72 years). Sixty percent (n=36) of the participants were women and 40% (n=24) were men. The most prevalent advanced pathology was cancer (n=46, 76%), followed by other diseases (n=7, 12%) and amyotrophic lateral sclerosis (n=5, 8%). Seventy percent (n=42) of the patients were already in follow-up prior to the start of the study, while 30% (n=18) were included at the start of their follow-up. The information in the app was collected and entered by relatives or caregivers in 60% (n=36) of the cases. The median follow-up was 52 (IQR 14-104) days. In all, 69% (n=41) had a follow-up >30 days (10 were deceased and 9 were missing data). The use of the different sections of the app ranged from 37% (n=22) for the glycemic record to 90% (n=54) for the constipation scale). Patients and caregivers were delighted with its ease of use and usefulness. Conclusions: Incorporating an intelligent remote patient monitoring system in clinical practice for patients in palliative care can improve access to health services and provide more information to professionals. UR - https://formative.jmir.org/2023/1/e45654 UR - http://dx.doi.org/10.2196/45654 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256664 ID - info:doi/10.2196/45654 ER - TY - JOUR AU - Kusejko, Katharina AU - Smith, Daniel AU - Scherrer, Alexandra AU - Paioni, Paolo AU - Kohns Vasconcelos, Malte AU - Aebi-Popp, Karoline AU - Kouyos, D. Roger AU - Günthard, F. Huldrych AU - Kahlert, R. Christian AU - PY - 2023/5/31 TI - Migrating a Well-Established Longitudinal Cohort Database From Oracle SQL to Research Electronic Data Entry (REDCap): Data Management Research and Design Study JO - JMIR Form Res SP - e44567 VL - 7 KW - REDCap KW - cohort study KW - data collection KW - electronic case report forms KW - eCRF KW - software KW - digital solution KW - electronic data entry KW - HIV N2 - Background: Providing user-friendly electronic data collection tools for large multicenter studies is key for obtaining high-quality research data. Research Electronic Data Capture (REDCap) is a software solution developed for setting up research databases with integrated graphical user interfaces for electronic data entry. The Swiss Mother and Child HIV Cohort Study (MoCHiV) is a longitudinal cohort study with around 2 million data entries dating back to the early 1980s. Until 2022, data collection in MoCHiV was paper-based. Objective: The objective of this study was to provide a user-friendly graphical interface for electronic data entry for physicians and study nurses reporting MoCHiV data. Methods: MoCHiV collects information on obstetric events among women living with HIV and children born to mothers living with HIV. Until 2022, MoCHiV data were stored in an Oracle SQL relational database. In this project, R and REDCap were used to develop an electronic data entry platform for MoCHiV with migration of already collected data. Results: The key steps for providing an electronic data entry option for MoCHiV were (1) design, (2) data cleaning and formatting, (3) migration and compliance, and (4) add-on features. In the first step, the database structure was defined in REDCap, including the specification of primary and foreign keys, definition of study variables, and the hierarchy of questions (termed ?branching logic?). In the second step, data stored in Oracle were cleaned and formatted to adhere to the defined database structure. Systematic data checks ensured compliance to all branching logic and levels of categorical variables. REDCap-specific variables and numbering of repeated events for enabling a relational data structure in REDCap were generated using R. In the third step, data were imported to REDCap and then systematically compared to the original data. In the last step, add-on features, such as data access groups, redirections, and summary reports, were integrated to facilitate data entry in the multicenter MoCHiV study. Conclusions: By combining different software tools?Oracle SQL, R, and REDCap?and building a systematic pipeline for data cleaning, formatting, and comparing, we were able to migrate a multicenter longitudinal cohort study from Oracle SQL to REDCap. REDCap offers a flexible way for developing customized study designs, even in the case of longitudinal studies with different study arms (ie, obstetric events, women, and mother-child pairs). However, REDCap does not offer built-in tools for preprocessing large data sets before data import. Additional software is needed (eg, R) for data formatting and cleaning to achieve the predefined REDCap data structure. UR - https://formative.jmir.org/2023/1/e44567 UR - http://dx.doi.org/10.2196/44567 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256686 ID - info:doi/10.2196/44567 ER - TY - JOUR AU - Cernadas Ramos, Andrés AU - Fernández Da Silva, Ángela AU - Barral Buceta, Bran AU - Bouzas-Lorenzo, Ramón PY - 2023/5/18 TI - Offerings and User Demands of eHealth Services in Spain: National Survey JO - J Med Internet Res SP - e42304 VL - 25 KW - Spanish eHealth KW - health policies KW - digital health KW - COVID-19 KW - eHealth offers KW - eHealth demands N2 - Background: The accelerated development of information and communication technologies has made health care one of the pioneering fields in the incorporation of these tools. As new technologies have been applied, existing technologies have been sophisticated and improved and the concept of eHealth has expanded. However, these advances and expansion of eHealth do not seem to have served to adapt the supply of services to users? demands; rather, supply seems to be governed by other variables. Objective: The main objective of this work was to review the existing differences between user demands and the supply of eHealth services in Spain and their causes. The aim is to provide information on the level of use of the services and the causes of the variation in demand for these services, which can be useful in correcting existing differences and adapting them to the needs of users. Methods: A survey, ?Use and Attitudes Toward eHealth in Spain,? was applied by telephone to a sample of 1695 people aged 18 years and over, taking into account sociodemographic profile characteristics (sex, age, habitat, educational level). The confidence level was set at 95% and the margin of error was ±2.45 for the whole sample. Results: The survey results showed that the online doctor?s appointment service is the most frequently used eHealth service by users: 72.48% of respondents used this service at some point and 21.28% stated that they use it regularly. The other services showed significantly lower percentages of use, including ?managing health cards? (28.04%), ?consulting medical history? (20.37%), ?managing test results? (20.22%), ?communicating with health professionals? (17.80%), and ?requesting a change of doctor? (13.76%). Despite this low usage, a large majority of respondents (80.00%) attach great importance to all the services offered. Overall, 16.52% of the users surveyed were willing to make new service requests to the regional websites, with 9.33% of them highlighting services such as ?the availability of a complaints and claims mailbox,? ?the possibility of consulting medical records,? and ?the availability of more detailed information on medical centers (location, medical directory, waiting lists, etc).? Other outstanding requests (8.00%) were to simplify the procedures for using certain existing services. Conclusions: The data from the survey show that eHealth services are widely known and highly valued by users, but not all services are used with the same frequency or intensity. It appears that users find it difficult to suggest new services that might be useful to them in terms of demand for new services that do not currently exist. It would be useful to use qualitative studies to gain a deeper understanding of currently unmet needs and the possibilities of eHealth. The lack of access to and use of these services and the unmet needs particularly affect more vulnerable populations who have the greatest difficulty in meeting their needs through alternative means to eHealth. UR - https://www.jmir.org/2023/1/e42304 UR - http://dx.doi.org/10.2196/42304 UR - http://www.ncbi.nlm.nih.gov/pubmed/37200072 ID - info:doi/10.2196/42304 ER - TY - JOUR AU - Mamuye, Adane AU - Nigatu, Mesfin Araya AU - Chanyalew, Asressie Moges AU - Amor, Ben Lamia AU - Loukil, Sihem AU - Moyo, Chris AU - Quarshie, Samuel AU - Antypas, Konstantinos AU - Tilahun, Binyam PY - 2023/5/12 TI - Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study JO - JMIR Form Res SP - e41487 VL - 7 KW - attributes KW - Africa KW - eHealth KW - low- and middle-income countries KW - sustainability N2 - Background: Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. Objective: The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. Methods: A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. Results: A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5% (36/49) of them were male participants; and 71.4% (35/49) of them had a master?s degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. Conclusions: This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries. UR - https://formative.jmir.org/2023/1/e41487 UR - http://dx.doi.org/10.2196/41487 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171865 ID - info:doi/10.2196/41487 ER - TY - JOUR AU - Perrin Franck, Caroline AU - Babington-Ashaye, Awa AU - Dietrich, Damien AU - Bediang, Georges AU - Veltsos, Philippe AU - Gupta, Prasad Pramendra AU - Juech, Claudia AU - Kadam, Rigveda AU - Collin, Maxime AU - Setian, Lucy AU - Serrano Pons, Jordi AU - Kwankam, Yunkap S. AU - Garrette, Béatrice AU - Barbe, Solenne AU - Bagayoko, Oumar Cheick AU - Mehl, Garrett AU - Lovis, Christian AU - Geissbuhler, Antoine PY - 2023/5/10 TI - iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations JO - J Med Internet Res SP - e46694 VL - 25 KW - implementation science KW - knowledge management KW - reporting standards KW - publishing standards KW - guideline KW - Digital Health Hub KW - reporting guideline KW - digital health implementation KW - health outcome N2 - Background: Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. Objective: A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced ?I checked?) to improve the completeness of reporting on digital health implementations. Methods: A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. Results: The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. Conclusions: Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes. UR - https://www.jmir.org/2023/1/e46694 UR - http://dx.doi.org/10.2196/46694 UR - http://www.ncbi.nlm.nih.gov/pubmed/37163336 ID - info:doi/10.2196/46694 ER - TY - JOUR AU - Nakikj, Drashko AU - Kreda, David AU - Gehlenborg, Nils PY - 2023/4/3 TI - New Ways for Patients to Make Sense of Their Electronic Health Record Data Using the Discovery Web Application: Think-Aloud Evaluation Study JO - JMIR Form Res SP - e41346 VL - 7 KW - patient KW - sensemaking KW - electronic health records KW - personal health records KW - multiple providers KW - design N2 - Background: In the United States, patients can access their electronic health record (EHR) data through patient portals. However, current patient portals are mainly focused on a single provider, with very limited data sharing capabilities and put low emphasis on independent sensemaking of the EHR data. This makes it very challenging for patients to switch between different portals and aggregate the data to obtain a complete picture of their medical history and to make sense of it. Owing to this fragmentation, patients are exposed to numerous inconveniences such as medical errors, repeated tests, and limited self-advocacy. Objective: To overcome the limitations of EHR patient portals, we designed and developed Discovery?a web-based application that aggregates EHR data from multiple providers and present them to the patient for efficient exploration and sensemaking. To learn how well Discovery meets the patients? sensemaking needs and what features should such applications include, we conducted an evaluation study. Methods: We conducted a remote study with 14 participants. In a 60-minute session and relying on the think-aloud protocol, participants were asked to complete a variety of sensemaking tasks and provide feedback upon completion. The audio materials were transcribed for analysis and the video recordings of the users? interactions with Discovery were annotated to provide additional context. These combined textual data were thematically analyzed to surface themes that reflect how participants used Discovery?s features, what sensemaking of their EHR data really entails, and what features are desirable to support that process better. Results: We found that Discovery provided much needed features and could be used in a variety of everyday scenarios, especially for preparing and during clinical visits and also for raising awareness, reflection, and planning. According to the study participants, Discovery provided a robust set of features for supporting independent exploration and sensemaking of their EHR data: summary and quick overview of the data, finding prevalence, periodicity, co-occurrence, and pre-post of medical events, as well as comparing medical record types and subtypes across providers. In addition, we extracted important design implications from the user feedback on data exploration with multiple views and nonstandard user interface elements. Conclusions: Patient-centered sensemaking tools should have a core set of features that can be learned quickly and support common use cases for a variety of users. The patients should be able to detect time-oriented patterns of medical events and get enough context and explanation on demand in a single exploration view that feels warm and familiar and relies on patient-friendly language. However, this view should have enough plasticity to adjust to the patient?s information needs as the sensemaking unfolds. Future designs should include the physicians in the patient?s sensemaking process and improve the communication in clinical visits and via messaging. UR - https://formative.jmir.org/2023/1/e41346 UR - http://dx.doi.org/10.2196/41346 UR - http://www.ncbi.nlm.nih.gov/pubmed/37010887 ID - info:doi/10.2196/41346 ER - TY - JOUR AU - Syed, Rehan AU - Eden, Rebekah AU - Makasi, Tendai AU - Chukwudi, Ignatius AU - Mamudu, Azumah AU - Kamalpour, Mostafa AU - Kapugama Geeganage, Dakshi AU - Sadeghianasl, Sareh AU - Leemans, J. Sander J. AU - Goel, Kanika AU - Andrews, Robert AU - Wynn, Thandar Moe AU - ter Hofstede, Arthur AU - Myers, Trina PY - 2023/3/31 TI - Digital Health Data Quality Issues: Systematic Review JO - J Med Internet Res SP - e42615 VL - 25 KW - data quality KW - digital health KW - electronic health record KW - eHealth KW - systematic reviews N2 - Background: The promise of digital health is principally dependent on the ability to electronically capture data that can be analyzed to improve decision-making. However, the ability to effectively harness data has proven elusive, largely because of the quality of the data captured. Despite the importance of data quality (DQ), an agreed-upon DQ taxonomy evades literature. When consolidated frameworks are developed, the dimensions are often fragmented, without consideration of the interrelationships among the dimensions or their resultant impact. Objective: The aim of this study was to develop a consolidated digital health DQ dimension and outcome (DQ-DO) framework to provide insights into 3 research questions: What are the dimensions of digital health DQ? How are the dimensions of digital health DQ related? and What are the impacts of digital health DQ? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a developmental systematic literature review was conducted of peer-reviewed literature focusing on digital health DQ in predominately hospital settings. A total of 227 relevant articles were retrieved and inductively analyzed to identify digital health DQ dimensions and outcomes. The inductive analysis was performed through open coding, constant comparison, and card sorting with subject matter experts to identify digital health DQ dimensions and digital health DQ outcomes. Subsequently, a computer-assisted analysis was performed and verified by DQ experts to identify the interrelationships among the DQ dimensions and relationships between DQ dimensions and outcomes. The analysis resulted in the development of the DQ-DO framework. Results: The digital health DQ-DO framework consists of 6 dimensions of DQ, namely accessibility, accuracy, completeness, consistency, contextual validity, and currency; interrelationships among the dimensions of digital health DQ, with consistency being the most influential dimension impacting all other digital health DQ dimensions; 5 digital health DQ outcomes, namely clinical, clinician, research-related, business process, and organizational outcomes; and relationships between the digital health DQ dimensions and DQ outcomes, with the consistency and accessibility dimensions impacting all DQ outcomes. Conclusions: The DQ-DO framework developed in this study demonstrates the complexity of digital health DQ and the necessity for reducing digital health DQ issues. The framework further provides health care executives with holistic insights into DQ issues and resultant outcomes, which can help them prioritize which DQ-related problems to tackle first. UR - https://www.jmir.org/2023/1/e42615 UR - http://dx.doi.org/10.2196/42615 UR - http://www.ncbi.nlm.nih.gov/pubmed/37000497 ID - info:doi/10.2196/42615 ER - TY - JOUR AU - Tolley, Clare AU - Seymour, Helen AU - Watson, Neil AU - Nazar, Hamde AU - Heed, Jude AU - Belshaw, Dave PY - 2023/3/10 TI - Barriers and Opportunities for the Use of Digital Tools in Medicines Optimization Across the Interfaces of Care: Stakeholder Interviews in the United Kingdom JO - JMIR Med Inform SP - e42458 VL - 11 KW - health information exchange KW - patient safety KW - medicines optimization KW - transfer of care KW - health informatics KW - qualitative N2 - Background: People with long-term conditions frequently transition between care settings that require information about a patient?s medicines to be transferred or translated between systems. This process is currently error prone and associated with unintentional changes to medications and miscommunication, which can lead to serious patient consequences. One study estimated that approximately 250,000 serious medication errors occur in England when a patient transitions from hospital to home. Digital tools can equip health care professionals with the right information at the right time and place to support practice. Objective: This study aimed to answer the following questions: what systems are being used to transfer information across interfaces of care within a region of England? and what are the challenges and potential opportunities for more effective cross-sector working to support medicines optimization? Methods: A team of researchers at Newcastle University conducted a qualitative study by performing in-depth semistructured interviews with 23 key stakeholders in medicines optimization and IT between January and March 2022. The interviews lasted for approximately 1 hour. The interviews and field notes were transcribed and analyzed using the framework approach. The themes were discussed, refined, and applied systematically to the data set. Member checking was also performed. Results: This study revealed themes and subthemes pertaining to 3 key areas: transfer of care issues, challenges of digital tools, and future hopes and opportunities. We identified a major complexity in terms of the number of different medicine management systems used throughout the region. There were also important challenges owing to incomplete patient records. We also highlighted the barriers related to using multiple systems and their subsequent impact on user workflow, a lack of interoperability between systems, gaps in the availability of digital data, and poor IT and change management. Finally, participants described their hopes and opportunities for the future provision of medicines optimization services, and there was a clear need for a patient-centered consolidated integrated health record for use by all health and care professionals across different sectors, bridging those working in primary, secondary, and social care. Conclusions: The effectiveness and utility of shared records depend on the data within; therefore, health care and digital leaders must support and strongly encourage the adoption of established and approved digital information standards. Specific priorities regarding understanding of the vision for pharmacy services and supporting this with appropriate funding arrangements and strategic planning of the workforce were also described. In addition, the following were identified as key enablers to harness the benefits of digital tools to support future medicines optimization: development of minimal system requirements; enhanced IT system management to reduce unnecessary repetition; and importantly, meaningful and continued collaboration with clinical and IT stakeholders to optimize systems and share good practices across care sectors. UR - https://medinform.jmir.org/2023/1/e42458 UR - http://dx.doi.org/10.2196/42458 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897631 ID - info:doi/10.2196/42458 ER - TY - JOUR AU - Yip, Matthew AU - Ackery, Alun AU - Jamieson, Trevor AU - Mehta, Shaun PY - 2023/3/10 TI - The Priorities of End Users of Emergency Department Electronic Health Records: Modified Delphi Study JO - JMIR Hum Factors SP - e43103 VL - 10 KW - Delphi KW - EHR KW - electronic health record KW - emergency medicine KW - emergency KW - functionality KW - health information exchange KW - health system KW - medical informatics KW - patient-physician relationship KW - usability N2 - Background: The needs of the emergency department (ED) pose unique challenges to modern electronic health record (EHR) systems. A diverse case load of high-acuity, high-complexity presentations, and ambulatory patients, all requiring multiple transitions of care, creates a rich environment through which to critically examine EHRs. Objective: This investigation aims to capture and analyze the perspective of end users of EHR about the strengths, limitations, and future priorities for EHR in the setting of the ED. Methods: In the first phase of this investigation, a literature search was conducted to identify 5 key usage categories of ED EHRs. Using key usage categories in the first phase, a modified Delphi study was conducted with a group of 12 panelists with expertise in both emergency medicine and health informatics. Across 3 rounds of surveys, panelists generated and refined a list of strengths, limitations, and key priorities. Results: The findings from this investigation highlighted the preference of panelists for features maximizing functionality of basic clinical features relative to features of disruptive innovation. Conclusions: By capturing the perspectives of end users in the ED, this investigation highlights areas for the improvement or development of future EHRs in acute care settings. UR - https://humanfactors.jmir.org/2023/1/e43103 UR - http://dx.doi.org/10.2196/43103 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897633 ID - info:doi/10.2196/43103 ER - TY - JOUR AU - Sinaci, Anil A. AU - Gencturk, Mert AU - Teoman, Alper Huseyin AU - Laleci Erturkmen, Banu Gokce AU - Alvarez-Romero, Celia AU - Martinez-Garcia, Alicia AU - Poblador-Plou, Beatriz AU - Carmona-Pírez, Jonás AU - Löbe, Matthias AU - Parra-Calderon, Luis Carlos PY - 2023/3/8 TI - A Data Transformation Methodology to Create Findable, Accessible, Interoperable, and Reusable Health Data: Software Design, Development, and Evaluation Study JO - J Med Internet Res SP - e42822 VL - 25 KW - Health Level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - Findable, Accessible, Interoperable, and Reusable principles KW - FAIR principles KW - health data sharing KW - health data transformation KW - secondary use N2 - Background: Sharing health data is challenging because of several technical, ethical, and regulatory issues. The Findable, Accessible, Interoperable, and Reusable (FAIR) guiding principles have been conceptualized to enable data interoperability. Many studies provide implementation guidelines, assessment metrics, and software to achieve FAIR-compliant data, especially for health data sets. Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) is a health data content modeling and exchange standard. Objective: Our goal was to devise a new methodology to extract, transform, and load existing health data sets into HL7 FHIR repositories in line with FAIR principles, develop a Data Curation Tool to implement the methodology, and evaluate it on health data sets from 2 different but complementary institutions. We aimed to increase the level of compliance with FAIR principles of existing health data sets through standardization and facilitate health data sharing by eliminating the associated technical barriers. Methods: Our approach automatically processes the capabilities of a given FHIR end point and directs the user while configuring mappings according to the rules enforced by FHIR profile definitions. Code system mappings can be configured for terminology translations through automatic use of FHIR resources. The validity of the created FHIR resources can be automatically checked, and the software does not allow invalid resources to be persisted. At each stage of our data transformation methodology, we used particular FHIR-based techniques so that the resulting data set could be evaluated as FAIR. We performed a data-centric evaluation of our methodology on health data sets from 2 different institutions. Results: Through an intuitive graphical user interface, users are prompted to configure the mappings into FHIR resource types with respect to the restrictions of selected profiles. Once the mappings are developed, our approach can syntactically and semantically transform existing health data sets into HL7 FHIR without loss of data utility according to our privacy-concerned criteria. In addition to the mapped resource types, behind the scenes, we create additional FHIR resources to satisfy several FAIR criteria. According to the data maturity indicators and evaluation methods of the FAIR Data Maturity Model, we achieved the maximum level (level 5) for being Findable, Accessible, and Interoperable and level 3 for being Reusable. Conclusions: We developed and extensively evaluated our data transformation approach to unlock the value of existing health data residing in disparate data silos to make them available for sharing according to the FAIR principles. We showed that our method can successfully transform existing health data sets into HL7 FHIR without loss of data utility, and the result is FAIR in terms of the FAIR Data Maturity Model. We support institutional migration to HL7 FHIR, which not only leads to FAIR data sharing but also eases the integration with different research networks. UR - https://www.jmir.org/2023/1/e42822 UR - http://dx.doi.org/10.2196/42822 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884270 ID - info:doi/10.2196/42822 ER - TY - JOUR AU - Gottumukkala, Madhu PY - 2023/2/17 TI - Design, Development, and Evaluation of an Automated Solution for Electronic Information Exchange Between Acute and Long-term Postacute Care Facilities: Design Science Research JO - JMIR Form Res SP - e43758 VL - 7 KW - information exchange KW - interoperability KW - care transition KW - health information technology KW - health information exchange KW - open standards KW - long-term and postacute care KW - LTPAC KW - design science research N2 - Background: Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, considerable delays in care, and even readmissions. Unfortunately, long-term and postacute care facilities often lag behind other health care facilities in adopting health information technologies, increasing difficulty in facilitating care transitions through electronic information exchange. The research gap is most evident when considering the implications of the inability to electronically transfer patients? health records between these facilities. Objective: This study aimed to design and evaluate an open standards?based interoperability solution that facilitates seamless bidirectional information exchange between acute care and long-term and postacute care facilities using 2 vendor electronic health record (EHR) systems. Methods: Using the design science research methodology, we designed an interoperability solution that improves the bidirectional information exchange between acute care and long-term care (LTC) facilities using different EHR systems. Different approaches were applied in the study with a focus on the relevance cycle, including eliciting detailed requirements from stakeholders in the health system who understand the complex data formats, constraints, and workflows associated with transferring patient records between 2 different EHR systems. We performed literature reviews and sought experts in the health care industry from different organizations with a focus on the rigor cycle to identify the components relevant to the interoperability solution. The design cycle focused on iterating between the core activities of implementing and evaluating the proposed artifact. The artifact was evaluated at a health care organization with a combined footprint of acute and postacute care operations using 2 different EHR systems. Results: The resulting interoperability solution offered integrations with source systems and was proven to facilitate bidirectional information exchange for patients transferring between an acute care facility using an Epic EHR system and an LTC facility using a PointClickCare EHR system. This solution serves as a proof of concept for bidirectional data exchange between Epic and PointClickCare for medications, yet the solution is designed to expand to additional data elements such as allergies, problem lists, and diagnoses. Conclusions: Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. In acute and LTC settings, there are differences in patients? needs and delivery of care workflows that are distinctly unique. In addition, the health care system?s components that offer long-term and acute care in the United States have evolved independently and separately. This study demonstrates that the interoperability solution improves the information exchange between acute and LTC facilities by simplifying data transfer, eliminating manual processes, and reducing data discrepancies using a design science research methodology. UR - https://formative.jmir.org/2023/1/e43758 UR - http://dx.doi.org/10.2196/43758 UR - http://www.ncbi.nlm.nih.gov/pubmed/36800213 ID - info:doi/10.2196/43758 ER - TY - JOUR AU - Kinast, Benjamin AU - Ulrich, Hannes AU - Bergh, Björn AU - Schreiweis, Björn PY - 2023/2/9 TI - Functional Requirements for Medical Data Integration into Knowledge Management Environments: Requirements Elicitation Approach Based on Systematic Literature Analysis JO - J Med Internet Res SP - e41344 VL - 25 KW - data integration KW - requirements engineering KW - requirements KW - knowledge management KW - software engineering N2 - Background: In patient care, data are historically generated and stored in heterogeneous databases that are domain specific and often noninteroperable or isolated. As the amount of health data increases, the number of isolated data silos is also expected to grow, limiting the accessibility of the collected data. Medical informatics is developing ways to move from siloed data to a more harmonized arrangement in information architectures. This paradigm shift will allow future research to integrate medical data at various levels and from various sources. Currently, comprehensive requirements engineering is working on data integration projects in both patient care? and research-oriented contexts, and it is significantly contributing to the success of such projects. In addition to various stakeholder-based methods, document-based requirement elicitation is a valid method for improving the scope and quality of requirements. Objective: Our main objective was to provide a general catalog of functional requirements for integrating medical data into knowledge management environments. We aimed to identify where integration projects intersect to derive consistent and representative functional requirements from the literature. On the basis of these findings, we identified which functional requirements for data integration exist in the literature and thus provide a general catalog of requirements. Methods: This work began by conducting a literature-based requirement elicitation based on a broad requirement engineering approach. Thus, in the first step, we performed a web-based systematic literature review to identify published articles that dealt with the requirements for medical data integration. We identified and analyzed the available literature by applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the second step, we screened the results for functional requirements using the requirements engineering method of document analysis and derived the requirements into a uniform requirement syntax. Finally, we classified the elicited requirements into a category scheme that represents the data life cycle. Results: Our 2-step requirements elicitation approach yielded 821 articles, of which 61 (7.4%) were included in the requirement elicitation process. There, we identified 220 requirements, which were covered by 314 references. We assigned the requirements to different data life cycle categories as follows: 25% (55/220) to data acquisition, 35.9% (79/220) to data processing, 12.7% (28/220) to data storage, 9.1% (20/220) to data analysis, 6.4% (14/220) to metadata management, 2.3% (5/220) to data lineage, 3.2% (7/220) to data traceability, and 5.5% (12/220) to data security. Conclusions: The aim of this study was to present a cross-section of functional data integration?related requirements defined in the literature by other researchers. The aim was achieved with 220 distinct requirements from 61 publications. We concluded that scientific publications are, in principle, a reliable source of information for functional requirements with respect to medical data integration. Finally, we provide a broad catalog to support other scientists in the requirement elicitation phase. UR - https://www.jmir.org/2023/1/e41344 UR - http://dx.doi.org/10.2196/41344 UR - http://www.ncbi.nlm.nih.gov/pubmed/36757764 ID - info:doi/10.2196/41344 ER - TY - JOUR AU - Ferguson, Karen AU - Fraser, Mark AU - Tuna, Meltem AU - Bruntz, Charles AU - Dahrouge, Simone PY - 2023/2/6 TI - The Impact of an Electronic Portal on Patient Encounters in Primary Care: Interrupted Time-Series Analysis JO - JMIR Med Inform SP - e43567 VL - 11 KW - electronic health records KW - health care utilization KW - patient portals KW - primary care KW - medical informatics KW - office visits KW - electronic KW - patient KW - online applications KW - virtual care KW - messaging KW - clinical KW - age KW - sex KW - education N2 - Background: Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the use of traditional primary care services is unclear, but it is an important question at this juncture, when portals are being incorporated into many primary care practices. Objective: We sought to investigate how an electronic patient portal affected the use of traditional, synchronous primary care services over a much longer time period than any existing studies and to assess the impact of portal messaging on clinicians? workload. Methods: We conducted a propensity-score?matched, open-cohort, interrupted time-series evaluation of a primary care portal from its implementation in 2010. We extracted information from the electronic medical record regarding age, sex, education, income, family health team enrollment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years before and after the index date and provider time spent on secure messaging through the portal. Results: A total of 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in annual number of visits to physicians in the portal arm (0.42 more visits/year vs control, P<.001) but not for visits to nurse practitioners and physician assistants. The annual number of calls to the practice triage nurses also showed a greater increase in the portal arm compared to the control arm after the index year (an additional 0.10 calls, P=.006). The average provider time spent on portal-related work was 5.7 minutes per patient per year. Conclusions: We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and an increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on use of traditional health care services and clerical burden must also be considered when they are incorporated into primary care. UR - https://medinform.jmir.org/2023/1/e43567 UR - http://dx.doi.org/10.2196/43567 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745495 ID - info:doi/10.2196/43567 ER - TY - JOUR AU - Li, Dongliang AU - Zhang, Rujia AU - Chen, Chun AU - Huang, Yunyun AU - Wang, Xiaoyi AU - Yang, Qingren AU - Zhu, Xuebo AU - Zhang, Xiangyang AU - Hao, Mo AU - Shui, Liming PY - 2023/1/9 TI - Developing a Capsule Clinic?A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China JO - JMIR Med Inform SP - e41212 VL - 11 KW - primary health care KW - accessibility KW - capsule clinic KW - 24-hour clinic KW - big-data KW - China KW - United Nations KW - internet clinic UR - https://medinform.jmir.org/2023/1/e41212 UR - http://dx.doi.org/10.2196/41212 UR - http://www.ncbi.nlm.nih.gov/pubmed/36622737 ID - info:doi/10.2196/41212 ER - TY - JOUR AU - Tuler de Oliveira, Marcela AU - Amorim Reis, Henrik Lúcio AU - Marquering, Henk AU - Zwinderman, H. Aeilko AU - Delgado Olabarriaga, Sílvia PY - 2022/12/23 TI - Perceptions of a Secure Cloud-Based Solution for Data Sharing During Acute Stroke Care: Qualitative Interview Study JO - JMIR Form Res SP - e40061 VL - 6 IS - 12 KW - qualitative interview study KW - electronic health records KW - cloud-based applications KW - acute stroke care KW - cross-organization data sharing KW - data privacy KW - encryption KW - data access control KW - mobile phone N2 - Background: Acute stroke care demands fast procedures performed through the collaboration of multiple professionals across multiple organizations. Cloud computing and the wide adoption of electronic medical records (EMRs) enable health care systems to improve data availability and facilitate sharing among professionals. However, designing a secure and privacy-preserving EMR cloud-based application is challenging because it must dynamically control the access to the patient?s EMR according to the needs for data during treatment. Objective: We developed a prototype of a secure EMR cloud-based application. The application explores the security features offered by the eHealth cloud-based framework created by the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Horizon 2020 project. This study aimed to collect impressions, challenges, and improvements for the prototype when applied to the use case of secure data sharing among acute care teams during emergency treatment in the Netherlands. Methods: We conducted 14 semistructured interviews with medical professionals with 4 prominent roles in acute care: emergency call centers, ambulance services, emergency hospitals, and general practitioner clinics. We used in-depth interviews to capture their perspectives about the application?s design and functions and its use in a simulated acute care event. We used thematic analysis of interview transcripts. Participants were recruited until the collected data reached thematic saturation. Results: The participants? perceptions and feedback are presented as 5 themes identified from the interviews: current challenges (theme 1), quality of the shared EMR data (theme 2), integrity and auditability of the EMR data (theme 3), usefulness and functionality of the application (theme 4), and trust and acceptance of the technology (theme 5). The results reinforced the current challenges in patient data sharing during acute stroke care. Moreover, from the user point of view, we expressed the challenges of adopting the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Acute Stroke Care application in a real scenario and provided suggestions for improving the proposed technology?s acceptability. Conclusions: This study has endorsed a system that supports data sharing among acute care professionals with efficiency, but without compromising the security and privacy of the patient. This explorative study identified several significant barriers to and improvement opportunities for the future acceptance and adoption of the proposed system. Moreover, the study results highlight that the desired digital transformation should consider integrating the already existing systems instead of requesting migration to a new centralized system. UR - https://formative.jmir.org/2022/12/e40061 UR - http://dx.doi.org/10.2196/40061 UR - http://www.ncbi.nlm.nih.gov/pubmed/36563043 ID - info:doi/10.2196/40061 ER - TY - JOUR AU - Wang, Bin AU - Lai, Junkai AU - Jin, Feifei AU - Liao, Xiwen AU - Zhu, Huan AU - Yao, Chen PY - 2022/12/23 TI - Clinical Source Data Production and Quality Control in Real-world Studies: Proposal for Development of the eSource Record System JO - JMIR Res Protoc SP - e42754 VL - 11 IS - 12 KW - electronic medical record KW - electronic health record KW - eSource KW - real-world data KW - eSource record KW - clinical research KW - data collection KW - data transcription KW - data quality KW - interoperability N2 - Background: An eSource generally includes the direct capture, collection, and storage of electronic data to simplify clinical research. It can improve data quality and patient safety and reduce clinical trial costs. There has been some eSource-related research progress in relatively large projects. However, most of these studies focused on technical explorations to improve interoperability among systems to reuse retrospective data for research. Few studies have explored source data collection and quality control during prospective data collection from a methodological perspective. Objective: This study aimed to design a clinical source data collection method that is suitable for real-world studies and meets the data quality standards for clinical research and to improve efficiency when writing electronic medical records (EMRs). Methods: On the basis of our group?s previous research experience, TransCelerate BioPharm Inc eSource logical architecture, and relevant regulations and guidelines, we designed a source data collection method and invited relevant stakeholders to optimize it. On the basis of this method, we proposed the eSource record (ESR) system as a solution and invited experts with different roles in the contract research organization company to discuss and design a flowchart for data connection between the ESR and electronic data capture (EDC). Results: The ESR method included 5 steps: research project preparation, initial survey collection, in-hospital medical record writing, out-of-hospital follow-up, and electronic case report form (eCRF) traceability. The data connection between the ESR and EDC covered the clinical research process from creating the eCRF to collecting data for the analysis. The intelligent data acquisition function of the ESR will automatically complete the empty eCRF to create an eCRF with values. When the clinical research associate and data manager conduct data verification, they can query the certified copy database through interface traceability and send data queries. The data queries are transmitted to the ESR through the EDC interface. The EDC and EMR systems interoperate through the ESR. The EMR and EDC systems transmit data to the ESR system through the data standards of the Health Level Seven Clinical Document Architecture and the Clinical Data Interchange Standards Consortium operational data model, respectively. When the implemented data standards for a given system are not consistent, the ESR will approach the problem by first automating mappings between standards and then handling extensions or corrections to a given data format through human evaluation. Conclusions: The source data collection method proposed in this study will help to realize eSource?s new strategy. The ESR solution is standardized and sustainable. It aims to ensure that research data meet the attributable, legible, contemporaneous, original, accurate, complete, consistent, enduring, and available standards for clinical research data quality and to provide a new model for prospective data collection in real-world studies. UR - https://www.researchprotocols.org/2022/12/e42754 UR - http://dx.doi.org/10.2196/42754 UR - http://www.ncbi.nlm.nih.gov/pubmed/36563036 ID - info:doi/10.2196/42754 ER - TY - JOUR AU - Marcolino, Soriano Milena AU - Diniz, Sousa Clara AU - Chagas, Azevedo Bruno AU - Mendes, Santos Mayara AU - Prates, Raquel AU - Pagano, Adriana AU - Ferreira, Castro Thiago AU - Alkmim, Moreira Maria Beatriz AU - Oliveira, Alves Clara Rodrigues AU - Borges, Nascimento Isabela AU - Raposo, César Magda AU - Reis, Nogueira Zilma Silveira AU - Paixão, Cristina Maria AU - Ribeiro, Bonisson Leonardo AU - Rocha, Machado Gustavo AU - Cardoso, Silva Clareci AU - Ribeiro, Pinho Antonio Luiz PY - 2022/12/22 TI - Synchronous Teleconsultation and Monitoring Service Targeting COVID-19: Leveraging Insights for Postpandemic Health Care JO - JMIR Med Inform SP - e37591 VL - 10 IS - 12 KW - COVID-19 KW - telemonitoring KW - remote consultation KW - telemedicine KW - primary health care KW - delivery of health care KW - telehealth KW - text message KW - mobile health KW - public health KW - remote care KW - digital health KW - usability N2 - Background: Although a great number of teleconsultation services have been developed during the COVID-19 pandemic, studies assessing usability and health care provider satisfaction are still incipient. Objective: This study aimed to describe the development, implementation, and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and health care professionals? satisfaction. Methods: This mixed methods study was developed in 5 phases: (1) the identification of components, technical and functional requirements, and system architecture; (2) system and user interface development and validation; (3) pilot-testing in the city of Divinópolis; (4) expansion in the cities of Divinópolis, Teófilo Otoni, and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; and (5) usability and satisfaction assessment, using Likert-scale and open-ended questions. Results: During pilot development, problems contacting users were solved by introducing standardized SMS text messages, which were sent to users to obtain their feedback and keep track of them. Until April 2022, the expanded system served 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27.7% (40,486/146,158) of cases. Teleconsultation efficiency per city was 93.7% (13,317/14,212) in Teófilo Otoni, 92.4% (11,747/12,713) in Divinópolis, and 98.8% (4981/5041) in Belo Horizonte (university campus), thus avoiding in-person assistance for a great majority of patients. In total, 50 (83%) out of 60 health care professionals assessed the system?s usability as satisfactory, despite a few system instability problems. Conclusions: The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development, and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a postpandemic scenario. UR - https://medinform.jmir.org/2022/12/e37591 UR - http://dx.doi.org/10.2196/37591 UR - http://www.ncbi.nlm.nih.gov/pubmed/36191175 ID - info:doi/10.2196/37591 ER - TY - JOUR AU - Fan, ZhiYuan AU - Cui, LiYuan AU - Ye, Ying AU - Li, ShouCheng AU - Deng, Ning PY - 2022/12/19 TI - Telehealth System Based on the Ontology Design of a Diabetes Management Pathway Model in China: Development and Usability Study JO - JMIR Med Inform SP - e42664 VL - 10 IS - 12 KW - diabetes KW - chronic disease management KW - Chronic Disease Management Pathway KW - ontology KW - Semantic Web Rule Language rules KW - SWRL rules N2 - Background: Diabetes needs to be under control through management and intervention. Management of diabetes through mobile health is a practical approach; however, most diabetes mobile health management systems do not meet expectations, which may be because of the lack of standardized management processes in the systems and the lack of intervention implementation recommendations in the management knowledge base. Objective: In this study, we aimed to construct a diabetes management care pathway suitable for the actual situation in China to express the diabetes management care pathway using ontology and develop a diabetes closed-loop system based on the construction results of the diabetes management pathway and apply it practically. Methods: This study proposes a diabetes management care pathway model in which the management process of diabetes is divided into 9 management tasks, and the Diabetes Care Pathway Ontology (DCPO) is constructed to represent the knowledge contained in this pathway model. A telehealth system, which can support the comprehensive management of patients with diabetes while providing active intervention by physicians, was designed and developed based on the DCPO. A retrospective study was performed based on the data records extracted from the system to analyze the usability and treatment effects of the DCPO. Results: The diabetes management pathway ontology constructed in this study contains 119 newly added classes, 28 object properties, 58 data properties, 81 individuals, 426 axioms, and 192 Semantic Web Rule Language rules. The developed mobile medical system was applied to 272 patients with diabetes. Within 3 months, the average fasting blood glucose of the patients decreased by 1.34 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.63 mmol/L (P=.003); the average systolic and diastolic blood pressures decreased by 11.84 mmHg (P=.02) and 8.8 mmHg (P=.02), respectively. In patients who received physician interventions owing to abnormal attention or low-compliance warnings, the average fasting blood glucose decreased by 2.45 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.89 mmol/L (P=.003) in all patients with diabetes; the average systolic and diastolic blood pressure decreased by 20.06 mmHg (P=.02) and 17.37 mmHg (P=.02), respectively, in patients with both hypertension and diabetes during the 3-month management period. Conclusions: This study helps guide the timing and content of interactive interventions between physicians and patients and regulates physicians? medical service behavior. Different management plans are formulated for physicians and patients according to different characteristics to comprehensively manage various cardiovascular risk factors. The application of the DCPO in the diabetes management system can provide effective and adequate management support for patients with diabetes and those with both diabetes and hypertension. UR - https://medinform.jmir.org/2022/12/e42664 UR - http://dx.doi.org/10.2196/42664 UR - http://www.ncbi.nlm.nih.gov/pubmed/36534448 ID - info:doi/10.2196/42664 ER - TY - JOUR AU - Kosowan, Leanne AU - Singer, Alexander AU - Zulkernine, Farhana AU - Zafari, Hasan AU - Nesca, Marcello AU - Muthumuni, Dhasni PY - 2022/12/13 TI - Pan-Canadian Electronic Medical Record Diagnostic and Unstructured Text Data for Capturing PTSD: Retrospective Observational Study JO - JMIR Med Inform SP - e41312 VL - 10 IS - 12 KW - electronic health records KW - EHR KW - natural language processing KW - NLP KW - medical informatics KW - primary health care KW - stress disorders, posttraumatic KW - posttraumatic stress disorder KW - PTSD N2 - Background: The availability of electronic medical record (EMR) free-text data for research varies. However, access to short diagnostic text fields is more widely available. Objective: This study assesses agreement between free-text and short diagnostic text data from primary care EMR for identification of posttraumatic stress disorder (PTSD). Methods: This retrospective cross-sectional study used EMR data from a pan-Canadian repository representing 1574 primary care providers at 265 clinics using 11 EMR vendors. Medical record review using free text and short diagnostic text fields of the EMR produced reference standards for PTSD. Agreement was assessed with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Results: Our reference set contained 327 patients with free text and short diagnostic text. Among these patients, agreement between free text and short diagnostic text had an accuracy of 93.6% (CI 90.4%-96.0%). In a single Canadian province, case definitions 1 and 4 had a sensitivity of 82.6% (CI 74.4%-89.0%) and specificity of 99.5% (CI 97.4%-100%). However, when the reference set was expanded to a pan-Canada reference (n=12,104 patients), case definition 4 had the strongest agreement (sensitivity: 91.1%, CI 90.1%-91.9%; specificity: 99.1%, CI 98.9%-99.3%). Conclusions: Inclusion of free-text encounter notes during medical record review did not lead to improved capture of PTSD cases, nor did it lead to significant changes in case definition agreement. Within this pan-Canadian database, jurisdictional differences in diagnostic codes and EMR structure suggested the need to supplement diagnostic codes with natural language processing to capture PTSD. When unavailable, short diagnostic text can supplement free-text data for reference set creation and case validation. Application of the PTSD case definition can inform PTSD prevalence and characteristics. UR - https://medinform.jmir.org/2022/12/e41312 UR - http://dx.doi.org/10.2196/41312 UR - http://www.ncbi.nlm.nih.gov/pubmed/36512389 ID - info:doi/10.2196/41312 ER - TY - JOUR AU - Shau, Wen-Yi AU - Setia, Sajita AU - Shinde, Prakash Salil AU - Santoso, Handoko AU - Furtner, Daniel PY - 2022/12/13 TI - Contemporary Databases in Real-world Studies Regarding the Diverse Health Care Systems of India, Thailand, and Taiwan: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e43741 VL - 11 IS - 12 KW - Asia KW - health care databases KW - real-world data KW - real-world evidence KW - scoping review N2 - Background: Real-world data (RWD) related to patient health status or health care delivery can be broadly defined as data collected outside of conventional clinical trials, including those from databases, treatment and disease registries, electronic medical records, insurance claims, and information directly contributed by health care professionals or patients. RWD are used to generate real-world evidence (RWE), which is increasingly relevant to policy makers in Asia, who use RWE to support decision-making in several areas, including public health policy, regulatory health technology assessment, and reimbursement; set priorities; or inform clinical practice. Objective: To support the achievement of the benefits of RWE in Asian health care strategies and policies, we sought to identify the linked contemporary databases used in real-world studies from three representative countries?India, Thailand, and Taiwan?and explore variations in results based on these countries? economies and health care reimbursement systems by performing a systematic scoping review. Herein, we describe the protocol and preliminary findings of our scoping review. Methods: The PubMed search strategy covered 3 concepts. Concept 1 was designed to identify potential RWE and RWD studies by applying various Medical Subject Headings (MeSH) terms (?Treatment Outcome,? ?Evidence-Based Medicine,? ?Retrospective Studies,? and ?Time Factors?) and related keywords (eg, ?real-world,? ?actual life,? and ?actual practice?). Concept 2 introduced the three countries?India, Taiwan, and Thailand. Concept 3 focused on data types, using a combination of MeSH terms (?Electronic Health Records,? ?Insurance, Health,? ?Registries,? ?Databases, Pharmaceutical,? and ?Pharmaceutical Services?) and related keywords (eg, ?electronic medical record,? ?electronic healthcare record,? ?EMR,? ?EHR,? ?administrative database,? and ?registry?). These searches were conducted with filters for language (English) and publication date (publications in the last 5 years before the search). The retrieved articles will undergo 2 screening phases (phase 1: review of titles and abstracts; phase 2: review of full texts) to identify relevant and eligible articles for data extraction. The data to be extracted from eligible studies will include the characteristics of databases, the regions covered, and the patient populations. Results: The literature search was conducted on September 27, 2022. We retrieved 3,172,434, 1,094,125, and 672,794 articles for concepts 1, 2, and 3, respectively. After applying all 3 concepts and the language and publication date filters, 2277 articles were identified. These will be further screened to identify eligible studies. Based on phase 1 screening and our progress to date, approximately 44% (1003/2277) of articles have undergone phase 2 screening to judge their eligibility. Around 800 studies will be used for data extraction. Conclusions: Our research will be crucial for nurturing advancement in RWD generation within Asia by identifying linked clinical RWD databases and new avenues for public-private partnerships and multiple collaborations for expanding the scope and spectrum of high-quality, robust RWE generation in Asia. International Registered Report Identifier (IRRID): DERR1-10.2196/43741 UR - https://www.researchprotocols.org/2022/12/e43741 UR - http://dx.doi.org/10.2196/43741 UR - http://www.ncbi.nlm.nih.gov/pubmed/36512386 ID - info:doi/10.2196/43741 ER - TY - JOUR AU - Guardiolle, Vianney AU - Bazoge, Adrien AU - Morin, Emmanuel AU - Daille, Béatrice AU - Toublant, Delphine AU - Bouzillé, Guillaume AU - Merel, Youenn AU - Pierre-Jean, Morgane AU - Filiot, Alexandre AU - Cuggia, Marc AU - Wargny, Matthieu AU - Lamer, Antoine AU - Gourraud, Pierre-Antoine PY - 2022/11/1 TI - Linking Biomedical Data Warehouse Records With the National Mortality Database in France: Large-scale Matching Algorithm JO - JMIR Med Inform SP - e36711 VL - 10 IS - 11 KW - data warehousing KW - clinical data warehouse KW - medical informatics applications KW - medical record linkage KW - French National Mortality Database KW - data reuse KW - open data, R KW - clinical informatics N2 - Background: Often missing from or uncertain in a biomedical data warehouse (BDW), vital status after discharge is central to the value of a BDW in medical research. The French National Mortality Database (FNMD) offers open-source nominative records of every death. Matching large-scale BDWs records with the FNMD combines multiple challenges: absence of unique common identifiers between the 2 databases, names changing over life, clerical errors, and the exponential growth of the number of comparisons to compute. Objective: We aimed to develop a new algorithm for matching BDW records to the FNMD and evaluated its performance. Methods: We developed a deterministic algorithm based on advanced data cleaning and knowledge of the naming system and the Damerau-Levenshtein distance (DLD). The algorithm?s performance was independently assessed using BDW data of 3 university hospitals: Lille, Nantes, and Rennes. Specificity was evaluated with living patients on January 1, 2016 (ie, patients with at least 1 hospital encounter before and after this date). Sensitivity was evaluated with patients recorded as deceased between January 1, 2001, and December 31, 2020. The DLD-based algorithm was compared to a direct matching algorithm with minimal data cleaning as a reference. Results: All centers combined, sensitivity was 11% higher for the DLD-based algorithm (93.3%, 95% CI 92.8-93.9) than for the direct algorithm (82.7%, 95% CI 81.8-83.6; P<.001). Sensitivity was superior for men at 2 centers (Nantes: 87%, 95% CI 85.1-89 vs 83.6%, 95% CI 81.4-85.8; P=.006; Rennes: 98.6%, 95% CI 98.1-99.2 vs 96%, 95% CI 94.9-97.1; P<.001) and for patients born in France at all centers (Nantes: 85.8%, 95% CI 84.3-87.3 vs 74.9%, 95% CI 72.8-77.0; P<.001). The DLD-based algorithm revealed significant differences in sensitivity among centers (Nantes, 85.3% vs Lille and Rennes, 97.3%, P<.001). Specificity was >98% in all subgroups. Our algorithm matched tens of millions of death records from BDWs, with parallel computing capabilities and low RAM requirements. We used the Inseehop open-source R script for this measurement. Conclusions: Overall, sensitivity/recall was 11% higher using the DLD-based algorithm than that using the direct algorithm. This shows the importance of advanced data cleaning and knowledge of a naming system through DLD use. Statistically significant differences in sensitivity between groups could be found and must be considered when performing an analysis to avoid differential biases. Our algorithm, originally conceived for linking a BDW with the FNMD, can be used to match any large-scale databases. While matching operations using names are considered sensitive computational operations, the Inseehop package released here is easy to run on premises, thereby facilitating compliance with cybersecurity local framework. The use of an advanced deterministic matching algorithm such as the DLD-based algorithm is an insightful example of combining open-source external data to improve the usage value of BDWs. UR - https://medinform.jmir.org/2022/11/e36711 UR - http://dx.doi.org/10.2196/36711 UR - http://www.ncbi.nlm.nih.gov/pubmed/36318244 ID - info:doi/10.2196/36711 ER - TY - JOUR AU - Scheenstra, Bart AU - Bruninx, Anke AU - van Daalen, Florian AU - Stahl, Nina AU - Latuapon, Elizabeth AU - Imkamp, Maike AU - Ippel, Lianne AU - Duijsings-Mahangi, Sulaika AU - Smits, Djura AU - Townend, David AU - Bermejo, Inigo AU - Dekker, Andre AU - Hochstenbach, Laura AU - Spreeuwenberg, Marieke AU - Maessen, Jos AU - van 't Hof, Arnoud AU - Kietselaer, Bas PY - 2022/10/17 TI - Digital Health Solutions to Reduce the Burden of Atherosclerotic Cardiovascular Disease Proposed by the CARRIER Consortium JO - JMIR Cardio SP - e37437 VL - 6 IS - 2 KW - atherosclerotic cardiovascular disease KW - ASCVD KW - cardiovascular risk management KW - CVRM KW - eHealth KW - digital Health KW - personalized e-coach KW - big data KW - clinical prediction models KW - federated data infrastructure UR - https://cardio.jmir.org/2022/2/e37437 UR - http://dx.doi.org/10.2196/37437 UR - http://www.ncbi.nlm.nih.gov/pubmed/36251353 ID - info:doi/10.2196/37437 ER - TY - JOUR AU - Frid, Santiago AU - Fuentes Expósito, Angeles Maria AU - Grau-Corral, Inmaculada AU - Amat-Fernandez, Clara AU - Muñoz Mateu, Montserrat AU - Pastor Duran, Xavier AU - Lozano-Rubí, Raimundo PY - 2022/10/12 TI - Successful Integration of EN/ISO 13606?Standardized Extracts From a Patient Mobile App Into an Electronic Health Record: Description of a Methodology JO - JMIR Med Inform SP - e40344 VL - 10 IS - 10 KW - health information interoperability KW - mobile app KW - health information standards KW - artificial intelligence KW - electronic health records KW - machine learning N2 - Background: There is an increasing need to integrate patient-generated health data (PGHD) into health information systems (HISs). The use of health information standards based on the dual model allows the achievement of semantic interoperability among systems. Although there is evidence in the use of the Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR) framework for standardized communication between mobile apps and electronic health records (EHRs), the use of European Norm/International Organization for Standardization (EN/ISO) 13606 has not been explored yet, despite some advantages over FHIR in terms of modeling and formalization of clinical knowledge, as well as flexibility in the creation of new concepts. Objective: This study aims to design and implement a methodology based on the dual-model paradigm to communicate clinical information between a patient mobile app (Xemio Research) and an institutional ontology-based clinical repository (OntoCR) without loss of meaning. Methods: This paper is framed within Artificial intelligence Supporting CAncer Patients across Europe (ASCAPE), a project that aims to use artificial intelligence (AI)/machine learning (ML) mechanisms to support cancer patients? health status and quality of life (QoL). First, the variables ?side effect? and ?daily steps? were defined and represented with EN/ISO 13606 archetypes. Next, ontologies that model archetyped concepts and map them to the standard were created and uploaded to OntoCR, where they were ready to receive instantiated patient data. Xemio Research used a conversion module in the ASCAPE Local Edge to transform data entered into the app to create EN/ISO 13606 extracts, which were sent to an Application Programming Interface (API) in OntoCR that maps each element in the normalized XML files to its corresponding location in the ontology. This way, instantiated data of patients are stored in the clinical repository. Results: Between December 22, 2020, and April 4, 2022, 1100 extracts of 47 patients were successfully communicated (234/1100, 21.3%, extracts of side effects and 866/1100, 78.7%, extracts of daily activity). Furthermore, the creation of EN/ISO 13606?standardized archetypes allows the reuse of clinical information regarding daily activity and side effects, while with the creation of ontologies, we extended the knowledge representation of our clinical repository. Conclusions: Health information interoperability is one of the requirements for continuity of health care. The dual model allows the separation of knowledge and information in HISs. EN/ISO 13606 was chosen for this project because of the operational mechanisms it offers for data exchange, as well as its flexibility for modeling knowledge and creating new concepts. To the best of our knowledge, this is the first experience reported in the literature of effective communication of EN/ISO 13606 EHR extracts between a patient mobile app and an institutional clinical repository using a scalable standard-agnostic methodology that can be applied to other projects, data sources, and institutions. UR - https://medinform.jmir.org/2022/10/e40344 UR - http://dx.doi.org/10.2196/40344 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222792 ID - info:doi/10.2196/40344 ER - TY - JOUR AU - Al-Otaibi, Jawaher AU - Tolma, Eleni AU - Alali, Walid AU - Alhuwail, Dari AU - Aljunid, Mohamed Syed PY - 2022/10/7 TI - The Factors Contributing to Physicians? Current Use of and Satisfaction With Electronic Health Records in Kuwait?s Public Health Care: Cross-sectional Questionnaire Study JO - JMIR Med Inform SP - e36313 VL - 10 IS - 10 KW - health informatics KW - information systems adoption KW - electronic health record KW - EHR KW - public health informatics N2 - Background: Electronic health record (EHR) has emerged as a backbone health care organization that aims to integrate health care records and automate clinical workflow. With the adoption of the eHealth care system, health information communication technologies and EHRs are offering significant health care advantages in the form of error reduction, improved communication, and patient satisfaction. Objective: This study aimed to (1) investigate factors associated with physicians? EHR adoption status and prevalence of EHRs in Kuwait and (2) identify factors predicting physician satisfaction with EHRs in public hospitals in Kuwait. Methods: This study was conducted at Kuwait?s public Al-Jahra hospital from May to September 2019, using quantitative research methods. Primary data were gathered via questionnaires distributed among 295 physicians recruited using convenience sampling. Data were analyzed in SPSS using descriptive, bivariate, and multivariate linear regression, adjusted for demographics. Results: Results of the study revealed that the controlled variable of gender (?=?.197; P=.02) along with explanatory variables, such as training quality (?=.068; P=.005), perception of barriers (?=?.107; P=.04), and effect on physician (?=.521; P<.001) have a significant statistical relationship with physicians? EHR adoption status. Furthermore, findings also suggested that controlled variables of gender (?=?.193; P=.02), education (?=?.164; P=.03), effect on physician (?=.417; P<.001), and level of ease of use (?=.254; P<.001) are significant predictors of the degree of physician satisfaction with the EHR system. Conclusions: The findings of this study had significant managerial and practical implications for creating an inductive environment for the acceptance of EHR systems across a broad spectrum of health care system in Kuwait. UR - https://medinform.jmir.org/2022/10/e36313 UR - http://dx.doi.org/10.2196/36313 UR - http://www.ncbi.nlm.nih.gov/pubmed/36206039 ID - info:doi/10.2196/36313 ER - TY - JOUR AU - Hota, Bala AU - Casey, Paul AU - McIntyre, F. Anne AU - Khan, Jawad AU - Rab, Shafiq AU - Chopra, Aneesh AU - Lateef, Omar AU - Layden, E. Jennifer PY - 2022/9/27 TI - A Standard-Based Citywide Health Information Exchange for Public Health in Response to COVID-19: Development Study JO - JMIR Public Health Surveill SP - e35973 VL - 8 IS - 9 KW - public health KW - informatics KW - surveillance KW - disease surveillance KW - epidemiology KW - health data KW - electronic health record KW - data hub KW - acute care hospital KW - COVID-19 KW - pandemic KW - data governance N2 - Background: Disease surveillance is a critical function of public health, provides essential information about the disease burden and the clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by electronic health record (EHR) meaningful use should enable rapid health care data exchange in the setting of disruptive health care events, such as a pandemic. In reality, access to data remains challenging and, even if available, often lacks conformity to regulated standards. Objective: We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We described the technical and operational components, governance model, and timelines required to implement the public health order that mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluated the data sources, infrastructure requirements, and the completeness of data supplied to the platform and the capacity to link these sources. Methods: Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems?a regional data hub to enhance public health surveillance. A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. We measured the completeness of each feed and the match rate between feeds. Results: Data from 88,906 persons from CCDA records among 14 facilities and 408,741 persons from ELR records among 88 facilities were submitted. Most (n=448,380, 90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability. Conclusions: We described the development of a citywide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment those feeds with CCDA documents, establish secure transfer methods for data exchange, develop a cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and the disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHRs and a potential template for future use of standards to improve public health surveillance. UR - https://publichealth.jmir.org/2022/9/e35973 UR - http://dx.doi.org/10.2196/35973 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544440 ID - info:doi/10.2196/35973 ER - TY - JOUR AU - Modi, Shikha AU - Feldman, S. Sue PY - 2022/9/27 TI - The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review JO - JMIR Med Inform SP - e37283 VL - 10 IS - 9 KW - electronic health records KW - EHRs KW - value KW - financial outcomes KW - clinical outcomes KW - health informatics KW - clinical informatics N2 - Background: Electronic health records (EHRs) are the electronic records of patient health information created during ?1 encounter in any health care setting. The Health Information Technology Act of 2009 has been a major driver of the adoption and implementation of EHRs in the United States. Given that the adoption of EHRs is a complex and expensive investment, a return on this investment is expected. Objective: This literature review aims to focus on how the value of EHRs as an intervention is defined in relation to the elaboration of value into 2 different value outcome categories, financial and clinical outcomes, and to understand how EHRs contribute to these 2 value outcome categories. Methods: This literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The initial search of key terms, EHRs, values, financial outcomes, and clinical outcomes in 3 different databases yielded 971 articles, of which, after removing 410 (42.2%) duplicates, 561 (57.8%) were incorporated in the title and abstract screening. During the title and abstract screening phase, articles were excluded from further review phases if they met any of the following criteria: not relevant to the outcomes of interest, not relevant to EHRs, nonempirical, and non?peer reviewed. After the application of the exclusion criteria, 80 studies remained for a full-text review. After evaluating the full text of the residual 80 studies, 26 (33%) studies were excluded as they did not address the impact of EHR adoption on the outcomes of interest. Furthermore, 4 additional studies were discovered through manual reference searches and were added to the total, resulting in 58 studies for analysis. A qualitative analysis tool, ATLAS.ti. (version 8.2), was used to categorize and code the final 58 studies. Results: The findings from the literature review indicated a combination of positive and negative impacts of EHRs on financial and clinical outcomes. Of the 58 studies surveyed for this review of the literature, 5 (9%) reported on the intersection of financial and clinical outcomes. To investigate this intersection further, the category ?Value?Intersection of Financial and Clinical Outcomes? was generated. Approximately 80% (4/5) of these studies specified a positive association between EHR adoption and financial and clinical outcomes. Conclusions: This review of the literature reports on the individual and collective value of EHRs from a financial and clinical outcomes perspective. The collective perspective examined the intersection of financial and clinical outcomes, suggesting a reversal of the current understanding of how IT investments could generate improvements in productivity, and prompted a new question to be asked about whether an increase in productivity could potentially lead to more IT investments. UR - https://medinform.jmir.org/2022/9/e37283 UR - http://dx.doi.org/10.2196/37283 UR - http://www.ncbi.nlm.nih.gov/pubmed/36166286 ID - info:doi/10.2196/37283 ER - TY - JOUR AU - Iglesias, Natalia AU - Juarez, M. Jose AU - Campos, Manuel PY - 2022/9/15 TI - Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis JO - J Med Internet Res SP - e29927 VL - 24 IS - 9 KW - openEHR task planning KW - business process model and notation KW - BPMN KW - clinical pathways KW - catheter-related bloodstream infection KW - CR-BSI KW - clinical guidelines N2 - Background: Clinical pathways (CPs) are usually expressed by means of workflow formalisms, providing health care personnel with an easy-to-understand, high-level conceptual model of medical steps in specific patient conditions, thereby improving overall health care process quality in clinical practice. From a standardized perspective, the business process model and notation (BPMN), a widely spread general-purpose process formalism, has been used for conceptual modeling in clinical domains, mainly because of its easy-to-use graphical notation, facilitating the common understanding and communication of the parties involved in health care. However, BPMN is not particularly oriented toward the peculiarities of complex clinical processes such as infection diagnosis and treatment, in which time plays a critical role, which is why much of the BPMN clinical-oriented research has revolved around how to extend the standard to address these special needs. The shift from an agnostic, general-purpose BPMN notation to a natively clinical-oriented notation such as openEHR Task Planning (TP) could constitute a major step toward clinical process improvement, enhancing the representation of CPs for infection treatment and other complex scenarios. Objective: Our work aimed to analyze the suitability of a clinical-oriented formalism (TP) to successfully represent typical process patterns in infection treatment, identifying domain-specific improvements to the standard that could help enhance its modeling capabilities, thereby promoting the widespread adoption of CPs to improve medical practice and overall health care quality. Methods: Our methodology consisted of 4 major steps: identification of key features of infection CPs through literature review, clinical guideline analysis, and BPMN extensions; analysis of the presence of key features in TP; modeling of relevant process patterns of catheter-related bloodstream infection as a case study; and analysis and proposal of extensions in view of the results. Results: We were able to easily represent the same logic applied in the extended BPMN-based process models in our case study using out-of-the-box standard TP primitives. However, we identified possible improvements to the current version of TP to allow for simpler conceptual models of infection CPs and possibly of other complex clinical scenarios. Conclusions: Our study showed that the clinical-oriented TP specification is able to successfully represent the most complex catheter-related bloodstream infection process patterns depicted in our case study and identified possible extensions that can help increase its adequacy for modeling infection CPs and possibly other complex clinical conditions. UR - https://www.jmir.org/2022/9/e29927 UR - http://dx.doi.org/10.2196/29927 UR - http://www.ncbi.nlm.nih.gov/pubmed/36107480 ID - info:doi/10.2196/29927 ER - TY - JOUR AU - Lee, Young-ji AU - Lee, Seohyun AU - Kim, SeYeon AU - Choi, Wonil AU - Jeong, Yoojin AU - Rhim, Joo Nina Jin AU - Seo, Ilwon AU - Kim, Sun-Young PY - 2022/8/31 TI - An mHealth-Based Health Management Information System Among Health Workers in Volta and Eastern Regions of Ghana: Pre-Post Comparison Analysis JO - JMIR Med Inform SP - e29431 VL - 10 IS - 8 KW - mobile health KW - mHealth KW - e-Tracker KW - health information system KW - HIS KW - health information management system KW - HIMS KW - District Health Information Management System KW - DHIMS KW - maternal and child health KW - MCH KW - electronic health record KW - EHR KW - health workers N2 - Background: Despite the increasing attention to electronic health management information systems (HMISs) in global health, most African countries still depend on inefficient paper-based systems. Good Neighbors International and Evaluate 4 Health have recently supported the Ghana Health Service on the rollout of a mobile health?based HMIS called the e-Tracker system in 2 regions in Ghana. The e-Tracker is an Android-based tracker capture app that electronically manages maternal and child health (MCH) data. The Ghana Health Service has implemented this new system in Community Health Planning and Services in the 2 regions (Volta and Eastern). Objective: This study aims to evaluate changes in health workers? capacity and behavior after using the e-Tracker to deliver MCH services. Specifically, the study assesses the changes in knowledge, attitude, and practice (KAP) of the health workers toward the e-Tracker system by comparing the pre- and postsurvey results. Methods: The KAP of frontline health workers was measured through self-administered surveys before and after using the e-Tracker system to assess their capacity and behavioral change toward the system. A total of 1124 health workers from the Volta and Eastern regions responded to the pre-post surveys. This study conducted the McNemar chi-square test and Wilcoxon signed-rank test for a pre-post comparison analysis. In addition, random-effects ordered logistic regression analysis and random-effects panel analysis were conducted to identify factors associated with KAP level. Results: The pre-post comparison analysis showed significant improvement in health workers? capacity, with higher knowledge and practice levels after using the e-Tracker system. As for knowledge, there was a 9.9%-point increase (from 559/1109, 50.41% to 669/1109, 60.32%) in the proportion of the respondents who were able to generate basic statistics on the number of children born in a random month within 30 minutes. In the practice section, the percentage of respondents who had scheduled clientencounters increased from 91.41% (968/1059) to 97.83% (1036/1059). By contrast, responses to the attitude (acceptability) became less favorable after experiencing the actual system. For instance, 48.53% (544/1121) initially expressed their preferences for an electronic system; however, the proportion decreased to 33.45% (375/1121) after the intervention. Random-effects ordered logistic regression showed that days of overwork were significantly associated with health workers? attitudes toward the e-Tracker system. Conclusions: This study provides empirical evidence that the e-Tracker system is conducive to enhancing capacity in MCH data management for providing necessary MCH services. However, the change in attitude implies that the users appear to feel less comfortable using the new system. As Ghana plans to scale up the electronic HMIS system using the e-Tracker to the national level, strategies to enhance health workers? attitudes are necessary to sustain this new system. UR - https://medinform.jmir.org/2022/8/e29431 UR - http://dx.doi.org/10.2196/29431 UR - http://www.ncbi.nlm.nih.gov/pubmed/36044256 ID - info:doi/10.2196/29431 ER - TY - JOUR AU - Maré, Adele Irma AU - Kramer, Beverley AU - Hazelhurst, Scott AU - Nhlapho, Dorcus Mapule AU - Zent, Roy AU - Harris, A. Paul AU - Klipin, Michael PY - 2022/8/30 TI - Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study JO - JMIR Med Inform SP - e33402 VL - 10 IS - 8 KW - electronic data capture KW - implementation science KW - Research Electronic Data Capture KW - REDCap KW - biomedical informatics KW - South Africa N2 - Background: Electronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping. Objective: The aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap?s global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings. Methods: The strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center. Results: During the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system. Conclusions: By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology. UR - https://medinform.jmir.org/2022/8/e33402 UR - http://dx.doi.org/10.2196/33402 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040763 ID - info:doi/10.2196/33402 ER - TY - JOUR AU - Alexander, L. Gregory AU - Liu, Jianfang AU - Powell, R. Kimberly AU - Stone, W. Patricia PY - 2022/8/23 TI - Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity JO - JMIR Aging SP - e37482 VL - 5 IS - 3 KW - nursing homes KW - health information technology KW - policy KW - nursing informatics KW - electronic health record KW - electronic data KW - data sharing KW - care providers KW - resident KW - care KW - quality of care KW - structural disparity KW - clinical support KW - administration N2 - Background: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods: NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes. UR - https://aging.jmir.org/2022/3/e37482 UR - http://dx.doi.org/10.2196/37482 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998030 ID - info:doi/10.2196/37482 ER - TY - JOUR AU - Haverinen, Jari AU - Keränen, Niina AU - Tuovinen, Timo AU - Ruotanen, Ronja AU - Reponen, Jarmo PY - 2022/8/12 TI - National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study JO - JMIR Med Inform SP - e35612 VL - 10 IS - 8 KW - eHealth KW - electronic health records KW - picture archiving and communication systems KW - health information exchange KW - electronic prescribing KW - referral and consultation KW - videoconferencing KW - clinical decision support systems KW - health informatics KW - clinical informatics N2 - Background: eHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities. Objective: The first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020. Methods: Data for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable. Results: All the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations. Conclusions: eHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies. UR - https://medinform.jmir.org/2022/8/e35612 UR - http://dx.doi.org/10.2196/35612 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969462 ID - info:doi/10.2196/35612 ER - TY - JOUR AU - Adedeji, Taiwo AU - Fraser, Hamish AU - Scott, Philip PY - 2022/8/11 TI - Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study JO - JMIR Med Inform SP - e33491 VL - 10 IS - 8 KW - theory of change KW - electronic health records KW - maternal and child health KW - primary health center KW - success criteria N2 - Background: Digital health has been a tool of transformation for the delivery of health care services globally. An electronic health record (EHR) system can solve the bottleneck of paper documentation in health service delivery if it is successfully implemented, but poor implementation can lead to a waste of resources. The study of EHR system implementation in low- and middle-income countries (LMICs) is of particular interest to health stakeholders such as policy makers, funders, and care providers because of the efficiencies and evidence base that could result from the appropriate evaluation of such systems. Objective: We aimed to develop a theory of change (ToC) for the implementation of EHRs for maternal and child health care delivery in LMICs. The ToC is an outcomes-based approach that starts with the long-term goals and works backward to the inputs and mediating components required to achieve these goals for complex programs. Methods: We used the ToC approach for the whole implementation?s life cycle to guide the pilot study and identify the preconditions needed to realize the study?s long-term goal at Festac Primary Health Centre in Lagos, Nigeria. To evaluate the maturity of the implementation, we adapted previously defined success factors to supplement the ToC approach. Results: The initial ToC map showed that the long-term goal was an improved service delivery in primary care with the introduction of EHRs. The revised ToC revealed that the long-term change was the improved maternal and child health care delivery at Festac Primary Health Center using EHRs. We proposed a generic ToC map that implementers in LMICs can use to introduce an optimized EHR system, with assumptions about sustainability and other relevant factors. The outcomes from the critical success factors were sustainability: the sustained improvements included trained health care professionals, a change in mindset from using paper systems toward digital health transformation, and using the project?s laptops to collect aggregate data for the District Health Information System 2?based national health information management system; financial: we secured funding to procure IT equipment, including servers, laptops, and networking, but the initial cost of implementation was high, and funds mainly came from the funding partner; and organizational: the health professionals, especially the head of nursing and health information officers, showed significant commitment to adopting the EHR system, but certain physicians and midwives were unwilling to use the EHR system initially until they were persuaded or incentivized by the management. Conclusions: This study shows that the ToC is a rewarding approach to framing dialogue with stakeholders and serves as a framework for planning, evaluation, learning, and reflection. We hypothesized that any future health IT implementation in primary care could adapt our ToC approach to their contexts with necessary modifications based on inherent characteristics. UR - https://medinform.jmir.org/2022/8/e33491 UR - http://dx.doi.org/10.2196/33491 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969461 ID - info:doi/10.2196/33491 ER - TY - JOUR AU - Krzyzanowski, Brittany AU - Manson, M. Steven PY - 2022/8/3 TI - Twenty Years of the Health Insurance Portability and Accountability Act Safe Harbor Provision: Unsolved Challenges and Ways Forward JO - JMIR Med Inform SP - e37756 VL - 10 IS - 8 KW - Health Insurance Portability and Accountability Act KW - HIPAA KW - data privacy KW - health KW - maps KW - safe harbor KW - visualization KW - patient privacy UR - https://medinform.jmir.org/2022/8/e37756 UR - http://dx.doi.org/10.2196/37756 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921140 ID - info:doi/10.2196/37756 ER - TY - JOUR AU - Black, Bell Georgia AU - Bhuiya, Afsana AU - Friedemann Smith, Claire AU - Hirst, Yasemin AU - Nicholson, David Brian PY - 2022/8/1 TI - Harnessing the Electronic Health Care Record to Optimize Patient Safety in Primary Care: Framework for Evaluating e?Safety-Netting Tools JO - JMIR Med Inform SP - e35726 VL - 10 IS - 8 KW - primary care KW - patient safety KW - electronic health record KW - safety KW - optimize KW - framework KW - evaluation KW - tool KW - diagnostic KW - uncertainty KW - management KW - netting KW - software KW - criteria UR - https://medinform.jmir.org/2022/8/e35726 UR - http://dx.doi.org/10.2196/35726 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916722 ID - info:doi/10.2196/35726 ER - TY - JOUR AU - Lubell-Doughtie, Peter AU - Bhatt, Shiven AU - Wong, Roger AU - Shankar, H. Anuraj PY - 2022/7/29 TI - Transforming Rapid Diagnostic Tests for Precision Public Health: Open Guidelines for Manufacturers and Users JO - JMIR Biomed Eng SP - e26800 VL - 7 IS - 2 KW - rapid diagnostic test KW - precision public health KW - digital health KW - diagnostic KW - testing KW - guideline KW - manufacture KW - surveillance KW - FHIR KW - Fast Healthcare Interoperability Resources N2 - Background: Precision public health (PPH) can maximize impact by targeting surveillance and interventions by temporal, spatial, and epidemiological characteristics. Although rapid diagnostic tests (RDTs) have enabled ubiquitous point-of-care testing in low-resource settings, their impact has been less than anticipated, owing in part to lack of features to streamline data capture and analysis. Objective: We aimed to transform the RDT into a tool for PPH by defining information and data axioms and an information utilization index (IUI); identifying design features to maximize the IUI; and producing open guidelines (OGs) for modular RDT features that enable links with digital health tools to create an RDT-OG system. Methods: We reviewed published papers and conducted a survey with experts or users of RDTs in the sectors of technology, manufacturing, and deployment to define features and axioms for information utilization. We developed an IUI, ranging from 0% to 100%, and calculated this index for 33 World Health Organization?prequalified RDTs. RDT-OG specifications were developed to maximize the IUI; the feasibility and specifications were assessed through developing malaria and COVID-19 RDTs based on OGs for use in Kenya and Indonesia. Results: The survey respondents (n=33) included 16 researchers, 7 technologists, 3 manufacturers, 2 doctors or nurses, and 5 other users. They were most concerned about the proper use of RDTs (30/33, 91%), their interpretation (28/33, 85%), and reliability (26/33, 79%), and were confident that smartphone-based RDT readers could address some reliability concerns (28/33, 85%), and that readers were more important for complex or multiplex RDTs (33/33, 100%). The IUI of prequalified RDTs ranged from 13% to 75% (median 33%). In contrast, the IUI for an RDT-OG prototype was 91%. The RDT open guideline system that was developed was shown to be feasible by (1) creating a reference RDT-OG prototype; (2) implementing its features and capabilities on a smartphone RDT reader, cloud information system, and Fast Healthcare Interoperability Resources; and (3) analyzing the potential public health impact of RDT-OG integration with laboratory, surveillance, and vital statistics systems. Conclusions: Policy makers and manufacturers can define, adopt, and synergize with RDT-OGs and digital health initiatives. The RDT-OG approach could enable real-time diagnostic and epidemiological monitoring with adaptive interventions to facilitate control or elimination of current and emerging diseases through PPH. UR - https://biomedeng.jmir.org/2022/2/e26800 UR - http://dx.doi.org/10.2196/26800 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875688 ID - info:doi/10.2196/26800 ER - TY - JOUR AU - Iqbal, Mujtaba Fahad AU - Joshi, Meera AU - Khan, Sadia AU - Wright, Mike AU - Ashrafian, Hutan AU - Darzi, Ara PY - 2022/7/21 TI - Key Stakeholder Barriers and Facilitators to Implementing Remote Monitoring Technologies: Protocol for a Mixed Methods Analysis JO - JMIR Res Protoc SP - e38437 VL - 11 IS - 7 KW - implementation science KW - health plan implementation KW - mobile health KW - health care industry KW - stakeholder KW - barriers KW - remote monitoring KW - implementation KW - digitization KW - digital solutions N2 - Background: The implementation of novel digital solutions within the National Health Service has historically been challenging. Since the start of the COVID-19 pandemic, there has been a greater push for digitization and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation have been poorly studied. Objective: We aim to investigate key stakeholder barriers and facilitators to implementing remote monitoring solutions to identify factors that could affect successful adoption. Methods: A mixed methods approach will be implemented. Semistructured interviews will be conducted with high-level stakeholders from industry and academia and health care providers who have played an instrumental role in, and have prior experience with, implementing digital solutions, alongside the use of an adapted version of the Technology Acceptance Model questionnaire. Results: Enrollment is currently underway, having started in February 2022. It is anticipated to end in July 2022, with data analysis scheduled to commence in August 2022. Conclusions: The results of our study may highlight key barriers and facilitators to implementing digital remote monitoring solutions, thereby allowing for improved widespread adoption within the National Health Service in the future. Trial Registration: ClinicalTrials.gov NCT05321004; https://clinicaltrials.gov/ct2/show/NCT05321004 UR - https://www.researchprotocols.org/2022/7/e38437 UR - http://dx.doi.org/10.2196/38437 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862185 ID - info:doi/10.2196/38437 ER - TY - JOUR AU - Vorisek, Nina Carina AU - Lehne, Moritz AU - Klopfenstein, Ines Sophie Anne AU - Mayer, Josephine Paula AU - Bartschke, Alexander AU - Haese, Thomas AU - Thun, Sylvia PY - 2022/7/19 TI - Fast Healthcare Interoperability Resources (FHIR) for Interoperability in Health Research: Systematic Review JO - JMIR Med Inform SP - e35724 VL - 10 IS - 7 KW - Fast Healthcare Interoperability Resources KW - FHIR KW - interoperability KW - health research KW - health care KW - health information technology KW - research KW - clinical research KW - public health KW - epidemiology N2 - Background: The standard Fast Healthcare Interoperability Resources (FHIR) is widely used in health information technology. However, its use as a standard for health research is still less prevalent. To use existing data sources more efficiently for health research, data interoperability becomes increasingly important. FHIR provides solutions by offering resource domains such as ?Public Health & Research? and ?Evidence-Based Medicine? while using already established web technologies. Therefore, FHIR could help standardize data across different data sources and improve interoperability in health research. Objective: The aim of our study was to provide a systematic review of existing literature and determine the current state of FHIR implementations in health research and possible future directions. Methods: We searched the PubMed/MEDLINE, Embase, Web of Science, IEEE Xplore, and Cochrane Library databases for studies published from 2011 to 2022. Studies investigating the use of FHIR in health research were included. Articles published before 2011, abstracts, reviews, editorials, and expert opinions were excluded. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered this study with PROSPERO (CRD42021235393). Data synthesis was done in tables and figures. Results: We identified a total of 998 studies, of which 49 studies were eligible for inclusion. Of the 49 studies, most (73%, n=36) covered the domain of clinical research, whereas the remaining studies focused on public health or epidemiology (6%, n=3) or did not specify their research domain (20%, n=10). Studies used FHIR for data capture (29%, n=14), standardization of data (41%, n=20), analysis (12%, n=6), recruitment (14%, n=7), and consent management (4%, n=2). Most (55%, 27/49) of the studies had a generic approach, and 55% (12/22) of the studies focusing on specific medical specialties (infectious disease, genomics, oncology, environmental health, imaging, and pulmonary hypertension) reported their solutions to be conferrable to other use cases. Most (63%, 31/49) of the studies reported using additional data models or terminologies: Systematized Nomenclature of Medicine Clinical Terms (29%, n=14), Logical Observation Identifiers Names and Codes (37%, n=18), International Classification of Diseases 10th Revision (18%, n=9), Observational Medical Outcomes Partnership common data model (12%, n=6), and others (43%, n=21). Only 4 (8%) studies used a FHIR resource from the domain ?Public Health & Research.? Limitations using FHIR included the possible change in the content of FHIR resources, safety, legal matters, and the need for a FHIR server. Conclusions: Our review found that FHIR can be implemented in health research, and the areas of application are broad and generalizable in most use cases. The implementation of international terminologies was common, and other standards such as the Observational Medical Outcomes Partnership common data model could be used as a complement to FHIR. Limitations such as the change of FHIR content, lack of FHIR implementation, safety, and legal matters need to be addressed in future releases to expand the use of FHIR and, therefore, interoperability in health research. UR - https://medinform.jmir.org/2022/7/e35724 UR - http://dx.doi.org/10.2196/35724 UR - http://www.ncbi.nlm.nih.gov/pubmed/35852842 ID - info:doi/10.2196/35724 ER - TY - JOUR AU - Yigzaw, Yitbarek Kassaye AU - Chomutare, Taridzo AU - Wynn, Rolf AU - Berntsen, Rosvold Gro Karine AU - Bellika, Gustav Johan PY - 2022/7/13 TI - A Privacy-Preserving Audit and Feedback System for the Antibiotic Prescribing of General Practitioners: Survey Study JO - JMIR Form Res SP - e31650 VL - 6 IS - 7 KW - learning health care system KW - feedback KW - antimicrobial stewardship KW - quality improvement KW - privacy KW - electronic health record KW - antibiotics KW - prescription KW - patient privacy KW - clinical setting N2 - Background: Antibiotic resistance is a worldwide public health problem that is accelerated by the misuse and overuse of antibiotics. Studies have shown that audits and feedback enable clinicians to compare their personal clinical performance with that of their peers and are effective in reducing the inappropriate prescribing of antibiotics. However, privacy concerns make audits and feedback hard to implement in clinical settings. To solve this problem, we developed a privacy-preserving audit and feedback (A&F) system. Objective: This study aims to evaluate a privacy-preserving A&F system in clinical settings. Methods: A privacy-preserving A&F system was deployed at three primary care practices in Norway to generate feedback for 20 general practitioners (GPs) on their prescribing of antibiotics for selected respiratory tract infections. The GPs were asked to participate in a survey shortly after using the system. Results: A total of 14 GPs responded to the questionnaire, representing a 70% (14/20) response rate. The participants were generally satisfied with the usefulness of the feedback and the comparisons with peers, as well as the protection of privacy. The majority of the GPs (9/14, 64%) valued the protection of their own privacy as well as that of their patients. Conclusions: The system overcomes important privacy and scaling challenges that are commonly associated with the secondary use of electronic health record data and has the potential to improve antibiotic prescribing behavior; however, further study is required to assess its actual effect. UR - https://formative.jmir.org/2022/7/e31650 UR - http://dx.doi.org/10.2196/31650 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830221 ID - info:doi/10.2196/31650 ER - TY - JOUR AU - Chukwu, Emeka AU - Garg, Lalit AU - Foday, Edward AU - Konomanyi, Abdul AU - Wright, Royston AU - Smart, Francis PY - 2022/6/10 TI - Digital Health Solutions and State of Interoperability: Landscape Analysis of Sierra Leone JO - JMIR Form Res SP - e29930 VL - 6 IS - 6 KW - digital health KW - mHealth KW - mobile health KW - eHealth KW - Health information and communication technologies KW - Sierra Leone KW - big data KW - HIE KW - interoperability N2 - Background: The government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone?s government launched its first digital health strategy in 2018. In 2019, a broader national innovation and digital strategy was launched. The health pillar direction will use big data and artificial intelligence (AI) to improve health care in general and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies. Objective: This paper presents the state of digital health solutions in Sierra Leone and how these solutions currently interoperate. This study further presents opportunities for big data and AI applications. Methods: All the district health management teams, all digital health implementing organizations, and a stratified sample of 72 (out of 1284) health facilities were purposefully selected from all health districts and surveyed. Results: The National Health Management Information System?s (NHMIS?s) aggregate reporting solution populated by health facility forms HF1 to HF9 was, by far, the most used tool. A health facility?based weekly aggregate electronic integrated disease surveillance and response solution was also widely used. Half of the health facilities had more than 2 digital health solutions in use. The different digital health software solutions do not share data among one another, though aggregate reporting data were sent as necessary. None of the respondents use any of the health care registries for patient, provider, health facility, or terminology identification. Conclusions: Many digital health solutions are currently used at health facilities in Sierra Leone. The government can leverage current investment in HIS from surveillance and reporting for using big data and AI for care. The vision of using big data for health care is achievable if stakeholders prioritize individualized and longitudinal patient data exchange using agreed use cases from national strategies. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities and opportunities for leveraging big data to fill critical gaps necessary to achieve the national digital health vision. UR - https://formative.jmir.org/2022/6/e29930 UR - http://dx.doi.org/10.2196/29930 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687406 ID - info:doi/10.2196/29930 ER - TY - JOUR AU - Gambril, John AU - Boyd, Carter AU - Egbaria, Jamal PY - 2022/5/30 TI - Application of Nonfungible Tokens to Health Care. Comment on ?Blockchain Technology Projects to Provide Telemedical Services: Systematic Review? JO - J Med Internet Res SP - e34276 VL - 24 IS - 5 KW - telemedicine KW - distributed ledger KW - health information exchange KW - blockchain KW - cryptocurrency KW - nonfungible token KW - non-fungible token KW - medical education KW - internet KW - finance UR - https://www.jmir.org/2022/5/e34276 UR - http://dx.doi.org/10.2196/34276 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635749 ID - info:doi/10.2196/34276 ER - TY - JOUR AU - Gruendner, Julian AU - Deppenwiese, Noemi AU - Folz, Michael AU - Köhler, Thomas AU - Kroll, Björn AU - Prokosch, Hans-Ulrich AU - Rosenau, Lorenz AU - Rühle, Mathias AU - Scheidl, Marc-Anton AU - Schüttler, Christina AU - Sedlmayr, Brita AU - Twrdik, Alexander AU - Kiel, Alexander AU - Majeed, W. Raphael PY - 2022/5/25 TI - The Architecture of a Feasibility Query Portal for Distributed COVID-19 Fast Healthcare Interoperability Resources (FHIR) Patient Data Repositories: Design and Implementation Study JO - JMIR Med Inform SP - e36709 VL - 10 IS - 5 KW - federated feasibility queries KW - FHIR KW - distributed analysis KW - feasibility study KW - HL7 FHIR KW - FHIR Search KW - CQL KW - COVID-19 KW - pandemic KW - health data KW - query KW - patient data KW - consensus data set KW - medical informatics KW - Fast Healthcare Interoperability Resources N2 - Background: An essential step in any medical research project after identifying the research question is to determine if there are sufficient patients available for a study and where to find them. Pursuing digital feasibility queries on available patient data registries has proven to be an excellent way of reusing existing real-world data sources. To support multicentric research, these feasibility queries should be designed and implemented to run across multiple sites and securely access local data. Working across hospitals usually involves working with different data formats and vocabularies. Recently, the Fast Healthcare Interoperability Resources (FHIR) standard was developed by Health Level Seven to address this concern and describe patient data in a standardized format. The Medical Informatics Initiative in Germany has committed to this standard and created data integration centers, which convert existing data into the FHIR format at each hospital. This partially solves the interoperability problem; however, a distributed feasibility query platform for the FHIR standard is still missing. Objective: This study described the design and implementation of the components involved in creating a cross-hospital feasibility query platform for researchers based on FHIR resources. This effort was part of a large COVID-19 data exchange platform and was designed to be scalable for a broad range of patient data. Methods: We analyzed and designed the abstract components necessary for a distributed feasibility query. This included a user interface for creating the query, backend with an ontology and terminology service, middleware for query distribution, and FHIR feasibility query execution service. Results: We implemented the components described in the Methods section. The resulting solution was distributed to 33 German university hospitals. The functionality of the comprehensive network infrastructure was demonstrated using a test data set based on the German Corona Consensus Data Set. A performance test using specifically created synthetic data revealed the applicability of our solution to data sets containing millions of FHIR resources. The solution can be easily deployed across hospitals and supports feasibility queries, combining multiple inclusion and exclusion criteria using standard Health Level Seven query languages such as Clinical Quality Language and FHIR Search. Developing a platform based on multiple microservices allowed us to create an extendable platform and support multiple Health Level Seven query languages and middleware components to allow integration with future directions of the Medical Informatics Initiative. Conclusions: We designed and implemented a feasibility platform for distributed feasibility queries, which works directly on FHIR-formatted data and distributed it across 33 university hospitals in Germany. We showed that developing a feasibility platform directly on the FHIR standard is feasible. UR - https://medinform.jmir.org/2022/5/e36709 UR - http://dx.doi.org/10.2196/36709 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486893 ID - info:doi/10.2196/36709 ER - TY - JOUR AU - Yeng, Kandabongee Prosper AU - Fauzi, Ali Muhammad AU - Sun, Luyi AU - Yang, Bian PY - 2022/5/25 TI - Assessing the Legal Aspects of Information Security Requirements for Health Care in 3 Countries: Scoping Review and Framework Development JO - JMIR Hum Factors SP - e30050 VL - 9 IS - 2 KW - legal requirement KW - information security KW - healthcare KW - security practice N2 - Background: The loss of human lives from cyberattacks in health care is no longer a probabilistic quantification but a reality that has begun. In addition, the threat scope is also expanding to involve a threat of national security, among others, resulting in surging data breaches within the health care sector. For that matter, there have been provisions of various legislation, regulations, and information security governance tools such as policies, standards, and directives toward enhancing health care information security?conscious care behavior among users. Meanwhile, in a research scenario, there are no comprehensive required security practices to serve as a yardstick in assessing security practices in health care. Moreover, an analysis of the holistic view of the requirements that need more concentration of management, end users, or both has not been comprehensively developed. Thus, there is a possibility that security practice research will leave out vital requirements. Objective: The objective of this study was to systematically identify, assess, and analyze the state-of-the-art information security requirements in health care. These requirements can be used to develop a framework to serve as a yardstick for measuring the future real security practices of health care staff. Methods: A scoping review was, as a result, adopted to identify, assess, and analyze the information security requirement sources within health care in Norway, Indonesia, and Ghana. Results: Of 188 security and privacy requirement sources that were initially identified, 130 (69.1%) were fully read by the authors. Subsequently, of these 188 requirement documents, 82 (43.6%) fully met the inclusion criteria and were accessed and analyzed. In total, 253 security and privacy requirements were identified in this work. The findings were then used to develop a framework to serve as a benchmark for modeling and analyzing health care security practices. Conclusions: On the basis of these findings, a framework for modeling, analyzing, and developing effective security countermeasures, including incentivization measures, was developed. Following this framework, research results of health care security practices would be more reliable and effective than relying on incomprehensive security requirements. UR - https://humanfactors.jmir.org/2022/2/e30050 UR - http://dx.doi.org/10.2196/30050 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612891 ID - info:doi/10.2196/30050 ER - TY - JOUR AU - Yuan, Yingzhe AU - Price, Megan AU - Schmidt, F. David AU - Ward, Merry AU - Nebeker, Jonathan AU - Pizer, Steven PY - 2022/5/20 TI - Integrated Health Record Viewers and Reduction in Duplicate Medical Imaging: Retrospective Observational Analysis JO - JMIR Med Inform SP - e32168 VL - 10 IS - 5 KW - health informatics KW - duplicate medical imaging KW - health record viewer KW - health care system KW - health care KW - health records KW - electronic health records KW - health information exchange N2 - Background: Health information exchange and multiplatform health record viewers support more informed medical decisions, improve quality of care, and reduce the risk of adverse outcomes due to fragmentation and discontinuity in care during transition of care. An example of a multiplatform health record viewer is the VA/DoD Joint Longitudinal Viewer (JLV), which supports the Department of Veterans Affairs (VA) and Department of Defense (DoD) health care providers with read-only access to patient medical records integrated from multiple sources. JLV is intended to support more informed medical decisions such as reducing duplicate medical imaging when previous image study results may meet current clinical needs. Objective: We estimated the impact of provider usage of JLV on duplicate imaging for service members transitioning from the DoD to the VA health care system. Methods: We conducted a retrospective cross-sectional study in fiscal year 2018 to examine the relationship between providers? use of JLV and the likelihood of ordering duplicate images. Our sample included recently separated service members who had a VA primary care visit in fiscal year 2018 within 90 days of a DoD imaging study. Patients who received at least one imaging study at VA within 90 days of a DoD imaging study of the same imaging mode and on the same body part are considered to have received potentially duplicate imaging studies. We use a logistic regression model with ?JLV provider? (providers with 1 or more JLV audits in the prior 6 months) as the independent variable to estimate the relationship between JLV use and ordering of duplicate images. Control variables included provider image ordering rates in the prior 6 months, provider type, patient demographics (age, race, gender), and clinical characteristics (Elixhauser comorbidity score). Results: Providers known to utilize JLV in the prior 6 months order fewer duplicate images relative to providers not utilizing JLV for similar visits over time (odds ratio 0.44, 95% CI 0.24-0.78; P=.005). This effect is robust across multiple specifications of linear and logistic regression models. The provider?s practice pattern of ordering image studies and the patient?s health status are powerful confounders. Conclusions: This study provides evidence that adoption of a longitudinal viewer of health records from multiple electronic health record systems is associated with a reduced likelihood of ordering duplicate images. Investments in health information exchange systems may be effective ways to improve the quality of care and reduce adverse outcomes for patients experiencing fragmentation and discontinuity of care. UR - https://medinform.jmir.org/2022/5/e32168 UR - http://dx.doi.org/10.2196/32168 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594070 ID - info:doi/10.2196/32168 ER - TY - JOUR AU - Stahl, Melissa AU - Cheung, James AU - Post, Kevin AU - Valin, P. James AU - Jacobs, Ira PY - 2022/5/16 TI - Accelerating Virtual Health Implementation Following the COVID-19 Pandemic: Questionnaire Study JO - JMIR Form Res SP - e32819 VL - 6 IS - 5 KW - virtual health KW - eHealth KW - mHealth KW - telemedicine KW - telehealth KW - COVID-19 KW - health system KW - care delivery KW - strategy KW - business model N2 - Background: The COVID-19 pandemic accelerated drivers for virtual health adoption and triggered the US federal government to implement regulatory changes to reduce barriers to virtual health implementation. Consequently, virtual health solutions have been increasingly adopted, and health systems in the United States have been reorganizing their care delivery process with unprecedented speed. Objective: This study aimed to assess and make recommendations on the strategy, business model, implementation, and future considerations for scaling and sustaining virtual health solutions based on the views of executives from the largest health systems in the United States. Methods: In September 2020 and October 2020, the Health Management Academy conducted 29 quantitative surveys and 23 qualitative interviews involving 58 executives from 41 of the largest health systems in the United States. Participating health systems were approximately equally distributed across size categories (small, medium, and large, defined as annual total operating revenue US $2-3 billion, $3-6 billion, and >$6 billion, respectively) and US Census Bureau regions (Northeast, Midwest, South, and West). Results: Based on the Health Management Academy?s assessment of approaches to governance, financing, data infrastructure, and clinical integration of virtual health, most participating health systems (13/24, 54%) had a mid-stage level of maturity in virtual health implementation. Executives reported the pandemic is forcing health systems to re-examine strategic priorities; the most commonly raised key impacts were increased access (15/21, 71%) and flexibility (10/21, 48%) as well as lower costs of care delivery (9/21, 43%). Most executives (16/28, 57%) reported their organization had a defined budget for virtual health, and many noted that virtual health is best supported through value-based payment models. Irrespective of health system maturity, reimbursement was consistently rated as a key challenge to virtual health scaling, along with patient access to and understanding of virtual health technology. The success of virtual health implementation was most commonly measured by patient satisfaction, health care provider engagement, and proportion of health care providers using virtual health solutions (reported by 7/8, 88%; 6/8, 75%; and 7/8, 75% of information technology executives, respectively). Almost all health systems (27/29, 93%) expect to continue growing their virtual health offerings for the foreseeable future, with user-friendliness and ease of integration into the electronic medical record as key factors in making go-forward decisions on virtual health solutions (each selected by 9/10, 90% executives). Conclusions: The increased demand for virtual health solutions during the COVID-19 pandemic is expected to continue postpandemic. Consequently, health systems are re-evaluating their current platforms, processes, and strategy to develop a sustainable, long-term approach to virtual health. To ensure future success, health system leaders need to proactively build on their virtual health solutions; advocate for payment, site flexibility, and reimbursement parity for virtual health; and demonstrate continued engagement and boldness to evolve care beyond established models. UR - https://formative.jmir.org/2022/5/e32819 UR - http://dx.doi.org/10.2196/32819 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323115 ID - info:doi/10.2196/32819 ER - TY - JOUR AU - Lai, Chao-Han AU - Li, Kai-Wen AU - Hu, Fang-Wen AU - Su, Pei-Fang AU - Hsu, I-Lin AU - Huang, Min?Hsin AU - Huang, Yen?Ta AU - Liu, Ping-Yen AU - Shen, Meng-Ru PY - 2022/5/13 TI - Integration of an Intensive Care Unit Visualization Dashboard (i-Dashboard) as a Platform to Facilitate Multidisciplinary Rounds: Cluster-Randomized Controlled Trial JO - J Med Internet Res SP - e35981 VL - 24 IS - 5 KW - Intensive care unit KW - multidisciplinary round KW - visualization dashboard KW - large screen KW - information management strategy KW - electronic health record KW - medical record KW - digital health KW - dashboard KW - i-Dashboard KW - electronic medical record KW - information exchange N2 - Background:  Multidisciplinary rounds (MDRs) are scheduled, patient-focused communication mechanisms among multidisciplinary providers in the intensive care unit (ICU). Objective: i-Dashboard is a custom-developed visualization dashboard that supports (1) key information retrieval and reorganization, (2) time-series data, and (3) display on large touch screens during MDRs. This study aimed to evaluate the performance, including the efficiency of prerounding data gathering, communication accuracy, and information exchange, and clinical satisfaction of integrating i-Dashboard as a platform to facilitate MDRs. Methods: A cluster-randomized controlled trial was performed in 2 surgical ICUs at a university hospital. Study participants included all multidisciplinary care team members. The performance and clinical satisfaction of i-Dashboard during MDRs were compared with those of the established electronic medical record (EMR) through direct observation and questionnaire surveys. Results: Between April 26 and July 18, 2021, a total of 78 and 91 MDRs were performed with the established EMR and i-Dashboard, respectively. For prerounding data gathering, the median time was 10.4 (IQR 9.1-11.8) and 4.6 (IQR 3.5-5.8) minutes using the established EMR and i-Dashboard (P<.001), respectively. During MDRs, data misrepresentations were significantly less frequent with i-Dashboard (median 0, IQR 0-0) than with the established EMR (4, IQR 3-5; P<.001). Further, effective recommendations were significantly more frequent with i-Dashboard than with the established EMR (P<.001). The questionnaire results revealed that participants favored using i-Dashboard in association with the enhancement of care plan development and team participation during MDRs. Conclusions:  i-Dashboard increases efficiency in data gathering. Displaying i-Dashboard on large touch screens in MDRs may enhance communication accuracy, information exchange, and clinical satisfaction. The design concepts of i-Dashboard may help develop visualization dashboards that are more applicable for ICU MDRs. Trial Registration: ClinicalTrials.gov NCT04845698; https://clinicaltrials.gov/ct2/show/NCT04845698 UR - https://www.jmir.org/2022/5/e35981 UR - http://dx.doi.org/10.2196/35981 UR - http://www.ncbi.nlm.nih.gov/pubmed/35560107 ID - info:doi/10.2196/35981 ER - TY - JOUR AU - Wolff, L. Jennifer AU - Dukhanin, Vadim AU - Burgdorf, G. Julia AU - DesRoches, M. Catherine PY - 2022/5/4 TI - Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity JO - JMIR Aging SP - e34628 VL - 5 IS - 2 KW - patient portal KW - electronic health record KW - care partners KW - proxy KW - health equity KW - health informatics KW - health services KW - elderly KW - older adults KW - aging KW - cognition KW - health system KW - care delivery KW - elderly care UR - https://aging.jmir.org/2022/2/e34628 UR - http://dx.doi.org/10.2196/34628 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507405 ID - info:doi/10.2196/34628 ER - TY - JOUR AU - Ye, Jiancheng AU - Wang, Zidan AU - Hai, Jiarui PY - 2022/4/29 TI - Social Networking Service, Patient-Generated Health Data, and Population Health Informatics: National Cross-sectional Study of Patterns and Implications of Leveraging Digital Technologies to Support Mental Health and Well-being JO - J Med Internet Res SP - e30898 VL - 24 IS - 4 KW - patient-generated health data KW - social network KW - population health informatics KW - mental health KW - social determinants of health KW - health data sharing KW - technology acceptability KW - mobile phone KW - mobile health N2 - Background: The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient?s health and quality of life over time, increase visibility into a patient?s adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode. Objective: Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates. Methods: We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates. Results: Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos. Conclusions: This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management. UR - https://www.jmir.org/2022/4/e30898 UR - http://dx.doi.org/10.2196/30898 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486428 ID - info:doi/10.2196/30898 ER - TY - JOUR AU - Rosenau, Lorenz AU - Majeed, W. Raphael AU - Ingenerf, Josef AU - Kiel, Alexander AU - Kroll, Björn AU - Köhler, Thomas AU - Prokosch, Hans-Ulrich AU - Gruendner, Julian PY - 2022/4/27 TI - Generation of a Fast Healthcare Interoperability Resources (FHIR)-based Ontology for Federated Feasibility Queries in the Context of COVID-19: Feasibility Study JO - JMIR Med Inform SP - e35789 VL - 10 IS - 4 KW - federated queries KW - feasibility study KW - Fast Healthcare Interoperability Resource KW - FHIR Search KW - CQL KW - ontology KW - terminology server KW - query KW - feasibility KW - FHIR KW - terminology KW - development KW - COVID-19 KW - automation KW - user interface KW - map KW - input KW - hospital KW - data KW - Germany KW - accessibility KW - harmonized N2 - Background: The COVID-19 pandemic highlighted the importance of making research data from all German hospitals available to scientists to respond to current and future pandemics promptly. The heterogeneous data originating from proprietary systems at hospitals' sites must be harmonized and accessible. The German Corona Consensus Dataset (GECCO) specifies how data for COVID-19 patients will be standardized in Fast Healthcare Interoperability Resources (FHIR) profiles across German hospitals. However, given the complexity of the FHIR standard, the data harmonization is not sufficient to make the data accessible. A simplified visual representation is needed to reduce the technical burden, while allowing feasibility queries. Objective: This study investigates how a search ontology can be automatically generated using FHIR profiles and a terminology server. Furthermore, it describes how this ontology can be used in a user interface (UI) and how a mapping and a terminology tree created together with the ontology can translate user input into FHIR queries. Methods: We used the FHIR profiles from the GECCO data set combined with a terminology server to generate an ontology and the required mapping files for the translation. We analyzed the profiles and identified search criteria for the visual representation. In this process, we reduced the complex profiles to code value pairs for improved usability. We enriched our ontology with the necessary information to display it in a UI. We also developed an intermediate query language to transform the queries from the UI to federated FHIR requests. Separation of concerns resulted in discrepancies between the criteria used in the intermediate query format and the target query language. Therefore, a mapping was created to reintroduce all information relevant for creating the query in its target language. Further, we generated a tree representation of the ontology hierarchy, which allows resolving child concepts in the process. Results: In the scope of this project, 82 (99%) of 83 elements defined in the GECCO profile were successfully implemented. We verified our solution based on an independently developed test patient. A discrepancy between the test data and the criteria was found in 6 cases due to different versions used to generate the test data and the UI profiles, the support for specific code systems, and the evaluation of postcoordinated Systematized Nomenclature of Medicine (SNOMED) codes. Our results highlight the need for governance mechanisms for version changes, concept mapping between values from different code systems encoding the same concept, and support for different unit dimensions. Conclusions: We developed an automatic process to generate ontology and mapping files for FHIR-formatted data. Our tests found that this process works for most of our chosen FHIR profile criteria. The process established here works directly with FHIR profiles and a terminology server, making it extendable to other FHIR profiles and demonstrating that automatic ontology generation on FHIR profiles is feasible. UR - https://medinform.jmir.org/2022/4/e35789 UR - http://dx.doi.org/10.2196/35789 UR - http://www.ncbi.nlm.nih.gov/pubmed/35380548 ID - info:doi/10.2196/35789 ER - TY - JOUR AU - Chanyalew, Asressie Moges AU - Yitayal, Mezgebu AU - Atnafu, Asmamaw AU - Mengiste, Anagaw Shegaw AU - Tilahun, Binyam PY - 2022/4/22 TI - The Effectiveness of the Capacity Building and Mentorship Program in Improving Evidence-Based Decision-making in the Amhara Region, Northwest Ethiopia: Difference-in-Differences Study JO - JMIR Med Inform SP - e30518 VL - 10 IS - 4 KW - capacity building KW - mentorship KW - mentoring KW - mentor KW - training KW - data use KW - information use KW - facility head KW - department head KW - quasi-experiment KW - difference-in-differences KW - Ethiopia KW - Amhara KW - weak health information system KW - HIS KW - health information system KW - CBMP KW - DID KW - decision-making KW - Africa KW - evidence based KW - effectiveness N2 - Background: Weak health information systems (HISs) hobble countries? abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager. Objective: This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia. Methods: The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was calculated using the double population formula, and we recruited 172 participants from each group. We applied a difference-in-differences analysis approach to determine the effectiveness of the intervention. Heterogeneity of program effect among subgroups was assessed using a triple differences method (ie, difference-in-difference-in-differences [DIDID] method). Thus, the ? coefficients, 95% CIs, and P values were calculated for each parameter, and we determined that the program was effective if the interaction term was significant at P<.05. Results: Data were collected using the endpoint survey from 155 out of 172 (90.1%) participants in the intervention group and 166 out of 172 (96.5%) participants in the comparison group. The average level of information use for the comparison group was 37.3% (95% CI 31.1%-43.6%) at baseline and 43.7% (95% CI 37.9%-49.5%) at study endpoint. The average level of information use for the intervention group was 52.2% (95% CI 46.2%-58.3%) at baseline and 75.8% (95% CI 71.6%-80.0%) at study endpoint. The study indicated that the net program change over time was 17% (95% CI 5%-28%; P=.003). The subgroup analysis also indicated that location showed significant program effect heterogeneity, with a DIDID estimate equal to 0.16 (95% CI 0.026-0.29; P=.02). However, sex, age, educational level, salary, and experience did not show significant heterogeneity in program effect, with DIDID estimates of 0.046 (95% CI ?0.089 to 0.182), ?0.002 (95% CI ?0.015 to 0.009), ?0.055 (95% CI ?0.190 to 0.079), ?1.63 (95% CI ?5.22 to 1.95), and ?0.006 (95% CI ?0.017 to 0.005), respectively. Conclusions: The CBMP was effective at enhancing the capacity of study participants in using the routine HIS for decision-making. We noted that urban facilities had benefited more than their counterparts. The intervention has been shown to produce positive outcomes and should be scaled up to be used in other districts. Moreover, the mentorship modalities for rural facilities should be redesigned to maximize the benefits. Trial Registration: Pan African Clinical Trials Registry PACTR202001559723931; https://tinyurl.com/3j7e5ka5 UR - https://medinform.jmir.org/2022/4/e30518 UR - http://dx.doi.org/10.2196/30518 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451990 ID - info:doi/10.2196/30518 ER - TY - JOUR AU - Kainiemi, Emma AU - Vehko, Tuulikki AU - Kyytsönen, Maiju AU - Hörhammer, Iiris AU - Kujala, Sari AU - Jormanainen, Vesa AU - Heponiemi, Tarja PY - 2022/4/22 TI - The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey JO - JMIR Med Inform SP - e37500 VL - 10 IS - 4 KW - patient portal KW - digital technology KW - eHealth KW - nonuse KW - dissatisfaction KW - COVID-19 KW - digital health KW - patient empowerment KW - epidemiology KW - population survey KW - national survey N2 - Background: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public?s confidence in the protection of their confidential data. UR - https://medinform.jmir.org/2022/4/e37500 UR - http://dx.doi.org/10.2196/37500 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404831 ID - info:doi/10.2196/37500 ER - TY - JOUR AU - Yuan, Junyi AU - Wang, Sufen AU - Pan, Changqing PY - 2022/4/21 TI - Mechanism of Impact of Big Data Resources on Medical Collaborative Networks From the Perspective of Transaction Efficiency of Medical Services: Survey Study JO - J Med Internet Res SP - e32776 VL - 24 IS - 4 KW - medical collaborative networks KW - big data resources KW - transaction efficiency N2 - Background: The application of big data resources and the development of medical collaborative networks (MCNs) boost each other. However, MCNs are often assumed to be exogenous. How big data resources affect the emergence, development, and evolution of endogenous MCNs has not been well explained. Objective: This study aimed to explore and understand the influence of the mechanism of a wide range of shared and private big data resources on the transaction efficiency of medical services to reveal the impact of big data resources on the emergence and development of endogenous MCNs. Methods: This study was conducted by administering a survey questionnaire to information technology staff and medical staff from 132 medical institutions in China. Data from information technology staff and medical staff were integrated. Structural equation modeling was used to test the direct impact of big data resources on transaction efficiency of medical services. For those big data resources that had no direct impact, we analyzed their indirect impact. Results: Sharing of diagnosis and treatment data (?=.222; P=.03) and sharing of medical research data (?=.289; P=.04) at the network level (as big data itself) positively directly affected the transaction efficiency of medical services. Network protection of the external link systems (?=.271; P=.008) at the level of medical institutions (as big data technology) positively directly affected the transaction efficiency of medical services. Encryption security of web-based data (as big data technology) at the level of medical institutions, medical service capacity available for external use, real-time data of diagnosis and treatment services (as big data itself) at the level of medical institutions, and policies and regulations at the network level indirectly affected the transaction efficiency through network protection of the external link systems at the level of medical institutions. Conclusions: This study found that big data technology, big data itself, and policy at the network and organizational levels interact with, and influence, each other to form the transaction efficiency of medical services. On the basis of the theory of neoclassical economics, the study highlighted the implications of big data resources for the emergence and development of endogenous MCNs. UR - https://www.jmir.org/2022/4/e32776 UR - http://dx.doi.org/10.2196/32776 UR - http://www.ncbi.nlm.nih.gov/pubmed/35318187 ID - info:doi/10.2196/32776 ER - TY - JOUR AU - Fitzer, Kai AU - Haeuslschmid, Renate AU - Blasini, Romina AU - Altun, Betül Fatma AU - Hampf, Christopher AU - Freiesleben, Sherry AU - Macho, Philipp AU - Prokosch, Hans-Ulrich AU - Gulden, Christian PY - 2022/4/20 TI - Patient Recruitment System for Clinical Trials: Mixed Methods Study About Requirements at Ten University Hospitals JO - JMIR Med Inform SP - e28696 VL - 10 IS - 4 KW - patient recruitment system KW - clinical trial recruitment support system KW - recruitment KW - patient screening KW - requirements KW - user needs KW - clinical trial KW - interview KW - survey KW - electronic support KW - clinical information systems KW - eHealth N2 - Background: Clinical trials are the gold standard for advancing medical knowledge and improving patient outcomes. For their success, an appropriately sized cohort is required. However, patient recruitment remains one of the most challenging aspects of clinical trials. Information technology (IT) support systems?for instance, patient recruitment systems?may help overcome existing challenges and improve recruitment rates, when customized to the user needs and environment. Objective: The goal of our study is to describe the status quo of patient recruitment processes and to identify user requirements for the development of a patient recruitment system. Methods: We conducted a web-based survey with 56 participants as well as semistructured interviews with 33 participants from 10 German university hospitals. Results: We here report the recruitment procedures and challenges of 10 university hospitals. The recruitment process was influenced by diverse factors such as the ward, use of software, and the study inclusion criteria. Overall, clinical staff seemed more involved in patient identification, while the research staff focused on screening tasks. Ad hoc and planned screenings were common. Identifying eligible patients was still associated with significant manual efforts. The recruitment staff used Microsoft Office suite because tailored software were not available. To implement such software, data from disparate sources will need to be made available. We discussed concrete technical challenges concerning patient recruitment systems, including requirements for features, data, infrastructure, and workflow integration, and we contributed to the support of developing a successful system. Conclusions: Identifying eligible patients is still associated with significant manual efforts. To fully make use of the high potential of IT in patient recruitment, many technical and process challenges have to be solved first. We contribute and discuss concrete technical challenges for patient recruitment systems, including requirements for features, data, infrastructure, and workflow integration. UR - https://medinform.jmir.org/2022/4/e28696 UR - http://dx.doi.org/10.2196/28696 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442203 ID - info:doi/10.2196/28696 ER - TY - JOUR AU - Wang, Miye AU - Li, Sheyu AU - Zheng, Tao AU - Li, Nan AU - Shi, Qingke AU - Zhuo, Xuejun AU - Ding, Renxin AU - Huang, Yong PY - 2022/4/13 TI - Big Data Health Care Platform With Multisource Heterogeneous Data Integration and Massive High-Dimensional Data Governance for Large Hospitals: Design, Development, and Application JO - JMIR Med Inform SP - e36481 VL - 10 IS - 4 KW - big data platform in health care KW - multisource KW - heterogeneous KW - data integration KW - data governance KW - data application KW - data security KW - data quality control KW - big data KW - data science KW - medical informatics KW - health care N2 - Background: With the advent of data-intensive science, a full integration of big data science and health care will bring a cross-field revolution to the medical community in China. The concept big data represents not only a technology but also a resource and a method. Big data are regarded as an important strategic resource both at the national level and at the medical institutional level, thus great importance has been attached to the construction of a big data platform for health care. Objective: We aimed to develop and implement a big data platform for a large hospital, to overcome difficulties in integrating, calculating, storing, and governing multisource heterogeneous data in a standardized way, as well as to ensure health care data security. Methods: The project to build a big data platform at West China Hospital of Sichuan University was launched in 2017. The West China Hospital of Sichuan University big data platform has extracted, integrated, and governed data from different departments and sections of the hospital since January 2008. A master?slave mode was implemented to realize the real-time integration of multisource heterogeneous massive data, and an environment that separates heterogeneous characteristic data storage and calculation processes was built. A business-based metadata model was improved for data quality control, and a standardized health care data governance system and scientific closed-loop data security ecology were established. Results: After 3 years of design, development, and testing, the West China Hospital of Sichuan University big data platform was formally brought online in November 2020. It has formed a massive multidimensional data resource database, with more than 12.49 million patients, 75.67 million visits, and 8475 data variables. Along with hospital operations data, newly generated data are entered into the platform in real time. Since its launch, the platform has supported more than 20 major projects and provided data service, storage, and computing power support to many scientific teams, facilitating a shift in the data support model?from conventional manual extraction to self-service retrieval (which has reached 8561 retrievals per month). Conclusions: The platform can combine operation systems data from all departments and sections in a hospital to form a massive high-dimensional high-quality health care database that allows electronic medical records to be used effectively and taps into the value of data to fully support clinical services, scientific research, and operations management. The West China Hospital of Sichuan University big data platform can successfully generate multisource heterogeneous data storage and computing power. By effectively governing massive multidimensional data gathered from multiple sources, the West China Hospital of Sichuan University big data platform provides highly available data assets and thus has a high application value in the health care field. The West China Hospital of Sichuan University big data platform facilitates simpler and more efficient utilization of electronic medical record data for real-world research. UR - https://medinform.jmir.org/2022/4/e36481 UR - http://dx.doi.org/10.2196/36481 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416792 ID - info:doi/10.2196/36481 ER - TY - JOUR AU - Haithcoat, Timothy AU - Liu, Danlu AU - Young, Tiffany AU - Shyu, Chi-Ren PY - 2022/4/6 TI - Investigating Health Context Using a Spatial Data Analytical Tool: Development of a Geospatial Big Data Ecosystem JO - JMIR Med Inform SP - e35073 VL - 10 IS - 4 KW - context KW - Geographic Information System KW - big data KW - equity KW - population health KW - public health KW - digital health KW - eHealth KW - location KW - geospatial KW - data analytics KW - analytical framework KW - medical informatics KW - research knowledgebase N2 - Background: Enabling the use of spatial context is vital to understanding today?s digital health problems. Any given location is associated with many different contexts. The strategic transformation of population health, epidemiology, and eHealth studies requires vast amounts of integrated digital data. Needed is a novel analytical framework designed to leverage location to create new contextual knowledge. The Geospatial Analytical Research Knowledgebase (GeoARK), a web-based research resource has robust, locationally integrated, social, environmental, and infrastructural information to address today?s complex questions, investigate context, and spatially enable health investigations. GeoARK is different from other Geographic Information System (GIS) resources in that it has taken the layered world of the GIS and flattened it into a big data table that ties all the data and information together using location and developing its context. Objective: It is paramount to build a robust spatial data analytics framework that integrates social, environmental, and infrastructural knowledge to empower health researchers? use of geospatial context to timely answer population health issues. The goal is twofold in that it embodies an innovative technological approach and serves to ease the educational burden for health researchers to think spatially about their problems. Methods: A unique analytical tool using location as the key was developed. It allows integration across source, geography, and time to create a geospatial big table with over 162 million individual locations (X-Y points that serve as rows) and 5549 attributes (represented as columns). The concept of context (adjacency, proximity, distance, etc) is quantified through geoanalytics and captured as new distance, density, or neighbor attributes within the system. Development of geospatial analytics permits contextual extraction and investigator-initiated eHealth and mobile health (mHealth) analysis across multiple attributes. Results: We built a unique geospatial big data ecosystem called GeoARK. Analytics on this big table occur across resolution groups, sources, and geographies for extraction and analysis of information to gain new insights. Case studies, including telehealth assessment in North Carolina, national income inequality and health outcome disparity, and a Missouri COVID-19 risk assessment, demonstrate the capability to support robust and efficient geospatial understanding of a wide spectrum of population health questions. Conclusions: This research identified, compiled, transformed, standardized, and integrated multifaceted data required to better understand the context of health events within a large location-enabled database. The GeoARK system empowers health professionals to engage more complex research where the synergisms of health and geospatial information will be robustly studied beyond what could be accomplished today. No longer is the need to know how to perform geospatial processing an impediment to the health researcher, but rather the development of how to think spatially becomes the greater challenge. UR - https://medinform.jmir.org/2022/4/e35073 UR - http://dx.doi.org/10.2196/35073 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311683 ID - info:doi/10.2196/35073 ER - TY - JOUR AU - Nicolet, Anna AU - Assouline, Dan AU - Le Pogam, Marie-Annick AU - Perraudin, Clémence AU - Bagnoud, Christophe AU - Wagner, Joël AU - Marti, Joachim AU - Peytremann-Bridevaux, Isabelle PY - 2022/4/4 TI - Exploring Patient Multimorbidity and Complexity Using Health Insurance Claims Data: A Cluster Analysis Approach JO - JMIR Med Inform SP - e34274 VL - 10 IS - 4 KW - multimorbidity KW - pharmacy cost groups KW - cluster analysis KW - claims data KW - patient complexity KW - health claims KW - informatics N2 - Background: Although the trend of progressing morbidity is widely recognized, there are numerous challenges when studying multimorbidity and patient complexity. For multimorbid or complex patients, prone to fragmented care and high health care use, novel estimation approaches need to be developed. Objective: This study aims to investigate the patient multimorbidity and complexity of Swiss residents aged ?50 years using clustering methodology in claims data. Methods: We adopted a clustering methodology based on random forests and used 34 pharmacy-based cost groups as the only input feature for the procedure. To detect clusters, we applied hierarchical density-based spatial clustering of applications with noise. The reasonable hyperparameters were chosen based on various metrics embedded in the algorithms (out-of-bag misclassification error, normalized stress, and cluster persistence) and the clinical relevance of the obtained clusters. Results: Based on cluster analysis output for 18,732 individuals, we identified an outlier group and 7 clusters: individuals without diseases, patients with only hypertension-related diseases, patients with only mental diseases, complex high-cost high-need patients, slightly complex patients with inexpensive low-severity pharmacy-based cost groups, patients with 1 costly disease, and older high-risk patients. Conclusions: Our study demonstrated that cluster analysis based on pharmacy-based cost group information from claims-based data is feasible and highlights clinically relevant clusters. Such an approach allows expanding the understanding of multimorbidity beyond simple disease counts and can identify the population profiles with increased health care use and costs. This study may foster the development of integrated and coordinated care, which is high on the agenda in policy making, care planning, and delivery. UR - https://medinform.jmir.org/2022/4/e34274 UR - http://dx.doi.org/10.2196/34274 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377334 ID - info:doi/10.2196/34274 ER - TY - JOUR AU - Shen, Nelson AU - Kassam, Iman AU - Zhao, Haoyu AU - Chen, Sheng AU - Wang, Wei AU - Wickham, Sarah AU - Strudwick, Gillian AU - Carter-Langford, Abigail PY - 2022/3/31 TI - Foundations for Meaningful Consent in Canada?s Digital Health Ecosystem: Retrospective Study JO - JMIR Med Inform SP - e30986 VL - 10 IS - 3 KW - consent KW - eConsent KW - privacy KW - trust KW - digital health KW - health information exchange KW - patient perspective KW - health informatics KW - Canada N2 - Background: Canadians are increasingly gaining web-based access to digital health services, and they expect to access their data from these services through a central patient access channel. Implementing data sharing between these services will require patient trust that is fostered through meaningful consent and consent management. Understanding user consent requirements and information needs is necessary for developing a trustworthy and transparent consent management system. Objective: The objective of this study is to explore consent management preferences and information needs to support meaningful consent. Methods: A secondary analysis of a national survey was conducted using a retrospective descriptive study design. The 2019 cross-sectional survey used a series of vignettes and consent scenarios to explore Canadians? privacy perspectives and preferences regarding consent management. Nonparametric tests and logistic regression analyses were conducted to identify the differences and associations between various factors. Results: Of the 1017 total responses, 716 (70.4%) participants self-identified as potential users. Of the potential users, almost all (672/716, 93.8%) felt that the ability to control their data was important, whereas some (385/716, 53.8%) believed that an all or none control at the data source level was adequate. Most potential users preferred new data sources to be accessible by health care providers (546/716, 76.3%) and delegated parties (389/716, 54.3%) by default. Prior digital health use was associated with greater odds of granting default access when compared with no prior use, with the greatest odds of granting default access to digital health service providers (odds ratio 2.17, 95% CI 1.36-3.46). From a list of 9 information elements found in consent forms, potential users selected an average of 5.64 (SD 2.68) and 5.54 (SD 2.85) items to feel informed in consenting to data access by care partners and commercial digital health service providers, respectively. There was no significant difference in the number of items selected between the 2 scenarios (P>.05); however, there were significant differences (P<.05) in information types that were selected between the scenarios. Conclusions: A majority of survey participants reported that they would register and use a patient access channel and believed that the ability to control data access was important, especially as it pertains to access by those outside their care. These findings suggest that a broad all or none approach based on data source may be accepted; however, approximately one-fifth of potential users were unable to decide. Although vignettes were used to introduce the questions, this study showed that more context is required for potential users to make informed consent decisions. Understanding their information needs will be critical, as these needs vary with the use case, highlighting the importance of prioritizing and tailoring information to enable meaningful consent. UR - https://medinform.jmir.org/2022/3/e30986 UR - http://dx.doi.org/10.2196/30986 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357318 ID - info:doi/10.2196/30986 ER - TY - JOUR AU - Duncan, Rhona AU - Eden, Rebekah AU - Woods, Leanna AU - Wong, Ides AU - Sullivan, Clair PY - 2022/3/30 TI - Synthesizing Dimensions of Digital Maturity in Hospitals: Systematic Review JO - J Med Internet Res SP - e32994 VL - 24 IS - 3 KW - digital maturity KW - digital capability KW - eHealth KW - digital hospitals KW - capability model KW - maturity model KW - literature review KW - electronic medical records N2 - Background: Digital health in hospital settings is viewed as a panacea for achieving the ?quadruple aim? of health care, yet the outcomes have been largely inconclusive. To optimize digital health outcomes, a strategic approach is necessary, requiring digital maturity assessments. However, current approaches to assessing digital maturity have been largely insufficient, with uncertainty surrounding the dimensions to assess. Objective: The aim of this study was to identify the current dimensions used to assess the digital maturity of hospitals. Methods: A systematic literature review was conducted of peer-reviewed literature (published before December 2020) investigating maturity models used to assess the digital maturity of hospitals. A total of 29 relevant articles were retrieved, representing 27 distinct maturity models. The articles were inductively analyzed, and the maturity model dimensions were extracted and consolidated into a maturity model framework. Results: The consolidated maturity model framework consisted of 7 dimensions: strategy; information technology capability; interoperability; governance and management; patient-centered care; people, skills, and behavior; and data analytics. These 7 dimensions can be evaluated based on 24 respective indicators. Conclusions: The maturity model framework developed for this study can be used to assess digital maturity and identify areas for improvement. UR - https://www.jmir.org/2022/3/e32994 UR - http://dx.doi.org/10.2196/32994 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353050 ID - info:doi/10.2196/32994 ER - TY - JOUR AU - ­Lee, Sejong AU - Kim, Jaehyeon AU - Kwon, Yongseok AU - Kim, Teasung AU - Cho, Sunghyun PY - 2022/3/22 TI - Privacy Preservation in Patient Information Exchange Systems Based on Blockchain: System Design Study JO - J Med Internet Res SP - e29108 VL - 24 IS - 3 KW - electronic medical records KW - consortium blockchain KW - data security KW - medical data management KW - privacy preservation KW - smart contract KW - proxy re-encryption KW - patient-centered medical system KW - InterPlanetary File System N2 - Background: With the increasing sophistication of the medical industry, various advanced medical services such as medical artificial intelligence, telemedicine, and personalized health care services have emerged. The demand for medical data is also rapidly increasing today because advanced medical services use medical data such as user data and electronic medical records (EMRs) to provide services. As a result, health care institutions and medical practitioners are researching various mechanisms and tools to feed medical data into their systems seamlessly. However, medical data contain sensitive personal information of patients. Therefore, ensuring security while meeting the demand for medical data is a very important problem in the information age for which a solution is required. Objective: Our goal is to design a blockchain-based decentralized patient information exchange (PIE) system that can safely and efficiently share EMRs. The proposed system preserves patients? privacy in the EMRs through a medical information exchange process that includes data encryption and access control. Methods: We propose a blockchain-based EMR-sharing system that allows patients to manage their EMRs scattered across multiple hospitals and share them with other users. Our PIE system protects the patient?s EMR from security threats such as counterfeiting and privacy attacks during data sharing. In addition, it provides scalability by using distributed data-sharing methods to quickly share an EMR, regardless of its size or type. We implemented simulation models using Hyperledger Fabric, an open source blockchain framework. Results: We performed a simulation of the EMR-sharing process and compared it with previous works on blockchain-based medical systems to check the proposed system?s performance. During the simulation, we found that it takes an average of 0.01014 (SD 0.0028) seconds to download 1 MB of EMR in our proposed PIE system. Moreover, it has been confirmed that data can be freely shared with other users regardless of the size or format of the data to be transmitted through the distributed data-sharing technique using the InterPlanetary File System. We conducted a security analysis to check whether the proposed security mechanism can effectively protect users of the EMR-sharing system from security threats such as data forgery or unauthorized access, and we found that the distributed ledger structure and re-encryption?based data encryption method can effectively protect users? EMRs from forgery and privacy leak threats and provide data integrity. Conclusions: Blockchain is a distributed ledger technology that provides data integrity to enable patient-centered health information exchange and access control. PIE systems integrate and manage fragmented patient EMRs through blockchain and protect users from security threats during the data exchange process among users. To increase safety and efficiency in the EMR-sharing process, we used access control using security levels, data encryption based on re-encryption, and a distributed data-sharing scheme. UR - https://www.jmir.org/2022/3/e29108 UR - http://dx.doi.org/10.2196/29108 UR - http://www.ncbi.nlm.nih.gov/pubmed/35315778 ID - info:doi/10.2196/29108 ER - TY - JOUR AU - Almowil, Zahra AU - Zhou, Shang-Ming AU - Brophy, Sinead AU - Croxall, Jodie PY - 2022/3/15 TI - Concept Libraries for Repeatable and Reusable Research: Qualitative Study Exploring the Needs of Users JO - JMIR Hum Factors SP - e31021 VL - 9 IS - 1 KW - electronic health records KW - record linkage KW - reproducible research KW - clinical codes KW - concept libraries N2 - Background: Big data research in the field of health sciences is hindered by a lack of agreement on how to identify and define different conditions and their medications. This means that researchers and health professionals often have different phenotype definitions for the same condition. This lack of agreement makes it difficult to compare different study findings and hinders the ability to conduct repeatable and reusable research. Objective: This study aims to examine the requirements of various users, such as researchers, clinicians, machine learning experts, and managers, in the development of a data portal for phenotypes (a concept library). Methods: This was a qualitative study using interviews and focus group discussion. One-to-one interviews were conducted with researchers, clinicians, machine learning experts, and senior research managers in health data science (N=6) to explore their specific needs in the development of a concept library. In addition, a focus group discussion with researchers (N=14) working with the Secured Anonymized Information Linkage databank, a national eHealth data linkage infrastructure, was held to perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis for the phenotyping system and the proposed concept library. The interviews and focus group discussion were transcribed verbatim, and 2 thematic analyses were performed. Results: Most of the participants thought that the prototype concept library would be a very helpful resource for conducting repeatable research, but they specified that many requirements are needed before its development. Although all the participants stated that they were aware of some existing concept libraries, most of them expressed negative perceptions about them. The participants mentioned several facilitators that would stimulate them to share their work and reuse the work of others, and they pointed out several barriers that could inhibit them from sharing their work and reusing the work of others. The participants suggested some developments that they would like to see to improve reproducible research output using routine data. Conclusions: The study indicated that most interviewees valued a concept library for phenotypes. However, only half of the participants felt that they would contribute by providing definitions for the concept library, and they reported many barriers regarding sharing their work on a publicly accessible platform. Analysis of interviews and the focus group discussion revealed that different stakeholders have different requirements, facilitators, barriers, and concerns about a prototype concept library. UR - https://humanfactors.jmir.org/2022/1/e31021 UR - http://dx.doi.org/10.2196/31021 UR - http://www.ncbi.nlm.nih.gov/pubmed/35289755 ID - info:doi/10.2196/31021 ER - TY - JOUR AU - Turek, R. Janice AU - Bansal, Vikas AU - Tekin, Aysun AU - Singh, Shuchita AU - Deo, Neha AU - Sharma, Mayank AU - Bogojevic, Marija AU - Qamar, Shahraz AU - Singh, Romil AU - Kumar, Vishakha AU - Kashyap, Rahul PY - 2022/3/15 TI - Lessons From a Rapid Project Management Exercise in the Time of Pandemic: Methodology for a Global COVID-19 VIRUS Registry Database JO - JMIR Res Protoc SP - e27921 VL - 11 IS - 3 KW - COVID-19 KW - critical care KW - global KW - program management KW - registry N2 - Background: The rapid emergence of the COVID-19 pandemic globally collapsed health care organizations worldwide. Incomplete knowledge of best practices, progression of disease, and its impact could result in fallible care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission have not been captured or communicated well between international organizations experiencing the same impact from the virus. This led to the expedited need for establishing international communication and data collection on the critical care patients admitted with COVID-19. Objective: Developing a global registry to collect patient data in the critical care setting was imperative with the goal of analyzing and ameliorating outcomes. Methods: A prospective, observational global registry database was put together to record extensive deidentified clinical information for patients hospitalized with COVID-19. Results: Project management was crucial for prompt implementation of the registry for synchronization, improving efficiency, increasing innovation, and fostering global collaboration for valuable data collection. The Society of Critical Care Medicine Discovery VIRUS (Viral Infection and Respiratory Illness Universal Study): COVID-19 Registry would compile data for crucial longitudinal outcomes for disease, treatment, and research. The agile project management approach expedited establishing the registry in 15 days and submission of institutional review board agreement for 250 participating sites. There has been enrollment of sites every month with a total of 306 sites from 28 countries and 64,114 patients enrolled (as of June 7, 2021). Conclusions: This protocol addresses project management lessons in a time of crises which can be a precept for rapid project management for a large-scale health care data registry. We aim to discuss the approach and methodology for establishing the registry, the challenges faced, and the factors contributing to successful outcomes. Trial Registration: ClinicalTrials.gov NCT04323787; https://clinicaltrials.gov/ct2/show/NCT04323787 UR - https://www.researchprotocols.org/2022/3/e27921 UR - http://dx.doi.org/10.2196/27921 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762062 ID - info:doi/10.2196/27921 ER - TY - JOUR AU - Hirsch, Annemarie AU - Durden, Elizabeth T. AU - Silva, Jennifer PY - 2022/3/11 TI - Linking Electronic Health Records and In-Depth Interviews to Inform Efforts to Integrate Social Determinants of Health Into Health Care Delivery: Protocol for a Qualitative Research Study JO - JMIR Res Protoc SP - e36201 VL - 11 IS - 3 KW - electronic health records KW - social determinants of health KW - poverty KW - rural KW - qualitative KW - health system N2 - Background: Health systems are attempting to capture social determinants of health (SDoH) in electronic health records (EHR) and use these data to adjust care plans. To date, however, methods for identifying social needs, which are the SDoH prioritized by patients, have been underexplored, and there is little guidance as to how clinicians should act on SDoH data when caring for patients. Moreover, the unintended consequences of collecting and responding to SDoH are poorly understood. Objective: The objective of this study is to use two data sources, EHR data and patient interviews, to describe divergences between the EHR and patient experiences that could help identify gaps in the documentation of SDoH in the EHR; highlight potential missed opportunities for addressing social needs, and identify unintended consequences of efforts to integrate SDoH into clinical care. Methods: We are conducting a qualitative study that merges discrete and free-text data from EHRs with in-depth interviews with women residing in rural, socioeconomically deprived communities in the Mid-Atlantic region of the United States. Participants had to confirm that they had at least one visit with the large health system that serves the region. Interviews with the women included questions regarding health, interaction with the health system, and social needs. Next, with consent, we extracted discrete data (eg, diagnoses and medication orders) for each participant and free-text clinician notes from this health system?s EHRs between 1996 and the year of the interview. We used a standardized protocol to create an EHR narrative, a free-text summary of the EHR data. We used NVivo to identify themes in the interviews and the EHR narratives. Results: To date, we have interviewed 88 women, including 51 White women, 19 Black women, 14 Latina women, 2 mixed Black and Latina women, and 2 Asian Pacific women. We have completed the EHR narratives on 66 women. The women range in age from 18 to 90 years. We found corresponding EHR data on all but 4 of the interview participants. Participants had contact with a wide range of clinical departments (eg, psychiatry, neurology, and infectious disease) and received care in various clinical settings (eg, primary care clinics, emergency departments, and inpatient hospitalizations). A preliminary review of the EHR narratives revealed that the clinician notes were a source of data on a range of SDoH but did not always reflect the social needs that participants described in the interviews. Conclusions: This study will provide unique insight into the demands and consequences of integrating SDoH into clinical care. This work comes at a pivotal point in time, as health systems, payors, and policymakers accelerate attempts to deliver care within the context of social needs. International Registered Report Identifier (IRRID): DERR1-10.2196/36201 UR - https://www.researchprotocols.org/2022/3/e36201 UR - http://dx.doi.org/10.2196/36201 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275090 ID - info:doi/10.2196/36201 ER - TY - JOUR AU - Gao, Chuang AU - McGilchrist, Mark AU - Mumtaz, Shahzad AU - Hall, Christopher AU - Anderson, Ann Lesley AU - Zurowski, John AU - Gordon, Sharon AU - Lumsden, Joanne AU - Munro, Vicky AU - Wozniak, Artur AU - Sibley, Michael AU - Banks, Christopher AU - Duncan, Chris AU - Linksted, Pamela AU - Hume, Alastair AU - Stables, L. Catherine AU - Mayor, Charlie AU - Caldwell, Jacqueline AU - Wilde, Katie AU - Cole, Christian AU - Jefferson, Emily PY - 2022/3/9 TI - A National Network of Safe Havens: Scottish Perspective JO - J Med Internet Res SP - e31684 VL - 24 IS - 3 KW - electronic health records KW - Safe Haven KW - data governance UR - https://www.jmir.org/2022/3/e31684 UR - http://dx.doi.org/10.2196/31684 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262495 ID - info:doi/10.2196/31684 ER - TY - JOUR AU - Svedberg, Petra AU - Reed, Julie AU - Nilsen, Per AU - Barlow, James AU - Macrae, Carl AU - Nygren, Jens PY - 2022/3/9 TI - Toward Successful Implementation of Artificial Intelligence in Health Care Practice: Protocol for a Research Program JO - JMIR Res Protoc SP - e34920 VL - 11 IS - 3 KW - process evaluation KW - complex intervention KW - implementation KW - knowledge exchange KW - health policy KW - organizational change KW - capacity building KW - qualitative methods KW - framework analysis N2 - Background: The uptake of artificial intelligence (AI) in health care is at an early stage. Recent studies have shown a lack of AI-specific implementation theories, models, or frameworks that could provide guidance for how to translate the potential of AI into daily health care practices. This protocol provides an outline for the first 5 years of a research program seeking to address this knowledge-practice gap through collaboration and co-design between researchers, health care professionals, patients, and industry stakeholders. Objective: The first part of the program focuses on two specific objectives. The first objective is to develop a theoretically informed framework for AI implementation in health care that can be applied to facilitate such implementation in routine health care practice. The second objective is to carry out empirical AI implementation studies, guided by the framework for AI implementation, and to generate learning for enhanced knowledge and operational insights to guide further refinement of the framework. The second part of the program addresses a third objective, which is to apply the developed framework in clinical practice in order to develop regional capacity to provide the practical resources, competencies, and organizational structure required for AI implementation; however, this objective is beyond the scope of this protocol. Methods: This research program will use a logic model to structure the development of a methodological framework for planning and evaluating implementation of AI systems in health care and to support capacity building for its use in practice. The logic model is divided into time-separated stages, with a focus on theory-driven and coproduced framework development. The activities are based on both knowledge development, using existing theory and literature reviews, and method development by means of co-design and empirical investigations. The activities will involve researchers, health care professionals, and other stakeholders to create a multi-perspective understanding. Results: The project started on July 1, 2021, with the Stage 1 activities, including model overview, literature reviews, stakeholder mapping, and impact cases; we will then proceed with Stage 2 activities. Stage 1 and 2 activities will continue until June 30, 2026. Conclusions: There is a need to advance theory and empirical evidence on the implementation requirements of AI systems in health care, as well as an opportunity to bring together insights from research on the development, introduction, and evaluation of AI systems and existing knowledge from implementation research literature. Therefore, with this research program, we intend to build an understanding, using both theoretical and empirical approaches, of how the implementation of AI systems should be approached in order to increase the likelihood of successful and widespread application in clinical practice. International Registered Report Identifier (IRRID): PRR1-10.2196/34920 UR - https://www.researchprotocols.org/2022/3/e34920 UR - http://dx.doi.org/10.2196/34920 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262500 ID - info:doi/10.2196/34920 ER - TY - JOUR AU - Helminski, Danielle AU - Kurlander, E. Jacob AU - Renji, Deep Anjana AU - Sussman, B. Jeremy AU - Pfeiffer, N. Paul AU - Conte, L. Marisa AU - Gadabu, J. Oliver AU - Kokaly, N. Alex AU - Goldberg, Rebecca AU - Ranusch, Allison AU - Damschroder, J. Laura AU - Landis-Lewis, Zach PY - 2022/3/2 TI - Dashboards in Health Care Settings: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e34894 VL - 11 IS - 3 KW - dashboard KW - mHealth KW - medical informatics KW - quality improvement KW - scoping review KW - health care KW - Cochrane library KW - Cochrane KW - stakeholder KW - health care sector KW - digital health KW - design KW - end user KW - development KW - implementation KW - evaluation KW - user need N2 - Background: Health care organizations increasingly depend on business intelligence tools, including ?dashboards,? to capture, analyze, and present data on performance metrics. Ideally, dashboards allow users to quickly visualize actionable data to inform and optimize clinical and organizational performance. In reality, dashboards are typically embedded in complex health care organizations with massive data streams and end users with distinct needs. Thus, designing effective dashboards is a challenging task and theoretical underpinnings of health care dashboards are poorly characterized; even the concept of the dashboard remains ill-defined. Researchers, informaticists, clinical managers, and health care administrators will benefit from a clearer understanding of how dashboards have been developed, implemented, and evaluated, and how the design, end user, and context influence their uptake and effectiveness. Objective: This scoping review first aims to survey the vast published literature of ?dashboards? to describe where, why, and for whom they are used in health care settings, as well as how they are developed, implemented, and evaluated. Further, we will examine how dashboard design and content is informed by intended purpose and end users. Methods: In July 2020, we searched MEDLINE, Embase, Web of Science, and the Cochrane Library for peer-reviewed literature using a targeted strategy developed with a research librarian and retrieved 5188 results. Following deduplication, 3306 studies were screened in duplicate for title and abstract. Any abstracts mentioning a health care dashboard were retrieved in full text and are undergoing duplicate review for eligibility. Articles will be included for data extraction and analysis if they describe the development, implementation, or evaluation of a dashboard that was successfully used in routine workflow. Articles will be excluded if they were published before 2015, the full text is unavailable, they are in a non-English language, or they describe dashboards used for public health tracking, in settings where direct patient care is not provided, or in undergraduate medical education. Any discrepancies in eligibility determination will be adjudicated by a third reviewer. We chose to focus on articles published after 2015 and those that describe dashboards that were successfully used in routine practice to identify the most recent and relevant literature to support future dashboard development in the rapidly evolving field of health care informatics. Results: All articles have undergone dual review for title and abstract, with a total of 2019 articles mentioning use of a health care dashboard retrieved in full text for further review. We are currently reviewing all full-text articles in duplicate. We aim to publish findings by mid-2022. Findings will be reported following guidance from the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Conclusions: This scoping review will provide stakeholders with an overview of existing dashboard tools, highlighting the ways in which dashboards have been developed, implemented, and evaluated in different settings and for different end user groups, and identify potential research gaps. Findings will guide efforts to design and use dashboards in the health care sector more effectively. International Registered Report Identifier (IRRID): DERR1-10.2196/34894 UR - https://www.researchprotocols.org/2022/3/e34894 UR - http://dx.doi.org/10.2196/34894 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234650 ID - info:doi/10.2196/34894 ER - TY - JOUR AU - Ellis, A. Louise AU - Sarkies, Mitchell AU - Churruca, Kate AU - Dammery, Genevieve AU - Meulenbroeks, Isabelle AU - Smith, L. Carolynn AU - Pomare, Chiara AU - Mahmoud, Zeyad AU - Zurynski, Yvonne AU - Braithwaite, Jeffrey PY - 2022/2/23 TI - The Science of Learning Health Systems: Scoping Review of Empirical Research JO - JMIR Med Inform SP - e34907 VL - 10 IS - 2 KW - learning health systems KW - learning health care systems KW - implementation science KW - evaluation KW - health system KW - health care system KW - empirical research KW - medical informatics KW - review N2 - Background: The development and adoption of a learning health system (LHS) has been proposed as a means to address key challenges facing current and future health care systems. The first review of the LHS literature was conducted 5 years ago, identifying only a small number of published papers that had empirically examined the implementation or testing of an LHS. It is timely to look more closely at the published empirical research and to ask the question, Where are we now? 5 years on from that early LHS review. Objective: This study performed a scoping review of empirical research within the LHS domain. Taking an ?implementation science? lens, the review aims to map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. Methods: Two academic databases (PubMed and Scopus) were searched using the terms ?learning health* system*? for papers published between January 1, 2016, to January 31, 2021, that had an explicit empirical focus on LHSs. Study information was extracted relevant to the review objective, including each study?s publication details; primary concern or focus; context; design; data type; implementation framework, model, or theory used; and implementation determinants or outcomes examined. Results: A total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (53/76, 69.7%) designed to contribute to achieving an LHS. Most of these studies focused on a particular clinical context or patient population (37/53, 69.8%), with far fewer studies focusing on whole hospital systems (4/53, 7.5%) or on other broad health care systems encompassing multiple facilities (12/53, 22.6%). Over two-thirds of the program-specific studies utilized quantitative methods (37/53, 69.8%), with a smaller number utilizing qualitative methods (10/53, 18.9%) or mixed-methods designs (6/53, 11.3%). The remaining 23 studies were classified into 1 of 3 key areas: ethics, policies, and governance (10/76, 13.2%); stakeholder perspectives of LHSs (5/76, 6.6%); or LHS-specific research strategies and tools (8/76, 10.5%). Overall, relatively few studies were identified that incorporated an implementation science framework. Conclusions: Although there has been considerable growth in empirical applications of LHSs within the past 5 years, paralleling the recent emergence of LHS-specific research strategies and tools, there are few high-quality studies. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers, and implementation outcomes in this field and will enable comparison and identification of trends across studies. UR - https://medinform.jmir.org/2022/2/e34907 UR - http://dx.doi.org/10.2196/34907 UR - http://www.ncbi.nlm.nih.gov/pubmed/35195529 ID - info:doi/10.2196/34907 ER - TY - JOUR AU - Alhajri, Noora AU - Simsekler, Emre Mecit Can AU - Alfalasi, Buthaina AU - Alhashmi, Mohamed AU - Memon, Hamda AU - Housser, Emma AU - Abdi, Mustafa Abdulhamid AU - Balalaa, Nahed AU - Al Ali, Maryam AU - Almaashari, Raghda AU - Al Memari, Shammah AU - Al Hosani, Farida AU - Al Zaabi, Yousif AU - Almazrouei, Shereena AU - Alhashemi, Hamed PY - 2022/2/15 TI - Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: Cross-sectional Study JO - JMIR Med Inform SP - e32373 VL - 10 IS - 2 KW - COVID-19 KW - patient satisfaction KW - technology acceptance KW - hospital KW - community clinic KW - video consultation KW - audio consultation KW - outpatient department KW - OPD KW - policy making KW - UAE N2 - Background: Telemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients? perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic. Objective: We aimed to explore the differences in patients? perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine. Methods: In this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients? perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services. Results: A total of 515 patients participated in this survey. Patients? satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8%; community clinics: 114/172, 66.3%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95% CI 1.04-6.33; P=.04) and patients? support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95% CI 1.15-21.19; P=.03), addressed patients? needs (OR 2.63, 95% CI 1.13-6.11; P=.03), and eased expression of patients? medical concerns during the COVID-19 pandemic (OR 2.19, 95% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95% CI 1.09-4.14; P=.03), as compared to any other age group in this study. Conclusions: These findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery. UR - https://medinform.jmir.org/2022/2/e32373 UR - http://dx.doi.org/10.2196/32373 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978281 ID - info:doi/10.2196/32373 ER - TY - JOUR AU - Garcia, P. Angely AU - De La Vega, F. Shelley AU - Mercado, P. Susan PY - 2022/2/14 TI - Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study JO - J Med Internet Res SP - e29541 VL - 24 IS - 2 KW - health information systems KW - the Philippines KW - aged KW - hospitals KW - community health centers KW - database KW - geriatric assessment KW - elderly KW - digital health KW - medical records KW - health policy N2 - Background: The rapid aging of the world?s population requires systems that support health facilities? provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee?approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52%) of the 27 hospitals and 4 (25%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96%) hospitals and all (16/16, 100%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility?based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. UR - https://www.jmir.org/2022/2/e29541 UR - http://dx.doi.org/10.2196/29541 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156927 ID - info:doi/10.2196/29541 ER - TY - JOUR AU - Ashworth, Henry AU - Ebrahim, Senan AU - Ebrahim, Hassaan AU - Bhaiwala, Zahra AU - Chilazi, Michael PY - 2022/2/11 TI - A Free, Open-Source, Offline Digital Health System for Refugee Care JO - JMIR Med Inform SP - e33848 VL - 10 IS - 2 KW - electronic health record KW - mHealth KW - refugee KW - displaced population KW - digital health KW - COVID-19 KW - health care N2 - Background: Rise of conflict, extreme weather events, and pandemics have led to larger displaced populations worldwide. Displaced populations have unique acute and chronic health needs that must be met by low-resource health systems. Electronic health records (EHRs) have been shown to improve health outcomes in displaced populations, but need to be adapted to meet the constraints of these health systems. Objective: The aim of this viewpoint is to describe the development and deployment of an EHR designed to care for displaced populations in low-resource settings. Methods: Using a human-centered design approach, we conducted in-depth interviews and focus groups with patients, health care providers, and administrators in Lebanon and Jordan to identify the essential EHR features. These features, including modular workflows, multilingual interfaces, and offline-first capabilities, led to the development of the Hikma Health EHR, which has been deployed in Lebanon and Nicaragua. Results: We report the successes and challenges from 12 months of Hikma Health EHR deployment in a mobile clinic providing care to Syrian refugees in Bekaa Valley, Lebanon. Successes include the EHR?s ability to (1) increase clinical efficacy by providing detailed patient records, (2) be adaptable to the threats of COVID-19, and (3) improve organizational planning. Lessons learned include technical fixes to methods of identifying patients through name or their medical record ID. Conclusions: As the number of displaced people continues to rise globally, it is imperative that solutions are created to help maximize the health care they receive. Free, open-sourced, and adaptable EHRs can enable organizations to better provide for displaced populations. UR - https://medinform.jmir.org/2022/2/e33848 UR - http://dx.doi.org/10.2196/33848 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147509 ID - info:doi/10.2196/33848 ER - TY - JOUR AU - Tran, Minh Duc AU - Thwaites, Louise C. AU - Van Nuil, Ilo Jennifer AU - McKnight, Jacob AU - Luu, Phuoc An AU - Paton, Chris AU - PY - 2022/2/9 TI - Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review JO - J Med Internet Res SP - e32392 VL - 24 IS - 2 KW - digital health KW - eHealth KW - policy KW - Vietnam KW - hospital care KW - data KW - health KW - electronic medical records KW - standards KW - compulsory KW - patient ID KW - administrative information KW - health insurance ID KW - mobile phone N2 - Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence?based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government?s requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Th? Vi?n Pháp Lu?t, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians? performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system?s capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting. UR - https://www.jmir.org/2022/2/e32392 UR - http://dx.doi.org/10.2196/32392 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138264 ID - info:doi/10.2196/32392 ER - TY - JOUR AU - Khan, Ullah Waqas AU - Shachak, Aviv AU - Seto, Emily PY - 2022/2/7 TI - Understanding Decision-Making in the Adoption of Digital Health Technology: The Role of Behavioral Economics? Prospect Theory JO - J Med Internet Res SP - e32714 VL - 24 IS - 2 KW - decision-making KW - digital health technology adoption KW - prospect theory UR - https://www.jmir.org/2022/2/e32714 UR - http://dx.doi.org/10.2196/32714 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129459 ID - info:doi/10.2196/32714 ER - TY - JOUR AU - Chukwu, Emeka AU - Garg, Lalit AU - Foday, Edward AU - Konomanyi, Abdul AU - Wright, Royston AU - Smart, Francis PY - 2022/2/3 TI - Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study JO - JMIR Med Inform SP - e30040 VL - 10 IS - 2 KW - digital health KW - mHealth KW - eHealth infrastructure KW - health ICT KW - SpaceX KW - connectivity KW - Sierra Leone KW - rural-urban divide KW - rural areas KW - internet N2 - Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility?based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions. Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period. Results: Among the 72 surveyed health facilities, 59 (82%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60%) use solar energy as their only electricity source and the other 6 (40%) have no electricity source. Similarly, among the 13 hospitals, 5 (38%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3%) PHUs have one computer each, and 37 (63%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95% confidence level within an 11% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22%) of the 72 respondents stated that device theft is a primary hindrance to digitization. Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone. UR - https://medinform.jmir.org/2022/2/e30040 UR - http://dx.doi.org/10.2196/30040 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113026 ID - info:doi/10.2196/30040 ER - TY - JOUR AU - Neher, Margit AU - Nygårdh, Annette AU - Broström, Anders AU - Lundgren, Johan AU - Johansson, Peter PY - 2022/1/28 TI - Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study JO - J Med Internet Res SP - e28870 VL - 24 IS - 1 KW - clients KW - computer-assisted therapy KW - consultation telehealth KW - decision-makers KW - implementation KW - patients KW - politicians KW - qualitative methods KW - remote KW - mobile phone N2 - Background: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers? conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth. UR - https://www.jmir.org/2022/1/e28870 UR - http://dx.doi.org/10.2196/28870 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089139 ID - info:doi/10.2196/28870 ER - TY - JOUR AU - Schilling, George AU - Villarosa, Leonardo PY - 2022/1/27 TI - An Information Directory App InHouse Call for Streamlining Communication to Optimize Efficiency and Patient Care in a Hospital: Pilot Mixed Methods Design and Utility Study JO - JMIR Hum Factors SP - e23833 VL - 9 IS - 1 KW - InHouse Call KW - communication KW - hospital directory KW - healthcare KW - health care KW - health informatics KW - mHealth KW - mobile app KW - digital health KW - patient records KW - electronic health N2 - Background: Communication failures disrupt physician workflow, lead to poor patient outcomes, and are associated with significant economic burden. To increase efficiency when contacting a team member in a hospital, we have designed an information directory app, InHouse Call. Objective: This study aimed to describe the design of InHouse Call, objectively compare the usefulness of the app versus that of traditional methods (operator or pocket cards, etc), and determine its subjective usefulness through user surveys and a net promoter score (NPS). Methods: This pilot study utilizing before-after trials was carried out at a tertiary academic hospital and involved 20 clinicians, including physiatrists, hospitalists, internal medicine and family medicine residents, and advanced practice providers/nurse practitioners/physician assistants. InHouse Call was designed to efficiently supply contact information to providers through a simple, user-friendly interface. The participants used InHouse Call in timed trials to contact a health care team member in the hospital via a telephone call. The effectiveness of InHouse Call in connecting the user with a contact in the hospital was measured through timed trials comparing the amount of time spent in attempting to make the connection using traditional methods versus the app. Usability was measured through exit surveys and NPS. Results: The average time spent connecting to the correct contact using traditional methods was 59.5 seconds, compared to 13.8 seconds when using InHouse Call. The degree of variance when using traditional methods was 1544.2, compared to 19.7 with InHouse Call. A call made using the traditional methods deviated from the mean by 39.3 seconds, compared to 4.4 seconds when using InHouse Call. InHouse Call achieved an NPS of 95. Conclusions: InHouse Call significantly reduced the average amount of time spent connecting with the correct contact as well as the variability to complete the task, thus proving to be the superior method of communication for health care providers. The app garnered a high NPS and positive subjective feedback. UR - https://humanfactors.jmir.org/2022/1/e23833 UR - http://dx.doi.org/10.2196/23833 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084350 ID - info:doi/10.2196/23833 ER - TY - JOUR AU - Rolnick, Joshua AU - Ward, Robin AU - Tait, Gordon AU - Patel, Neha PY - 2022/1/25 TI - Early Adopters of Apple Health Records at a Large Academic Medical Center: Cross-sectional Survey of Users JO - J Med Internet Res SP - e29367 VL - 24 IS - 1 KW - Apple Health Records KW - personal health record KW - electronic health record KW - patient satisfaction KW - early adopters KW - cross-sectional survey N2 - Background: Mobile applications offer a new approach to personal health records, which are internet-based tools for patients to consolidate and manage their health information. The University of Pennsylvania Health System (UPHS) was one of the first health systems to participate in Apple Health Records (AHR), a prominent example of this new generation of personal health records. Objective: This study aimed to characterize early adoption of AHR among UPHS patients and understand user perspectives. Methods: An email-based survey with fixed answer, Likert scale, and open-ended questions was administered to all UPHS patients using AHR in the first 10 months of enrollment. Survey data linked to the UPHS electronic health record system were used to analyze responses. Multivariable logistic regression modeled the association of patient characteristics with user ratings. Content analysis was used to analyze open-ended questions. Results: At the time of the survey, a total of 1458 patients had used AHR at least once. Mean age of AHR users was 47.5 years, 66.3% (967/1458) were male, 70.9% (1033/1458) were white, and 80.8% (1178/1458) had private insurance. Response rate was 26.8% (391/1458); 46.3% (180/389) were very satisfied with AHR, and 67.7% (264/390) described it as very easy to use. The most commonly utilized features were lab results (324/391, 82.9%), clinical vitals (264/391, 67.5%), and medications (253/391, 64.7%). No patient characteristics were associated with reporting high satisfaction or ease of use. The most common reason for using AHR was convenience/ease of use, and 58.2% (160/275) of users reported allowing no other apps to access their health information, citing privacy as one consideration. Conclusions: Early adopters of AHR were demographically white, male, and privately insured. Convenience was an important facilitator, and users were selective in which apps they allowed to access their health information. UR - https://www.jmir.org/2022/1/e29367 UR - http://dx.doi.org/10.2196/29367 UR - http://www.ncbi.nlm.nih.gov/pubmed/35076397 ID - info:doi/10.2196/29367 ER - TY - JOUR AU - Görtz, Magdalena AU - Byczkowski, Michael AU - Rath, Mathias AU - Schütz, Viktoria AU - Reimold, Philipp AU - Gasch, Claudia AU - Simpfendörfer, Tobias AU - März, Keno AU - Seitel, Alexander AU - Nolden, Marco AU - Ross, Tobias AU - Mindroc-Filimon, Diana AU - Michael, Dominik AU - Metzger, Jasmin AU - Onogur, Sinan AU - Speidel, Stefanie AU - Mündermann, Lars AU - Fallert, Johannes AU - Müller, Michael AU - von Knebel Doeberitz, Magnus AU - Teber, Dogu AU - Seitz, Peter AU - Maier-Hein, Lena AU - Duensing, Stefan AU - Hohenfellner, Markus PY - 2022/1/20 TI - A Platform and Multisided Market for Translational, Software-Defined Medical Procedures in the Operating Room (OP 4.1): Proof-of-Concept Study JO - JMIR Med Inform SP - e27743 VL - 10 IS - 1 KW - cloud-based platform KW - data KW - eHealth KW - Internet of Medical Things KW - IoT KW - medical apps KW - multisided market KW - perioperative medicine KW - software-defined healthcare KW - translational research N2 - Background: Although digital and data-based technologies are widespread in various industries in the context of Industry 4.0, the use of smart connected devices in health care is still in its infancy. Innovative solutions for the medical environment are affected by difficult access to medical device data and high barriers to market entry because of proprietary systems. Objective: In the proof-of-concept project OP 4.1, we show the business viability of connecting and augmenting medical devices and data through software add-ons by giving companies a technical and commercial platform for the development, implementation, distribution, and billing of innovative software solutions. Methods: The creation of a central platform prototype requires the collaboration of several independent market contenders, including medical users, software developers, medical device manufacturers, and platform providers. A dedicated consortium of clinical and scientific partners as well as industry partners was set up. Results: We demonstrate the successful development of the prototype of a user-centric, open, and extensible platform for the intelligent support of processes starting with the operating room. By connecting heterogeneous data sources and medical devices from different manufacturers and making them accessible for software developers and medical users, the cloud-based platform OP 4.1 enables the augmentation of medical devices and procedures through software-based solutions. The platform also allows for the demand-oriented billing of apps and medical devices, thus permitting software-based solutions to fast-track their economic development and become commercially successful. Conclusions: The technology and business platform OP 4.1 creates a multisided market for the successful development, implementation, distribution, and billing of new software solutions in the operating room and in the health care sector in general. Consequently, software-based medical innovation can be translated into clinical routine quickly, efficiently, and cost-effectively, optimizing the treatment of patients through smartly assisted procedures. UR - https://medinform.jmir.org/2022/1/e27743 UR - http://dx.doi.org/10.2196/27743 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049510 ID - info:doi/10.2196/27743 ER - TY - JOUR AU - Cihoric, Nikola AU - Badra, Vlaskou Eugenia AU - Stenger-Weisser, Anna AU - Aebersold, M. Daniel AU - Pavic, Matea PY - 2022/1/19 TI - Toward Data-Driven Radiation Oncology Using Standardized Terminology as a Starting Point: Cross-sectional Study JO - JMIR Form Res SP - e27550 VL - 6 IS - 1 KW - terminology KW - semantic interoperability KW - radiation oncology KW - informatics KW - medical informatics KW - oncology KW - lexical analysis KW - eHealth N2 - Background: The inability to seamlessly exchange information across radiation therapy ecosystems is a limiting factor in the pursuit of data-driven clinical practice. The implementation of semantic interoperability is a prerequisite for achieving the full capacity of the latest developments in personalized and precision medicine, such as mathematical modeling, advanced algorithmic information processing, and artificial intelligence approaches. Objective: This study aims to evaluate the state of terminology resources (TRs) dedicated to radiation oncology as a prerequisite for an oncology semantic ecosystem. The goal of this cross-sectional analysis is to quantify the state of the art in radiation therapy specific terminology. Methods: The Unified Medical Language System (UMLS) was searched for the following terms: radio oncology, radiation oncology, radiation therapy, and radiotherapy. We extracted 6509 unique concepts for further analysis. We conducted a quantitative analysis of available source vocabularies (SVs) and analyzed all UMLS SVs according to the route source, number, author, location of authors, license type, the lexical density of TR, and semantic types. Descriptive data are presented as numbers and percentages. Results: The concepts were distributed across 35 SVs. The median number of unique concepts per SV was 5 (range 1-5479), with 14% (5/35) of SVs containing 94.59% (6157/6509) of the concepts. The SVs were created by 29 authors, predominantly legal entities registered in the United States (25/35, 71%), followed by international organizations (6/35, 17%), legal entities registered in Australia (2/35, 6%), and the Netherlands and the United Kingdom with 3% (1/35) of authors each. Of the total 35 SVs, 16 (46%) did not have any restrictions on use, whereas for 19 (54%) of SVs, some level of restriction was required. Overall, 57% (20/35) of SVs were updated within the last 5 years. All concepts found within radiation therapy SVs were labeled with one of the 29 semantic types represented within UMLS. After removing the stop words, the total number of words for all SVs together was 56,219, with a median of 25 unique words per SV (range 3-50,682). The total number of unique words in all SVs was 1048, with a median of 19 unique words per vocabulary (range 3-406). The lexical density for all concepts within all SVs was 0 (0.02 rounded to 2 decimals). Median lexical density per unique SV was 0.7 (range 0.0-1.0). There were no dedicated radiation therapy SVs. Conclusions: We did not identify any dedicated TRs for radiation oncology. Current terminologies are not sufficient to cover the need of modern radiation oncology practice and research. To achieve a sufficient level of interoperability, of the creation of a new, standardized, universally accepted TR dedicated to modern radiation therapy is required. UR - https://formative.jmir.org/2022/1/e27550 UR - http://dx.doi.org/10.2196/27550 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044315 ID - info:doi/10.2196/27550 ER - TY - JOUR AU - Petsani, Despoina AU - Ahmed, Sara AU - Petronikolou, Vasileia AU - Kehayia, Eva AU - Alastalo, Mika AU - Santonen, Teemu AU - Merino-Barbancho, Beatriz AU - Cea, Gloria AU - Segkouli, Sofia AU - Stavropoulos, G. Thanos AU - Billis, Antonis AU - Doumas, Michael AU - Almeida, Rosa AU - Nagy, Enik? AU - Broeckx, Leen AU - Bamidis, Panagiotis AU - Konstantinidis, Evdokimos PY - 2022/1/19 TI - Digital Biomarkers for Supporting Transitional Care Decisions: Protocol for a Transnational Feasibility Study JO - JMIR Res Protoc SP - e34573 VL - 11 IS - 1 KW - Living Lab KW - cocreation KW - transitional care KW - technology KW - feasibility study N2 - Background: Virtual Health and Wellbeing Living Lab Infrastructure is a Horizon 2020 project that aims to harmonize Living Lab procedures and facilitate access to European health and well-being research infrastructures. In this context, this study presents a joint research activity that will be conducted within Virtual Health and Wellbeing Living Lab Infrastructure in the transitional care domain to test and validate the harmonized Living Lab procedures and infrastructures. The collection of data from various sources (information and communications technology and clinical and patient-reported outcome measures) demonstrated the capacity to assess risk and support decisions during care transitions, but there is no harmonized way of combining this information. Objective: This study primarily aims to evaluate the feasibility and benefit of collecting multichannel data across Living Labs on the topic of transitional care and to harmonize data processes and collection. In addition, the authors aim to investigate the collection and use of digital biomarkers and explore initial patterns in the data that demonstrate the potential to predict transition outcomes, such as readmissions and adverse events. Methods: The current research protocol presents a multicenter, prospective, observational cohort study that will consist of three phases, running consecutively in multiple sites: a cocreation phase, a testing and simulation phase, and a transnational pilot phase. The cocreation phase aims to build a common understanding among different sites, investigate the differences in hospitalization discharge management among countries, and the willingness of different stakeholders to use technological solutions in the transitional care process. The testing and simulation phase aims to explore ways of integrating observation of a patient?s clinical condition, patient involvement, and discharge education in transitional care. The objective of the simulation phase is to evaluate the feasibility and the barriers faced by health care professionals in assessing transition readiness. Results: The cocreation phase will be completed by April 2022. The testing and simulation phase will begin in September 2022 and will partially overlap with the deployment of the transnational pilot phase that will start in the same month. The data collection of the transnational pilots will be finalized by the end of June 2023. Data processing is expected to be completed by March 2024. The results will consist of guidelines and implementation pathways for large-scale studies and an analysis for identifying initial patterns in the acquired data. Conclusions: The knowledge acquired through this research will lead to harmonized procedures and data collection for Living Labs that support transitions in care. International Registered Report Identifier (IRRID): PRR1-10.2196/34573 UR - https://www.researchprotocols.org/2022/1/e34573 UR - http://dx.doi.org/10.2196/34573 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044303 ID - info:doi/10.2196/34573 ER - TY - JOUR AU - Woodcock, W. Elizabeth PY - 2022/1/11 TI - Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review JO - J Med Internet Res SP - e28323 VL - 24 IS - 1 KW - appointment KW - scheduling KW - outpatient KW - ambulatory KW - online KW - self-serve KW - e-book KW - web-based KW - automation KW - patient satisfaction KW - self-scheduling KW - eHealth KW - digital health KW - mobile phone N2 - Background: Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients? arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective: The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods: A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results: In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients? needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework?s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions: This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research. UR - https://www.jmir.org/2022/1/e28323 UR - http://dx.doi.org/10.2196/28323 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014968 ID - info:doi/10.2196/28323 ER - TY - JOUR AU - Zhang, Xinyue AU - Saltman, Richard PY - 2022/1/11 TI - Impact of Electronic Health Record Interoperability on Telehealth Service Outcomes JO - JMIR Med Inform SP - e31837 VL - 10 IS - 1 KW - Electronic Health Records KW - Telehealth KW - Telemental health KW - Pandemic KW - Health outcomes KW - Health Policy UR - https://medinform.jmir.org/2022/1/e31837 UR - http://dx.doi.org/10.2196/31837 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890347 ID - info:doi/10.2196/31837 ER - TY - JOUR AU - Zhang, Zhongan AU - Zheng, Xu AU - An, Kai AU - He, Yunfan AU - Wang, Tong AU - Zhou, Ruizhu AU - Zheng, Qilin AU - Nuo, Mingfu AU - Liang, Jun AU - Lei, Jianbo PY - 2022/1/11 TI - Current Status of the Health Information Technology Industry in China from the China Hospital Information Network Conference: Cross-sectional Study of Participating Companies JO - JMIR Med Inform SP - e33600 VL - 10 IS - 1 KW - medical informatics KW - China Hospital Information Network Conference KW - industry analysis KW - county medical community KW - smart hospital KW - cross-sectional study KW - digital therapeutic KW - information network KW - health care KW - hospital information KW - medical information KW - tertiary hospital N2 - Background: The China Hospital Information Network Conference (CHINC) is one of the most influential academic and technical exchange activities in medical informatics and medical informatization in China. It collects frontier ideas in medical information and has an important reference value for the analysis of China's medical information industry development. Objective: This study summarizes the current situation and future development of China's medical information industry and provides a future reference for China and abroad in the future by analyzing the characteristics of CHINC exhibitors in 2021. Methods: The list of enterprises and participating keywords were obtained from the official website of CHINC. Basic characteristics of the enterprises, industrial fields, applied technologies, company concepts, and other information were collected from the TianYanCha website and the VBDATA company library. Descriptive analysis was used to analyze the collected data, and we summarized the future development directions. Results: A total of 205 enterprises officially participated in the exhibition. Most of the enterprises were newly founded, of which 61.9% (127/205) were founded in the past 10 years. The majority of these enterprises were from first-tier cities, and 79.02% (162/205) were from Beijing, Zhejiang, Guangdong, Shanghai, and Jiangsu Provinces. The median registered capital is 16.67 million RMB (about US $2.61 million), and there are 35 (72.2%) enterprises with a registered capital of more than 100 million RMB (about US $15.68 million), 17 (8.3%) of which are already listed. A total of 126 enterprises were found in the VBDATA company library, of which 39 (30.9%) are information technology vendors and 57 (45.2%) are application technology vendors. In addition, 16 of the 57 (28%) use artificial intelligence technology. Smart medicine and internet hospitals were the focus of the enterprises participating in this conference. Conclusions: China's tertiary hospital informatization has basically completed the construction of the primary stage. The average grade of hospital electronic medical records exceeds grade 3, and 78.13% of the provinces have reached grade 3 or above. The characteristics are as follows: On the one hand, China's medical information industry is focusing on the construction of smart hospitals, including intelligent systems supporting doctors' scientific research, diagnosis-related group intelligent operation systems, and office automation systems supporting hospital management, single-disease clinical decision support systems assisting doctors' clinical care, and intelligent internet of things for logistics. On the other hand, the construction of a compact county medical community is becoming a new focus of enterprises under the guidance of practical needs and national policies to improve the quality of grassroots health services. In addition, whole-course management and digital therapy will also become a new hotspot in the future. UR - https://medinform.jmir.org/2022/1/e33600 UR - http://dx.doi.org/10.2196/33600 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014959 ID - info:doi/10.2196/33600 ER - TY - JOUR AU - Bønes, Erlend AU - Granja, Conceição AU - Solvoll, Terje PY - 2022/1/10 TI - Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study JO - J Med Internet Res SP - e32220 VL - 24 IS - 1 KW - mental health KW - FACT KW - electronic health records KW - eHealth KW - FACT implementation KW - EHR KW - implementation KW - assessment KW - model KW - community KW - treatment KW - policy KW - regulation KW - infrastructure KW - literature KW - challenge KW - intervention N2 - Background: Flexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway. Objective: The objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams. Methods: We have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway. Results: FACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams. Conclusions: Weaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers. UR - https://www.jmir.org/2022/1/e32220 UR - http://dx.doi.org/10.2196/32220 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006087 ID - info:doi/10.2196/32220 ER - TY - JOUR AU - Lee, WJ Edmund AU - McCloud, F. Rachel AU - Viswanath, Kasisomayajula PY - 2022/1/7 TI - Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment JO - J Med Internet Res SP - e25419 VL - 24 IS - 1 KW - eHealth KW - mobile health KW - communication inequalities KW - health disparities KW - health informatics KW - mobile phone UR - https://www.jmir.org/2022/1/e25419 UR - http://dx.doi.org/10.2196/25419 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994700 ID - info:doi/10.2196/25419 ER - TY - JOUR AU - Vaidyam, Aditya AU - Halamka, John AU - Torous, John PY - 2022/1/7 TI - Enabling Research and Clinical Use of Patient-Generated Health Data (the mindLAMP Platform): Digital Phenotyping Study JO - JMIR Mhealth Uhealth SP - e30557 VL - 10 IS - 1 KW - digital phenotyping KW - mHealth KW - apps KW - FHIR KW - digital health KW - health data KW - patient-generated health data KW - mobile health KW - smartphones KW - wearables KW - mobile apps KW - mental health, mobile phone N2 - Background: There is a growing need for the integration of patient-generated health data (PGHD) into research and clinical care to enable personalized, preventive, and interactive care, but technical and organizational challenges, such as the lack of standards and easy-to-use tools, preclude the effective use of PGHD generated from consumer devices, such as smartphones and wearables. Objective: This study outlines how we used mobile apps and semantic web standards such as HTTP 2.0, Representational State Transfer, JSON (JavaScript Object Notation), JSON Schema, Transport Layer Security (version 1.3), Advanced Encryption Standard-256, OpenAPI, HTML5, and Vega, in conjunction with patient and provider feedback to completely update a previous version of mindLAMP. Methods: The Learn, Assess, Manage, and Prevent (LAMP) platform addresses the abovementioned challenges in enhancing clinical insight by supporting research, data analysis, and implementation efforts around PGHD as an open-source solution with freely accessible and shared code. Results: With a simplified programming interface and novel data representation that captures additional metadata, the LAMP platform enables interoperability with existing Fast Healthcare Interoperability Resources?based health care systems as well as consumer wearables and services such as Apple HealthKit and Google Fit. The companion Cortex data analysis and machine learning toolkit offer robust support for artificial intelligence, behavioral feature extraction, interactive visualizations, and high-performance data processing through parallelization and vectorization techniques. Conclusions: The LAMP platform incorporates feedback from patients and clinicians alongside a standards-based approach to address these needs and functions across a wide range of use cases through its customizable and flexible components. These range from simple survey-based research to international consortiums capturing multimodal data to simple delivery of mindfulness exercises through personalized, just-in-time adaptive interventions. UR - https://mhealth.jmir.org/2022/1/e30557 UR - http://dx.doi.org/10.2196/30557 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994710 ID - info:doi/10.2196/30557 ER - TY - JOUR AU - Eum, Ji Nam AU - Kim, Hyun Seung PY - 2022/1/7 TI - The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study JO - JMIR Public Health Surveill SP - e31066 VL - 8 IS - 1 KW - health policy KW - telehealth KW - physical distancing KW - disease transmission KW - COVID-19 N2 - Background: Despite worldwide efforts, control of COVID-19 transmission and its after effects is lagging. As seen from the cases of SARS-CoV-2 and influenza, worldwide crises associated with infections and their side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to identify the factors that can mitigate disease spread. We observed that the transmission speed and severity of consequences of COVID-19 varied substantially across countries, signaling the need for a country-level investigation. Objective: We aimed to investigate how distancing-enabling information and communications technology (ICT) infrastructure and medical ICT infrastructure, and related policies have affected the cumulative number of confirmed cases, fatality rate, and initial speed of transmission across different countries. Methods: We analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics, including demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density. Results: Our full sample analysis showed that implied telehealth policy, which refers to the lack of a specific telehealth-related policy but presence of a general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (P=.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7%. Interestingly, stated telehealth policy, which refers to the existence of a specified telehealth policy, was found to not be associated with lower fatality rates (P=.30). Furthermore, countries with a government-run health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (P=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (P=.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in the full sample analysis (P=.04), but not in the subsample analysis (P=.76), highlighting that distancing-enabling ICT is more useful in densely populated countries. Conclusions: Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians? autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics. UR - https://publichealth.jmir.org/2022/1/e31066 UR - http://dx.doi.org/10.2196/31066 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817392 ID - info:doi/10.2196/31066 ER - TY - JOUR AU - Garcia, Gracie AU - Crenner, Christopher PY - 2022/1/7 TI - Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study JO - JMIR Hum Factors SP - e28762 VL - 9 IS - 1 KW - electronic health records KW - electronic medical records KW - health information technology KW - health information exchange KW - health policy KW - international KW - emergency medicine KW - medical informatics KW - meaningful use KW - burnout N2 - Background: The variability in physicians? attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective: This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods: We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results: Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care?s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions: Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research. UR - https://humanfactors.jmir.org/2022/1/e28762 UR - http://dx.doi.org/10.2196/28762 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994702 ID - info:doi/10.2196/28762 ER - TY - JOUR AU - Tseng, Henry Chinyang AU - Chen, Ray-Jade AU - Tsai, Shang-Yu AU - Wu, Tsung-Ren AU - Tsaur, Woei-Jiunn AU - Chiu, Hung-Wen AU - Yang, Cheng-Yi AU - Lo, Yu-Sheng PY - 2022/1/6 TI - Exploring the COVID-19 Pandemic as a Catalyst for Behavior Change Among Patient Health Record App Users in Taiwan: Development and Usability Study JO - J Med Internet Res SP - e33399 VL - 24 IS - 1 KW - personal health records KW - COVID-19 KW - My Health Bank KW - blockchain KW - public health N2 - Background: During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan?s National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile apps with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low. Objective: We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the app?s log data to examine patients? MHB use during the COVID-19 pandemic. Methods: We integrated our existing blockchain-enabled mobile app with the MHB SDK to enable NHIA MHB data retrieval. The app utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the app and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the app?s access logs to compare patients? activities during high and low COVID-19 infection periods. Results: We successfully integrated the MHB SDK into our mobile app, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the app?s log data for the period of July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people who applied to create a blockchain account for access to their medical data and the number of app subscribers among patients who visited the outpatient department (OPD) and emergency department (ED). Notably, for patients who visited the OPD and ED, the peak proportions with respect to the use of the app for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40% for ED notes in June 2021, 88.10% for ED laboratory test reports in May 2021, 34.61% for OPD notes in June 2021, and 41.87% for OPD laboratory test reports in June 2021. These peaks coincided with Taiwan?s local COVID-19 outbreak lasting from May to June 2021. Conclusions: This study developed a blockchain-enabled mobile app, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users? access logs revealed that the COVID-19 pandemic substantially increased individuals? use of PHRs and their health awareness with respect to COVID-19 prevention. UR - https://www.jmir.org/2022/1/e33399 UR - http://dx.doi.org/10.2196/33399 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951863 ID - info:doi/10.2196/33399 ER - TY - JOUR AU - Cresswell, Kathrin AU - Domínguez Hernández, Andrés AU - Williams, Robin AU - Sheikh, Aziz PY - 2022/1/6 TI - Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study JO - JMIR Hum Factors SP - e31246 VL - 9 IS - 1 KW - cloud technology KW - qualitative KW - adoption KW - implementation KW - digital health KW - data processing KW - health care KW - risk assessment KW - user engagement N2 - Background: The use of cloud computing (involving storage and processing of data on the internet) in health care has increasingly been highlighted as having great potential in facilitating data-driven innovations. Although some provider organizations are reaping the benefits of using cloud providers to store and process their data, others are lagging behind. Objective: We aim to explore the existing challenges and barriers to the use of cloud computing in health care settings and investigate how perceived risks can be addressed. Methods: We conducted a qualitative case study of cloud computing in health care settings, interviewing a range of individuals with perspectives on supply, implementation, adoption, and integration of cloud technology. Data were collected through a series of in-depth semistructured interviews exploring current applications, implementation approaches, challenges encountered, and visions for the future. The interviews were transcribed and thematically analyzed using NVivo 12 (QSR International). We coded the data based on a sociotechnical coding framework developed in related work. Results: We interviewed 23 individuals between September 2020 and November 2020, including professionals working across major cloud providers, health care provider organizations, innovators, small and medium-sized software vendors, and academic institutions. The participants were united by a common vision of a cloud-enabled ecosystem of applications and by drivers surrounding data-driven innovation. The identified barriers to progress included the cost of data migration and skill gaps to implement cloud technologies within provider organizations, the cultural shift required to move to externally hosted services, a lack of user pull as many benefits were not visible to those providing frontline care, and a lack of interoperability standards and central regulations. Conclusions: Implementations need to be viewed as a digitally enabled transformation of services, driven by skill development, organizational change management, and user engagement, to facilitate the implementation and exploitation of cloud-based infrastructures and to maximize returns on investment. UR - https://humanfactors.jmir.org/2022/1/e31246 UR - http://dx.doi.org/10.2196/31246 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989688 ID - info:doi/10.2196/31246 ER - TY - JOUR AU - Ogundaini, Oluwamayowa AU - de la Harpe, Retha PY - 2022/1/4 TI - The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach JO - JMIR Form Res SP - e23236 VL - 6 IS - 1 KW - agency KW - health care professionals KW - technology performativity KW - sub-Saharan Africa KW - service design KW - work activities KW - mobile phone N2 - Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants? data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. UR - https://formative.jmir.org/2022/1/e23236 UR - http://dx.doi.org/10.2196/23236 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982713 ID - info:doi/10.2196/23236 ER - TY - JOUR AU - Yeng, Kandabongee Prosper AU - Nweke, Obiora Livinus AU - Yang, Bian AU - Ali Fauzi, Muhammad AU - Snekkenes, Arthur Einar PY - 2021/12/22 TI - Artificial Intelligence?Based Framework for Analyzing Health Care Staff Security Practice: Mapping Review and Simulation Study JO - JMIR Med Inform SP - e19250 VL - 9 IS - 12 KW - artificial intelligence KW - machine learning KW - health care KW - security practice KW - framework KW - security KW - modeling KW - analysis N2 - Background: Blocklisting malicious activities in health care is challenging in relation to access control in health care security practices due to the fear of preventing legitimate access for therapeutic reasons. Inadvertent prevention of legitimate access can contravene the availability trait of the confidentiality, integrity, and availability triad, and may result in worsening health conditions, leading to serious consequences, including deaths. Therefore, health care staff are often provided with a wide range of access such as a ?breaking-the-glass? or ?self-authorization? mechanism for emergency access. However, this broad access can undermine the confidentiality and integrity of sensitive health care data because breaking-the-glass can lead to vast unauthorized access, which could be problematic when determining illegitimate access in security practices. Objective: A review was performed to pinpoint appropriate artificial intelligence (AI) methods and data sources that can be used for effective modeling and analysis of health care staff security practices. Based on knowledge obtained from the review, a framework was developed and implemented with simulated data to provide a comprehensive approach toward effective modeling and analyzing security practices of health care staff in real access logs. Methods: The flow of our approach was a mapping review to provide AI methods, data sources and their attributes, along with other categories as input for framework development. To assess implementation of the framework, electronic health record (EHR) log data were simulated and analyzed, and the performance of various approaches in the framework was compared. Results: Among the total 130 articles initially identified, 18 met the inclusion and exclusion criteria. A thorough assessment and analysis of the included articles revealed that K-nearest neighbor, Bayesian network, and decision tree (C4.5) algorithms were predominantly applied to EHR and network logs with varying input features of health care staff security practices. Based on the review results, a framework was developed and implemented with simulated logs. The decision tree obtained the best precision of 0.655, whereas the best recall was achieved by the support vector machine (SVM) algorithm at 0.977. However, the best F1-score was obtained by random forest at 0.775. In brief, three classifiers (random forest, decision tree, and SVM) in the two-class approach achieved the best precision of 0.998. Conclusions: The security practices of health care staff can be effectively analyzed using a two-class approach to detect malicious and nonmalicious security practices. Based on our comparative study, the algorithms that can effectively be used in related studies include random forest, decision tree, and SVM. Deviations of security practices from required health care staff?s security behavior in the big data context can be analyzed with real access logs to define appropriate incentives for improving conscious care security practice. UR - https://medinform.jmir.org/2021/12/e19250 UR - http://dx.doi.org/10.2196/19250 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941549 ID - info:doi/10.2196/19250 ER - TY - JOUR AU - Mudaranthakam, Pal Dinesh AU - Brown, Alexandra AU - Kerling, Elizabeth AU - Carlson, E. Susan AU - Valentine, J. Christina AU - Gajewski, Byron PY - 2021/12/22 TI - The Successful Synchronized Orchestration of an Investigator-Initiated Multicenter Trial Using a Clinical Trial Management System and Team Approach: Design and Utility Study JO - JMIR Form Res SP - e30368 VL - 5 IS - 12 KW - data management KW - data quality KW - metrics KW - trial execution KW - clinical trials KW - cost KW - accrual KW - accrual inequality KW - rare diseases KW - healthcare KW - health care KW - health operations N2 - Background: As the cost of clinical trials continues to rise, novel approaches are required to ensure ethical allocation of resources. Multisite trials have been increasingly utilized in phase 1 trials for rare diseases and in phase 2 and 3 trials to meet accrual needs. The benefits of multisite trials include easier patient recruitment, expanded generalizability, and more robust statistical analyses. However, there are several problems more likely to arise in multisite trials, including accrual inequality, protocol nonadherence, data entry mistakes, and data integration difficulties. Objective: The Biostatistics & Data Science department at the University of Kansas Medical Center developed a clinical trial management system (comprehensive research information system [CRIS]) specifically designed to streamline multisite clinical trial management. Methods: A National Institute of Child Health and Human Development?funded phase 3 trial, the ADORE (assessment of docosahexaenoic acid [DHA] on reducing early preterm birth) trial fully utilized CRIS to provide automated accrual reports, centralize data capture, automate trial completion reports, and streamline data harmonization. Results: Using the ADORE trial as an example, we describe the utility of CRIS in database design, regulatory compliance, training standardization, study management, and automated reporting. Our goal is to continue to build a CRIS through use in subsequent multisite trials. Reports generated to suit the needs of future studies will be available as templates. Conclusions: The implementation of similar tools and systems could provide significant cost-saving and operational benefit to multisite trials. Trial Registration: ClinicalTrials.gov NCT02626299; https://tinyurl.com/j6erphcj UR - https://formative.jmir.org/2021/12/e30368 UR - http://dx.doi.org/10.2196/30368 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941552 ID - info:doi/10.2196/30368 ER - TY - JOUR AU - Yeung, Karen PY - 2021/12/20 TI - The Health Care Sector?s Experience of Blockchain: A Cross-disciplinary Investigation of Its Real Transformative Potential JO - J Med Internet Res SP - e24109 VL - 23 IS - 12 KW - blockchain KW - health information management KW - health information systems KW - electronic health record KW - data sharing KW - health services administration KW - privacy of patient data KW - computer security KW - mobile phone N2 - Background: Academic literature highlights blockchain?s potential to transform health care, particularly by seamlessly and securely integrating existing data silos while enabling patients to exercise automated, fine-grained control over access to their electronic health records. However, no serious scholarly attempt has been made to assess how these technologies have in fact been applied to real-world health care contexts. Objective: The primary aim of this paper is to assess whether blockchain?s theoretical potential to deliver transformative benefits to health care is likely to become a reality by undertaking a critical investigation of the health care sector?s actual experience of blockchain technologies to date. Methods: This mixed methods study entailed a series of iterative, in-depth, theoretically oriented, desk-based investigations and 2 focus group investigations. It builds on the findings of a companion research study documenting real-world engagement with blockchain technologies in health care. Data were sourced from academic and gray literature from multiple disciplinary perspectives concerned with the configuration, design, and functionality of blockchain technologies. The analysis proceeded in 3 stages. First, it undertook a qualitative investigation of observed patterns of blockchain for health care engagement to identify the application domains, data-sharing problems, and the challenges encountered to date. Second, it critically compared these experiences with claims about blockchain?s potential benefits in health care. Third, it developed a theoretical account of challenges that arise in implementing blockchain in health care contexts, thus providing a firmer foundation for appraising its future prospects in health care. Results: Health care organizations have actively experimented with blockchain technologies since 2016 and have demonstrated proof of concept for several applications (use cases) primarily concerned with administrative data and to facilitate medical research by enabling algorithmic models to be trained on multiple disparately located sets of patient data in a secure, privacy-preserving manner. However, blockchain technology is yet to be implemented at scale in health care, remaining largely in its infancy. These early experiences have demonstrated blockchain?s potential to generate meaningful value to health care by facilitating data sharing between organizations in circumstances where computational trust can overcome a lack of social trust that might otherwise prevent valuable cooperation. Although there are genuine prospects of using blockchain to bring about positive transformations in health care, the successful development of blockchain for health care applications faces a number of very significant, multidimensional, and highly complex challenges. Early experience suggests that blockchain is unlikely to rapidly and radically revolutionize health care. Conclusions: The successful development of blockchain for health care applications faces numerous significant, multidimensional, and complex challenges that will not be easily overcome, suggesting that blockchain technologies are unlikely to revolutionize health care in the near future. UR - https://www.jmir.org/2021/12/e24109 UR - http://dx.doi.org/10.2196/24109 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932009 ID - info:doi/10.2196/24109 ER - TY - JOUR AU - Were, Chieng Martin AU - Savai, Simon AU - Mokaya, Benard AU - Mbugua, Samuel AU - Ribeka, Nyoman AU - Cholli, Preetam AU - Yeung, Ada PY - 2021/12/14 TI - mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale JO - J Med Internet Res SP - e26381 VL - 23 IS - 12 KW - mobile health KW - electronic medical records KW - developing countries KW - digital divide KW - digital health KW - global health N2 - Background: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. Objective: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). Methods: The ?Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)? checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima?s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. Results: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO?s Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. Conclusions: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains. UR - https://www.jmir.org/2021/12/e26381 UR - http://dx.doi.org/10.2196/26381 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904952 ID - info:doi/10.2196/26381 ER - TY - JOUR AU - Paris, Nicolas AU - Lamer, Antoine AU - Parrot, Adrien PY - 2021/12/14 TI - Transformation and Evaluation of the MIMIC Database in the OMOP Common Data Model: Development and Usability Study JO - JMIR Med Inform SP - e30970 VL - 9 IS - 12 KW - data reuse KW - open data KW - OMOP KW - common data model KW - critical care KW - machine learning KW - big data KW - health informatics KW - health data KW - health database KW - electronic health records KW - open access database KW - digital health KW - intensive care KW - health care N2 - Background: In the era of big data, the intensive care unit (ICU) is likely to benefit from real-time computer analysis and modeling based on close patient monitoring and electronic health record data. The Medical Information Mart for Intensive Care (MIMIC) is the first open access database in the ICU domain. Many studies have shown that common data models (CDMs) improve database searching by allowing code, tools, and experience to be shared. The Observational Medical Outcomes Partnership (OMOP) CDM is spreading all over the world. Objective: The objective was to transform MIMIC into an OMOP database and to evaluate the benefits of this transformation for analysts. Methods: We transformed MIMIC (version 1.4.21) into OMOP format (version 5.3.3.1) through semantic and structural mapping. The structural mapping aimed at moving the MIMIC data into the right place in OMOP, with some data transformations. The mapping was divided into 3 phases: conception, implementation, and evaluation. The conceptual mapping aimed at aligning the MIMIC local terminologies to OMOP's standard ones. It consisted of 3 phases: integration, alignment, and evaluation. A documented, tested, versioned, exemplified, and open repository was set up to support the transformation and improvement of the MIMIC community's source code. The resulting data set was evaluated over a 48-hour datathon. Results: With an investment of 2 people for 500 hours, 64% of the data items of the 26 MIMIC tables were standardized into the OMOP CDM and 78% of the source concepts mapped to reference terminologies. The model proved its ability to support community contributions and was well received during the datathon, with 160 participants and 15,000 requests executed with a maximum duration of 1 minute. Conclusions: The resulting MIMIC-OMOP data set is the first MIMIC-OMOP data set available free of charge with real disidentified data ready for replicable intensive care research. This approach can be generalized to any medical field. UR - https://medinform.jmir.org/2021/12/e30970 UR - http://dx.doi.org/10.2196/30970 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904958 ID - info:doi/10.2196/30970 ER - TY - JOUR AU - Bannay, Aurélie AU - Bories, Mathilde AU - Le Corre, Pascal AU - Riou, Christine AU - Lemordant, Pierre AU - Van Hille, Pascal AU - Chazard, Emmanuel AU - Dode, Xavier AU - Cuggia, Marc AU - Bouzillé, Guillaume PY - 2021/12/13 TI - Leveraging National Claims and Hospital Big Data: Cohort Study on a Statin-Drug Interaction Use Case JO - JMIR Med Inform SP - e29286 VL - 9 IS - 12 KW - drug interactions KW - statins KW - administrative claims KW - health care KW - big data KW - data linking KW - data warehousing N2 - Background: Linking different sources of medical data is a promising approach to analyze care trajectories. The aim of the INSHARE (Integrating and Sharing Health Big Data for Research) project was to provide the blueprint for a technological platform that facilitates integration, sharing, and reuse of data from 2 sources: the clinical data warehouse (CDW) of the Rennes academic hospital, called eHOP (entrepôt Hôpital), and a data set extracted from the French national claim data warehouse (Système National des Données de Santé [SNDS]). Objective: This study aims to demonstrate how the INSHARE platform can support big data analytic tasks in the health field using a pharmacovigilance use case based on statin consumption and statin-drug interactions. Methods: A Spark distributed cluster-computing framework was used for the record linkage procedure and all analyses. A semideterministic record linkage method based on the common variables between the chosen data sources was developed to identify all patients discharged after at least one hospital stay at the Rennes academic hospital between 2015 and 2017. The use-case study focused on a cohort of patients treated with statins prescribed by their general practitioner or during their hospital stay. Results: The whole process (record linkage procedure and use-case analyses) required 88 minutes. Of the 161,532 and 164,316 patients from the SNDS and eHOP CDW data sets, respectively, 159,495 patients were successfully linked (98.74% and 97.07% of patients from SNDS and eHOP CDW, respectively). Of the 16,806 patients with at least one statin delivery, 8293 patients started the consumption before and continued during the hospital stay, 6382 patients stopped statin consumption at hospital admission, and 2131 patients initiated statins in hospital. Statin-drug interactions occurred more frequently during hospitalization than in the community (3800/10,424, 36.45% and 3253/14,675, 22.17%, respectively; P<.001). Only 121 patients had the most severe level of statin-drug interaction. Hospital stay burden (length of stay and in-hospital mortality) was more severe in patients with statin-drug interactions during hospitalization. Conclusions: This study demonstrates the added value of combining and reusing clinical and claim data to provide large-scale measures of drug-drug interaction prevalence and care pathways outside hospitals. It builds a path to move the current health care system toward a Learning Health System using knowledge generated from research on real-world health data. UR - https://medinform.jmir.org/2021/12/e29286 UR - http://dx.doi.org/10.2196/29286 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898457 ID - info:doi/10.2196/29286 ER - TY - JOUR AU - Chan, Erina AU - Small, S. Serena AU - Wickham, E. Maeve AU - Cheng, Vicki AU - Balka, Ellen AU - Hohl, M. Corinne PY - 2021/12/10 TI - The Utility of Different Data Standards to Document Adverse Drug Event Symptoms and Diagnoses: Mixed Methods Study JO - J Med Internet Res SP - e27188 VL - 23 IS - 12 KW - adverse drug events KW - health information technology KW - data standards N2 - Background: Existing systems to document adverse drug events often use free text data entry, which produces nonstandardized and unstructured data that are prone to misinterpretation. Standardized terminology may improve data quality; however, it is unclear which data standard is most appropriate for documenting adverse drug event symptoms and diagnoses. Objective: This study aims to compare the utility, strengths, and weaknesses of different data standards for documenting adverse drug event symptoms and diagnoses. Methods: We performed a mixed methods substudy of a multicenter retrospective chart review. We reviewed the research records of prospectively diagnosed adverse drug events at 5 Canadian hospitals. A total of 2 pharmacy research assistants independently entered the symptoms and diagnoses for the adverse drug events using four standards: Medical Dictionary for Regulatory Activities (MedDRA), Systematized Nomenclature of Medicine (SNOMED) Clinical Terms, SNOMED Adverse Reaction (SNOMED ADR), and International Classification of Diseases (ICD) 11th Revision. Disagreements between research assistants regarding the case-specific utility of data standards were discussed until a consensus was reached. We used consensus ratings to determine the proportion of adverse drug events covered by a data standard and coded and analyzed field notes from the consensus sessions. Results: We reviewed 573 adverse drug events and found that MedDRA and ICD-11 had excellent coverage of adverse drug event symptoms and diagnoses. MedDRA had the highest number of matches between the research assistants, whereas ICD-11 had the fewest. SNOMED ADR had the lowest proportion of adverse drug event coverage. The research assistants were most likely to encounter terminological challenges with SNOMED ADR and usability challenges with ICD-11, whereas least likely to encounter challenges with MedDRA. Conclusions: Usability, comprehensiveness, and accuracy are important features of data standards for documenting adverse drug event symptoms and diagnoses. On the basis of our results, we recommend the use of MedDRA. UR - https://www.jmir.org/2021/12/e27188 UR - http://dx.doi.org/10.2196/27188 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890351 ID - info:doi/10.2196/27188 ER - TY - JOUR AU - Janssen, Anna AU - Talic, Stella AU - Gasevic, Dragan AU - Kay, Judy AU - Shaw, Tim PY - 2021/12/9 TI - Exploring the Intersection Between Health Professionals? Learning and eHealth Data: Protocol for a Comprehensive Research Program in Practice Analytics in Health Care JO - JMIR Res Protoc SP - e27984 VL - 10 IS - 12 KW - digital health KW - health informatics KW - practice analytics in health care KW - health professions education KW - continuing professional development N2 - Background: There is an increasing amount of electronic data sitting within the health system. These data have untapped potential to improve clinical practice if extracted efficiently and harnessed to change the behavior of health professionals. Furthermore, there is an increasing expectation from the government and peak bodies that both individual health professionals and health care organizations will use electronic data for a range of applications, including improving health service delivery and informing clinical practice and professional accreditation. Objective: The aim of this research program is to make eHealth data captured within tertiary health care organizations more actionable to health professionals for use in practice reflection, professional development, and other quality improvement activities. Methods: A multidisciplinary approach was used to connect academic experts from core disciplines of health and medicine, education and learning sciences, and engineering and information communication technology with government and health service partners to identify key problems preventing the health care industry from using electronic data to support health professional learning. This multidisciplinary approach was used to design a large-scale research program to solve the problem of making eHealth data more accessible to health professionals for practice reflection. The program will be delivered over 5 years by doctoral candidates undertaking research projects with discrete aims that run in parallel to achieving this program?s objectives. Results: The process used to develop the research program identified 7 doctoral research projects to answer the program objectives, split across 3 streams. Conclusions: This research program has the potential to successfully unpack electronic data siloed within clinical sites and enable health professionals to use them to reflect on their practice and deliver informed and improved care. The program will contribute to current practices by fostering stronger connections between industry and academia, interlinking doctoral research projects to solve complex problems, and creating new knowledge for clinical sites on how data can be used to understand and improve performance. Furthermore, the program aims to affect policy by developing insights on how professional development programs may be strengthened to enhance their alignment with clinical practice. The key contributions of this paper include the introduction of a new conceptualized research program, Practice Analytics in Health care, by describing the foundational academic disciplines that the program is formed of and presenting scientific methods for its design and development. International Registered Report Identifier (IRRID): PRR1-10.2196/27984 UR - https://www.researchprotocols.org/2021/12/e27984 UR - http://dx.doi.org/10.2196/27984 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889768 ID - info:doi/10.2196/27984 ER - TY - JOUR AU - Pan, Youcheng AU - Wang, Chenghao AU - Hu, Baotian AU - Xiang, Yang AU - Wang, Xiaolong AU - Chen, Qingcai AU - Chen, Junjie AU - Du, Jingcheng PY - 2021/12/8 TI - A BERT-Based Generation Model to Transform Medical Texts to SQL Queries for Electronic Medical Records: Model Development and Validation JO - JMIR Med Inform SP - e32698 VL - 9 IS - 12 KW - electronic medical record KW - text-to-SQL generation KW - BERT KW - grammar-based decoding KW - tree-structured intermediate representation N2 - Background: Electronic medical records (EMRs) are usually stored in relational databases that require SQL queries to retrieve information of interest. Effectively completing such queries can be a challenging task for medical experts due to the barriers in expertise. Existing text-to-SQL generation studies have not been fully embraced in the medical domain. Objective: The objective of this study was to propose a neural generation model that can jointly consider the characteristics of medical text and the SQL structure to automatically transform medical texts to SQL queries for EMRs. Methods: We proposed a medical text?to-SQL model (MedTS), which employed a pretrained Bidirectional Encoder Representations From Transformers model as the encoder and leveraged a grammar-based long short-term memory network as the decoder to predict the intermediate representation that can easily be transformed into the final SQL query. We adopted the syntax tree as the intermediate representation rather than directly regarding the SQL query as an ordinary word sequence, which is more in line with the tree-structure nature of SQL and can also effectively reduce the search space during generation. Experiments were conducted on the MIMICSQL dataset, and 5 competitor methods were compared. Results: Experimental results demonstrated that MedTS achieved the accuracy of 0.784 and 0.899 on the test set in terms of logic form and execution, respectively, which significantly outperformed the existing state-of-the-art methods. Further analyses proved that the performance on each component of the generated SQL was relatively balanced and offered substantial improvements. Conclusions: The proposed MedTS was effective and robust for improving the performance of medical text?to-SQL generation, indicating strong potential to be applied in the real medical scenario. UR - https://medinform.jmir.org/2021/12/e32698 UR - http://dx.doi.org/10.2196/32698 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889749 ID - info:doi/10.2196/32698 ER - TY - JOUR AU - Espinoza, Juan AU - Sikder, Taher Abu AU - Dickhoner, James AU - Lee, Thomas PY - 2021/12/8 TI - Assessing Health Data Security Risks in Global Health Partnerships: Development of a Conceptual Framework JO - JMIR Form Res SP - e25833 VL - 5 IS - 12 KW - health information technology KW - low- and middle-income countries KW - low income KW - conceptual framework analysis KW - framework method KW - data security KW - decision-making KW - database KW - information use KW - misuse KW - global health KW - security N2 - Background: Health care databases contain a wealth of information that can be used to develop programs and mature health care systems. There is concern that the sensitive nature of health data (eg, ethnicity, reproductive health, sexually transmitted infections, and lifestyle information) can have significant impact on individuals if misused, particularly among vulnerable and marginalized populations. As academic institutions, nongovernmental organizations, and international agencies begin to collaborate with low- and middle-income countries to develop and deploy health information technology (HIT), it is important to understand the technical and practical security implications of these initiatives. Objective: Our aim is to develop a conceptual framework for risk stratification of global health data partnerships and HIT projects. In addition to identifying key conceptual domains, we map each domain to a variety of publicly available indices that could be used to inform a quantitative model. Methods: We conducted an overview of the literature to identify relevant publications, position statements, white papers, and reports. The research team reviewed all sources and used the framework method and conceptual framework analysis to name and categorize key concepts, integrate them into domains, and synthesize them into an overarching conceptual framework. Once key domains were identified, public international data sources were searched for relevant structured indices to generate quantitative counterparts. Results: We identified 5 key domains to inform our conceptual framework: State of HIT, Economics of Health Care, Demographics and Equity, Societal Freedom and Safety, and Partnership and Trust. Each of these domains was mapped to a number of structured indices. Conclusions: There is a complex relationship among the legal, economic, and social domains of health care, which affects the state of HIT in low- and middle-income countries and associated data security risks. The strength of partnership and trust among collaborating organizations is an important moderating factor. Additional work is needed to formalize the assessment of partnership and trust and to develop a quantitative model of the conceptual framework that can help support organizational decision-making. UR - https://formative.jmir.org/2021/12/e25833 UR - http://dx.doi.org/10.2196/25833 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889752 ID - info:doi/10.2196/25833 ER - TY - JOUR AU - Mehta, Paul AU - Raymond, Jaime AU - Han, Kwon Moon AU - Larson, Theodore AU - Berry, D. James AU - Paganoni, Sabrina AU - Mitsumoto, Hiroshi AU - Bedlack, Stanley Richard AU - Horton, Kevin D. PY - 2021/12/7 TI - Recruitment of Patients With Amyotrophic Lateral Sclerosis for Clinical Trials and Epidemiological Studies: Descriptive Study of the National ALS Registry?s Research Notification Mechanism JO - J Med Internet Res SP - e28021 VL - 23 IS - 12 KW - amyotrophic lateral sclerosis KW - Lou Gehrig disease KW - motor neuron disease KW - clinical trials KW - patient recruitment KW - National ALS Registry KW - research notification mechanism N2 - Background: Researchers face challenges in patient recruitment, especially for rare, fatal diseases such as amyotrophic lateral sclerosis (ALS). These challenges include obtaining sufficient statistical power as well as meeting eligibility requirements such as age, sex, and study proximity. Similarly, persons with ALS (PALS) face difficulty finding and enrolling in research studies for which they are eligible. Objective: The aim of this study was to describe how the federal Agency for Toxic Substances and Disease Registry?s (ATSDR) National ALS Registry is linking PALS to scientists who are conducting research, clinical trials, and epidemiological studies. Methods: Through the Registry?s online research notification mechanism (RNM), PALS can elect to be notified about new research opportunities. This mechanism allows researchers to upload a standardized application outlining their study design and objectives, and proof of Institutional Review Board approval. If the application is approved, ATSDR queries the Registry for PALS meeting the study?s specific eligibility criteria, and then distributes the researcher?s study material and contact information to PALS via email. PALS then need to contact the researcher directly to take part in any research. Such an approach allows ATSDR to protect the confidentiality of Registry enrollees. Results: From 2013 to 2019, a total of 46 institutions around the United States and abroad have leveraged this tool and over 600,000 emails have been sent, resulting in over 2000 patients conservatively recruited for clinical trials and epidemiological studies. Patients between the ages of 60 and 69 had the highest level of participation, whereas those between the ages of 18 and 39 and aged over 80 had the lowest. More males participated (4170/7030, 59.32%) than females (2860/7030, 40.68%). Conclusions: The National ALS Registry?s RNM benefits PALS by connecting them to appropriate ALS research. Simultaneously, the system benefits researchers by expediting recruitment, increasing sample size, and efficiently identifying PALS meeting specific eligibility requirements. As more researchers learn about and use this mechanism, both PALS and researchers can hasten research and expand trial options for PALS. UR - https://www.jmir.org/2021/12/e28021 UR - http://dx.doi.org/10.2196/28021 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878988 ID - info:doi/10.2196/28021 ER - TY - JOUR AU - Chen, Rai-Fu AU - Hsiao, Ju-Ling PY - 2021/11/30 TI - Health Professionals? Perspectives on Electronic Medical Record Infusion and Individual Performance: Model Development and Questionnaire Survey Study JO - JMIR Med Inform SP - e32180 VL - 9 IS - 11 KW - health care professional KW - electronic medical records KW - IS infusion KW - individual performance KW - EHR KW - electronic health record KW - performance KW - perspective KW - information system KW - integration KW - decision-making KW - health information exchange KW - questionnaire N2 - Background: Electronic medical records (EMRs) are integrated information sources generated by health care professionals (HCPs) from various health care information systems. EMRs play crucial roles in improving the quality of care and medical decision-making and in facilitating cross-hospital health information exchange. Although many hospitals have invested considerable resources and efforts to develop EMRs for several years, the factors affecting the long-term success of EMRs, particularly in the EMR infusion stage, remain unclear. Objective: The aim of this study was to investigate the effects of technology, user, and task characteristics on EMR infusion to determine the factors that largely affect EMR infusion. In addition, we examined the effect of EMR infusion on individual HCP performance. Methods: A questionnaire survey was used to collect data from HCPs with >6 months experience in using EMRs in a Taiwanese teaching hospital. A total of 316 questionnaires were distributed and 211 complete copies were returned, yielding a valid response rate of 66.8%. The collected data were further analyzed using WarpPLS 5.0. Results: EMR infusion (R2=0.771) was mainly affected by user habits (?=.411), portability (?=.217), personal innovativeness (?=.198), technostress (?=.169), and time criticality (?=.168), and individual performance (R2=0.541) was affected by EMR infusion (?=.735). This finding indicated that user (habit, personal innovativeness, and technostress), technology (portability), and task (mobility and time criticality) characteristics have major effects on EMR infusion. Furthermore, the results indicated that EMR infusion positively affects individual performance. Conclusions: The factors identified in this study can extend information systems infusion theory and provide useful insights for the further improvement of EMR development in hospitals and by the government, specifically in its infusion stage. In addition, the developed instrument can be used as an assessment tool to identify the key factors for EMR infusion, and to evaluate the extent of EMR infusion and the individual performance of hospitals that have implemented EMR systems. Moreover, the results can help governments to understand the urgent needs of hospitals in implementing EMR systems, provide sufficient resources and support to improve the incentives of EMR development, and develop adequate EMR policies for the meaningful use of electronic health records among hospitals and clinics. UR - https://medinform.jmir.org/2021/11/e32180 UR - http://dx.doi.org/10.2196/32180 UR - http://www.ncbi.nlm.nih.gov/pubmed/34851297 ID - info:doi/10.2196/32180 ER - TY - JOUR AU - Stöhr, R. Mark AU - Günther, Andreas AU - Majeed, W. Raphael PY - 2021/11/29 TI - The Collaborative Metadata Repository (CoMetaR) Web App: Quantitative and Qualitative Usability Evaluation JO - JMIR Med Inform SP - e30308 VL - 9 IS - 11 KW - usability KW - metadata KW - data visualization KW - semantic web KW - data management KW - data warehousing KW - communication barriers KW - quality improvement KW - biological ontologies KW - data curation N2 - Background: In the field of medicine and medical informatics, the importance of comprehensive metadata has long been recognized, and the composition of metadata has become its own field of profession and research. To ensure sustainable and meaningful metadata are maintained, standards and guidelines such as the FAIR (Findability, Accessibility, Interoperability, Reusability) principles have been published. The compilation and maintenance of metadata is performed by field experts supported by metadata management apps. The usability of these apps, for example, in terms of ease of use, efficiency, and error tolerance, crucially determines their benefit to those interested in the data. Objective: This study aims to provide a metadata management app with high usability that assists scientists in compiling and using rich metadata. We aim to evaluate our recently developed interactive web app for our collaborative metadata repository (CoMetaR). This study reflects how real users perceive the app by assessing usability scores and explicit usability issues. Methods: We evaluated the CoMetaR web app by measuring the usability of 3 modules: core module, provenance module, and data integration module. We defined 10 tasks in which users must acquire information specific to their user role. The participants were asked to complete the tasks in a live web meeting. We used the System Usability Scale questionnaire to measure the usability of the app. For qualitative analysis, we applied a modified think aloud method with the following thematic analysis and categorization into the ISO 9241-110 usability categories. Results: A total of 12 individuals participated in the study. We found that over 97% (85/88) of all the tasks were completed successfully. We measured usability scores of 81, 81, and 72 for the 3 evaluated modules. The qualitative analysis resulted in 24 issues with the app. Conclusions: A usability score of 81 implies very good usability for the 2 modules, whereas a usability score of 72 still indicates acceptable usability for the third module. We identified 24 issues that serve as starting points for further development. Our method proved to be effective and efficient in terms of effort and outcome. It can be adapted to evaluate apps within the medical informatics field and potentially beyond. UR - https://medinform.jmir.org/2021/11/e30308 UR - http://dx.doi.org/10.2196/30308 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847059 ID - info:doi/10.2196/30308 ER - TY - JOUR AU - Rauwerdink, Anneloek AU - Kasteleyn, J. Marise AU - Chavannes, H. Niels AU - Schijven, P. Marlies PY - 2021/11/25 TI - Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study JO - J Med Internet Res SP - e25170 VL - 23 IS - 11 KW - CSIRO framework KW - evaluation strategy KW - eHealth KW - telemedicine KW - qualitative research KW - formative evaluation KW - digital health N2 - Background: A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. Objective: The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. Methods: To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. Results: The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects? progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. Conclusions: The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects? progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. International Registered Report Identifier (IRRID): RR2-10.1016/j.ceh.2020.12.002 UR - https://www.jmir.org/2021/11/e25170 UR - http://dx.doi.org/10.2196/25170 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842536 ID - info:doi/10.2196/25170 ER - TY - JOUR AU - Pankhurst, Tanya AU - Evison, Felicity AU - Atia, Jolene AU - Gallier, Suzy AU - Coleman, Jamie AU - Ball, Simon AU - McKee, Deborah AU - Ryan, Steven AU - Black, Ruth PY - 2021/11/23 TI - Introduction of Systematized Nomenclature of Medicine?Clinical Terms Coding Into an Electronic Health Record and Evaluation of its Impact: Qualitative and Quantitative Study JO - JMIR Med Inform SP - e29532 VL - 9 IS - 11 KW - coding standards KW - clinical decision support KW - Clinician led design KW - clinician reported experience KW - clinical usability KW - data sharing KW - diagnoses KW - electronic health records KW - electronic health record standards KW - health data exchange KW - health data research KW - International Classification of Diseases version 10 (ICD-10) KW - National Health Service Blueprint KW - patient diagnoses KW - population health KW - problem list KW - research KW - Systematized Nomenclature Of Medicine?Clinical Terms (SNOMED-CT) KW - use of electronic health data KW - user-led design N2 - Background: This study describes the conversion within an existing electronic health record (EHR) from the International Classification of Diseases, Tenth Revision coding system to the SNOMED-CT (Systematized Nomenclature of Medicine?Clinical Terms) for the collection of patient histories and diagnoses. The setting is a large acute hospital that is designing and building its own EHR. Well-designed EHRs create opportunities for continuous data collection, which can be used in clinical decision support rules to drive patient safety. Collected data can be exchanged across health care systems to support patients in all health care settings. Data can be used for research to prevent diseases and protect future populations. Objective: The aim of this study was to migrate a current EHR, with all relevant patient data, to the SNOMED-CT coding system to optimize clinical use and clinical decision support, facilitate data sharing across organizational boundaries for national programs, and enable remodeling of medical pathways. Methods: The study used qualitative and quantitative data to understand the successes and gaps in the project, clinician attitudes toward the new tool, and the future use of the tool. Results: The new coding system (tool) was well received and immediately widely used in all specialties. This resulted in increased, accurate, and clinically relevant data collection. Clinicians appreciated the increased depth and detail of the new coding, welcomed the potential for both data sharing and research, and provided extensive feedback for further development. Conclusions: Successful implementation of the new system aligned the University Hospitals Birmingham NHS Foundation Trust with national strategy and can be used as a blueprint for similar projects in other health care settings. UR - https://medinform.jmir.org/2021/11/e29532 UR - http://dx.doi.org/10.2196/29532 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817387 ID - info:doi/10.2196/29532 ER - TY - JOUR AU - Greulich, Leonard AU - Hegselmann, Stefan AU - Dugas, Martin PY - 2021/11/19 TI - An Open-Source, Standard-Compliant, and Mobile Electronic Data Capture System for Medical Research (OpenEDC): Design and Evaluation Study JO - JMIR Med Inform SP - e29176 VL - 9 IS - 11 KW - electronic data capture KW - open science KW - data interoperability KW - metadata reuse KW - mobile health KW - data standard KW - mobile phone N2 - Background: Medical research and machine learning for health care depend on high-quality data. Electronic data capture (EDC) systems have been widely adopted for metadata-driven digital data collection. However, many systems use proprietary and incompatible formats that inhibit clinical data exchange and metadata reuse. In addition, the configuration and financial requirements of typical EDC systems frequently prevent small-scale studies from benefiting from their inherent advantages. Objective: The aim of this study is to develop and publish an open-source EDC system that addresses these issues. We aim to plan a system that is applicable to a wide range of research projects. Methods: We conducted a literature-based requirements analysis to identify the academic and regulatory demands for digital data collection. After designing and implementing OpenEDC, we performed a usability evaluation to obtain feedback from users. Results: We identified 20 frequently stated requirements for EDC. According to the International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 25010 norm, we categorized the requirements into functional suitability, availability, compatibility, usability, and security. We developed OpenEDC based on the regulatory-compliant Clinical Data Interchange Standards Consortium Operational Data Model (CDISC ODM) standard. Mobile device support enables the collection of patient-reported outcomes. OpenEDC is publicly available and released under the MIT open-source license. Conclusions: Adopting an established standard without modifications supports metadata reuse and clinical data exchange, but it limits item layouts. OpenEDC is a stand-alone web app that can be used without a setup or configuration. This should foster compatibility between medical research and open science. OpenEDC is targeted at observational and translational research studies by clinicians. UR - https://medinform.jmir.org/2021/11/e29176 UR - http://dx.doi.org/10.2196/29176 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806987 ID - info:doi/10.2196/29176 ER - TY - JOUR AU - Shah, Surbhi AU - Switzer, Sean AU - Shippee, D. Nathan AU - Wogensen, Pamela AU - Kosednar, Kathryn AU - Jones, Emma AU - Pestka, L. Deborah AU - Badlani, Sameer AU - Butler, Mary AU - Wagner, Brittin AU - White, Katie AU - Rhein, Joshua AU - Benson, Bradley AU - Reding, Mark AU - Usher, Michael AU - Melton, B. Genevieve AU - Tignanelli, James Christopher PY - 2021/11/18 TI - Implementation of an Anticoagulation Practice Guideline for COVID-19 via a Clinical Decision Support System in a Large Academic Health System and Its Evaluation: Observational Study JO - JMIR Med Inform SP - e30743 VL - 9 IS - 11 KW - COVID-19 KW - anticoagulation KW - clinical practice guideline KW - evidence-based practice KW - clinical decision support KW - implementation science KW - RE-AIM N2 - Background: Studies evaluating strategies for the rapid development, implementation, and evaluation of clinical decision support (CDS) systems supporting guidelines for diseases with a poor knowledge base, such as COVID-19, are limited. Objective: We developed an anticoagulation clinical practice guideline (CPG) for COVID-19, which was delivered and scaled via CDS across a 12-hospital Midwest health care system. This study represents a preplanned 6-month postimplementation evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Methods: The implementation outcomes evaluated were reach, adoption, implementation, and maintenance. To evaluate effectiveness, the association of CPG adherence on hospital admission with clinical outcomes was assessed via multivariable logistic regression and nearest neighbor propensity score matching. A time-to-event analysis was conducted. Sensitivity analyses were also conducted to evaluate the competing risk of death prior to intensive care unit (ICU) admission. The models were risk adjusted to account for age, gender, race/ethnicity, non-English speaking status, area deprivation index, month of admission, remdesivir treatment, tocilizumab treatment, steroid treatment, BMI, Elixhauser comorbidity index, oxygen saturation/fraction of inspired oxygen ratio, systolic blood pressure, respiratory rate, treating hospital, and source of admission. A preplanned subgroup analysis was also conducted in patients who had laboratory values (D-dimer, C-reactive protein, creatinine, and absolute neutrophil to absolute lymphocyte ratio) present. The primary effectiveness endpoint was the need for ICU admission within 48 hours of hospital admission. Results: A total of 2503 patients were included in this study. CDS reach approached 95% during implementation. Adherence achieved a peak of 72% during implementation. Variation was noted in adoption across sites and nursing units. Adoption was the highest at hospitals that were specifically transformed to only provide care to patients with COVID-19 (COVID-19 cohorted hospitals; 74%-82%) and the lowest in academic settings (47%-55%). CPG delivery via the CDS system was associated with improved adherence (odds ratio [OR] 1.43, 95% CI 1.2-1.7; P<.001). Adherence with the anticoagulation CPG was associated with a significant reduction in the need for ICU admission within 48 hours (OR 0.39, 95% CI 0.30-0.51; P<.001) on multivariable logistic regression analysis. Similar findings were noted following 1:1 propensity score matching for patients who received adherent versus nonadherent care (21.5% vs 34.3% incidence of ICU admission within 48 hours; log-rank test P<.001). Conclusions: Our institutional experience demonstrated that adherence with the institutional CPG delivered via the CDS system resulted in improved clinical outcomes for patients with COVID-19. CDS systems are an effective means to rapidly scale a CPG across a heterogeneous health care system. Further research is needed to investigate factors associated with adherence at low and high adopting sites and nursing units. UR - https://medinform.jmir.org/2021/11/e30743 UR - http://dx.doi.org/10.2196/30743 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550900 ID - info:doi/10.2196/30743 ER - TY - JOUR AU - Abdullahi Yari, Imrana AU - Dehling, Tobias AU - Kluge, Felix AU - Geck, Juergen AU - Sunyaev, Ali AU - Eskofier, Bjoern PY - 2021/11/15 TI - Security Engineering of Patient-Centered Health Care Information Systems in Peer-to-Peer Environments: Systematic Review JO - J Med Internet Res SP - e24460 VL - 23 IS - 11 KW - patient-centered KW - health care KW - information infrastructures KW - decentralization KW - mobile health KW - peer-to-peer KW - COVID-19 proximity trackers KW - edge computing KW - security KW - vulnerabilities KW - attacks KW - threats KW - mobile phone N2 - Background: Patient-centered health care information systems (PHSs) enable patients to take control and become knowledgeable about their own health, preferably in a secure environment. Current and emerging PHSs use either a centralized database, peer-to-peer (P2P) technology, or distributed ledger technology for PHS deployment. The evolving COVID-19 decentralized Bluetooth-based tracing systems are examples of disease-centric P2P PHSs. Although using P2P technology for the provision of PHSs can be flexible, scalable, resilient to a single point of failure, and inexpensive for patients, the use of health information on P2P networks poses major security issues as users must manage information security largely by themselves. Objective: This study aims to identify the inherent security issues for PHS deployment in P2P networks and how they can be overcome. In addition, this study reviews different P2P architectures and proposes a suitable architecture for P2P PHS deployment. Methods: A systematic literature review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Thematic analysis was used for data analysis. We searched the following databases: IEEE Digital Library, PubMed, Science Direct, ACM Digital Library, Scopus, and Semantic Scholar. The search was conducted on articles published between 2008 and 2020. The Common Vulnerability Scoring System was used as a guide for rating security issues. Results: Our findings are consolidated into 8 key security issues associated with PHS implementation and deployment on P2P networks and 7 factors promoting them. Moreover, we propose a suitable architecture for P2P PHSs and guidelines for the provision of PHSs while maintaining information security. Conclusions: Despite the clear advantages of P2P PHSs, the absence of centralized controls and inconsistent views of the network on some P2P systems have profound adverse impacts in terms of security. The security issues identified in this study need to be addressed to increase patients? intention to use PHSs on P2P networks by making them safe to use. UR - https://www.jmir.org/2021/11/e24460 UR - http://dx.doi.org/10.2196/24460 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779788 ID - info:doi/10.2196/24460 ER - TY - JOUR AU - Lang, Michael AU - Lemieux, Sébastien AU - Hébert, Josée AU - Sauvageau, Guy AU - Zawati, H. Ma'n PY - 2021/11/11 TI - Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review JO - J Med Internet Res SP - e26450 VL - 23 IS - 11 KW - medical ethics KW - web portal KW - scoping review KW - eHealth KW - portal N2 - Background: This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. Objective: This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. Methods: This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O?Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. Results: We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. Conclusions: We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care. UR - https://www.jmir.org/2021/11/e26450 UR - http://dx.doi.org/10.2196/26450 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762055 ID - info:doi/10.2196/26450 ER - TY - JOUR AU - Sääskilahti, Maria AU - Ojanen, Anna AU - Ahonen, Riitta AU - Timonen, Johanna PY - 2021/11/3 TI - Benefits, Problems, and Potential Improvements in a Nationwide Patient Portal: Cross-sectional Survey of Pharmacy Customers? Experiences JO - J Med Internet Res SP - e31483 VL - 23 IS - 11 KW - benefit KW - problem KW - improvement need KW - patient portal KW - patient engagement KW - experience KW - survey N2 - Background: Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients? knowledge about their health and care and therefore enhance patient engagement. Portal users? experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. Objective: The aim of this study is to analyze pharmacy customers? experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. Methods: A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ?18 years who were purchasing prescription medicines for themselves or their children aged <18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. Results: Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). Conclusions: Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement. UR - https://www.jmir.org/2021/11/e31483 UR - http://dx.doi.org/10.2196/31483 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730542 ID - info:doi/10.2196/31483 ER - TY - JOUR AU - Fatoum, Hanaa AU - Hanna, Sam AU - Halamka, D. John AU - Sicker, C. Douglas AU - Spangenberg, Peter AU - Hashmi, K. Shahrukh PY - 2021/11/2 TI - Blockchain Integration With Digital Technology and the Future of Health Care Ecosystems: Systematic Review JO - J Med Internet Res SP - e19846 VL - 23 IS - 11 KW - blockchain, Internet of Things KW - digital KW - artificial intelligence KW - machine learning KW - eHealth KW - ledger KW - distributed ledger technology N2 - Background: In the era of big data, artificial intelligence (AI), and the Internet of Things (IoT), digital data have become essential for our everyday functioning and in health care services. The sensitive nature of health care data presents several crucial issues such as privacy, security, interoperability, and reliability that must be addressed in any health care data management system. However, most of the current health care systems are still facing major obstacles and are lacking in some of these areas. This is where decentralized, secure, and scalable databases, most notably blockchains, play critical roles in addressing these requirements without compromising security, thereby attracting considerable interest within the health care community. A blockchain can be maintained and widely distributed using a large network of nodes, mostly computers, each of which stores a full replica of the data. A blockchain protocol is a set of predefined rules or procedures that govern how the nodes interact with the network, view, verify, and add data to the ledger. Objective: In this article, we aim to explore blockchain technology, its framework, current applications, and integration with other innovations, as well as opportunities in diverse areas of health care and clinical research, in addition to clarifying its future impact on the health care ecosystem. We also elucidate 2 case studies to instantiate the potential role of blockchains in health care. Methods: To identify related existing work, terms based on Medical Subject Headings were used. We included studies focusing mainly on health care and clinical research and developed a functional framework for implementation and testing with data. The literature sources for this systematic review were PubMed, Medline, and the Cochrane library, in addition to a preliminary search of IEEE Xplore. Results: The included studies demonstrated multiple framework designs and various implementations in health care including chronic disease diagnosis, management, monitoring, and evaluation. We found that blockchains exhibit many promising applications in clinical trial management such as smart-contract application, participant-controlled data access, trustless protocols, and data validity. Electronic health records (EHRs), patient-centered interoperability, remote patient monitoring, and clinical trial data management were found to be major areas for blockchain usage, which can become a key catalyst for health care innovations. Conclusions: The potential benefits of blockchains are limitless; however, concrete data on long-term clinical outcomes based on blockchains powered and supplemented by AI and IoT are yet to be obtained. Nonetheless, implementing blockchains as a novel way to integrate EHRs nationwide and manage common clinical problems in an algorithmic fashion has the potential for improving patient outcomes, health care experiences, as well as the overall health and well-being of individuals. UR - https://www.jmir.org/2021/11/e19846 UR - http://dx.doi.org/10.2196/19846 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726603 ID - info:doi/10.2196/19846 ER - TY - JOUR AU - Nunes Vilaza, Giovanna AU - Coyle, David AU - Bardram, Eyvind Jakob PY - 2021/10/29 TI - Public Attitudes to Digital Health Research Repositories: Cross-sectional International Survey JO - J Med Internet Res SP - e31294 VL - 23 IS - 10 KW - digital medicine KW - health informatics KW - health data repositories KW - personal sensing KW - technology acceptance KW - willingness to share data KW - human-centered computing KW - ethics N2 - Background: Digital health research repositories propose sharing longitudinal streams of health records and personal sensing data between multiple projects and researchers. Motivated by the prospect of personalizing patient care (precision medicine), these initiatives demand broad public acceptance and large numbers of data contributors, both of which are challenging. Objective: This study investigates public attitudes toward possibly contributing to digital health research repositories to identify factors for their acceptance and to inform future developments. Methods: A cross-sectional online survey was conducted from March 2020 to December 2020. Because of the funded project scope and a multicenter collaboration, study recruitment targeted young adults in Denmark and Brazil, allowing an analysis of the differences between 2 very contrasting national contexts. Through closed-ended questions, the survey examined participants? willingness to share different data types, data access preferences, reasons for concern, and motivations to contribute. The survey also collected information about participants? demographics, level of interest in health topics, previous participation in health research, awareness of examples of existing research data repositories, and current attitudes about digital health research repositories. Data analysis consisted of descriptive frequency measures and statistical inferences (bivariate associations and logistic regressions). Results: The sample comprises 1017 respondents living in Brazil (1017/1600, 63.56%) and 583 in Denmark (583/1600, 36.44%). The demographics do not differ substantially between participants of these countries. The majority is aged between 18 and 27 years (933/1600, 58.31%), is highly educated (992/1600, 62.00%), uses smartphones (1562/1600, 97.63%), and is in good health (1407/1600, 87.94%). The analysis shows a vast majority were very motivated by helping future patients (1366/1600, 85.38%) and researchers (1253/1600, 78.31%), yet very concerned about unethical projects (1219/1600, 76.19%), profit making without consent (1096/1600, 68.50%), and cyberattacks (1055/1600, 65.94%). Participants? willingness to share data is lower when sharing personal sensing data, such as the content of calls and texts (1206/1600, 75.38%), in contrast to more traditional health research information. Only 13.44% (215/1600) find it desirable to grant data access to private companies, and most would like to stay informed about which projects use their data (1334/1600, 83.38%) and control future data access (1181/1600, 73.81%). Findings indicate that favorable attitudes toward digital health research repositories are related to a personal interest in health topics (odds ratio [OR] 1.49, 95% CI 1.10-2.02; P=.01), previous participation in health research studies (OR 1.70, 95% CI 1.24-2.35; P=.001), and awareness of examples of research repositories (OR 2.78, 95% CI 1.83-4.38; P<.001). Conclusions: This study reveals essential factors for acceptance and willingness to share personal data with digital health research repositories. Implications include the importance of being more transparent about the goals and beneficiaries of research projects using and re-using data from repositories, providing participants with greater autonomy for choosing who gets access to which parts of their data, and raising public awareness of the benefits of data sharing for research. In addition, future developments should engage with and reduce risks for those unwilling to participate. UR - https://www.jmir.org/2021/10/e31294 UR - http://dx.doi.org/10.2196/31294 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714253 ID - info:doi/10.2196/31294 ER - TY - JOUR AU - Xie, Yi AU - Zhang, Jiayao AU - Wang, Honglin AU - Liu, Pengran AU - Liu, Songxiang AU - Huo, Tongtong AU - Duan, Yu-Yu AU - Dong, Zhe AU - Lu, Lin AU - Ye, Zhewei PY - 2021/10/28 TI - Applications of Blockchain in the Medical Field: Narrative Review JO - J Med Internet Res SP - e28613 VL - 23 IS - 10 KW - blockchain KW - smart health care KW - health care KW - health data KW - review KW - COVID-19 KW - electronic health records N2 - Background: As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice. Objective: This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed. Methods: We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology. Results: We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy. Conclusions: Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility. UR - https://www.jmir.org/2021/10/e28613 UR - http://dx.doi.org/10.2196/28613 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533470 ID - info:doi/10.2196/28613 ER - TY - JOUR AU - Yousef, Cheriece Consuela AU - Salgado, M. Teresa AU - Farooq, Ali AU - Burnett, Keisha AU - McClelland, E. Laura AU - Abu Esba, Carolina Laila AU - Alhamdan, Solaiman Hani AU - Khoshhal, Sahal AU - Aldossary, Fahad Ibrahim AU - Alyas, Anwar Omar AU - DeShazo, P. Jonathan PY - 2021/10/21 TI - Health Care Providers? Acceptance of a Personal Health Record: Cross-sectional Study JO - J Med Internet Res SP - e31582 VL - 23 IS - 10 KW - personal health records KW - patient portals KW - Ministry of National Guard Health Affairs KW - UTAUT KW - eHealth KW - Middle East N2 - Background: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs? acceptance of PHRs in the Kingdom of Saudi Arabia. Objective: The aim of this study was to identify predictors of HCPs? acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. Methods: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. Results: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (?=.17, P=.03) and attitude (?=.61, P<.01). No moderating effects were present. Conclusions: This study identified performance expectancy and attitude as predictors of HCPs? behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors. UR - https://www.jmir.org/2021/10/e31582 UR - http://dx.doi.org/10.2196/31582 UR - http://www.ncbi.nlm.nih.gov/pubmed/34569943 ID - info:doi/10.2196/31582 ER - TY - JOUR AU - Li, Mengyang AU - Cai, Hailing AU - Nan, Shan AU - Li, Jialin AU - Lu, Xudong AU - Duan, Huilong PY - 2021/10/21 TI - A Patient-Screening Tool for Clinical Research Based on Electronic Health Records Using OpenEHR: Development Study JO - JMIR Med Inform SP - e33192 VL - 9 IS - 10 KW - openEHR KW - patient screening KW - electronic health record KW - clinical research N2 - Background: The widespread adoption of electronic health records (EHRs) has facilitated the secondary use of EHR data for clinical research. However, screening eligible patients from EHRs is a challenging task. The concepts in eligibility criteria are not completely matched with EHRs, especially derived concepts. The lack of high-level expression of Structured Query Language (SQL) makes it difficult and time consuming to express them. The openEHR Expression Language (EL) as a domain-specific language based on clinical information models shows promise to represent complex eligibility criteria. Objective: The study aims to develop a patient-screening tool based on EHRs for clinical research using openEHR to solve concept mismatch and improve query performance. Methods: A patient-screening tool based on EHRs using openEHR was proposed. It uses the advantages of information models and EL in openEHR to provide high-level expressions and improve query performance. First, openEHR archetypes and templates were chosen to define concepts called simple concepts directly from EHRs. Second, openEHR EL was used to generate derived concepts by combining simple concepts and constraints. Third, a hierarchical index corresponding to archetypes in Elasticsearch (ES) was generated to improve query performance for subqueries and join queries related to the derived concepts. Finally, we realized a patient-screening tool for clinical research. Results: In total, 500 sentences randomly selected from 4691 eligibility criteria in 389 clinical trials on stroke from the Chinese Clinical Trial Registry (ChiCTR) were evaluated. An openEHR-based clinical data repository (CDR) in a grade A tertiary hospital in China was considered as an experimental environment. Based on these, 589 medical concepts were found in the 500 sentences. Of them, 513 (87.1%) concepts could be represented, while the others could not be, because of a lack of information models and coarse-grained requirements. In addition, our case study on 6 queries demonstrated that our tool shows better query performance among 4 cases (66.67%). Conclusions: We developed a patient-screening tool using openEHR. It not only helps solve concept mismatch but also improves query performance to reduce the burden on researchers. In addition, we demonstrated a promising solution for secondary use of EHR data using openEHR, which can be referenced by other researchers. UR - https://medinform.jmir.org/2021/10/e33192 UR - http://dx.doi.org/10.2196/33192 UR - http://www.ncbi.nlm.nih.gov/pubmed/34673526 ID - info:doi/10.2196/33192 ER - TY - JOUR AU - Luu, S. Hung AU - Filkins, M. Laura AU - Park, Y. Jason AU - Rakheja, Dinesh AU - Tweed, Jefferson AU - Menzies, Christopher AU - Wang, J. Vincent AU - Mittal, Vineeta AU - Lehmann, U. Christoph AU - Sebert, E. Michael PY - 2021/10/18 TI - Harnessing the Electronic Health Record and Computerized Provider Order Entry Data for Resource Management During the COVID-19 Pandemic: Development of a Decision Tree JO - JMIR Med Inform SP - e32303 VL - 9 IS - 10 KW - COVID-19 KW - computerized provider order entry KW - electronic health record KW - resource utilization KW - personal protective equipment KW - SARS-CoV-2 testing KW - clinical decision support N2 - Background: The COVID-19 pandemic has resulted in shortages of diagnostic tests, personal protective equipment, hospital beds, and other critical resources. Objective: We sought to improve the management of scarce resources by leveraging electronic health record (EHR) functionality, computerized provider order entry, clinical decision support (CDS), and data analytics. Methods: Due to the complex eligibility criteria for COVID-19 tests and the EHR implementation?related challenges of ordering these tests, care providers have faced obstacles in selecting the appropriate test modality. As test choice is dependent upon specific patient criteria, we built a decision tree within the EHR to automate the test selection process by using a branching series of questions that linked clinical criteria to the appropriate SARS-CoV-2 test and triggered an EHR flag for patients who met our institutional persons under investigation criteria. Results: The percentage of tests that had to be canceled and reordered due to errors in selecting the correct testing modality was 3.8% (23/608) before CDS implementation and 1% (262/26,643) after CDS implementation (P<.001). Patients for whom multiple tests were ordered during a 24-hour period accounted for 0.8% (5/608) and 0.3% (76/26,643) of pre- and post-CDS implementation orders, respectively (P=.03). Nasopharyngeal molecular assay results were positive in 3.4% (826/24,170) of patients who were classified as asymptomatic and 10.9% (1421/13,074) of symptomatic patients (P<.001). Positive tests were more frequent among asymptomatic patients with a history of exposure to COVID-19 (36/283, 12.7%) than among asymptomatic patients without such a history (790/23,887, 3.3%; P<.001). Conclusions: The leveraging of EHRs and our CDS algorithm resulted in a decreased incidence of order entry errors and the appropriate flagging of persons under investigation. These interventions optimized reagent and personal protective equipment usage. Data regarding symptoms and COVID-19 exposure status that were collected by using the decision tree correlated with the likelihood of positive test results, suggesting that clinicians appropriately used the questions in the decision tree algorithm. UR - https://medinform.jmir.org/2021/10/e32303 UR - http://dx.doi.org/10.2196/32303 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546942 ID - info:doi/10.2196/32303 ER - TY - JOUR AU - Berenspöhler, Sarah AU - Minnerup, Jens AU - Dugas, Martin AU - Varghese, Julian PY - 2021/10/12 TI - Common Data Elements for Meaningful Stroke Documentation in Routine Care and Clinical Research: Retrospective Data Analysis JO - JMIR Med Inform SP - e27396 VL - 9 IS - 10 KW - common data elements KW - stroke KW - documentation N2 - Background: Medical information management for stroke patients is currently a very time-consuming endeavor. There are clear guidelines and procedures to treat patients having acute stroke, but it is not known how well these established practices are reflected in patient documentation. Objective: This study compares a variety of documentation processes regarding stroke. The main objective of this work is to provide an overview of the most commonly occurring medical concepts in stroke documentation and identify overlaps between different documentation contexts to allow for the definition of a core data set that could be used in potential data interfaces. Methods: Medical source documentation forms from different documentation contexts, including hospitals, clinical trials, registries, and international standards, regarding stroke treatment followed by rehabilitation were digitized in the operational data model. Each source data element was semantically annotated using the Unified Medical Language System. The concept codes were analyzed for semantic overlaps. A concept was considered common if it appeared in at least two documentation contexts. The resulting common concepts were extended with implementation details, including data types and permissible values based on frequent patterns of source data elements, using an established expert-based and semiautomatic approach. Results: In total, 3287 data elements were identified, and 1051 of these emerged as unique medical concepts. The 100 most frequent medical concepts cover 9.51% (100/1051) of all concept occurrences in stroke documentation, and the 50 most frequent concepts cover 4.75% (50/1051). A list of common data elements was implemented in different standardized machine-readable formats on a public metadata repository for interoperable reuse. Conclusions: Standardization of medical documentation is a prerequisite for data exchange as well as the transferability and reuse of data. In the long run, standardization would save time and money and extend the capabilities for which such data could be used. In the context of this work, a lack of standardization was observed regarding current information management. Free-form text fields and intricate questions complicate automated data access and transfer between institutions. This work also revealed the potential of a unified documentation process as a core data set of the 50 most frequent common data elements, accounting for 34% of the documentation in medical information management. Such a data set offers a starting point for standardized and interoperable data collection in routine care, quality management, and clinical research. UR - https://medinform.jmir.org/2021/10/e27396 UR - http://dx.doi.org/10.2196/27396 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636733 ID - info:doi/10.2196/27396 ER - TY - JOUR AU - Jo, Youngji AU - Barthel, Nathan AU - Stierman, Elizabeth AU - Clifton, Kathryn AU - Pak, Semee Esther AU - Ezeiru, Sonachi AU - Ekweremadu, Diwe AU - Onugu, Nnaemeka AU - Ali, Zainab AU - Egwu, Elijah AU - Akoh, Ochayi AU - Uzunyayla, Orkan AU - Van Hulle, Suzanne PY - 2021/10/8 TI - The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study JO - JMIR Form Res SP - e23648 VL - 5 IS - 10 KW - long-lasting insecticide-treated nets KW - malaria KW - Nigeria KW - information communication technology KW - geographic information system KW - supply chain management N2 - Background: Nigeria has the world?s largest malaria burden, accounting for 27% of the world?s malaria cases and 23% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria. Objective: This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues. Methods: Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)?based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system. Results: The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days. Conclusions: The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system. UR - https://formative.jmir.org/2021/10/e23648 UR - http://dx.doi.org/10.2196/23648 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623310 ID - info:doi/10.2196/23648 ER - TY - JOUR AU - Wiljer, David AU - Salhia, Mohammad AU - Dolatabadi, Elham AU - Dhalla, Azra AU - Gillan, Caitlin AU - Al-Mouaswas, Dalia AU - Jackson, Ethan AU - Waldorf, Jacqueline AU - Mattson, Jane AU - Clare, Megan AU - Lalani, Nadim AU - Charow, Rebecca AU - Balakumar, Sarmini AU - Younus, Sarah AU - Jeyakumar, Tharshini AU - Peteanu, Wanda AU - Tavares, Walter PY - 2021/10/6 TI - Accelerating the Appropriate Adoption of Artificial Intelligence in Health Care: Protocol for a Multistepped Approach JO - JMIR Res Protoc SP - e30940 VL - 10 IS - 10 KW - artificial intelligence KW - health care providers KW - education KW - learning KW - patient care KW - adoption KW - mHealth N2 - Background: Significant investments and advances in health care technologies and practices have created a need for digital and data-literate health care providers. Artificial intelligence (AI) algorithms transform the analysis, diagnosis, and treatment of medical conditions. Complex and massive data sets are informing significant health care decisions and clinical practices. The ability to read, manage, and interpret large data sets to provide data-driven care and to protect patient privacy are increasingly critical skills for today?s health care providers. Objective: The aim of this study is to accelerate the appropriate adoption of data-driven and AI-enhanced care by focusing on the mindsets, skillsets, and toolsets of point-of-care health providers and their leaders in the health system. Methods: To accelerate the adoption of AI and the need for organizational change at a national level, our multistepped approach includes creating awareness and capacity building, learning through innovation and adoption, developing appropriate and strategic partnerships, and building effective knowledge exchange initiatives. Education interventions designed to adapt knowledge to the local context and address any challenges to knowledge use include engagement activities to increase awareness, educational curricula for health care providers and leaders, and the development of a coaching and practice-based innovation hub. Framed by the Knowledge-to-Action framework, we are currently in the knowledge creation stage to inform the curricula for each deliverable. An environmental scan and scoping review were conducted to understand the current state of AI education programs as reported in the academic literature. Results: The environmental scan identified 24 AI-accredited programs specific to health providers, of which 11 were from the United States, 6 from Canada, 4 from the United Kingdom, and 3 from Asian countries. The most common curriculum topics across the environmental scan and scoping review included AI fundamentals, applications of AI, applied machine learning in health care, ethics, data science, and challenges to and opportunities for using AI. Conclusions: Technologies are advancing more rapidly than organizations, and professionals can adopt and adapt to them. To help shape AI practices, health care providers must have the skills and abilities to initiate change and shape the future of their discipline and practices for advancing high-quality care within the digital ecosystem. International Registered Report Identifier (IRRID): PRR1-10.2196/30940 UR - https://www.researchprotocols.org/2021/10/e30940 UR - http://dx.doi.org/10.2196/30940 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612839 ID - info:doi/10.2196/30940 ER - TY - JOUR AU - Alaqra, Sarah Ala AU - Kane, Bridget AU - Fischer-Hübner, Simone PY - 2021/9/16 TI - Machine Learning?Based Analysis of Encrypted Medical Data in the Cloud: Qualitative Study of Expert Stakeholders? Perspectives JO - JMIR Hum Factors SP - e21810 VL - 8 IS - 3 KW - medical data analysis KW - encryption KW - privacy-enhancing technologies KW - machine learning KW - stakeholders KW - tradeoffs KW - perspectives KW - eHealth KW - interviews N2 - Background: Third-party cloud-based data analysis applications are proliferating in electronic health (eHealth) because of the expertise offered and their monetary advantage. However, privacy and security are critical concerns when handling sensitive medical data in the cloud. Technical advances based on ?crypto magic? in privacy-preserving machine learning (ML) enable data analysis in encrypted form for maintaining confidentiality. Such privacy-enhancing technologies (PETs) could be counterintuitive to relevant stakeholders in eHealth, which could in turn hinder adoption; thus, more attention is needed on human factors for establishing trust and transparency. Objective: The aim of this study was to analyze eHealth expert stakeholders? perspectives and the perceived tradeoffs in regard to data analysis on encrypted medical data in the cloud, and to derive user requirements for development of a privacy-preserving data analysis tool. Methods: We used semistructured interviews and report on 14 interviews with individuals having medical, technical, or research expertise in eHealth. We used thematic analysis for analyzing interview data. In addition, we conducted a workshop for eliciting requirements. Results: Our results show differences in the understanding of and in trusting the technology; caution is advised by technical experts, whereas patient safety assurances are required by medical experts. Themes were identified with general perspectives on data privacy and practices (eg, acceptance of using external services), as well as themes highlighting specific perspectives (eg, data protection drawbacks and concerns of the data analysis on encrypted data). The latter themes result in requiring assurances and conformance testing for trusting tools such as the proposed ML-based tool. Communicating privacy, and utility benefits and tradeoffs with stakeholders is essential for trust. Furthermore, stakeholders and their organizations share accountability of patient data. Finally, stakeholders stressed the importance of informing patients about the privacy of their data. Conclusions: Understanding the benefits and risks of using eHealth PETs is crucial, and collaboration among diverse stakeholders is essential. Assurances of the tool?s privacy, accuracy, and patient safety should be in place for establishing trust of ML-based PETs, especially if used in the cloud. UR - https://humanfactors.jmir.org/2021/3/e21810 UR - http://dx.doi.org/10.2196/21810 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528892 ID - info:doi/10.2196/21810 ER - TY - JOUR AU - Lopez Segui, Francesc AU - Hernandez Guillamet, Guillem AU - Pifarré Arolas, Héctor AU - Marin-Gomez, X. Francesc AU - Ruiz Comellas, Anna AU - Ramirez Morros, Maria Anna AU - Adroher Mas, Cristina AU - Vidal-Alaball, Josep PY - 2021/9/14 TI - Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study JO - J Med Internet Res SP - e29622 VL - 23 IS - 9 KW - COVID-19 KW - primary care KW - diagnose variations KW - big data KW - ICD10 KW - health system KW - healthcare system N2 - Background: The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems?the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. Objective: The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. Methods: We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. Results: The increase in non?face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (?47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: ?32.73%) or diabetes (ICD-10 codes E08-E13: ?21.13%), but also obesity (E65-E68: ?48.58%) and bodily injuries (ICD-10 code T14: ?33.70%). Visits with mental health?related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations?for children, adolescents, and adults?for respiratory infections (ICD-10 codes J00-J06: ?40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. Conclusions: The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non?face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic. UR - https://www.jmir.org/2021/9/e29622 UR - http://dx.doi.org/10.2196/29622 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313600 ID - info:doi/10.2196/29622 ER - TY - JOUR AU - McKillop, Mollie AU - Snowdon, Jane AU - Willis, C. Van AU - Alevy, Shira AU - Rizvi, Rubina AU - Rewalt, Karen AU - Lefebvre-Paillé, Charlyne AU - Kassler, William AU - Purcell Jackson, Gretchen PY - 2021/8/30 TI - A System to Support Diverse Social Program Management JO - JMIR Med Inform SP - e23219 VL - 9 IS - 8 KW - other clinical informatics applications KW - process management tools KW - requirements analysis and design KW - consumer health informatics KW - public health N2 - Background: Social programs are services provided by governments, nonprofits, and other organizations to help improve the health and well-being of individuals, families, and communities. Social programs aim to deliver services effectively and efficiently, but they are challenged by information silos, limited resources, and the need to deliver frequently changing mandated benefits. Objective: We aim to explore how an information system designed for social programs helps deliver services effectively and efficiently across diverse programs. Methods: This viewpoint describes the configurable and modular architecture of Social Program Management (SPM), a system to support efficient and effective delivery of services through a wide range of social programs and lessons learned from implementing SPM across diverse settings. We explored usage data to inform the engagement and impact of SPM on the efficient and effective delivery of services. Results: The features and functionalities of SPM seem to support the goals of social programs. We found that SPM provides fundamental management processes and configurable program-specific components to support social program administration; has been used by more than 280,000 caseworkers serving more than 30 million people in 13 countries; contains features designed to meet specific user requirements; supports secure information sharing and collaboration through data standardization and aggregation; and offers configurability and flexibility, which are important for digital transformation and organizational change. Conclusions: SPM is a user-centered, configurable, and flexible system for managing social program workflows. UR - https://medinform.jmir.org/2021/8/e23219 UR - http://dx.doi.org/10.2196/23219 UR - http://www.ncbi.nlm.nih.gov/pubmed/34459741 ID - info:doi/10.2196/23219 ER - TY - JOUR AU - van Rijt, Mattheus Antonius AU - Hulter, Pauline AU - Weggelaar-Jansen, Marie Anne AU - Ahaus, Kees AU - Pluut, Bettine PY - 2021/8/27 TI - Mental Health Care Professionals? Appraisal of Patients? Use of Web-Based Access to Their Electronic Health Record: Qualitative Study JO - J Med Internet Res SP - e28045 VL - 23 IS - 8 KW - patient portals KW - eHealth KW - mental health care professionals KW - mental health KW - eMental health KW - mental health care KW - patient-accessible KW - electronic health records KW - Open Notes KW - normalization process theory KW - NPT N2 - Background: Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient?s well-being and privacy as well as the professional?s own workload. Objective: This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. Methods: We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. Results: Our study provides insights into mental health care professionals? appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. Conclusions: Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals. UR - https://www.jmir.org/2021/8/e28045 UR - http://dx.doi.org/10.2196/28045 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448705 ID - info:doi/10.2196/28045 ER - TY - JOUR AU - Lyles, Rees Courtney AU - Adler-Milstein, Julia AU - Thao, Crishyashi AU - Lisker, Sarah AU - Nouri, Sarah AU - Sarkar, Urmimala PY - 2021/8/26 TI - Alignment of Key Stakeholders? Priorities for Patient-Facing Tools in Digital Health: Mixed Methods Study JO - J Med Internet Res SP - e24890 VL - 23 IS - 8 KW - medical informatics KW - medical informatics apps KW - information technology KW - implementation science KW - mixed methods N2 - Background: There is widespread agreement on the promise of patient-facing digital health tools to transform health care. Yet, few tools are in widespread use or have documented clinical effectiveness. Objective: The aim of this study was to gain insight into the gap between the potential of patient-facing digital health tools and real-world uptake. Methods: We interviewed and surveyed experts (in total, n=24) across key digital health stakeholder groups?venture capitalists, digital health companies, payers, and health care system providers or leaders?guided by the Consolidated Framework for Implementation Research. Results: Our findings revealed that external policy, regulatory demands, internal organizational workflow, and integration needs often take priority over patient needs and patient preferences for digital health tools, which lowers patient acceptance rates. We discovered alignment, across all 4 stakeholder groups, in the desire to engage both patients and frontline health care providers in broader dissemination and evaluation of digital health tools. However, major areas of misalignment between stakeholder groups have stymied the progress of digital health tool uptake?venture capitalists and companies focused on external policy and regulatory demands, while payers and providers focused on internal organizational workflow and integration needs. Conclusions: Misalignment of the priorities of digital health companies and their funders with those of providers and payers requires direct attention to improve uptake of patient-facing digital health tools and platforms. UR - https://www.jmir.org/2021/8/e24890 UR - http://dx.doi.org/10.2196/24890 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435966 ID - info:doi/10.2196/24890 ER - TY - JOUR AU - Lapão, Velez Luís AU - Peyroteo, Mariana AU - Maia, Melanie AU - Seixas, Jorge AU - Gregório, João AU - Mira da Silva, Miguel AU - Heleno, Bruno AU - Correia, César Jorge PY - 2021/8/26 TI - Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach JO - J Med Internet Res SP - e24181 VL - 23 IS - 8 KW - primary healthcare KW - information systems KW - telemedicine KW - implementation KW - design science research KW - COVID-19 KW - monitoring KW - chronic disease KW - elderly KW - digital health N2 - Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient?s health related outcomes. UR - https://www.jmir.org/2021/8/e24181 UR - http://dx.doi.org/10.2196/24181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313591 ID - info:doi/10.2196/24181 ER - TY - JOUR AU - Tai-Seale, Ming AU - Rosen, Rebecca AU - Ruo, Bernice AU - Hogarth, Michael AU - Longhurst, A. Christopher AU - Lander, Lina AU - Walker, L. Amanda AU - Stults, D. Cheryl AU - Chan, Albert AU - Mazor, Kathleen AU - Garber, Lawrence AU - Millen, Marlene PY - 2021/8/26 TI - Implementation of Patient Engagement Tools in Electronic Health Records to Enhance Patient-Centered Communication: Protocol for Feasibility Evaluation and Preliminary Results JO - JMIR Res Protoc SP - e30431 VL - 10 IS - 8 KW - electronic health record KW - patient portal KW - patient?physician communication KW - agenda setting KW - patient priorities KW - patient engagement KW - health care teams KW - electronic health record documentation KW - standard work KW - digital health N2 - Background: Patient?physician communication during clinical encounters is essential to ensure quality of care. Many studies have attempted to improve patient?physician communication. Incorporating patient priorities into agenda setting and medical decision-making are fundamental to patient-centered communication. Efficient and scalable approaches are needed to empower patients to speak up and prepare physicians to respond. Leveraging electronic health records (EHRs) in engaging patients and health care teams has the potential to enhance the integration of patient priorities in clinical encounters. A systematic approach to eliciting and documenting patient priorities before encounters could facilitate effective communication in such encounters. Objective: In this paper, we report the design and implementation of a set of EHR tools built into clinical workflows for facilitating patient?physician joint agenda setting and the documentation of patient concerns in the EHRs for ambulatory encounters. Methods: We engaged health information technology leaders and users in three health care systems for developing and implementing a set of EHR tools. The goal of these tools is to standardize the elicitation of patient priorities by using a previsit ?patient important issue? questionnaire distributed through the patient portal to the EHR. We built additional EHR documentation tools to facilitate patient?staff communication when the staff records the vital signs and the reason for the visit in the EHR while in the examination room, with a simple transmission method for physicians to incorporate patient concerns in EHR notes. Results: The study is ongoing. The anticipated completion date for survey data collection is November 2021. A total of 34,037 primary care patients from three health systems (n=26,441; n=5136; and n=2460 separately recruited from each system) used the previsit patient important issue questionnaire in 2020. The adoption of the digital previsit questionnaire during the COVID-19 pandemic was much higher in one health care system because it expanded the use of the questionnaire from physicians participating in trials to all primary care providers midway through the year. It also required the use of this previsit questionnaire for eCheck-ins, which are required for telehealth encounters. Physicians and staff suggested anecdotally that this questionnaire helped patient?clinician communication, particularly during the COVID-19 pandemic. Conclusions: EHR tools have the potential to facilitate the integration of patient priorities into agenda setting and documentation in real-world primary care practices. Early results suggest the feasibility and acceptability of such digital tools in three health systems. EHR tools can support patient engagement and clinicians? work during in-person and telehealth visits. They could potentially exert a sustained influence on patient and clinician communication behaviors in contrast to prior ad hoc educational efforts targeting patients or clinicians. Trial Registration: ClinicalTrials.gov NCT03385512; https://clinicaltrials.gov/ct2/show/NCT03385512 International Registered Report Identifier (IRRID): DERR1-10.2196/30431 UR - https://www.researchprotocols.org/2021/8/e30431 UR - http://dx.doi.org/10.2196/30431 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435960 ID - info:doi/10.2196/30431 ER - TY - JOUR AU - Neves, Luísa Ana AU - Li, Edmond AU - Serafini, Alice AU - Jimenez, Geronimo AU - Lingner, Heidrun AU - Koskela, H. Tuomas AU - Hoffman, D. Robert AU - Collins, Claire AU - Petek, Davorina AU - Claveria, Ana AU - Tsopra, Rosy AU - Irving, Greg AU - Gusso, Gustavo AU - O?Neill, Gregory Braden AU - Hoedebecke, Kyle AU - Espitia, Milena Sandra AU - Ungan, Mehmet AU - Nessler, Katarzyna AU - Lazic, Vanja AU - Laranjo, Liliana AU - Memarian, Ensieh AU - Fernandez, Jose Maria AU - Ghafur, Saira AU - Fontana, Gianluca AU - Majeed, Azeem AU - Car, Josip AU - Darzi, Ara PY - 2021/8/26 TI - Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study JO - JMIR Res Protoc SP - e30099 VL - 10 IS - 8 KW - primary care KW - telemedicine KW - virtual care KW - digital-first models KW - quality of care KW - patient safety N2 - Background: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. Objective: This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. Methods: This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers? personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants? characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. Results: Data collection took place from June 2020 to September 2020. As of this manuscript?s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. Conclusions: The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. International Registered Report Identifier (IRRID): DERR1-10.2196/30099 UR - https://www.researchprotocols.org/2021/8/e30099 UR - http://dx.doi.org/10.2196/30099 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292867 ID - info:doi/10.2196/30099 ER - TY - JOUR AU - Koshechkin, Konstantin AU - Lebedev, Georgy AU - Radzievsky, George AU - Seepold, Ralf AU - Martinez, Madrid Natividad PY - 2021/8/18 TI - Blockchain Technology Projects to Provide Telemedical Services: Systematic Review JO - J Med Internet Res SP - e17475 VL - 23 IS - 8 KW - telemedicine KW - distributed ledger KW - health information exchange KW - blockchain N2 - Background: One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment. Objective: This paper aims to review the feasibility of blockchain technology for telemedicine. Methods: The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex). Results: Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%). Conclusions: These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains. UR - https://www.jmir.org/2021/8/e17475 UR - http://dx.doi.org/10.2196/17475 UR - http://www.ncbi.nlm.nih.gov/pubmed/34407924 ID - info:doi/10.2196/17475 ER - TY - JOUR AU - Khuntia, Jiban AU - Ning, Xue AU - Stacey, Rulon PY - 2021/8/16 TI - Digital Orientation of Health Systems in the Post?COVID-19 ?New Normal? in the United States: Cross-sectional Survey JO - J Med Internet Res SP - e30453 VL - 23 IS - 8 KW - post?COVID-19 KW - digital orientation KW - health systems KW - digital transformation KW - digital health KW - telehealth KW - telemedicine KW - COVID-19 KW - impact KW - insight KW - cross-sectional KW - survey KW - United States KW - electronic health record KW - EHR N2 - Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems? abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post?COVID-19 ?new normal? in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation?oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems? digital orientation, whereas the latter two will prepare for future disruptions. Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption. Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations. Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern. UR - https://www.jmir.org/2021/8/e30453 UR - http://dx.doi.org/10.2196/30453 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254947 ID - info:doi/10.2196/30453 ER - TY - JOUR AU - Park, Sang Hyun AU - Kim, Il Kwang AU - Chung, Ho-Young AU - Jeong, Sungmoon AU - Soh, Young Jae AU - Hyun, Ho Young AU - Kim, Sun Hwa PY - 2021/8/4 TI - A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study JO - JMIR Med Inform SP - e29184 VL - 9 IS - 8 KW - personal health record app KW - workplace health promotion KW - Fast Healthcare Interoperability Resources KW - national health care data set KW - human-centered design N2 - Background: Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers? health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user?s perspective in their design. Objective: Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods: This study considered the user?s perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers? PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine?Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers? health information scattered across different Korean institutions through an interface method, and workers? PHRs were managed through a cloud server, using Azure API for FHIR. Results: In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions: The worker-centered PHR app integrates workers? health information from different institutions and provides a variety of health care services from linked institutions through workers? shared PHR. This app is expected to increase workers? autonomy over their health information and support medical personnel?s decision making regarding workers? health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user?s perspective, satisfies the prerequisites for its utilization in occupational health. UR - https://medinform.jmir.org/2021/8/e29184 UR - http://dx.doi.org/10.2196/29184 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346894 ID - info:doi/10.2196/29184 ER - TY - JOUR AU - Li, Rui AU - Niu, Yue AU - Scott, Robbins Sarah AU - Zhou, Chu AU - Lan, Lan AU - Liang, Zhigang AU - Li, Jia PY - 2021/8/3 TI - Using Electronic Medical Record Data for Research in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 Hospital in Beijing: Cross-sectional Study JO - JMIR Med Inform SP - e24405 VL - 9 IS - 8 KW - electronic medical records KW - data utilization KW - medical research KW - China N2 - Background: With the proliferation of electronic medical record (EMR) systems, there is an increasing interest in utilizing EMR data for medical research; yet, there is no quantitative research on EMR data utilization for medical research purposes in China. Objective: This study aimed to understand how and to what extent EMR data are utilized for medical research purposes in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 hospital in Beijing, China. Obstacles and issues in the utilization of EMR data were also explored to provide a foundation for the improved utilization of such data. Methods: For this descriptive cross-sectional study, cluster sampling from Xuanwu Hospital, one of two Stage 7 hospitals in Beijing, was conducted from 2016 to 2019. The utilization of EMR data was described as the number of requests, the proportion of requesters, and the frequency of requests per capita. Comparisons by year, professional title, and age were conducted by double-sided chi-square tests. Results: From 2016 to 2019, EMR data utilization was poor, as the proportion of requesters was 5.8% and the frequency was 0.1 times per person per year. The frequency per capita gradually slowed and older senior-level staff more frequently used EMR data compared with younger staff. Conclusions: The value of using EMR data for research purposes is not well studied in China. More research is needed to quantify to what extent EMR data are utilized across all hospitals in Beijing and how these systems can enhance future studies. The results of this study also suggest that young doctors may be less exposed or have less reason to access such research methods. UR - https://medinform.jmir.org/2021/8/e24405 UR - http://dx.doi.org/10.2196/24405 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342589 ID - info:doi/10.2196/24405 ER - TY - JOUR AU - Ayaz, Muhammad AU - Pasha, F. Muhammad AU - Alzahrani, Y. Mohammed AU - Budiarto, Rahmat AU - Stiawan, Deris PY - 2021/7/30 TI - The Fast Health Interoperability Resources (FHIR) Standard: Systematic Literature Review of Implementations, Applications, Challenges and Opportunities JO - JMIR Med Inform SP - e21929 VL - 9 IS - 7 KW - Fast Health Interoperability Resources KW - FHIR KW - electronic health record KW - EHR KW - clinical document architecture KW - CDA KW - Substitutable Medical Applications Reusable Technologies KW - SMART KW - HL7 KW - health standard KW - systematic literature review N2 - Background: Information technology has shifted paper-based documentation in the health care sector into a digital form, in which patient information is transferred electronically from one place to another. However, there remain challenges and issues to resolve in this domain owing to the lack of proper standards, the growth of new technologies (mobile devices, tablets, ubiquitous computing), and health care providers who are reluctant to share patient information. Therefore, a solid systematic literature review was performed to understand the use of this new technology in the health care sector. To the best of our knowledge, there is a lack of comprehensive systematic literature reviews that focus on Fast Health Interoperability Resources (FHIR)-based electronic health records (EHRs). In addition, FHIR is the latest standard, which is in an infancy stage of development. Therefore, this is a hot research topic with great potential for further research in this domain. Objective: The main aim of this study was to explore and perform a systematic review of the literature related to FHIR, including the challenges, implementation, opportunities, and future FHIR applications. Methods: In January 2020, we searched articles published from January 2012 to December 2019 via all major digital databases in the field of computer science and health care, including ACM, IEEE Explorer, Springer, Google Scholar, PubMed, and ScienceDirect. We identified 8181 scientific articles published in this field, 80 of which met our inclusion criteria for further consideration. Results: The selected 80 scientific articles were reviewed systematically, and we identified open questions, challenges, implementation models, used resources, beneficiary applications, data migration approaches, and goals of FHIR. Conclusions: The literature analysis performed in this systematic review highlights the important role of FHIR in the health care domain in the near future. UR - https://medinform.jmir.org/2021/7/e21929 UR - http://dx.doi.org/10.2196/21929 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328424 ID - info:doi/10.2196/21929 ER - TY - JOUR AU - Broekhuis, Marijke AU - van Velsen, Lex AU - Peute, Linda AU - Halim, Meilani AU - Hermens, Hermie PY - 2021/7/27 TI - Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications JO - JMIR Form Res SP - e18198 VL - 5 IS - 7 KW - usability benchmarking KW - eHealth systems KW - content analysis KW - usability framework KW - summative evaluation KW - mobile phone N2 - Background: Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions. However, most summative usability tests do not consider eHealth-specific factors that could potentially affect the usability of a system. One of the reasons for this is the lack of fine-grained frameworks or models of usability factors that are unique to the eHealth domain. Objective: In this study, we aim to develop an ontology of usability problems, specifically for eHealth applications, with patients as primary end users. Methods: We analyzed 8 data sets containing the results of 8 formative usability tests for eHealth applications. These data sets contained 400 usability problems that could be used for analysis. Both inductive and deductive coding were used to create an ontology from 6 data sets, and 2 data sets were used to validate the framework by assessing the intercoder agreement. Results: We identified 8 main categories of usability factors, including basic system performance, task-technology fit, accessibility, interface design, navigation and structure, information and terminology, guidance and support, and satisfaction. These 8 categories contained a total of 21 factors: 14 general usability factors and 7 eHealth-specific factors. Cohen ? was calculated for 2 data sets on both the category and factor levels, and all Cohen ? values were between 0.62 and 0.67, which is acceptable. Descriptive analysis revealed that approximately 69.5% (278/400) of the usability problems can be considered as general usability factors and 30.5% (122/400) as eHealth-specific usability factors. Conclusions: Our ontology provides a detailed overview of the usability factors for eHealth applications. Current usability benchmarking instruments include only a subset of the factors that emerged from our study and are therefore not fully suited for summative evaluations of eHealth applications. Our findings support the development of new usability benchmarking tools for the eHealth domain. UR - https://formative.jmir.org/2021/7/e18198 UR - http://dx.doi.org/10.2196/18198 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313594 ID - info:doi/10.2196/18198 ER - TY - JOUR AU - Shen, Nelson AU - Jankowicz, Damian AU - Strudwick, Gillian PY - 2021/7/21 TI - Patient and Family Engagement Approaches for Digital Health Initiatives: Protocol for a Case Study JO - JMIR Res Protoc SP - e24274 VL - 10 IS - 7 KW - digital health KW - patient engagement KW - case study KW - patient and family engagement KW - mental health N2 - Background: Digital health initiatives such as patient portals, virtual care platforms, and smartphone-based apps are being implemented at a rapid pace in health care organizations worldwide. This is often done to improve access beyond traditional in-person care and enhance care quality. Recent studies have indicated that better outcomes of using these initiatives and technologies may be achieved when patients and their family members are engaged in all aspects of planning, implementation, use, and evaluation. However, little guidance exists for how health care administrators can achieve effective engagement in digital health initiatives specifically. Objective: The objective of this study is to document processes related to planning and implementing patient and family engagement (PFE) in digital health initiatives. This information will be used to develop tangible resources (eg, a field guide) that other organizations can use to implement PFE approaches for digital health initiatives in their organizations. Methods: A previously developed multidimensional conceptual framework for PFE in health and health care contexts will be used to guide this work. To understand the intricacies involved in using PFE approaches in digital health strategies, a case study will be conducted. More specifically, this work will employ an embedded single-case design with PFE in digital health initiatives at a large Canadian mental health and addictions teaching hospital. Multiple digital health projects being undertaken at the study site will be explored to better understand where the PFE is intended to support the design, implementation, and operation of the digital health platform or technology. These projects will form the individual units of analysis. Data collection will involve field notes and artifact collection by a participant observer and interviews with the various digital health project teams. Data analysis will include a content and thematic analysis, triangulation of the findings, and a chronological mapping of data to a PFE process. Results: Funding for this work was provided by the Canadian Institutes of Health Research (CIHR), via a Health System Impact Fellowship. As of August 2020, digital health projects that will form the case study units have been identified, and the participant observer has started to embed themselves into these projects. Although the development and collection of field notes and artifacts, respectively, have begun, interviews have not been conducted. The study is expected to conclude in September 2021. Once this study is complete, the development of a field guide and resources to support the uptake of PFE strategies in digital health will begin. Conclusions: By better understanding the processes involved in PFE in digital health projects, guidance can be provided to relevant stakeholders and organizations about how to do this work in an effective manner. It is then anticipated that with the increasing use of PFE approaches, there may be improved uptake, experience, and outcomes associated with using digital health technologies. International Registered Report Identifier (IRRID): PRR1-10.2196/24274 UR - https://www.researchprotocols.org/2021/7/e24274 UR - http://dx.doi.org/10.2196/24274 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287212 ID - info:doi/10.2196/24274 ER - TY - JOUR AU - Ahuja, Manik AU - Aseltine Jr, Robert PY - 2021/7/13 TI - Barriers to Dissemination of Local Health Data Faced by US State Agencies: Survey Study of Behavioral Risk Factor Surveillance System Coordinators JO - J Med Internet Res SP - e16750 VL - 23 IS - 7 KW - web-based data query systems, WDQS KW - health data KW - population health KW - dissemination of local health data N2 - Background: Advances in information technology have paved the way to facilitate accessibility to population-level health data through web-based data query systems (WDQSs). Despite these advances in technology, US state agencies face many challenges related to the dissemination of their local health data. It is essential for the public to have access to high-quality data that are easy to interpret, reliable, and trusted. These challenges have been at the forefront throughout the COVID-19 pandemic. Objective: The purpose of this study is to identify the most significant challenges faced by state agencies, from the perspective of the Behavioral Risk Factor Surveillance System (BRFSS) coordinator from each state, and to assess if the coordinators from states with a WDQS perceive these challenges differently. Methods: We surveyed BRFSS coordinators (N=43) across all 50 US states and the District of Columbia. We surveyed the participants about contextual factors and asked them to rate system aspects and challenges they faced with their health data system on a Likert scale. We used two-sample t tests to compare the means of the ratings by participants from states with and without a WDQS. Results: Overall, 41/43 states (95%) make health data available over the internet, while 65% (28/43) employ a WDQS. States with a WDQS reported greater challenges (P=.01) related to the cost of hardware and software (mean score 3.44/4, 95% CI 3.09-3.78) than states without a WDQS (mean score 2.63/4, 95% CI 2.25-3.00). The system aspect of standardization of vocabulary scored more favorably (P=.01) in states with a WDQS (mean score 3.32/5, 95% CI 2.94-3.69) than in states without a WDQS (mean score 2.85/5, 95% CI 2.47-3.22). Conclusions: Securing of adequate resources and commitment to standardization are vital in the dissemination of local-level health data. Factors such as receiving data in a timely manner, privacy, and political opposition are less significant barriers than anticipated. UR - https://www.jmir.org/2021/7/e16750 UR - http://dx.doi.org/10.2196/16750 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255650 ID - info:doi/10.2196/16750 ER - TY - JOUR AU - Cui, Fangfang AU - He, Xianying AU - Zhai, Yunkai AU - Lyu, Minzhao AU - Shi, Jinming AU - Sun, Dongxu AU - Jiang, Shuai AU - Li, Chenchen AU - Zhao, Jie PY - 2021/7/12 TI - Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis JO - J Med Internet Res SP - e28009 VL - 23 IS - 7 KW - telemedicine KW - regional telemedicine service platform KW - remote consultation KW - efficiency KW - satisfaction degree KW - telehealth KW - mobile health KW - mHealth KW - remote KW - China N2 - Background: Telemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field. Objective: Our work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China. Methods: We collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method. Results: The regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness. Conclusions: The development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services. UR - https://www.jmir.org/2021/7/e28009 UR - http://dx.doi.org/10.2196/28009 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255686 ID - info:doi/10.2196/28009 ER - TY - JOUR AU - Rahman, Anisur AU - Friberg, K. Ingrid AU - Dolphyne, Akuba AU - Fjeldheim, Ingvild AU - Khatun, Fatema AU - O'Donnell, Brian AU - Pervin, Jesmin AU - Rahman, Monjur AU - Rahman, Qaiyum A. M. AU - Nu, Tin U. AU - Sarker, Krishna Bidhan AU - Venkateswaran, Mahima AU - Frøen, Frederik J. PY - 2021/7/6 TI - An Electronic Registry for Improving the Quality of Antenatal Care in Rural Bangladesh (eRegMat): Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e26918 VL - 10 IS - 7 KW - quality of care KW - antenatal care KW - maternal and newborn health KW - eHealth KW - digital health interventions KW - eRegistries KW - health information systems KW - Bangladesh N2 - Background: Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization?s guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. Objective: The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. Methods: The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. Results: The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. Conclusions: This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. Trial Registration: ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836 International Registered Report Identifier (IRRID): DERR1-10.2196/26918 UR - https://www.researchprotocols.org/2021/7/e26918 UR - http://dx.doi.org/10.2196/26918 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255723 ID - info:doi/10.2196/26918 ER - TY - JOUR AU - Killian, Daniel AU - Gibson, Emma AU - Kachule, Mphatso AU - Palamountain, Kara AU - Bangoh, Bitilinyu Joseph AU - Deo, Sarang AU - Jonasson, Oddur Jonas PY - 2021/7/6 TI - An Unstructured Supplementary Service Data System for Daily Tracking of Patient Samples and Diagnostic Results in a Diagnostic Network in Malawi: System Development and Field Trial JO - J Med Internet Res SP - e26582 VL - 23 IS - 7 KW - diagnostic networks KW - mobile phone KW - sample transportation KW - sub-Saharan Africa KW - data collection N2 - Background: Diagnostics in many low- and middle-income countries are conducted through centralized laboratory networks. Samples are collected from patients at remote point-of-care health facilities, and diagnostic tests are performed at centralized laboratories. Sample transportation systems that deliver diagnostic samples and test results are crucial for timely diagnosis and treatment in such diagnostic networks. However, they often lack the timely and accurate data (eg, the quantity and location of samples prepared for collection) required for efficient operation. Objective: This study aims to demonstrate the feasibility, adoption, and accuracy of a distributed data collection system that leverages basic mobile phone technology to gather reports on the quantity and location of patient samples and test results prepared for delivery in the diagnostic network of Malawi. Methods: We designed a system that leverages unstructured supplementary service data (USSD) technology to enable health workers to submit daily reports describing the quantity of transportation-ready diagnostic samples and test results at specific health care facilities, free of charge with any mobile phone, and aggregate these data for sample transportation administrators. We then conducted a year-long field trial of this system in 51 health facilities serving 3 districts in Malawi. Between July 2019 and July 2020, the participants submitted daily reports containing the number of patient samples or test results designated for viral load, early infant diagnosis, and tuberculosis testing at each facility. We monitored daily participation and compared the submitted USSD reports with program data to assess system feasibility, adoption, and accuracy. Results: The participating facilities submitted 37,771 reports over the duration of the field trial. Daily facility participation increased from an average of 50% (26/51) in the first 2 weeks of the trial to approximately 80% (41/51) by the midpoint of the trial and remained at or above 80% (41/51) until the conclusion of the trial. On average, more than 80% of the reports submitted by a facility for a specific type of sample matched the actual number of patient samples collected from that facility by a courier. Conclusions: Our findings suggest that a USSD-based system is a feasible, adoptable, and accurate solution to the challenges of untimely, inaccurate, or incomplete data in diagnostic networks. Certain design characteristics of our system, such as the use of USSD, and implementation characteristics, such as the supportive role of the field team, were necessary to ensure high participation and accuracy rates without any explicit financial incentives. UR - https://www.jmir.org/2021/7/e26582 UR - http://dx.doi.org/10.2196/26582 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255690 ID - info:doi/10.2196/26582 ER - TY - JOUR AU - Du, Jian AU - Chen, Ting AU - Zhang, Luxia PY - 2021/7/6 TI - Measuring the Interactions Between Health Demand, Informatics Supply, and Technological Applications in Digital Medical Innovation for China: Content Mapping and Analysis JO - JMIR Med Inform SP - e26393 VL - 9 IS - 7 KW - medical informatics KW - Medical Subject Headings (MeSH) KW - health demand KW - informatics supply KW - technological applications N2 - Background: There were 2 major incentives introduced by the Chinese government to promote medical informatics in 2009 and 2016. As new drugs are the major source of medical innovation, informatics-related concepts and techniques are a major source of digital medical innovation. However, it is unclear whether the research efforts of medical informatics in China have met the health needs, such as disease management and population health. Objective: We proposed an approach to mapping the interplay between different knowledge entities by using the tree structure of Medical Subject Headings (MeSH) to gain insights into the interactions between informatics supply, health demand, and technological applications in digital medical innovation in China. Methods: All terms under the MeSH tree parent node ?Diseases [C]? or node ?Health [N01.400]? or ?Public Health [N06.850]? were labelled as H. All terms under the node ?Information Science [L]? were labelled as I, and all terms under node ?Analytical, Diagnostic and Therapeutic Techniques, and Equipment [E]? were labelled as T. The H-I-T interactions can be measured by using their co-occurrences in a given publication. Results: The H-I-T interactions in China are showing significant growth and a more concentrated interplay were observed. Computing methodologies, informatics, and communications media (such as social media and the internet) constitute the majority of I-related concepts and techniques used for resolving the health promotion and diseases management problems in China. Generally there is a positive correlation between the burden and informatics research efforts for diseases in China. We think it is not contradictory that informatics research should be focused on the greatest burden of diseases or where it can have the most impact. Artificial intelligence is a competing field of medical informatics research in China, with a notable focus on diagnostic deep learning algorithms for medical imaging. Conclusions: It is suggested that technological transfers, namely the functionality to be realized by medical/health informatics (eg, diagnosis, therapeutics, surgical procedures, laboratory testing techniques, and equipment and supplies) should be strengthened. Research on natural language processing and electronic health records should also be strengthened to improve the real-world applications of health information technologies and big data in the future. UR - https://medinform.jmir.org/2021/7/e26393 UR - http://dx.doi.org/10.2196/26393 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255693 ID - info:doi/10.2196/26393 ER - TY - JOUR AU - Archer, Norman AU - Lokker, Cynthia AU - Ghasemaghaei, Maryam AU - DiLiberto, Deborah PY - 2021/6/18 TI - eHealth Implementation Issues in Low-Resource Countries: Model, Survey, and Analysis of User Experience JO - J Med Internet Res SP - e23715 VL - 23 IS - 6 KW - eHealth KW - low-resource countries KW - eHealth implementation effectiveness KW - end user survey KW - eHealth utilization N2 - Background: The implementation of eHealth in low-resource countries (LRCs) is challenged by limited resources and infrastructure, lack of focus on eHealth agendas, ethical and legal considerations, lack of common system interoperability standards, unreliable power, and shortage of trained workers. Objective: The aim of this study is to describe and study the current situation of eHealth implementation in a small number of LRCs from the perspectives of their professional eHealth users. Methods: We developed a structural equation model that reflects the opinions of professional eHealth users who work on LRC health care front lines. We recruited country coordinators from 4 LRCs to help recruit survey participants: India, Egypt, Nigeria, and Kenya. Through a web-based survey that focused on barriers to eHealth implementation, we surveyed 114 participants. We analyzed the information using a structural equation model to determine the relationships among the constructs in the model, including the dependent variable, eHealth utilization. Results: Although all the model constructs were important to participants, some constructs, such as user characteristics, perceived privacy, and perceived security, did not play a significant role in eHealth utilization. However, the constructs related to technology infrastructure tended to reduce the impact of concerns and uncertainties (path coefficient=?0.32; P=.001), which had a negative impact on eHealth utilization (path coefficient=?0.24; P=.01). Constructs that were positively related to eHealth utilization were implementation effectiveness (path coefficient=0.45; P<.001), the countries where participants worked (path coefficient=0.29; P=.004), and whether they worked for privately or publicly funded institutions (path coefficient=0.18; P<.001). As exploratory research, the model had a moderately good fit for eHealth utilization (adjusted R2=0.42). Conclusions: eHealth success factors can be categorized into 5 groups; our study focused on frontline eHealth workers? opinions concerning 2 of these groups: technology and its support infrastructure and user acceptance. We found significant disparities among the responses from different participant groups. Privately funded organizations tended to be further ahead with eHealth utilization than those that were publicly funded. Moreover, participant comments identified the need for more use of telemedicine in remote and rural regions in these countries. An understanding of these differences can help regions or countries that are lagging in the implementation and use of eHealth technologies. Our approach could also be applied to detailed studies of the other 3 categories of success factors: short- and long-term funding, organizational factors, and political or legislative aspects. UR - https://www.jmir.org/2021/6/e23715 UR - http://dx.doi.org/10.2196/23715 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142967 ID - info:doi/10.2196/23715 ER - TY - JOUR AU - Huang, Mian AU - Wang, Jian AU - Nicholas, Stephen AU - Maitland, Elizabeth AU - Guo, Ziyue PY - 2021/6/17 TI - Development, Status Quo, and Challenges to China?s Health Informatization During COVID-19: Evaluation and Recommendations JO - J Med Internet Res SP - e27345 VL - 23 IS - 6 KW - health informatization KW - COVID-19 KW - health policy KW - digital health KW - health information technology KW - China UR - https://www.jmir.org/2021/6/e27345 UR - http://dx.doi.org/10.2196/27345 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061761 ID - info:doi/10.2196/27345 ER - TY - JOUR AU - Góngora Alonso, Susel AU - de Bustos Molina, Andrés AU - Sainz-De-Abajo, Beatriz AU - Franco-Martín, Manuel AU - De la Torre Díez, Isabel PY - 2021/6/16 TI - Analysis of Mental Health Disease Trends Using BeGraph Software in Spanish Health Care Centers: Case Study JO - JMIR Med Inform SP - e15527 VL - 9 IS - 6 KW - BeGraph software KW - diseases KW - health care complexes KW - mental health KW - visualization N2 - Background: In the era of big data, networks are becoming a popular factor in the field of data analysis. Networks are part of the main structure of BeGraph software, which is a 3D visualization application dedicated to the analysis of complex networks. Objective: The main objective of this research was to visually analyze tendencies of mental health diseases in a region of Spain, using the BeGraph software, in order to make the most appropriate health-related decisions in each case. Methods: For the study, a database was used with 13,531 records of patients with mental health disorders in three acute medical units from different health care complexes in a region of Spain. For the analysis, BeGraph software was applied. It is a web-based 3D visualization tool that allows the exploration and analysis of data through complex networks. Results: The results obtained with the BeGraph software allowed us to determine the main disease in each of the health care complexes evaluated. We noted 6.50% (463/7118) of admissions involving unspecified paranoid schizophrenia at the University Clinic of Valladolid, 9.62% (397/4128) of admissions involving chronic paranoid schizophrenia with acute exacerbation at the Zamora Hospital, and 8.84% (202/2285) of admissions involving dysthymic disorder at the Rio Hortega Hospital in Valladolid. Conclusions: The data analysis allowed us to focus on the main diseases detected in the health care complexes evaluated in order to analyze the behavior of disorders and help in diagnosis and treatment. UR - https://medinform.jmir.org/2021/6/e15527 UR - http://dx.doi.org/10.2196/15527 UR - http://www.ncbi.nlm.nih.gov/pubmed/34132650 ID - info:doi/10.2196/15527 ER - TY - JOUR AU - Rottenberg, Shelley AU - Williams, Allison PY - 2021/6/15 TI - Web-Based Delivery of the Caregiving Essentials Course for Informal Caregivers of Older Adults in Ontario: Mixed Methods Evaluation Study JO - JMIR Aging SP - e25671 VL - 4 IS - 2 KW - informal caregivers KW - family caregivers KW - older adults KW - elder care KW - web-based intervention KW - online intervention KW - online course KW - health education KW - eHealth KW - evaluation N2 - Background: Many informal caregivers of older adults have limited time because of the number of responsibilities that their caregiving role entails. This population often experiences high levels of burden due to the stressful nature of their work and are vulnerable to developing negative psychological health outcomes. Easily accessible and flexible knowledge interventions are needed to alleviate the burden and stress experienced by this group. Objective: This study aims to evaluate the acceptability of the web-based delivery of the Caregiving Essentials course for informal caregivers of older adults. Both the strengths and limitations of using a web-based platform to provide information and resources were explored to see whether the method of delivery enhanced or hindered the overall course experience for participants. Methods: A mixed methodology of web-based pre- (n=111) and postcourse surveys (n=39) and telephone interviews (n=26) was used to collect both qualitative and quantitative data from participants. Individual interviews were also conducted with key stakeholders (n=6), and a focus group was conducted with nursing students (n=5) who were involved in the project. Results: The web-based delivery of the course provided participants with greater accessibility to the course because it allowed them to work independently through the modules at their own pace wherever and whenever. The discussion boards were also identified as a major strength because of the opportunity for social interaction and the sense of community that many felt through sharing their experiences. Some barriers to participation included age-related factors, issues with navigating aspects of the course, and concerns about privacy and anonymity. Some key suggestions included more engaging methods of web-based communication and the reorganization of the module content to reduce the amount of text and streamline information. Conclusions: The web-based delivery of Caregiving Essentials appeared to enhance the overall course experience by increasing accessibility and allowing participants to interact with the learning materials and other caregivers. The findings from this evaluation can be used to create and improve the web-based delivery of both the current and emerging interventions for caregivers. UR - https://aging.jmir.org/2021/2/e25671 UR - http://dx.doi.org/10.2196/25671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128815 ID - info:doi/10.2196/25671 ER - TY - JOUR AU - Matthewman, Spencer AU - Spencer, Sarah AU - Lavergne, Ruth M. AU - McCracken, K. Rita AU - Hedden, Lindsay PY - 2021/6/11 TI - An Environmental Scan of Virtual ?Walk-In? Clinics in Canada: Comparative Study JO - J Med Internet Res SP - e27259 VL - 23 IS - 6 KW - virtual care KW - primary care KW - Canada KW - virtual health KW - patients KW - physicians N2 - Background: Canada has been slow to implement virtual care relative to other countries. However, in recent years, the availability of on-demand, ?walk-in? virtual clinics has increased, with the COVID-19 pandemic contributing to the increased demand and provision of virtual care nationwide. Although virtual care facilitates access to physicians while maintaining physical distancing, there are concerns regarding the continuity and quality of care as well as equitable access. There is a paucity of research documenting the availability of virtual care in Canada, thus hampering the efforts to evaluate the impacts of its relatively rapid emergence on the broader health care system and on individual health. Objective: We conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics, cataloging the services they offer and whether they are operating through public or private payment. Methods: We developed a power term and implemented a structured Google search to identify relevant clinics. From each clinic meeting our inclusion criteria, we abstracted data on the payment model, region of operation, services offered, and continuity of care. We compared clinics operating under different payment models using Fisher exact tests. Results: We identified 18 virtual walk-in clinics. Of the 18 clinics, 10 (56%) provided some services under provincial public insurance, although 44% (8/18) operated on a fully private payment model while an additional 39% (7/18) charged patients out of pocket for some services. The most common supplemental services offered included dermatology (15/18, 83%), mental health services (14/18, 78%), and sexual health (11/18, 61%). Continuity, information sharing, or communication with the consumers? existing primary care providers were mentioned by 22% (4/18) of the clinics. Conclusions: Virtual walk-in clinics have proliferated; however, concerns about equitable access, continuity of care, and diversion of physician workforce within these models highlight the importance of supporting virtual care options within the context of longitudinal primary care. More research is needed to support quality virtual care and understand its effects on patient and provider experiences and the overall health system utilization and costs. UR - https://www.jmir.org/2021/6/e27259 UR - http://dx.doi.org/10.2196/27259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114963 ID - info:doi/10.2196/27259 ER - TY - JOUR AU - Blitz, Rogério AU - Storck, Michael AU - Baune, T. Bernhard AU - Dugas, Martin AU - Opel, Nils PY - 2021/6/9 TI - Design and Implementation of an Informatics Infrastructure for Standardized Data Acquisition, Transfer, Storage, and Export in Psychiatric Clinical Routine: Feasibility Study JO - JMIR Ment Health SP - e26681 VL - 8 IS - 6 KW - medical informatics KW - digital mental health KW - digital data collection KW - psychiatry KW - single-source metadata architecture transformation KW - mental health KW - design KW - implementation KW - feasibility KW - informatics KW - infrastructure KW - data N2 - Background: Empirically driven personalized diagnostic applications and treatment stratification is widely perceived as a major hallmark in psychiatry. However, databased personalized decision making requires standardized data acquisition and data access, which are currently absent in psychiatric clinical routine. Objective: Here, we describe the informatics infrastructure implemented at the psychiatric Münster University Hospital, which allows standardized acquisition, transfer, storage, and export of clinical data for future real-time predictive modelling in psychiatric routine. Methods: We designed and implemented a technical architecture that includes an extension of the electronic health record (EHR) via scalable standardized data collection and data transfer between EHRs and research databases, thus allowing the pooling of EHRs and research data in a unified database and technical solutions for the visual presentation of collected data and analyses results in the EHR. The Single-source Metadata ARchitecture Transformation (SMA:T) was used as the software architecture. SMA:T is an extension of the EHR system and uses module-driven engineering to generate standardized applications and interfaces. The operational data model was used as the standard. Standardized data were entered on iPads via the Mobile Patient Survey (MoPat) and the web application Mopat@home, and the standardized transmission, processing, display, and export of data were realized via SMA:T. Results: The technical feasibility of the informatics infrastructure was demonstrated in the course of this study. We created 19 standardized documentation forms with 241 items. For 317 patients, 6451 instances were automatically transferred to the EHR system without errors. Moreover, 96,323 instances were automatically transferred from the EHR system to the research database for further analyses. Conclusions: In this study, we present the successful implementation of the informatics infrastructure enabling standardized data acquisition and data access for future real-time predictive modelling in clinical routine in psychiatry. The technical solution presented here might guide similar initiatives at other sites and thus help to pave the way toward future application of predictive models in psychiatric clinical routine. UR - https://mental.jmir.org/2021/6/e26681 UR - http://dx.doi.org/10.2196/26681 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106072 ID - info:doi/10.2196/26681 ER - TY - JOUR AU - Velmovitsky, Elkind Pedro AU - Bublitz, Moreira Frederico AU - Fadrique, Xavier Laura AU - Morita, Pelegrini Plinio PY - 2021/6/8 TI - Blockchain Applications in Health Care and Public Health: Increased Transparency JO - JMIR Med Inform SP - e20713 VL - 9 IS - 6 KW - health care KW - blockchain KW - EHR KW - health insurance KW - drug supply chain KW - genomics KW - consent KW - digital ledger KW - food supply chain N2 - Background: Although big data and smart technologies allow for the development of precision medicine and predictive models in health care, there are still several challenges that need to be addressed before the full potential of these data can be realized (eg, data sharing and interoperability issues, lack of massive genomic data sets, data ownership, and security and privacy of health data). Health companies are exploring the use of blockchain, a tamperproof and distributed digital ledger, to address some of these challenges. Objective: In this viewpoint, we aim to obtain an overview of blockchain solutions that aim to solve challenges in health care from an industry perspective, focusing on solutions developed by health and technology companies. Methods: We conducted a literature review following the protocol defined by Levac et al to analyze the findings in a systematic manner. In addition to traditional databases such as IEEE and PubMed, we included search and news outlets such as CoinDesk, CoinTelegraph, and Medium. Results: Health care companies are using blockchain to improve challenges in five key areas. For electronic health records, blockchain can help to mitigate interoperability and data sharing in the industry by creating an overarching mechanism to link disparate personal records and can stimulate data sharing by connecting owners and buyers directly. For the drug (and food) supply chain, blockchain can provide an auditable log of a product?s provenance and transportation (including information on the conditions in which the product was transported), increasing transparency and eliminating counterfeit products in the supply chain. For health insurance, blockchain can facilitate the claims management process and help users to calculate medical and pharmaceutical benefits. For genomics, by connecting data buyers and owners directly, blockchain can offer a secure and auditable way of sharing genomic data, increasing their availability. For consent management, as all participants in a blockchain network view an immutable version of the truth, blockchain can provide an immutable and timestamped log of consent, increasing transparency in the consent management process. Conclusions: Blockchain technology can improve several challenges faced by the health care industry. However, companies must evaluate how the features of blockchain can affect their systems (eg, the append-only nature of blockchain limits the deletion of data stored in the network, and distributed systems, although more secure, are less efficient). Although these trade-offs need to be considered when viewing blockchain solutions, the technology has the potential to optimize processes, minimize inefficiencies, and increase trust in all contexts covered in this viewpoint. UR - https://medinform.jmir.org/2021/6/e20713 UR - http://dx.doi.org/10.2196/20713 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100768 ID - info:doi/10.2196/20713 ER - TY - JOUR AU - Kim, Hyeong-Joon AU - Kim, Hyeon Hye AU - Ku, Hosuk AU - Yoo, Don Kyung AU - Lee, Suehyun AU - Park, In Ji AU - Kim, Jin Hyo AU - Kim, Kyeongmin AU - Chung, Kyung Moon AU - Lee, Hwa Kye AU - Kim, Han Ju PY - 2021/6/7 TI - Smart Decentralization of Personal Health Records with Physician Apps and Helper Agents on Blockchain: Platform Design and Implementation Study JO - JMIR Med Inform SP - e26230 VL - 9 IS - 6 KW - personal health records KW - blockchain KW - mobile health KW - semantic interoperatbility KW - decentralized system KW - patient-centered system N2 - Background: The Health Avatar Platform provides a mobile health environment with interconnected patient Avatars, physician apps, and intelligent agents (termed IoA3) for data privacy and participatory medicine; however, its fully decentralized architecture has come at the expense of decentralized data management and data provenance. Objective: The introduction of blockchain and smart contract technologies to the legacy Health Avatar Platform with a clinical metadata registry remarkably strengthens decentralized health data integrity and immutable transaction traceability at the corresponding data-element level in a privacy-preserving fashion. A crypto-economy ecosystem was built to facilitate secure and traceable exchanges of sensitive health data. Methods: The Health Avatar Platform decentralizes patient data in appropriate locations (ie, on patients? smartphones and on physicians? smart devices). We implemented an Ethereum-based hash chain for all transactions and smart contract?based processes to guarantee decentralized data integrity and to generate block data containing transaction metadata on-chain. Parameters of all types of data communications were enumerated and incorporated into 3 smart contracts, in this case, a health data transaction manager, a transaction status manager, and an application programming interface transaction manager. The actual decentralized health data are managed in an off-chain manner on appropriate smart devices and authenticated by hashed metadata on-chain. Results: Metadata of each data transaction are captured in a Health Avatar Platform blockchain node by the smart contracts. We provide workflow diagrams each of the 3 use cases of data push (from a physician app or an intelligent agents to a patient Avatar), data pull (request to a patient Avatar by other entities), and data backup transactions. Each transaction can be finely managed at the corresponding data-element level rather than at the resource or document levels. Hash-chained metadata support data element?level verification of data integrity in subsequent transactions. Smart contracts can incentivize transactions for data sharing and intelligent digital health care services. Conclusions: Health Avatar Platform and interconnected patient Avatars, physician apps, and intelligent agents provide a decentralized blockchain ecosystem for health data that enables trusted and finely tuned data sharing and facilitates health value-creating transactions with smart contracts. UR - https://medinform.jmir.org/2021/6/e26230 UR - http://dx.doi.org/10.2196/26230 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096877 ID - info:doi/10.2196/26230 ER - TY - JOUR AU - Oh, SeHee AU - Sung, MinDong AU - Rhee, Yumie AU - Hong, Namki AU - Park, Rang Yu PY - 2021/5/31 TI - Evaluation of the Privacy Risks of Personal Health Identifiers and Quasi-Identifiers in a Distributed Research Network: Development and Validation Study JO - JMIR Med Inform SP - e24940 VL - 9 IS - 5 KW - distributed research network KW - Observational Medical Outcomes Partnership common data model KW - privacy risk quantification KW - personal health identifier KW - quasi-identifier N2 - Background: Privacy should be protected in medical data that include patient information. A distributed research network (DRN) is one of the challenges in privacy protection and in the encouragement of multi-institutional clinical research. A DRN standardizes multi-institutional data into a common structure and terminology called a common data model (CDM), and it only shares analysis results. It is necessary to measure how a DRN protects patient information privacy even without sharing data in practice. Objective: This study aimed to quantify the privacy risk of a DRN by comparing different deidentification levels focusing on personal health identifiers (PHIs) and quasi-identifiers (QIs). Methods: We detected PHIs and QIs in an Observational Medical Outcomes Partnership (OMOP) CDM as threatening privacy, based on 18 Health Insurance Portability and Accountability Act of 1996 (HIPPA) identifiers and previous studies. To compare the privacy risk according to the different privacy policies, we generated limited and safe harbor data sets based on 16 PHIs and 12 QIs as threatening privacy from the Synthetic Public Use File 5 Percent (SynPUF5PCT) data set, which is a public data set of the OMOP CDM. With minimum cell size and equivalence class methods, we measured the privacy risk reduction with a trust differential gap obtained by comparing the two data sets. We also measured the gap in randomly sampled records from the two data sets to adjust the number of PHI or QI records. Results: The gaps averaged 31.448% and 73.798% for PHIs and QIs, respectively, with a minimum cell size of one, which represents a unique record in a data set. Among PHIs, the national provider identifier had the highest gap of 71.236% (71.244% and 0.007% in the limited and safe harbor data sets, respectively). The maximum size of the equivalence class, which has the largest size of an indistinguishable set of records, averaged 771. In 1000 random samples of PHIs, Device_exposure_start_date had the highest gap of 33.730% (87.705% and 53.975% in the data sets). Among QIs, Death had the highest gap of 99.212% (99.997% and 0.784% in the data sets). In 1000, 10,000, and 100,000 random samples of QIs, Device_treatment had the highest gaps of 12.980% (99.980% and 87.000% in the data sets), 60.118% (99.831% and 39.713%), and 93.597% (98.805% and 5.207%), respectively, and in 1 million random samples, Death had the highest gap of 99.063% (99.998% and 0.934% in the data sets). Conclusions: In this study, we verified and quantified the privacy risk of PHIs and QIs in the DRN. Although this study used limited PHIs and QIs for verification, the privacy limitations found in this study could be used as a quality measurement index for deidentification of multi-institutional collaboration research, thereby increasing DRN safety. UR - https://medinform.jmir.org/2021/5/e24940 UR - http://dx.doi.org/10.2196/24940 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057426 ID - info:doi/10.2196/24940 ER - TY - JOUR AU - Wang, Zheyu AU - An, Jiye AU - Lin, Hui AU - Zhou, Jiaqiang AU - Liu, Fang AU - Chen, Juan AU - Duan, Huilong AU - Deng, Ning PY - 2021/5/17 TI - Pathway-Driven Coordinated Telehealth System for Management of Patients With Single or Multiple Chronic Diseases in China: System Development and Retrospective Study JO - JMIR Med Inform SP - e27228 VL - 9 IS - 5 KW - chronic disease KW - telehealth system KW - integrated care KW - pathway KW - ontology N2 - Background: Integrated care enhanced with information technology has emerged as a means to transform health services to meet the long-term care needs of patients with chronic diseases. However, the feasibility of applying integrated care to the emerging ?three-manager? mode in China remains to be explored. Moreover, few studies have attempted to integrate multiple types of chronic diseases into a single system. Objective: The aim of this study was to develop a coordinated telehealth system that addresses the existing challenges of the ?three-manager? mode in China while supporting the management of single or multiple chronic diseases. Methods: The system was designed based on a tailored integrated care model. The model was constructed at the individual scale, mainly focusing on specifying the involved roles and responsibilities through a universal care pathway. A custom ontology was developed to represent the knowledge contained in the model. The system consists of a service engine for data storage and decision support, as well as different forms of clients for care providers and patients. Currently, the system supports management of three single chronic diseases (hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease) and one type of multiple chronic conditions (hypertension with type 2 diabetes mellitus). A retrospective study was performed based on the long-term observational data extracted from the database to evaluate system usability, treatment effect, and quality of care. Results: The retrospective analysis involved 6964 patients with chronic diseases and 249 care providers who have registered in our system since its deployment in 2015. A total of 519,598 self-monitoring records have been submitted by the patients. The engine could generate different types of records regularly based on the specific care pathway. Results of the comparison tests and causal inference showed that a part of patient outcomes improved after receiving management through the system, especially the systolic blood pressure of patients with hypertension (P<.001 in all comparison tests and an approximately 5 mmHg decrease after intervention via causal inference). A regional case study showed that the work efficiency of care providers differed among individuals. Conclusions: Our system has potential to provide effective management support for single or multiple chronic conditions simultaneously. The tailored closed-loop care pathway was feasible and effective under the ?three-manager? mode in China. One direction for future work is to introduce advanced artificial intelligence techniques to construct a more personalized care pathway. UR - https://medinform.jmir.org/2021/5/e27228 UR - http://dx.doi.org/10.2196/27228 UR - http://www.ncbi.nlm.nih.gov/pubmed/33998999 ID - info:doi/10.2196/27228 ER - TY - JOUR AU - Haque, Naim Saira AU - DeStefano, Sydney AU - Banger, Alison AU - Rutledge, Regina AU - Romaire, Melissa PY - 2021/5/5 TI - Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study JO - JMIR Form Res SP - e24118 VL - 5 IS - 5 KW - telehealth KW - rural health KW - health IT KW - telemedicine KW - virtual care N2 - Background: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. Objective: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Methods: This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services?funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Results: Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Conclusions: Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing. UR - https://formative.jmir.org/2021/5/e24118 UR - http://dx.doi.org/10.2196/24118 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949958 ID - info:doi/10.2196/24118 ER - TY - JOUR AU - Støme, Nathalie Linn AU - Wilhelmsen, Ringnes Christian AU - Kværner, Jorunn Kari PY - 2021/4/30 TI - Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review JO - JMIR Form Res SP - e21357 VL - 5 IS - 4 KW - eHealth KW - feasibility KW - global health KW - implementation N2 - Background: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. Objective: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. Methods: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. Results: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. Conclusions: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods. UR - https://formative.jmir.org/2021/4/e21357 UR - http://dx.doi.org/10.2196/21357 UR - http://www.ncbi.nlm.nih.gov/pubmed/33929330 ID - info:doi/10.2196/21357 ER - TY - JOUR AU - Beauvais, Bradley AU - Kruse, Scott Clemens AU - Fulton, Lawrence AU - Shanmugam, Ramalingam AU - Ramamonjiarivelo, Zo AU - Brooks, Matthew PY - 2021/4/14 TI - Association of Electronic Health Record Vendors With Hospital Financial and Quality Performance: Retrospective Data Analysis JO - J Med Internet Res SP - e23961 VL - 23 IS - 4 KW - electronic health records KW - medical informatics KW - hospitals KW - delivery of health care KW - financial management KW - quality of health care KW - treatment outcome N2 - Background: Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear. Objective: In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance. Methods: This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value?Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure. Results: None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2=23.6%; ?=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R2=29.3%; ?=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R2=24.3%; ?=?.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R2=31.9%; Cerner: ?=.0330, SE 0.0135, P=.01; Epic: ?=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: ?=.0388, SE 0.0122, P=.002; Cerner: ?=.0283, SE 0.0124, P=.02; Meditech: ?=.0273, SE 0.0123, P=.03) but with low explanatory power (R2=4.2%). Conclusions: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery. UR - https://www.jmir.org/2021/4/e23961 UR - http://dx.doi.org/10.2196/23961 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851924 ID - info:doi/10.2196/23961 ER - TY - JOUR AU - Park, Ae Ji AU - Sung, Dong Min AU - Kim, Heon Ho AU - Park, Rang Yu PY - 2021/4/5 TI - Weight-Based Framework for Predictive Modeling of Multiple Databases With Noniterative Communication Without Data Sharing: Privacy-Protecting Analytic Method for Multi-Institutional Studies JO - JMIR Med Inform SP - e21043 VL - 9 IS - 4 KW - multi-institutional study KW - distributed data KW - data sharing KW - privacy-protecting methods N2 - Background: Securing the representativeness of study populations is crucial in biomedical research to ensure high generalizability. In this regard, using multi-institutional data have advantages in medicine. However, combining data physically is difficult as the confidential nature of biomedical data causes privacy issues. Therefore, a methodological approach is necessary when using multi-institution medical data for research to develop a model without sharing data between institutions. Objective: This study aims to develop a weight-based integrated predictive model of multi-institutional data, which does not require iterative communication between institutions, to improve average predictive performance by increasing the generalizability of the model under privacy-preserving conditions without sharing patient-level data. Methods: The weight-based integrated model generates a weight for each institutional model and builds an integrated model for multi-institutional data based on these weights. We performed 3 simulations to show the weight characteristics and to determine the number of repetitions of the weight required to obtain stable values. We also conducted an experiment using real multi-institutional data to verify the developed weight-based integrated model. We selected 10 hospitals (2845 intensive care unit [ICU] stays in total) from the electronic intensive care unit Collaborative Research Database to predict ICU mortality with 11 features. To evaluate the validity of our model, compared with a centralized model, which was developed by combining all the data of 10 hospitals, we used proportional overlap (ie, 0.5 or less indicates a significant difference at a level of .05; and 2 indicates 2 CIs overlapping completely). Standard and firth logistic regression models were applied for the 2 simulations and the experiment. Results: The results of these simulations indicate that the weight of each institution is determined by 2 factors (ie, the data size of each institution and how well each institutional model fits into the overall institutional data) and that repeatedly generating 200 weights is necessary per institution. In the experiment, the estimated area under the receiver operating characteristic curve (AUC) and 95% CIs were 81.36% (79.37%-83.36%) and 81.95% (80.03%-83.87%) in the centralized model and weight-based integrated model, respectively. The proportional overlap of the CIs for AUC in both the weight-based integrated model and the centralized model was approximately 1.70, and that of overlap of the 11 estimated odds ratios was over 1, except for 1 case. Conclusions: In the experiment where real multi-institutional data were used, our model showed similar results to the centralized model without iterative communication between institutions. In addition, our weight-based integrated model provided a weighted average model by integrating 10 models overfitted or underfitted, compared with the centralized model. The proposed weight-based integrated model is expected to provide an efficient distributed research approach as it increases the generalizability of the model and does not require iterative communication. UR - https://medinform.jmir.org/2021/4/e21043 UR - http://dx.doi.org/10.2196/21043 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818396 ID - info:doi/10.2196/21043 ER - TY - JOUR AU - Zegers, L. Catharina M. AU - Witteveen, Annemieke AU - Schulte, J. Mieke H. AU - Henrich, F. Julia AU - Vermeij, Anouk AU - Klever, Brigit AU - Dekker, Andre PY - 2021/3/17 TI - Mind Your Data: Privacy and Legal Matters in eHealth JO - JMIR Form Res SP - e17456 VL - 5 IS - 3 KW - data KW - privacy KW - eHealth UR - https://formative.jmir.org/2021/3/e17456 UR - http://dx.doi.org/10.2196/17456 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729163 ID - info:doi/10.2196/17456 ER - TY - JOUR AU - Romero-Lopez-Alberca, Cristina AU - Alonso-Trujillo, Federico AU - Almenara-Abellan, Luis Jose AU - Salinas-Perez, A. Jose AU - Gutierrez-Colosia, R. Mencia AU - Gonzalez-Caballero, Juan-Luis AU - Pinzon Pulido, Sandra AU - Salvador-Carulla, Luis PY - 2021/3/15 TI - A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study JO - J Med Internet Res SP - e24930 VL - 23 IS - 3 KW - DESDE-LTC KW - DESDE-AND KW - services coding KW - service directories KW - decision support system KW - impact analysis KW - maturity N2 - Background: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. Objective: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. Methods: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). Results: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. Conclusions: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care. UR - https://www.jmir.org/2021/3/e24930 UR - http://dx.doi.org/10.2196/24930 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720035 ID - info:doi/10.2196/24930 ER - TY - JOUR AU - Stanimirovic, Aleksandra AU - Francis, Troy AU - Cooper Reed, Anna AU - Meerai, Sonia AU - Sutakovic, Olivera AU - Merritt, Rebecca AU - Brent, Michael AU - Rac, Valeria PY - 2021/3/5 TI - Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study JO - JMIR Res Protoc SP - e23492 VL - 10 IS - 3 KW - gender KW - screening KW - diabetes KW - diabetic retinopathy KW - blindness KW - technology KW - tele-retina screening KW - health equity KW - intersectionality theory N2 - Background: By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender. Objective: We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019. Methods: Using a convergent mixed methods design, we want to understand patients?, providers?, administrators?, and decision makers? perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina. Results: For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021. Conclusions: In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. International Registered Report Identifier (IRRID): PRR1-10.2196/23492 UR - https://www.researchprotocols.org/2021/3/e23492 UR - http://dx.doi.org/10.2196/23492 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666559 ID - info:doi/10.2196/23492 ER - TY - JOUR AU - Kanfe, G. Shuma AU - Endehabtu, F. Berhanu AU - Ahmed, H. Mohammedjud AU - Mengestie, D. Nebyu AU - Tilahun, Binyam PY - 2021/3/4 TI - Commitment Levels of Health Care Providers in Using the District Health Information System and the Associated Factors for Decision Making in Resource-Limited Settings: Cross-sectional Survey Study JO - JMIR Med Inform SP - e23951 VL - 9 IS - 3 KW - commitment KW - district health information system KW - decision making KW - performance monitoring KW - health facilities KW - information use N2 - Background: Changing the culture of information use, which is one of the transformation agendas of the Ministry of Health of Ethiopia, cannot become real unless health care providers are committed to using locally collected data for evidence-based decision making. The commitment of health care providers has paramount influence on district health information system 2 (DHIS2) data utilization for decision making. Evidence is limited on health care providers? level of commitment to using DHIS2 data in Ethiopia. Therefore, this study aims to fill this evidence gap. Objective: This study aimed to assess the levels of commitment of health care providers and the factors influencing their commitment levels in using DHIS2 data for decision making at public health care facilities in the Ilu Aba Bora zone of the Oromia national regional state, Ethiopia in 2020. Methods: The cross-sectional quantitative study supplemented by qualitative methods was conducted from February 26, 2020 to April 17, 2020. A total of 264 participants were approached. SPSS version 20 software was used for data entry and analysis. Descriptive and analytical statistics, including bivariable and multivariable analyses, were performed. Thematic analysis was conducted for the qualitative data. Results: Of the 264 respondents, 121 (45.8%, 95% CI 40.0%-52.8%) respondents showed high commitment levels to use DHIS2 data. The variables associated with the level of commitment to use DHIS2 data were found to be provision of feedback for DHIS2 data use (adjusted odds ratio [AOR] 1.85, 95% CI 1.02-3.33), regular supervision and managerial support (AOR 2.84, 95% CI 1.50-5.37), information use culture (AOR 1.92, 95% CI 1.03-3.59), motivation to use DHIS2 data (AOR 1.80, 95% CI 1.00-3.25), health needs (AOR 3.96, 95% CI 2.11-7.41), and competency in DHIS2 tasks (AOR 2.41, 95% CI 1.27-4.55). Conclusions: In general, less than half of the study participants showed high commitment levels to use DHIS2 data for decision making in health care. Providing regular supportive supervision and feedback and increasing the motivation and competency of the health care providers in performing DHIS2 data tasks will help in promoting their levels of commitment that can result in the cultural transformation of data use for evidence-based decision making in health care. UR - https://medinform.jmir.org/2021/3/e23951 UR - http://dx.doi.org/10.2196/23951 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661133 ID - info:doi/10.2196/23951 ER - TY - JOUR AU - Tian, Jaminal Peter George AU - Harris, Richard Jeffrey AU - Seikaly, Hadi AU - Chambers, Thane AU - Alvarado, Sara AU - Eurich, Dean PY - 2021/2/23 TI - Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan JO - JMIR Form Res SP - e17672 VL - 5 IS - 2 KW - telephone consultations KW - teleconsultations KW - remote consultations KW - telemedicine KW - eHealth KW - environmental scan N2 - 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.? UR - https://formative.jmir.org/2021/2/e17672 UR - http://dx.doi.org/10.2196/17672 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620325 ID - info:doi/10.2196/17672 ER - TY - JOUR AU - Lam, Kyle AU - Iqbal, M. Fahad AU - Purkayastha, Sanjay AU - Kinross, M. James PY - 2021/2/22 TI - Investigating the Ethical and Data Governance Issues of Artificial Intelligence in Surgery: Protocol for a Delphi Study JO - JMIR Res Protoc SP - e26552 VL - 10 IS - 2 KW - artificial intelligence KW - digital surgery KW - Delphi KW - ethics KW - data governance KW - digital technology KW - operating room KW - surgery N2 - Background: The rapid uptake of digital technology into the operating room has the potential to improve patient outcomes, increase efficiency of the use of operating rooms, and allow surgeons to progress quickly up learning curves. These technologies are, however, dependent on huge amounts of data, and the consequences of their mismanagement are significant. While the field of artificial intelligence ethics is able to provide a broad framework for those designing and implementing these technologies into the operating room, there is a need to determine and address the ethical and data governance challenges of using digital technology in this unique environment. Objective: The objectives of this study are to define the term digital surgery and gain expert consensus on the key ethical and data governance issues, barriers, and future research goals of the use of artificial intelligence in surgery. Methods: Experts from the fields of surgery, ethics and law, policy, artificial intelligence, and industry will be invited to participate in a 4-round consensus Delphi exercise. In the first round, participants will supply free-text responses across 4 key domains: ethics, data governance, barriers, and future research goals. They will also be asked to provide their understanding of the term digital surgery. In subsequent rounds, statements will be grouped, and participants will be asked to rate the importance of each issue on a 9-point Likert scale ranging from 1 (not at all important) to 9 (critically important). Consensus is defined a priori as a score of 7 to 9 by 70% of respondents and 1 to 3 by less than 30% of respondents. A final online meeting round will be held to discuss inclusion of statements and draft a consensus document. Results: Full ethical approval has been obtained for the study by the local research ethics committee at Imperial College, London (20IC6136). We anticipate round 1 to commence in January 2021. Conclusions: The results of this study will define the term digital surgery, identify the key issues and barriers, and shape future research in this area. International Registered Report Identifier (IRRID): PRR1-10.2196/26552 UR - https://www.researchprotocols.org/2021/2/e26552 UR - http://dx.doi.org/10.2196/26552 UR - http://www.ncbi.nlm.nih.gov/pubmed/33616543 ID - info:doi/10.2196/26552 ER - TY - JOUR AU - Liang, Jun AU - Li, Ying AU - Zhang, Zhongan AU - Shen, Dongxia AU - Xu, Jie AU - Zheng, Xu AU - Wang, Tong AU - Tang, Buzhou AU - Lei, Jianbo AU - Zhang, Jiajie PY - 2021/2/18 TI - Adoption of Electronic Health Records (EHRs) in China During the Past 10 Years: Consecutive Survey Data Analysis and Comparison of Sino-American Challenges and Experiences JO - J Med Internet Res SP - e24813 VL - 23 IS - 2 KW - medical informatics KW - health information technologies KW - electronic health records KW - hospitals KW - Sino-American N2 - Background: The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country. Objective: This study summarizes and shares the experiences with EHR adoption in China and in the United States. Methods: Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association (CHIMA) and the 2008-2017 United States American Hospital Association Information Technology Supplement survey data, we compared the trends in EHR adoption rates in China and the United States. We then used the Bass model to fit these data and to analyze the modes of diffusion of EHRs in these 2 countries. Finally, using the 2007, 2010, and 2014 CHIMA and Healthcare Information and Management Systems Services survey data, we analyzed the major challenges faced by hospitals in China and the United States in developing health information technology. Results: From 2007 to 2018, the average adoption rates of the sampled hospitals in China increased from 18.6% to 85.3%, compared to the increase from 9.4% to 96% in US hospitals from 2008 to 2017. The annual average adoption rates in Chinese and US hospitals were 6.1% and 9.6%, respectively. However, the annual average number of hospitals adopting EHRs was 1500 in China and 534 in the US, indicating that the former might require more effort. Both countries faced similar major challenges for hospital digitalization. Conclusions: The adoption rates of hospital EHRs in China and the United States have both increased significantly in the past 10 years. The number of hospitals that adopted EHRs in China exceeded 16,000, which was 3.3 times that of the 4814 nonfederal US hospitals. This faster adoption outcome may have been a benefit of top-level design and government-led policies, particularly the inclusion of EHR adoption as an important indicator for performance evaluation and the appointment of public hospitals. UR - http://www.jmir.org/2021/2/e24813/ UR - http://dx.doi.org/10.2196/24813 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599615 ID - info:doi/10.2196/24813 ER - TY - JOUR AU - Weijers, Miriam AU - Bastiaenen, Caroline AU - Feron, Frans AU - Schröder, Kay PY - 2021/2/9 TI - Designing a Personalized Health Dashboard: Interdisciplinary and Participatory Approach JO - JMIR Form Res SP - e24061 VL - 5 IS - 2 KW - visualization design model KW - dashboard KW - evaluation KW - personalized health care KW - International Classification of Functioning, Disability and Health (ICF) KW - patient access to records KW - human?computer interaction KW - health information visualization N2 - Background: Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children?s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective: This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods: Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This model considers immediate upstream validation within 4 cascading design levels: Domain Problem and Data Characterization, Operation and Data Type Abstraction, Visual Encoding and Interaction Design, and Algorithm Design. This model also includes impact-oriented downstream validation, which can be initiated after delivering the prototype. Results: A comprehensible 360° CHILD-profile is developed: an online accessible visualization of CHC data based on the theoretical concept of the International Classification of Functioning, Disability and Health. This dashboard provides caregivers and parents/youth with a holistic view on children?s health and ?entry points? for preventive, individualized health plans. Conclusions: Describing this developmental process offers guidance on how to utilize the nested design model within a health care context. UR - https://formative.jmir.org/2021/2/e24061 UR - http://dx.doi.org/10.2196/24061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560229 ID - info:doi/10.2196/24061 ER - TY - JOUR AU - Laukka, Elina AU - Pölkki, Tarja AU - Heponiemi, Tarja AU - Kaihlanen, Anu-Marja AU - Kanste, Outi PY - 2021/2/4 TI - Leadership in Digital Health Services: Protocol for a Concept Analysis JO - JMIR Res Protoc SP - e25495 VL - 10 IS - 2 KW - health care KW - leadership KW - health services KW - concept analysis KW - telehealth N2 - 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 UR - http://www.researchprotocols.org/2021/2/e25495/ UR - http://dx.doi.org/10.2196/25495 UR - http://www.ncbi.nlm.nih.gov/pubmed/33538702 ID - info:doi/10.2196/25495 ER - TY - JOUR AU - Alves, Domingos AU - Yamada, Bettiol Diego AU - Bernardi, Andrade Filipe AU - Carvalho, Isabelle AU - Filho, Colombo Márcio Eloi AU - Neiva, Barros Mariane AU - Lima, Costa Vinícius AU - Félix, Maria Têmis PY - 2021/1/22 TI - Mapping, Infrastructure, and Data Analysis for the Brazilian Network of Rare Diseases: Protocol for the RARASnet Observational Cohort Study JO - JMIR Res Protoc SP - e24826 VL - 10 IS - 1 KW - rare disease KW - digital health KW - health observatory KW - data science KW - health network N2 - Background: A rare disease is a medical condition with low prevalence in the general population, but these can collectively affect up to 10% of the population. Thus, rare diseases have a significant impact on the health care system, and health professionals must be familiar with their diagnosis, management, and treatment. Objective: This paper aims to provide health indicators regarding the rare diseases in Brazil and to create a network of reference centers with health professionals from different regions of the country. RARASnet proposes to map, analyze, and communicate all the data regarding the infrastructure of the centers and the patients? progress or needs. The focus of the proposed study is to provide all the technical infrastructure and analysis, following the World Health Organization and the Brazilian Ministry of Health guidelines. Methods: To build this digitized system, we will provide a security framework to assure the privacy and protection of each patient when collecting data. Systems development life cycle methodologies will also be applied to align software development, infrastructure operation, and quality assurance. After data collection of all information designed by the specialists, the computational analysis, modeling, and results will be communicated in scientific research papers and a digital health observatory. Results: The project has several activities, and it is in an initial stage. Initially, a survey was given to all health care centers to understand the technical aspects of each network member, such as the existence of computers, technical support staff, and digitized systems. In this survey, we detected that 59% (23/39) of participating health units have electronic medical records, while 41% (16/39) have paper records. Therefore, we will have different strategies to access the data from each center in the data collection phase. Later, we will standardize and analyze the clinical and epidemiological data and use these data to develop a national network for monitoring rare diseases and a digital health observatory to make the information available. The project had its financing approved in December 2019. Retrospective data collection started in October 2020, and we expect to finish in January 2021. During the third quarter of 2020, we enrolled 40 health institutions from all regions of Brazil. Conclusions: The nature of rare disease diagnosis is complex and diverse, and many problems will be faced in the evolution of the project. However, decisions based on data analysis are the best option for the improvement of the rare disease network in Brazil. The creation of RARASnet, along with all the digitized infrastructure, can improve the accessibility of information and standardization of rare diseases in the country. International Registered Report Identifier (IRRID): DERR1-10.2196/24826 UR - http://www.researchprotocols.org/2021/1/e24826/ UR - http://dx.doi.org/10.2196/24826 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480849 ID - info:doi/10.2196/24826 ER - TY - JOUR AU - Hager, Andreas AU - Lindblad, Staffan AU - Brommels, Mats AU - Salomonsson, Stina AU - Wannheden, Carolina PY - 2021/1/19 TI - Sharing Patient-Controlled Real-World Data Through the Application of the Theory of Commons: Action Research Case Study JO - J Med Internet Res SP - e16842 VL - 23 IS - 1 KW - knowledge commons KW - learning networks KW - patient and family centered care KW - eHealth N2 - Background: Technological advances have radically changed the opportunities for individuals with chronic conditions to practice self-care and to coproduce health care and research. Digital technologies enable patients to perform tasks traditionally carried out by health care professionals in a more convenient way, at lower costs, and without compromising quality. Patients may also share real-world data with other stakeholders to promote individual and population health. However, there is a need for legal frameworks that enable patient privacy and control in such sharing of real-world data. We believe that this need could be met by the conceptualization of patient-controlled real-world data as knowledge commons, which is a resource shared by a group of people. Objective: This study aimed to propose a conceptual model that describes how patient-controlled real-world data can be shared effectively in chronic care management, in a way that supports individual and population health, while respecting personal data privacy and control. Methods: An action research approach was used to develop a solution to enable patients, in a self-determined way, to share patient-controlled data to other settings. We chose the context of cystic fibrosis (CF) care in Sweden, where coproduction between patients, their families, and health care professionals is critical in the introduction of new drugs. The first author, who is a lawyer and parent of children with CF, was a driver in the change process. All coauthors collaborated in the analysis. We collected primary and secondary data reflecting changes during the time period from 2012 to 2020, and performed a qualitative content analysis guided by the knowledge commons framework. Results: Through a series of changes, a national system for enabling patients to share patient-controlled real-world data to different stakeholders in CF care was implemented. The case analysis resulted in a conceptual model consisting of the following three knowledge commons arenas that contributed to patient-controlled real-world data collection, use, and sharing: (1) patient world arena involving the private sphere of patients and families; (2) clinical microsystem arena involving the professional sphere at frontline health care clinics; and (3) round table arena involving multiple stakeholders from different settings. Based on the specification of property rights, as presented in our model, the patient can keep control over personal health information and may grant use rights to other stakeholders. Conclusions: Health information exchanges for sharing patient-controlled real-world data are pivotal to enable patients, health care professionals, health care funders, researchers, authorities, and the industry to coproduce high-quality care and to introduce and follow-up novel health technologies. Our model proposes how technical and legal structures that protect the integrity and self-determination of patients can be implemented, which may be applicable in other chronic care settings as well. UR - http://www.jmir.org/2021/1/e16842/ UR - http://dx.doi.org/10.2196/16842 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464212 ID - info:doi/10.2196/16842 ER - TY - JOUR AU - Bugnon, Benjamin AU - Geissbuhler, Antoine AU - Bischoff, Thomas AU - Bonnabry, Pascal AU - von Plessen, Christian PY - 2021/1/7 TI - Improving Primary Care Medication Processes by Using Shared Electronic Medication Plans in Switzerland: Lessons Learned From a Participatory Action Research Study JO - JMIR Form Res SP - e22319 VL - 5 IS - 1 KW - shared electronic medication plan KW - medication list KW - medication reconciliation KW - electronic health records KW - primary care KW - national eHealth strategy KW - Switzerland KW - participatory action research KW - complex adaptive system KW - eHealth KW - medication KW - health information technology KW - implementation N2 - Background: Several countries have launched health information technology (HIT) systems for shared electronic medication plans. These systems enable patients and health care professionals to use and manage a common list of current medications across sectors and settings. Shared electronic medication plans have great potential to improve medication management and patient safety, but their integration into complex medication-related processes has proven difficult, and there is little scientific evidence to guide their implementation. Objective: The objective of this paper is to summarize lessons learned from primary care professionals involved in a pioneering pilot project in Switzerland for the systemwide implementation of shared electronic medication plans. We collected experiences, assessed the influences of the local context, and analyzed underlying mechanisms influencing the implementation. Methods: In this formative action research study, we followed 5 clusters of health care professionals during 6 months. The clusters represented rural and urban primary care settings. A total of 18 health care professionals (primary care physicians, pharmacists, and nurses) used the pilot version of a shared electronic medication plan on a secure web platform, the precursor of Switzerland?s electronic patient record infrastructure. We undertook 3 group interviews with each of the 5 clusters, analyzed the content longitudinally and across clusters, and summarized it into lessons learned. Results: Participants considered medication plan management, digitalized or not, a core element of good clinical practice. Requirements for the successful implementation of a shared electronic medication plan were the integration into and simplification of clinical routines. Participants underlined the importance of an enabling setting with designated reference professionals and regular high-quality interactions with patients. Such a setting should foster trusting relationships and nurture a culture of safety and data privacy. For participants, the HIT was a necessary but insufficient building block toward better interprofessional communication, especially in transitions. Despite oral and written information, the availability of shared electronic medication plans did not generate spontaneous demand from patients or foster more engagement in their medication management. The variable settings illustrated the diversity of medication management and the need for local adaptations. Conclusions: The results of our study present a unique and comprehensive description of the sociotechnical challenges of implementing shared electronic medication plans in primary care. The shared ownership among multiple stakeholders is a core challenge for implementers. No single stakeholder can build and maintain a safe, usable HIT system with up-to-date medication information. Buy-in from all involved health care professionals is necessary for consistent medication reconciliation along the entire care pathway. Implementers must balance the need to change clinical processes to achieve improvements with the need to integrate the shared electronic medication plan into existing routines to facilitate adoption. The lack of patient involvement warrants further study. UR - http://formative.jmir.org/2021/1/e22319/ UR - http://dx.doi.org/10.2196/22319 UR - http://www.ncbi.nlm.nih.gov/pubmed/33410753 ID - info:doi/10.2196/22319 ER - TY - JOUR AU - Huang, Yong Zhi AU - Wang, Yujie AU - Wang, Linling PY - 2020/12/9 TI - ISO/IEEE 11073 Treadmill Interoperability Framework and its Test Method: Design and Implementation JO - JMIR Med Inform SP - e22000 VL - 8 IS - 12 KW - ISO/IEEE 11073-PHD KW - treadmill KW - standard frame model KW - test standard KW - sports health data N2 - Background: Regular physical activity is proven to help prevent and treat noncommunicable diseases such as heart disease, stroke, diabetes, and breast and colon cancer. The exercise data generated by health and fitness devices (eg, treadmill, exercise bike) are very important for health management service providers to develop personalized training programs. However, at present, there is little research on a unified interoperability framework in the health and fitness domain, and there are not many solutions; besides, the privatized treadmill data transmission scheme is not conducive to data integration and analysis. Objective: This article will expand the IEEE 11073-PHD standard protocol family, develop standards for health and fitness device (using treadmill as an example) based on the latest version of the 11073-20601 optimized exchange protocol, and design protocol standards compliance testing process and inspection software, which can automatically detect whether the instantiated object of the treadmill meets the standard. Methods: The study includes the following steps: (1) Map the data transmitted by the treadmill to the 11073-PHD objects; (2) Construct a programming language structure corresponding to the 11073-PHD application protocol data unit (APDU) to complete the coding and decoding part of the test software; and (3) Transmit the instantiated simulated treadmill data to the gateway test software through transmission control protocol for standard compliance testing. Results: According to the characteristics of the treadmill, a data exchange framework conforming to 11073-PHD is constructed, and a corresponding testing framework is developed; a treadmill agent simulation is implemented, and the interoperability test is performed. Through the designed testing process, the corresponding testing software was developed to complete the standard compliance testing of the treadmill. Conclusions: The extended research of IEEE 11073-PHD in the field of health and fitness provides a potential new idea for the data transmission framework of sports equipment such as treadmills, which may also provide some help for the development of sports health equipment interoperability standards. UR - http://medinform.jmir.org/2020/12/e22000/ UR - http://dx.doi.org/10.2196/22000 UR - http://www.ncbi.nlm.nih.gov/pubmed/33295293 ID - info:doi/10.2196/22000 ER - TY - JOUR AU - Sugawara, Yuya AU - Murakami, Masayasu AU - Narimatsu, Hiroto PY - 2020/11/27 TI - Use of Social Media by Hospitals and Clinics in Japan: Descriptive Study JO - JMIR Med Inform SP - e18666 VL - 8 IS - 11 KW - social media KW - internet KW - hospitals KW - health promotion KW - Japan N2 - Background: The use of social media by hospitals has become widespread in the United States and Western European countries. However, in Japan, the extent to which hospitals and clinics use social media is unknown. Furthermore, recent revisions to the Medical Care Act may subject social media content to regulation. Objective: The purpose of this study was to examine social media use in Japanese hospitals and clinics. We investigated the adoption of social media, analyzed social media content, and compared content with medical advertising guidelines. Methods: We randomly sampled 300 hospitals and 300 clinics from a list of medical institutions that was compiled by the Ministry of Health, Labour and Welfare. We performed web and social media (Facebook and Twitter) searches using the hospital and clinic names to determine whether they had social media accounts. We collected Facebook posts and Twitter tweets and categorized them based on their content (eg, health promotion, participation in academic meetings and publications, public relations or news announcements, and recruitment). We compared the collected content with medical advertising guidelines. Results: We found that 26.0% (78/300) of the hospitals and 7.7% (23/300) of the clinics used Facebook, Twitter, or both. Public relations or news announcements accounted for 53.99% (724/1341) of the Facebook posts by hospitals and 58.4% (122/209) of the Facebook posts by clinics. In hospitals, 16/1341 (1.19%) Facebook posts and 6/574 (1.0%) tweets and in clinics, 8/209 (3.8%) Facebook posts and 15/330 (4.5%) tweets could conflict medical advertising guidelines. Conclusions: Fewer hospitals and clinics in Japan use social media as compared to other countries. Social media were mainly used for public relations. Some content disseminated by medical institutions could conflict with medical advertising guidelines. This study may serve as a reference for medical institutions to guide social media usage and may help improve medical website advertising in Japan. UR - https://medinform.jmir.org/2020/11/e18666 UR - http://dx.doi.org/10.2196/18666 UR - http://www.ncbi.nlm.nih.gov/pubmed/33245281 ID - info:doi/10.2196/18666 ER - TY - JOUR AU - Cecchetti, A. Alfred AU - Bhardwaj, Niharika AU - Murughiyan, Usha AU - Kothakapu, Gouthami AU - Sundaram, Uma PY - 2020/10/14 TI - Fueling Clinical and Translational Research in Appalachia: Informatics Platform Approach JO - JMIR Med Inform SP - e17962 VL - 8 IS - 10 KW - Appalachian region KW - medical informatics KW - health care disparities KW - electronic health records KW - data warehousing KW - data mining KW - data visualization KW - machine learning KW - data science N2 - Background: The Appalachian population is distinct, not just culturally and geographically but also in its health care needs, facing the most health care disparities in the United States. To meet these unique demands, Appalachian medical centers need an arsenal of analytics and data science tools with the foundation of a centralized data warehouse to transform health care data into actionable clinical interventions. However, this is an especially challenging task given the fragmented state of medical data within Appalachia and the need for integration of other types of data such as environmental, social, and economic with medical data. Objective: This paper aims to present the structure and process of the development of an integrated platform at a midlevel Appalachian academic medical center along with its initial uses. Methods: The Appalachian Informatics Platform was developed by the Appalachian Clinical and Translational Science Institute?s Division of Clinical Informatics and consists of 4 major components: a centralized clinical data warehouse, modeling (statistical and machine learning), visualization, and model evaluation. Data from different clinical systems, billing systems, and state- or national-level data sets were integrated into a centralized data warehouse. The platform supports research efforts by enabling curation and analysis of data using the different components, as appropriate. Results: The Appalachian Informatics Platform is functional and has supported several research efforts since its implementation for a variety of purposes, such as increasing knowledge of the pathophysiology of diseases, risk identification, risk prediction, and health care resource utilization research and estimation of the economic impact of diseases. Conclusions: The platform provides an inexpensive yet seamless way to translate clinical and translational research ideas into clinical applications for regions similar to Appalachia that have limited resources and a largely rural population. UR - http://medinform.jmir.org/2020/10/e17962/ UR - http://dx.doi.org/10.2196/17962 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052114 ID - info:doi/10.2196/17962 ER - TY - JOUR AU - Wu, Jun AU - Wang, Jian AU - Nicholas, Stephen AU - Maitland, Elizabeth AU - Fan, Qiuyan PY - 2020/10/9 TI - Application of Big Data Technology for COVID-19 Prevention and Control in China: Lessons and Recommendations JO - J Med Internet Res SP - e21980 VL - 22 IS - 10 KW - big data KW - COVID-19 KW - disease prevention and control N2 - Background: In the prevention and control of infectious diseases, previous research on the application of big data technology has mainly focused on the early warning and early monitoring of infectious diseases. Although the application of big data technology for COVID-19 warning and monitoring remain important tasks, prevention of the disease?s rapid spread and reduction of its impact on society are currently the most pressing challenges for the application of big data technology during the COVID-19 pandemic. After the outbreak of COVID-19 in Wuhan, the Chinese government and nongovernmental organizations actively used big data technology to prevent, contain, and control the spread of COVID-19. Objective: The aim of this study is to discuss the application of big data technology to prevent, contain, and control COVID-19 in China; draw lessons; and make recommendations. Methods: We discuss the data collection methods and key data information that existed in China before the outbreak of COVID-19 and how these data contributed to the prevention and control of COVID-19. Next, we discuss China?s new data collection methods and new information assembled after the outbreak of COVID-19. Based on the data and information collected in China, we analyzed the application of big data technology from the perspectives of data sources, data application logic, data application level, and application results. In addition, we analyzed the issues, challenges, and responses encountered by China in the application of big data technology from four perspectives: data access, data use, data sharing, and data protection. Suggestions for improvements are made for data collection, data circulation, data innovation, and data security to help understand China?s response to the epidemic and to provide lessons for other countries? prevention and control of COVID-19. Results: In the process of the prevention and control of COVID-19 in China, big data technology has played an important role in personal tracking, surveillance and early warning, tracking of the virus?s sources, drug screening, medical treatment, resource allocation, and production recovery. The data used included location and travel data, medical and health data, news media data, government data, online consumption data, data collected by intelligent equipment, and epidemic prevention data. We identified a number of big data problems including low efficiency of data collection, difficulty in guaranteeing data quality, low efficiency of data use, lack of timely data sharing, and data privacy protection issues. To address these problems, we suggest unified data collection standards, innovative use of data, accelerated exchange and circulation of data, and a detailed and rigorous data protection system. Conclusions: China has used big data technology to prevent and control COVID-19 in a timely manner. To prevent and control infectious diseases, countries must collect, clean, and integrate data from a wide range of sources; use big data technology to analyze a wide range of big data; create platforms for data analyses and sharing; and address privacy issues in the collection and use of big data. UR - http://www.jmir.org/2020/10/e21980/ UR - http://dx.doi.org/10.2196/21980 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001836 ID - info:doi/10.2196/21980 ER - TY - JOUR AU - Kazi, Momin Abdul AU - Qazi, Ahmed Saad AU - Ahsan, Nazia AU - Khawaja, Sadori AU - Sameen, Fareeha AU - Saqib, Muhammad AU - Khan Mughal, Ayub Muhammad AU - Wajidali, Zabin AU - Ali, Sikander AU - Ahmed, Moueed Rao AU - Kalimuddin, Hussain AU - Rauf, Yasir AU - Mahmood, Fatima AU - Zafar, Saad AU - Abbasi, Ahmad Tufail AU - Khoumbati, Khalil-Ur-Rahmen AU - Abbasi, A. Munir AU - Stergioulas, K. Lampros PY - 2020/9/3 TI - Current Challenges of Digital Health Interventions in Pakistan: Mixed Methods Analysis JO - J Med Internet Res SP - e21691 VL - 22 IS - 9 KW - digital health KW - eHealth KW - LMICs KW - mHealth KW - Pakistan KW - SWOT KW - telehealth N2 - Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization?s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations? inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects. Conclusions: We conclude that while digital health has a promising future in Pakistan, it is still in its infancy at the time of this study. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there is an increase in demand for digital health and implementation of health outcomes following global social distancing protocols, especially in LMICs. Hence, there is a need for active involvement by public and private organizations to regulate, mobilize, and expand the digital health sector for the improvement of health care systems in countries. UR - https://www.jmir.org/2020/9/e21691 UR - http://dx.doi.org/10.2196/21691 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880584 ID - info:doi/10.2196/21691 ER - TY - JOUR AU - Savage, Mark AU - Savage, Clara Lucia PY - 2020/9/2 TI - Doctors Routinely Share Health Data Electronically Under HIPAA, and Sharing With Patients and Patients? Third-Party Health Apps is Consistent: Interoperability and Privacy Analysis JO - J Med Internet Res SP - e19818 VL - 22 IS - 9 KW - digital health KW - privacy KW - interoperability KW - mobile phone, smartphone KW - electronic health records KW - EHR KW - patient access KW - patient engagement KW - Health Insurance Portability and Accountability Act KW - HIPAA KW - Health Information Technology for Economic and Clinical Health Act KW - HITECH KW - covered entity KW - business associate KW - protected health information KW - PHI KW - digital health applications KW - apps UR - https://www.jmir.org/2020/9/e19818 UR - http://dx.doi.org/10.2196/19818 UR - http://www.ncbi.nlm.nih.gov/pubmed/32876582 ID - info:doi/10.2196/19818 ER - TY - JOUR AU - Li, Yazi AU - Lu, Chunji AU - Liu, Yang PY - 2020/9/1 TI - Medical Insurance Information Systems in China: Mixed Methods Study JO - JMIR Med Inform SP - e18780 VL - 8 IS - 9 KW - medical insurance KW - medical insurance information system KW - health information exchange KW - information infrastructure KW - big data KW - policy review KW - privacy protection N2 - Background: Since the People?s Republic of China (PRC), or China, established the basic medical insurance system (MIS) in 1998, the medical insurance information systems (MIISs) in China have effectively supported the operation of the MIS through several phases of development; the phases included a stand-alone version, the internet, and big data. In 2018, China?s national medical security systems were integrated, while MIISs were facing reconstruction. We summarized China?s experience in medical insurance informatization over the past 20 years, aiming to provide a reference for the building of a new basic MIS for China and for developing countries. Objective: This paper aims to sort out medical insurance informatization policies throughout the years, use questionnaires to determine the status quo of provincial MIIS-building in China and the relevant policies, provide references and suggestions for the top-level design and implementation of the information systems in the transitional period of China?s MIS reform, and provide a reference for the building of MIISs in developing countries. Methods: We conducted policy analysis by collecting the laws, regulations, and policy documents?issued from 1998 to 2020?on China's medical insurance and its informatization; we also analyzed the US Health Insurance Portability and Accountability Act and other relevant policies. We conducted a questionnaire survey by sending out questionnaires to 31 Chinese, provincial, medical security bureaus to collect information about network links, system functions, data exchange, standards and specifications, and building modes, among other items. We conducted a literature review by searching for documents about relevant laws and policies, building methods, application results, and other documents related to MIISs; we conducted searches using PubMed, Elsevier, China National Knowledge Infrastructure, and other major literature databases. We conducted telephone interviews to verify the results of questionnaires and to understand the focus issues concerning the building of China?s national MIISs during the period of integration and transition of China's MIS. Results: In 74% (23/31) of the regions in China, MIISs were networked through dedicated fiber optic lines. In 65% (20/31) of the regions in China, MIISs supported identity recognition based on both ID cards and social security cards. In 55% (17/31) of the regions in China, MIISs at provincial and municipal levels were networked and have gathered basic medical insurance data, whereas MIISs were connected to health insurance companies in 35% (11/31) of the regions in China. China?s MIISs are comprised of 11 basic functional modules, among which the modules of business operation, transregional referral, reimbursement, and monitoring systems are widely applied. MIISs in 83% (20/24) of Chinese provinces have stored data on coverage, payment, and settlement compensation of medical insurance. However, in terms of data security and privacy protection, pertinent policies are absent and data utilization is not in-depth enough. Respondents to telephone interviews universally reflected on the following issues and suggestions: in the period of integration and transition of MISs, close attention should be paid to the top-level design, and repeated investment should be avoided for the building of MIISs; MIISs should be adapted to the health care reform, and efforts should be made to strengthen the informatization support for the reform of payment methods; and MIISs should be adapted for the widespread application of mobile phones and should provide insured persons with more self-service functions. Conclusions: In the future, the building of China?s basic MIISs should be deployed at the national, provincial, prefectural, and municipal levels on a unified basis. Efforts should be made to strengthen the development of standard codes, data exchange, and data utilization. Work should be done to formulate the rules and regulations for security and privacy protection and to balance the right to be informed with the mining and utilization of big data. Efforts should be made to intensify the interconnectivity between MISs and other health systems and to strengthen the application of medical insurance information in public health monitoring and early warning systems; this would ultimately improve the degree of trust from stakeholders, including individuals, medical service providers, and public health institutions, in the basic MIISs. UR - https://medinform.jmir.org/2020/9/e18780 UR - http://dx.doi.org/10.2196/18780 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673209 ID - info:doi/10.2196/18780 ER - TY - JOUR AU - Chang, Ernest Shuchih AU - Chen, YiChian PY - 2020/8/31 TI - Blockchain in Health Care Innovation: Literature Review and Case Study From a Business Ecosystem Perspective JO - J Med Internet Res SP - e19480 VL - 22 IS - 8 KW - blockchain KW - health care industry KW - business ecosystem KW - smart contract KW - paradigm shift N2 - Background: Blockchain technology is leveraging its innovative potential in various sectors and its transformation of business-related processes has drawn much attention. Topics of research interest have focused on medical and health care applications, while research implications have generally concluded in system design, literature reviews, and case studies. However, a general overview and knowledge about the impact on the health care ecosystem is limited. Objective: This paper explores a potential paradigm shift and ecosystem evolution in health care utilizing blockchain technology. Methods: A literature review with a case study on a pioneering initiative was conducted. With a systematic life cycle analysis, this study sheds light on the evolutionary development of blockchain in health care scenarios and its interactive relationship among stakeholders. Results: Four stages?birth, expansion, leadership, and self-renewal or death?in the life cycle of the business ecosystem were explored to elucidate the evolving trajectories of blockchain-based health care implementation. Focused impacts on the traditional health care industry are highlighted within each stage to further support the potential health care paradigm shift in the future. Conclusions: This paper enriches the existing body of literature in this field by illustrating the potential of blockchain in fulfilling stakeholders? needs and elucidating the phenomenon of coevolution within the health care ecosystem. Blockchain not only catalyzes the interactions among players but also facilitates the formation of the ecosystem life cycle. The collaborative network linked by blockchain may play a critical role on value creation, transfer, and sharing among the health care community. Future efforts may focus on empirical or case studies to validate the proposed evolution of the health care ecosystem. UR - http://www.jmir.org/2020/8/e19480/ UR - http://dx.doi.org/10.2196/19480 UR - http://www.ncbi.nlm.nih.gov/pubmed/32865501 ID - info:doi/10.2196/19480 ER - TY - JOUR AU - Jurkeviciute, Monika AU - Eriksson, Henrik PY - 2020/8/28 TI - Exploring the Use of Evidence From the Development and Evaluation of an Electronic Health (eHealth) Trial: Case Study JO - J Med Internet Res SP - e17718 VL - 22 IS - 8 KW - evidence-based practice KW - evidence use KW - eHealth KW - evaluation KW - evaluation use N2 - Background: Evidence-based practice refers to building clinical decisions on credible research evidence, professional experience, and patient preferences. However, there is a growing concern that evidence in the context of electronic health (eHealth) is not sufficiently used when forming policies and practice of health care. In this context, using evaluation and research evidence in clinical or policy decisions dominates the discourse. However, the use of additional types of evidence, such as professional experience, is underexplored. Moreover, there might be other ways of using evidence than in clinical or policy decisions. Objective: This study aimed to analyze how different types of evidence (such as evaluation outcomes [including patient preferences], professional experiences, and existing scientific evidence from other research) obtained within the development and evaluation of an eHealth trial are used by diverse stakeholders. An additional aim was to identify barriers to the use of evidence and ways to support its use. Methods: This study was built on a case of an eHealth trial funded by the European Union. The project included 4 care centers, 2 research and development companies that provided the web-based physical exercise program and an activity monitoring device, and 2 science institutions. The qualitative data collection included 9 semistructured interviews conducted 8 months after the evaluation was concluded. The data analysis concerned (1) activities and decisions that were made based on evidence after the project ended, (2) evidence used for those activities and decisions, (3) in what way the evidence was used, and (4) barriers to the use of evidence. Results: Evidence generated from eHealth trials can be used by various stakeholders for decisions regarding clinical integration of eHealth solutions, policy making, scientific publishing, research funding applications, eHealth technology, and teaching. Evaluation evidence has less value than professional experiences to local decision making regarding eHealth integration into clinical practice. Professional experiences constitute the evidence that is valuable to the highest variety of activities and decisions in relation to eHealth trials. When using existing scientific evidence related to eHealth trials, it is important to consider contextual relevance, such as location or disease. To support the use of evidence, it is suggested to create possibilities for health care professionals to gain experience, assess a few rather than a large number of variables, and design for shorter iterative cycles of evaluation. Conclusions: Initiatives to support and standardize evidence-based practice in the context of eHealth should consider the complexities in how the evidence is used in order to achieve better uptake of evidence in practice. However, one should be aware that the assumption of fact-based decision making in organizations is misleading. In order to create better chances that the evidence produced would be used, this should be addressed through the design of eHealth trials. UR - http://www.jmir.org/2020/8/e17718/ UR - http://dx.doi.org/10.2196/17718 UR - http://www.ncbi.nlm.nih.gov/pubmed/32857057 ID - info:doi/10.2196/17718 ER - TY - JOUR AU - Chang, I-Chiu AU - Lin, Po-Jin AU - Chen, Ting-Hung AU - Chang, Chia-Hui PY - 2020/8/12 TI - Cultural Impact on the Intention to Use Nursing Information Systems of Nurses in Taiwan and China: Survey and Analysis JO - J Med Internet Res SP - e18078 VL - 22 IS - 8 KW - Nursing information system KW - intention to use KW - cultural differences KW - information literacy N2 - Background: Nursing workforce shortage has emerged as a global problem. Foreign nurse importation is a popular strategy to address the shortage. The interactions between nursing staff on either side of the Taiwan Strait continue to increase. Since both nurses in Taiwan and nurses in China have adopted nursing information systems to improve health care processes and quality, it is necessary to investigate factors influencing nursing information system usage in nursing practice. Objective: This study examined the effects of cultural and other related factors on nurses? intentions to use nursing information systems. The findings were expected to serve as an empirical base for further benchmarking and management of cross-strait nurses. Methods: This survey was conducted in two case hospitals (one in Taiwan and one in China). A total of 880 questionnaires were distributed (n=440 in each hospital). Results: The results showed effort expectancy had a significant effect on the intention to use nursing information systems of nurses in China (P=.003) but not nurses in Taiwan (P=.16). Conclusions: Findings suggest nursing managers should adopt different strategies to motivate cross-strait nurses to use nursing information systems. Promoting effort expectancy is more likely to motivate nurses in China than in Taiwan. This discrepancy is probably due to the less hierarchical and more feminine society in Taiwan. UR - https://www.jmir.org/2020/8/e18078 UR - http://dx.doi.org/10.2196/18078 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784174 ID - info:doi/10.2196/18078 ER - TY - JOUR AU - Bhardwaj, Niharika AU - Cecchetti, A. Alfred AU - Murughiyan, Usha AU - Neitch, Shirley PY - 2020/8/4 TI - Analysis of Benzodiazepine Prescription Practices in Elderly Appalachians with Dementia via the Appalachian Informatics Platform: Longitudinal Study JO - JMIR Med Inform SP - e18389 VL - 8 IS - 8 KW - dementia KW - Alzheimer disease KW - benzodiazepines KW - Appalachia KW - geriatrics KW - informatics platform KW - interactive visualization KW - eHealth KW - clinical data N2 - Background: Caring for the growing dementia population with complex health care needs in West Virginia has been challenging due to its large, sizably rural-dwelling geriatric population and limited resource availability. Objective: This paper aims to illustrate the application of an informatics platform to drive dementia research and quality care through a preliminary study of benzodiazepine (BZD) prescription patterns and its effects on health care use by geriatric patients. Methods: The Maier Institute Data Mart, which contains clinical and billing data on patients aged 65 years and older (N=98,970) seen within our clinics and hospital, was created. Relevant variables were analyzed to identify BZD prescription patterns and calculate related charges and emergency department (ED) use. Results: Nearly one-third (4346/13,910, 31.24%) of patients with dementia received at least one BZD prescription, 20% more than those without dementia. More women than men received at least one BZD prescription. On average, patients with dementia and at least one BZD prescription sustained higher charges and visited the ED more often than those without one. Conclusions: The Appalachian Informatics Platform has the potential to enhance dementia care and research through a deeper understanding of dementia, data enrichment, risk identification, and care gap analysis. UR - https://medinform.jmir.org/2020/8/e18389 UR - http://dx.doi.org/10.2196/18389 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749226 ID - info:doi/10.2196/18389 ER - TY - JOUR AU - Chang, Ernest Shuchih AU - Chen, YiChian AU - Lu, MingFang AU - Luo, Louis Hueimin PY - 2020/7/28 TI - Development and Evaluation of a Smart Contract?Enabled Blockchain System for Home Care Service Innovation: Mixed Methods Study JO - JMIR Med Inform SP - e15472 VL - 8 IS - 7 KW - home care service KW - trust KW - innovation KW - blockchain KW - smart contract KW - automation N2 - Background: In the home care industry, the assignment and tracking of care services are controlled by care centers that are centralized in nature and prone to inefficient information transmission. A lack of trust among the involved parties, information opaqueness, and large manual manipulation result in lower process efficiency. Objective: This study aimed to explore and demonstrate the application of blockchain and smart contract technologies to innovate/renovate home care services for harvesting the desired blockchain benefits of process transparency, traceability, and interoperability. Methods: An object-oriented analysis/design combined with a unified modeling language tool was used to construct the architecture of the proposed home care service system. System feasibility was evaluated via an implementation test, and a questionnaire survey was performed to collect opinions from home care service respondents knowledgeable about blockchain and smart contracts. Results: According to the comparative analysis results, the proposed design outperformed the existing system in terms of traceability, system efficiency, and process automation. Moreover, for the questionnaire survey, the quantitative analysis results showed that the proposed blockchain-based system had significantly (P<.001) higher mean scores (when compared with the existing system) in terms of important factors, including timeliness, workflow efficiency, automatic notifications, insurance functionality, and auditable traceability. In summary, blockchain-based home care service participants will be able to enjoy improved efficiency, better transparency, and higher levels of process automation. Conclusions: Blockchain and smart contracts can provide valuable benefits to the home care service industry via distributed data management and process automation. The proposed system enhances user experiences by mitigating human intervention and improving service interoperability, transparency/traceability, and real-time response to home care service events. Efforts in exploring and integrating blockchain-based home care services with emerging technologies, such as the internet of things and artificial intelligence, are expected to provide further benefits and therefore are subject to future research. UR - https://medinform.jmir.org/2020/7/e15472 UR - http://dx.doi.org/10.2196/15472 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720903 ID - info:doi/10.2196/15472 ER - TY - JOUR AU - Zhuang, Yan AU - Chen, Yin-Wu AU - Shae, Zon-Yin AU - Shyu, Chi-Ren PY - 2020/7/27 TI - Generalizable Layered Blockchain Architecture for Health Care Applications: Development, Case Studies, and Evaluation JO - J Med Internet Res SP - e19029 VL - 22 IS - 7 KW - blockchain KW - smart contract KW - health information exchange KW - electronic health records KW - health care application N2 - Background: Data coordination across multiple health care facilities has become increasingly important for many emerging health care applications. Distrust has been recognized as a key barrier to the success of such applications. Leveraging blockchain technology could provide potential solutions tobuild trust between data providers and receivers by taking advantage of blockchain properties such as security, immutability, anonymity, decentralization, and smart contracts. Many health technologies have empirically proven that blockchain designs fit well with the needs of health care applications with certain degrees of success. However, there is a lack of robust architecture to provide a practical framework for developers to implement applications and test the performance of stability, efficiency, and scalability using standard blockchain designs. A generalized blockchain model is needed for the health care community to adopt blockchain technology and develop applications in a timely fashion. Objective: This study aimed at building a generalized blockchain architecture that provides data coordination functions, including data requests, permission granting, data exchange, and usage tracking, for a wide spectrum of health care application developments. Methods: An augmented, 3-layered blockchain architecture was built on a private blockchain network. The 3 layers, from bottom to top, are as follows: (1) incorporation of fundamental blockchain settings and smart contract design for data collection; (2) interactions between the blockchain and health care application development environment using Node.js and web3.js; and (3) a flexible development platform that supports web technologies such as HTML, https, and various programing languages. Two example applications, health information exchange (HIE) and clinical trial recruitment, were developed in our design to demonstrate the feasibility of the layered architecture. Case studies were conducted to test the performance in terms of stability, efficiency, and scalability of the blockchain system. Results: A total of 331,142 simulated HIE requests from accounts of 40,000 patients were successfully validated through this layered blockchain architecture with an average exchange time of 11.271 (SD 2.208) seconds. We also simulated a clinical trial recruitment scenario with the same set of patients and various recruitment criteria to match potential subjects using the same architecture. Potential subjects successfully received the clinical trial recruitment information and granted permission to the trial sponsors to access their health records with an average time of 3.07 seconds. Conclusions: This study proposes a generalized layered blockchain architecture that offers health technology community blockchain features for application development without requiring developers to have extensive experience with blockchain technology. The case studies tested the performance of our design and empirically proved the feasibility of the architecture in 2 relevant health application domains. UR - https://www.jmir.org/2020/7/e19029 UR - http://dx.doi.org/10.2196/19029 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716300 ID - info:doi/10.2196/19029 ER - TY - JOUR AU - Poba-Nzaou, Placide AU - Uwizeyemungu, Sylvestre AU - Liu, Xuecheng PY - 2020/7/23 TI - Adoption and Performance of Complementary Clinical Information Technologies: Analysis of a Survey of General Practitioners JO - J Med Internet Res SP - e16300 VL - 22 IS - 7 KW - electronic health record KW - personal health record KW - health information exchange KW - telehealth KW - general practitioners KW - quality of care KW - efficiency KW - organizational productivity N2 - Background: The benefits from the combination of 4 clinical information systems (CISs)?electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth?in primary care depend on the configuration of their functional capabilities available to clinicians. However, our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation. Objective: This study aims to pursue 3 objectives: (1) characterize general practitioners (GPs) by uncovering the typical profiles of combinations of 4 major CIS capabilities, (2) identify physician and practice characteristics that predict cluster membership, and (3) assess the variation in the levels of performance associated with each configuration. Methods: We used data from a survey of GPs conducted throughout the European Union (N=5793). First, 4 factors, that is, EHRs, HIE, PHRs, and Telehealth, were created. Second, a cluster analysis helps uncover clusters of GPs based on the 4 factors. Third, we compared the clusters according to five performance outcomes using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. Fourth, univariate and multivariate multinomial logistic regressions were used to identify predictors of the clusters. Finally, with a multivariate multinomial logistic regression, among the clusters, we compared performance in terms of the number of patients treated (3 levels) over the last 2 years. Results: We unveiled 3 clusters of GPs with different levels of CIS capability profiles: strong (1956/5793, 37.36%), medium (2764/5793, 47.71%), and weak (524/5793, 9.04%). The logistic regression analysis indicates that physicians (younger, female, and less experienced) and practice (solo) characteristics are significantly associated with a weak profile. The ANOVAs revealed a strong cluster associated with significantly high practice performance outcomes in terms of the quality of care, efficiency, productivity, and improvement of working processes, and two noncomprehensive medium and weak profiles associated with medium (equifinal) practice performance outcomes. The logistic regression analysis also revealed that physicians in the weak profile are associated with a decrease in the number of patients treated over the last 2 years. Conclusions: Different CIS capability profiles may lead to similar equifinal performance outcomes. This underlines the importance of looking beyond the adoption of 1 CIS capability versus a cluster of capabilities when studying CISs. GPs in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes. Our findings indicate that medical practices should develop high capabilities in all 4 CISs if they have to maximize their performance outcomes because efforts to develop high capabilities selectively may only be in vain. UR - http://www.jmir.org/2020/7/e16300/ UR - http://dx.doi.org/10.2196/16300 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706715 ID - info:doi/10.2196/16300 ER - TY - JOUR AU - Pellison, Carvalho Felipe AU - Rijo, Lopes Rui Pedro Charters AU - Lima, Costa Vinicius AU - Crepaldi, Yukie Nathalia AU - Bernardi, Andrade Filipe AU - Galliez, Mello Rafael AU - Kritski, Afrânio AU - Abhishek, Kumar AU - Alves, Domingos PY - 2020/7/6 TI - Data Integration in the Brazilian Public Health System for Tuberculosis: Use of the Semantic Web to Establish Interoperability JO - JMIR Med Inform SP - e17176 VL - 8 IS - 7 KW - health information systems KW - tuberculosis KW - ontology KW - interoperability KW - electronic health records KW - semantic web N2 - Background: Interoperability of health information systems is a challenge due to the heterogeneity of existing systems at both the technological and semantic levels of their data. The lack of existing data about interoperability disrupts intra-unit and inter-unit medical operations as well as creates challenges in conducting studies on existing data. The goal is to exchange data while providing the same meaning for data from different sources. Objective: To find ways to solve this challenge, this research paper proposes an interoperability solution for the tuberculosis treatment and follow-up scenario in Brazil using Semantic Web technology supported by an ontology. Methods: The entities of the ontology were allocated under the definitions of Basic Formal Ontology. Brazilian tuberculosis applications were tagged with entities from the resulting ontology. Results: An interoperability layer was developed to retrieve data with the same meaning and in a structured way enabling semantic and functional interoperability. Conclusions: Health professionals could use the data gathered from several data sources to enhance the effectiveness of their actions and decisions, as shown in a practical use case to integrate tuberculosis data in the State of São Paulo. UR - https://medinform.jmir.org/2020/7/e17176 UR - http://dx.doi.org/10.2196/17176 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628611 ID - info:doi/10.2196/17176 ER - TY - JOUR AU - de Lusignan, Simon AU - Jones, Nicholas AU - Dorward, Jienchi AU - Byford, Rachel AU - Liyanage, Harshana AU - Briggs, John AU - Ferreira, Filipa AU - Akinyemi, Oluwafunmi AU - Amirthalingam, Gayatri AU - Bates, Chris AU - Lopez Bernal, Jamie AU - Dabrera, Gavin AU - Eavis, Alex AU - Elliot, J. Alex AU - Feher, Michael AU - Krajenbrink, Else AU - Hoang, Uy AU - Howsam, Gary AU - Leach, Jonathan AU - Okusi, Cecilia AU - Nicholson, Brian AU - Nieri, Philip AU - Sherlock, Julian AU - Smith, Gillian AU - Thomas, Mark AU - Thomas, Nicholas AU - Tripathy, Manasa AU - Victor, William AU - Williams, John AU - Wood, Ian AU - Zambon, Maria AU - Parry, John AU - O?Hanlon, Shaun AU - Joy, Mark AU - Butler, Chris AU - Marshall, Martin AU - Hobbs, Richard F. D. PY - 2020/7/2 TI - The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms JO - JMIR Public Health Surveill SP - e19773 VL - 6 IS - 3 KW - primary health care KW - general practice KW - medical record systems, computerized KW - sentinel surveillance KW - public health surveillance KW - clinical trials as a topic KW - adaptive clinical trials KW - severe acute respiratory syndrome coronavirus 2 KW - COVID-19 N2 - Background: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. Objective: The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. Methods: We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. Results: The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. Conclusions: ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. International Registered Report Identifier (IRRID): DERR1-10.2196/19773 UR - https://publichealth.jmir.org/2020/3/e19773 UR - http://dx.doi.org/10.2196/19773 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484782 ID - info:doi/10.2196/19773 ER - TY - JOUR AU - Lee, Hsiu-An AU - Kung, Hsin-Hua AU - Udayasankaran, Ganesh Jai AU - Kijsanayotin, Boonchai AU - B Marcelo, Alvin AU - Chao, R. Louis AU - Hsu, Chien-Yeh PY - 2020/6/9 TI - An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study JO - J Med Internet Res SP - e16748 VL - 22 IS - 6 KW - blockchain KW - personal health records KW - health information interoperability KW - precision health care KW - health information management N2 - Background: Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. Objective: This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. Methods: The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. Results: The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange. Conclusions: Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network?s regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform?s provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine. UR - https://www.jmir.org/2020/6/e16748 UR - http://dx.doi.org/10.2196/16748 UR - http://www.ncbi.nlm.nih.gov/pubmed/32515743 ID - info:doi/10.2196/16748 ER - TY - JOUR AU - Ye, Qing AU - Zhou, Jin AU - Wu, Hong PY - 2020/6/8 TI - Using Information Technology to Manage the COVID-19 Pandemic: Development of a Technical Framework Based on Practical Experience in China JO - JMIR Med Inform SP - e19515 VL - 8 IS - 6 KW - COVID-19 KW - pandemic KW - health informatics KW - health information technology KW - technical framework KW - privacy protection N2 - Background: The coronavirus disease (COVID-19) epidemic poses an enormous challenge to the global health system, and governments have taken active preventive and control measures. The health informatics community in China has actively taken action to leverage health information technologies for epidemic monitoring, detection, early warning, prevention and control, and other tasks. Objective: The aim of this study was to develop a technical framework to respond to the COVID-19 epidemic from a health informatics perspective. Methods: In this study, we collected health information technology?related information to understand the actions taken by the health informatics community in China during the COVID-19 outbreak and developed a health information technology framework for epidemic response based on health information technology?related measures and methods. Results: Based on the framework, we review specific health information technology practices for managing the outbreak in China, describe the highlights of their application in detail, and discuss critical issues to consider when using health information technology. Technologies employed include mobile and web-based services such as Internet hospitals and Wechat, big data analyses (including digital contact tracing through QR codes or epidemic prediction), cloud computing, Internet of things, Artificial Intelligence (including the use of drones, robots, and intelligent diagnoses), 5G telemedicine, and clinical information systems to facilitate clinical management for COVID-19. Conclusions: Practical experience in China shows that health information technologies play a pivotal role in responding to the COVID-19 epidemic. UR - http://medinform.jmir.org/2020/6/e19515/ UR - http://dx.doi.org/10.2196/19515 UR - http://www.ncbi.nlm.nih.gov/pubmed/32479411 ID - info:doi/10.2196/19515 ER - TY - JOUR AU - Her, Qoua AU - Malenfant, Jessica AU - Zhang, Zilu AU - Vilk, Yury AU - Young, Jessica AU - Tabano, David AU - Hamilton, Jack AU - Johnson, Ron AU - Raebel, Marsha AU - Boudreau, Denise AU - Toh, Sengwee PY - 2020/6/4 TI - Distributed Regression Analysis Application in Large Distributed Data Networks: Analysis of Precision and Operational Performance JO - JMIR Med Inform SP - e15073 VL - 8 IS - 6 KW - distributed regression analysis KW - distributed data networks KW - privacy-protecting analytics KW - pharmacoepidemiology KW - PopMedNet N2 - Background: A distributed data network approach combined with distributed regression analysis (DRA) can reduce the risk of disclosing sensitive individual and institutional information in multicenter studies. However, software that facilitates large-scale and efficient implementation of DRA is limited. Objective: This study aimed to assess the precision and operational performance of a DRA application comprising a SAS-based DRA package and a file transfer workflow developed within the open-source distributed networking software PopMedNet in a horizontally partitioned distributed data network. Methods: We executed the SAS-based DRA package to perform distributed linear, logistic, and Cox proportional hazards regression analysis on a real-world test case with 3 data partners. We used PopMedNet to iteratively and automatically transfer highly summarized information between the data partners and the analysis center. We compared the DRA results with the results from standard SAS procedures executed on the pooled individual-level dataset to evaluate the precision of the SAS-based DRA package. We computed the execution time of each step in the workflow to evaluate the operational performance of the PopMedNet-driven file transfer workflow. Results: All DRA results were precise (<10?12), and DRA model fit curves were identical or similar to those obtained from the corresponding pooled individual-level data analyses. All regression models required less than 20 min for full end-to-end execution. Conclusions: We integrated a SAS-based DRA package with PopMedNet and successfully tested the new capability within an active distributed data network. The study demonstrated the validity and feasibility of using DRA to enable more privacy-protecting analysis in multicenter studies. UR - https://medinform.jmir.org/2020/6/e15073 UR - http://dx.doi.org/10.2196/15073 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496200 ID - info:doi/10.2196/15073 ER - TY - JOUR AU - King, Kathryn AU - Ford, Dee AU - Haschker, Michael AU - Harvey, Jillian AU - Kruis, Ryan AU - McElligott, James PY - 2020/5/22 TI - Clinical and Technical Considerations of an Open Access Telehealth Network in South Carolina: Definition and Deployment JO - J Med Internet Res SP - e17348 VL - 22 IS - 5 KW - telehealth KW - health information technology N2 - Background: Today, telehealth is experiencing exponential growth in utilization. Paralleling this trend is the growth in the telehealth industry, with sharp increases in the number of platforms, functionalities, and levels of integrations within both the electronic health record and other technical systems supporting health care. When a telehealth network is intended to be used across independent health care systems, an additional layer of complexity emerges. In the context of regionalized telehealth networks that are not within the same health care system, not only are technical interoperability challenges a practical barrier, but administrative, clinical, and competitive elements also quickly emerge, resulting in fragmented, siloed technologies. Objective: The study aimed to describe a statewide approach to deploying an interoperable open access telehealth network across multiple health systems. Methods: One promising solution to the abovementioned concerns is an open access telehealth network. In the field of telehealth, an open access network (OAN) can be defined as a network infrastructure that can be used by health care providers without a closed or proprietary platform, specific obligatory network, or service-specific telehealth technologies. This framework for the development of an OAN is grounded in practical examples of clinical programs that function in each stage of network maturity based on the experience of the South Carolina Telehealth Alliance (SCTA). The SCTA?s experience details successes and challenges in an ongoing effort to achieve an OAN. The model describes an OAN in stages of collaborative maturity and provides insights into the technological, clinical, and administrative implications of making the collaboration possible. Results: The four stages of an OAN are defined according to operational maturity, ranging from feasibility to demonstration of implementation. Each stage is associated with infrastructure and resource requirements and technical and clinical activities. In stage 1, technical standards are agreed upon, and the clinical programs are designed to utilize compliant technologies. In stage 2, collaboration is demonstrated through technical teams working together to address barriers, whereas clinical and administrative teams share best practices. In stage 3, a functional interoperable network is demonstrated with different institutions providing service through common telehealth end points at different patient care sites. In stage 4, clinical workflows are streamlined and standardized across institutions, and economies of scale are achieved through technical and administrative innovations. Conclusions: The approach to OAN development described provides a roadmap for achieving a functional telehealth network across independent health systems. The South Carolina experience reveals both successes and challenges in achieving this goal. The next steps toward the development of OANs include advocacy and ongoing engagement with the developers of telehealth technologies regarding their commitment to interoperability. UR - http://www.jmir.org/2020/5/e17348/ UR - http://dx.doi.org/10.2196/17348 UR - http://www.ncbi.nlm.nih.gov/pubmed/32441657 ID - info:doi/10.2196/17348 ER - TY - JOUR AU - Gu, Dongxiao AU - Yang, Xuejie AU - Deng, Shuyuan AU - Liang, Changyong AU - Wang, Xiaoyu AU - Wu, Jiao AU - Guo, Jingjing PY - 2020/2/25 TI - Tracking Knowledge Evolution in Cloud Health Care Research: Knowledge Map and Common Word Analysis JO - J Med Internet Res SP - e15142 VL - 22 IS - 2 KW - cloud health care KW - cloud computing KW - health care informatics KW - cybermetrics KW - co-word analysis N2 - Background: With the continuous development of the internet and the explosive growth in data, big data technology has emerged. With its ongoing development and application, cloud computing technology provides better data storage and analysis. The development of cloud health care provides a more convenient and effective solution for health. Studying the evolution of knowledge and research hotspots in the field of cloud health care is increasingly important for medical informatics. Scholars in the medical informatics community need to understand the extent of the evolution of and possible trends in cloud health care research to inform their future research. Objective: Drawing on the cloud health care literature, this study aimed to describe the development and evolution of research themes in cloud health care through a knowledge map and common word analysis. Methods: A total of 2878 articles about cloud health care was retrieved from the Web of Science database. We used cybermetrics to analyze and visualize the keywords in these articles. We created a knowledge map to show the evolution of cloud health care research. We used co-word analysis to identify the hotspots and their evolution in cloud health care research. Results: The evolution and development of cloud health care services are described. In 2007-2009 (Phase I), most scholars used cloud computing in the medical field mainly to reduce costs, and grid computing and cloud computing were the primary technologies. In 2010-2012 (Phase II), the security of cloud systems became of interest to scholars. In 2013-2015 (Phase III), medical informatization enabled big data for health services. In 2016-2017 (Phase IV), machine learning and mobile technologies were introduced to the medical field. Conclusions: Cloud health care research has been rapidly developing worldwide, and technologies used in cloud health research are simultaneously diverging and becoming smarter. Cloud?based mobile health, cloud?based smart health, and the security of cloud health data and systems are three possible trends in the future development of the cloud health care field. UR - http://www.jmir.org/2020/2/e15142/ UR - http://dx.doi.org/10.2196/15142 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130115 ID - info:doi/10.2196/15142 ER - TY - JOUR AU - Della Mea, Vincenzo AU - Popescu, Horia Mihai AU - Gonano, Dario AU - Petaros, Toma? AU - Emili, Ivo AU - Fattori, Grazia Maria PY - 2020/2/25 TI - A Communication Infrastructure for the Health and Social Care Internet of Things: Proof-of-Concept Study JO - JMIR Med Inform SP - e14583 VL - 8 IS - 2 KW - health services for the aged KW - remote sensing technology KW - sensors and actuators KW - embedded systems KW - Internet of Things KW - LoRaWAN N2 - Background: Increasing life expectancy and reducing birth rates indicate that the world population is becoming older, with many challenges related to quality of life for old and fragile people, as well as their informal caregivers. In the last few years, novel information and communication technology techniques generally known as the Internet of Things (IoT) have been developed, and they are centered around the provision of computation and communication capabilities to objects. The IoT may provide older people with devices that enable their functional independence in daily life by either extending their own capacity or facilitating the efforts of their caregivers. LoRa is a proprietary wireless transmission protocol optimized for long-range, low-power, low?data-rate applications. LoRaWAN is an open stack built upon LoRa. Objective: This paper describes an infrastructure designed and experimentally developed to support IoT deployment in a health care setup, and the management of patients with Alzheimer?s disease and dementia has been chosen for a proof-of-concept study. The peculiarity of the proposed approach is that it is based on the LoRaWAN protocol stack, which exploits unlicensed frequencies and allows for the use of very low-power radio devices, making it a rational choice for IoT communication. Methods: A complete LoRaWAN-based infrastructure was designed, with features partly decided in agreement with caregivers, including outdoor patient tracking to control wandering; fall recognition; and capability of collecting data for further clinical studies. Further features suggested by caregivers were night motion surveillance and indoor tracking for large residential structures. Implementation involved a prototype node with tracking and fall recognition capabilities, a middle layer based on an existing network server, and a Web application for overall management of patients and caregivers. Tests were performed to investigate indoor and outdoor capabilities in a real-world setting and study the applicability of LoRaWAN in health and social care scenarios. Results: Three experiments were carried out. One aimed to test the technical functionality of the infrastructure, another assessed indoor features, and the last assessed outdoor features. The only critical issue was fall recognition, because a slip was not always easy to recognize. Conclusions: The project allowed the identification of some advantages and restrictions of the LoRaWAN technology when applied to the health and social care sectors. Free installation allows the development of services that reach ranges comparable to those available with cellular telephony, but without running costs like telephony fees. However, there are technological limitations, which restrict the scenarios in which LoRaWAN is applicable, although there is room for many applications. We believe that setting up low-weight infrastructure and carefully determining whether applications can be concretely implemented within LoRaWAN limits might help in optimizing community care activities while not adding much burden and cost in information technology management. UR - http://medinform.jmir.org/2020/2/e14583/ UR - http://dx.doi.org/10.2196/14583 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130158 ID - info:doi/10.2196/14583 ER - TY - JOUR AU - Seto, Emily AU - Smith, Dallas AU - Jacques, Matt AU - Morita, Pelegrini Plinio PY - 2019/11/1 TI - Opportunities and Challenges of Telehealth in Remote Communities: Case Study of the Yukon Telehealth System JO - JMIR Med Inform SP - e11353 VL - 7 IS - 4 KW - health care systems KW - telemedicine KW - remote consultation KW - Yukon territory KW - telehealth KW - program evaluation KW - medical informatics N2 - Background: Telehealth has been shown to improve access to health care and to reduce costs to the patient and health care system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities. Objective: The study aimed to explore the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities. Methods: A mixed methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. Web-based questionnaires were administered to nurses in each of the 14 Yukon community health centers outside of Whitehorse and patients who had used telehealth. Qualitative data included focus groups and semistructured interviews with 36 telehealth stakeholders. Results: Since 2008, there has been a consistent number of telehealth sessions of about 1000 per year, with clinical care as the main use (69.06% [759/1099] of all sessions in 2015). From the questionnaire (11 community nurses and 10 patients) and the interview data, there was a consensus among the clinicians and patients that the system provided timely access and cost savings from reduced travel. However, they believed that it was underutilized, and the equipment was outdated. The following 4 factors were identified, which should be considered when trying to advance and expand a telehealth program: (1) patient and clinician buy-in: past telehealth experiences (eg, negative clinician experiences with outdated technology) should be considered when advancing the system. Expansion of services in orthopedics, dermatology, and psychiatry were found to be particularly feasible and beneficial in Yukon; (2) workflow: the use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon telehealth coordinator; (3) access to telehealth technology: clinicians and patients should have easy access to up-to-date telehealth technology. The use of consumer products, such as mobile technology, should be leveraged as appropriate; and (4) infrastructure: the required human resources and technology need to be established when expanding and advancing telehealth. Conclusions: While clinicians and patients had generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to expand the types of telehealth services and the number of telehealth sessions, including the expansion of services in several new specialty areas, updating telehealth equipment to streamline workflows and increase convenience and uptake, and integrating novel technologies. The identified barriers and recommendations from this evaluation can be applied to the development and expansion of telehealth in other remote communities to realize telehealth?s potential for providing efficient, safe, convenient, and cost-effective care delivery. UR - http://medinform.jmir.org/2019/4/e11353/ UR - http://dx.doi.org/10.2196/11353 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682581 ID - info:doi/10.2196/11353 ER - TY - JOUR AU - Wu, Na AU - Gong, Enying AU - Wang, Bo AU - Gu, Wanbing AU - Ding, Nan AU - Zhang, Zhuoran AU - Chen, Mengyao AU - Yan, L. Lijing AU - Oldenburg, Brian AU - Xu, Li-Qun PY - 2019/07/19 TI - A Smart and Multifaceted Mobile Health System for Delivering Evidence-Based Secondary Prevention of Stroke in Rural China: Design, Development, and Feasibility Study JO - JMIR Mhealth Uhealth SP - e13503 VL - 7 IS - 7 KW - stroke KW - secondary prevention KW - rural health services KW - mobile application KW - software design KW - China N2 - Background: Mobile health (mHealth) technologies hold great promise in improving the delivery of high-quality health care services. Yet, there has been little research so far applying mHealth technologies in the context of delivering stroke care in resource-limited rural regions. Objective: This study aimed to introduce the design and development of an mHealth system targeting primary health care providers and to ascertain its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) service for strengthening secondary prevention of stroke in rural China. Methods: The SINEMA mHealth system was designed by a multidisciplinary team comprising public health researchers, neurologists, and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following 5 steps: (1) assessing the needs of relevant end users through in-depth interviews of stakeholders, (2) designing the functional modules and evidence-based care content, (3) designing and building the system and user interface, (4) improving and enhancing the system through a 3-month pilot test in 4 villages, and (5) finalizing the system and deploying it in field trial, and finally, evaluating its feasibility through a survey of the dominant user group. Results: From the in-depth interviews of 49 relevant stakeholders, we found that village doctors had limited capacity in caring for village-dwelling stroke patients in rural areas. Primary health care workers demonstrated real needs in receiving appropriate training and support from the mHealth system as well as great interests in using the mHealth technologies and tools. Using these findings, we designed a multifaceted mHealth system with 7 functional modules by following the iterative user-centered design and software development approach. The mHealth system, aimed at 3 different types of users (village doctors, town physicians, and county managers), was developed and utilized in a cluster-randomized controlled trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients between July 2017 and July 2018. In the end, a survey on the usability and functions of the mHealth system among village doctors (the dominant group of users, response rate=96%, 24/25) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study. Conclusions: The mHealth system was feasible for assisting primary health care providers in rural China in delivering the SINEMA service on the secondary prevention of stroke. Further research and initiatives in scaling up the SINEMA approach and this mHealth system to other resource-limited regions in China and beyond will likely enhance the quality and accessibility of essential secondary prevention among stroke patients. ClinicalTrial: ClinicalTrials.gov NCT03185858; https://clinicaltrials.gov/ct2/show/NCT03185858 International Registered Report Identifier (IRRID): RR2-10.1016/j.ahj.2018.08.015 UR - http://mhealth.jmir.org/2019/7/e13503/ UR - http://dx.doi.org/10.2196/13503 UR - http://www.ncbi.nlm.nih.gov/pubmed/31325288 ID - info:doi/10.2196/13503 ER - TY - JOUR AU - Kawaguchi, Hideaki AU - Koike, Soichi AU - Ohe, Kazuhiko PY - 2019/6/14 TI - Facility and Regional Factors Associated With the New Adoption of Electronic Medical Records in Japan: Nationwide Longitudinal Observational Study JO - JMIR Med Inform SP - e14026 VL - 7 IS - 2 KW - electronic health records KW - health services research KW - health policy KW - Bayes theorem N2 - Background: The rate of adoption of electronic medical record (EMR) systems has increased internationally, and new EMR adoption is currently a major topic in Japan. However, no study has performed a detailed analysis of longitudinal data to evaluate the changes in the EMR adoption status over time. Objective: This study aimed to evaluate the changes in the EMR adoption status over time in hospitals and clinics in Japan and to examine the facility and regional factors associated with these changes. Methods: Secondary longitudinal data were created by matching data in fiscal year (FY) 2011 and FY 2014 using reference numbers. EMR adoption status was defined as ?EMR adoption,? ?specified adoption schedule,? or ?no adoption schedule.? Data were obtained for hospitals (n=4410) and clinics (n=67,329) that had no adoption schedule in FY 2011 and for hospitals (n=1068) and clinics (n=3132) with a specified adoption schedule in FY 2011. The EMR adoption statuses of medical institutions in FY 2014 were also examined. A multinomial logistic model was used to investigate the associations between EMR adoption status in FY 2014 and facility and regional factors in FY 2011. Considering the regional variations of these models, multilevel analyses with second levels were conducted. These models were constructed separately for hospitals and clinics, resulting in four multinomial logistic models. The odds ratio (OR) and 95% Bayesian credible interval (CI) were estimated for each variable. Results: A total of 6.9% of hospitals and 14.82% of clinics with no EMR adoption schedules in FY 2011 had adopted EMR by FY 2014, while 10.49% of hospitals and 33.65% of clinics with specified adoption schedules in FY 2011 had cancelled the scheduled adoption by FY 2014. For hospitals with no adoption schedules in FY 2011, EMR adoption/scheduled adoption was associated with practice size characteristics, such as number of outpatients (from quantile 4 to quantile 1: OR 1.67, 95% CI 1.005-2.84 and OR 2.40, 95% CI 1.80-3.21, respectively), and number of doctors (from quantile 4 to quantile 1: OR 4.20, 95% CI 2.39-7.31 and OR 2.02, 95% CI 1.52-2.64, respectively). For clinics with specified EMR adoption schedules in FY 2011, the factors negatively associated with EMR adoption/cancellation of scheduled EMR adoption were the presence of beds (quantile 4 to quantile 1: OR 0.57, 95% CI 0.45-0.72 and OR 0.74, 95% CI 0.58-0.96, respectively) and having a private establisher (quantile 4 to quantile 1: OR 0.27, 95% CI 0.13-0.55 and OR 0.43, 95% CI 0.19-0.91, respectively). No regional factors were significantly associated with the EMR adoption status of hospitals with no EMR adoption schedules; population density was positively associated with EMR adoption in clinics with no EMR adoption schedule (quantile 4 to quantile 1: OR 1.49, 95% CI 1.32-1.69). Conclusions: Different approaches are needed to promote new adoption of EMR systems in hospitals as compared to clinics. It is important to induce decision making in small- and medium-sized hospitals, and regional postdecision technical support is important to avoid cancellation of scheduled EMR adoption in clinics. UR - http://medinform.jmir.org/2019/2/e14026/ UR - http://dx.doi.org/10.2196/14026 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199307 ID - info:doi/10.2196/14026 ER - TY - JOUR AU - Dobrow, J. Mark AU - Bytautas, P. Jessica AU - Tharmalingam, Sukirtha AU - Hagens, Simon PY - 2019/06/06 TI - Interoperable Electronic Health Records and Health Information Exchanges: Systematic Review JO - JMIR Med Inform SP - e12607 VL - 7 IS - 2 KW - health information exchange KW - electronic health record KW - interoperability KW - use KW - impact KW - systematic review N2 - Background: As the availability of interoperable electronic health records (iEHRs) or health information exchanges (HIEs) continues to increase, there is greater need and opportunity to assess the current evidence base on what works and what does not regarding the adoption, use, and impact of iEHRs. Objective: The purpose of this project is to assess the international evidence base on the adoption, use, and impact of iEHRs. Methods: We conducted a systematic review, searching multiple databases?MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)?with supplemental searches conducted in Google Scholar and grey literature sources (ie, Google, Grey Literature Report, and OpenGrey). All searches were conducted in January and February 2017. Articles were eligible for inclusion if they were published in English, were published from 2006 to 2017, and were either an original research study or a literature review. In order to be included, articles needed to focus on iEHRs and HIEs across multiple health care settings, as well as on the impact and effectiveness of iEHR adoption and use. Results: We included 130 articles in the synthesis (113 primary studies, 86.9%; 17 reviews, 13.1%), with the majority focused on the United States (88/130, 67.7%). The primary studies focused on a wide range of health care settings; the three most prevalent settings studied included acute care (59/113, 52.2%), primary care (44/113, 38.9%), and emergency departments (34/113, 30.1%). We identified 29 distinct measurement items in the 113 primary studies that were linked to 522 specific measurement outcomes. Productivity and quality were the two evaluation dimensions that received the most attention, accounting for 14 of 29 (48%) measurement items and 306 of 522 (58.6%) measurement outcomes identified. Overall, the majority of the 522 measurement outcomes were positive (298/522, 57.1%). We also identified 17 reviews on iEHR use and impact, 6 (35%) that focused on barriers and facilitators to adoption and implementation and 11 (65%) that focused on benefits and impacts, with the more recent reviews finding little generalizable evidence of benefit and impact. Conclusions: This review captures the status of an evolving and active field focused on the use and impact of iEHRs. While the overall findings suggest many positive impacts, the quality of the primary studies were not evaluated systematically. When broken down by specific measurement item, the results directed attention both to measurement outcomes that were consistently positive and others that were mostly negative or equivocal. UR - http://medinform.jmir.org/2019/2/e12607/ UR - http://dx.doi.org/10.2196/12607 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172961 ID - info:doi/10.2196/12607 ER - TY - JOUR AU - Schofield, Penelope AU - Shaw, Tim AU - Pascoe, Michaela PY - 2019/06/04 TI - Toward Comprehensive Patient-Centric Care by Integrating Digital Health Technology With Direct Clinical Contact in Australia JO - J Med Internet Res SP - e12382 VL - 21 IS - 6 KW - health care KW - health KW - eHealth N2 - Background: There is an escalating crisis in health care, locally and internationally. The current health care model is unable to meet the increasing health care demands. Objective: The aim of this study was to reconceptualize the provision of health care to produce better outcomes at no greater cost, by placing individuals in the position of authority to direct their own care, in a personalized, integrated health care system. Methods: In this study, we used the Australian health care system as a model. We reviewed the current landscape of digital health in Australia and discussed how electronic medical records (EMRs) can be further developed into a personalized, integrated health care system. Results: Some components of an EMR and digital health system are already being used in Australia, but the systems are not linked. A personalized, integrated health care model that is responsive to consumer needs requires not just a passive repository of medical information; it would require a team approach, including the government, health care funders, industries, consumers and advocacy groups, health care professionals, community groups, and universities. Conclusions: Implementation of a personalized, integrated health care system can result in reduced pressure on the current health care system, and it can result in the delivery of best-practice health care, regardless of location. Importantly, a personalized, integrated health care system could serve as an education platform, ?upskilling? not only clinicians but also, more importantly, patients and carers by providing them with accurate information about their condition, treatment options, medications, and management strategies. By proposing personalized, integrated health care, we offer an intelligent model of health care that is ubiquitous, efficient, and continuously improving. UR - https://www.jmir.org/2019/6/e12382/ UR - http://dx.doi.org/10.2196/12382 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165713 ID - info:doi/10.2196/12382 ER - TY - JOUR AU - Colicchio, K. Tiago AU - Cimino, J. James AU - Del Fiol, Guilherme PY - 2019/06/03 TI - Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era JO - J Med Internet Res SP - e13313 VL - 21 IS - 6 KW - meaningful use KW - medical informatics applications KW - adoption UR - https://www.jmir.org/2019/6/e13313/ UR - http://dx.doi.org/10.2196/13313 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162125 ID - info:doi/10.2196/13313 ER - TY - JOUR AU - O'Donoghue, Odhran AU - Vazirani, A. Anuraag AU - Brindley, David AU - Meinert, Edward PY - 2019/05/10 TI - Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review JO - J Med Internet Res SP - e12426 VL - 21 IS - 5 KW - blockchain KW - interoperability KW - distributed ledger technology KW - scalability KW - health information exchange N2 - Background: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as ?a compromise between two desirable but incompatible features.? Objective: This review?s primary research question was: ?What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?? Methods: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies?of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. Results: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. Conclusions: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. International Registered Report Identifier (IRRID): RR2-10.2196/10994 UR - https://www.jmir.org/2019/5/e12426/ UR - http://dx.doi.org/10.2196/12426 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094344 ID - info:doi/10.2196/12426 ER - TY - JOUR AU - Zhu, Zhihui AU - Zhang, Haibo AU - Li, Yuehuan AU - Meng, Xu AU - Jiao, Yuqing AU - Qin, Ying AU - Li, Yan AU - Han, Jie AU - Liu, Kun AU - Liu, Chongyang PY - 2019/04/01 TI - Establishment of a New Platform for the Management of Patients After Cardiac Surgery: Descriptive Study JO - JMIR Med Inform SP - e13123 VL - 7 IS - 2 KW - follow-up KW - cardiac surgery KW - telemedicine N2 - Background: Medical care for the Chinese population has been focused on first-line treatment, but with little follow-up on treated patients. As an important part of clinical work, follow-up evaluations are of great significance for the long-term survival of patients and for clinical and scientific research. However, the overall follow-up rate of discharged patients after surgery has been low for many years because of the limitations of certain follow-up methods and the presence of objective, practical problems. Objective: This study aimed to construct a new two-way interactive telemedicine follow-up platform to improve the collection of clinical data after cardiac surgery and provide reliable and high-quality follow-up services. Methods: Computer and network technologies were employed in the context of ?Internet +? to develop follow-up databases and software compatible with a mobile network. Postoperative follow-up quality data including the follow-up rate and important postoperative indices were used as standards to evaluate the new follow-up management model after cardiac surgery. Results: This system has been officially operated for more than 5 years. A total of 5347 patients undergoing cardiac surgery have been enrolled, and the total follow-up rate was 90.22%. In addition, 6349 echocardiographic images, 4717 electrocardiographic images, and 3504 chest radiographic images have been uploaded during follow-up assessments. The international standardized ratio was 20,696 person-times. Conclusions: This new management follow-up platform can be used to effectively collect clinical data, provide technical support for academic research, extend medical services, and provide more help to patients. It is of great significance for managing patients after cardiac surgery. UR - https://medinform.jmir.org/2019/2/e13123/ UR - http://dx.doi.org/10.2196/13123 UR - http://www.ncbi.nlm.nih.gov/pubmed/30932865 ID - info:doi/10.2196/13123 ER - TY - JOUR AU - Wen, Hsyien-Chia AU - Chang, Wei-Pin AU - Hsu, Min-Huei AU - Ho, Cheng-Hsun AU - Chu, Chi-Ming PY - 2019/03/28 TI - An Assessment of the Interoperability of Electronic Health Record Exchanges Among Hospitals and Clinics in Taiwan JO - JMIR Med Inform SP - e12630 VL - 7 IS - 1 KW - electronic health records KW - interoperability KW - data exchange KW - hospitals KW - clinics N2 - Background: The rapid aging of the Taiwanese population in recent years has led to high medical needs for the elderly and increasing medical costs. Integrating patient information through electronic health records (EHRs) to reduce unnecessary medications and tests and enhance the quality of care has currently become an important issue. Although electronic data interchanges among hospitals and clinics have been implemented for many years in Taiwan, the interoperability of EHRs has not adequately been assessed. Objective: The study aimed to analyze the efficiency of data exchanges and provide suggestions for future improvements. Methods: We obtained 30 months of uploaded and downloaded data of EHRs among hospitals and clinics. The research objects of this study comprised 19 medical centers, 57 regional hospitals, 95 district hospitals, and 5520 clinics. We examined 4 exchange EHR forms: laboratory test reports, medical images, discharge summaries, and outpatient medical records. We used MySQL (Oracle Corporation) software (to save our data) and phpMyAdmin, which is a Personal Home Page program, to manage the database and then analyzed the data using SPSS 19.0 statistical software. Results: The quarterly mean uploaded volume of EHRs among hospitals was 52,790,721 (SD 580,643). The quarterly mean downloaded volume of EHRs among hospitals and clinics was 650,323 (SD 215,099). The ratio of uploaded to downloaded EHRs was about 81:1. The total volume of EHRs was mainly downloaded by medical centers and clinics, which accounted for 53.82% (mean 318,717.80) and 45.41% (mean 269,082.10), respectively, and the statistical test was significant among different hospital accreditation levels (F2=7.63; P<.001). A comparison of EHR download volumes among the 6 National Health Insurance (NHI) branches showed that the central NHI branch downloaded 11,366,431 records (21.53%), which was the highest, and the eastern branch downloaded 1,615,391 records (3.06%), which was the lowest. The statistical test among the 6 NHI branches was significant (F5=8.82; P<.001). The download volumes of laboratory tests reports and outpatient medical records were 26,980,425 (50.3%) and 21,747,588 records (40.9%), respectively, and were much higher than medical images and discharge summaries. The statistical test was also significant (F=17.72; P<.001). Finally, the download time showed that the average for x-rays was 32.05 seconds, which was the longest, and was 9.92 seconds for electrocardiogram, which was the shortest, but there was no statistically significant difference among download times for various medical images. Conclusions: After years of operation, the Electronic Medical Record Exchange Center has achieved the initial goal of EHR interoperability, and data exchanges are running quite stably in Taiwan. However, the meaningful use of EHRs among hospitals and clinics still needs further encouragement and promotion. We suggest that the government?s leading role and collective collaboration with health care organizations are important for providing effective health information exchanges. UR - http://medinform.jmir.org/2019/1/e12630/ UR - http://dx.doi.org/10.2196/12630 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920376 ID - info:doi/10.2196/12630 ER - TY - JOUR AU - Uwizeyemungu, Sylvestre AU - Poba-Nzaou, Placide AU - Cantinotti, Michael PY - 2019/03/25 TI - European Hospitals? Transition Toward Fully Electronic-Based Systems: Do Information Technology Security and Privacy Practices Follow? JO - JMIR Med Inform SP - e11211 VL - 7 IS - 1 KW - health information technology KW - data security KW - patient data privacy KW - health services KW - electronic health records N2 - Background: Traditionally, health information has been mainly kept in paper-based records. This has deeply changed throughout approximately the last three decades with the widespread use of multiple health information technologies. The digitization of health care systems contributes to improving health care delivery. However, it also exposes health records to security and privacy breaches inherently related to information technology (IT). Thus, health care organizations willing to leverage IT for improved health care delivery need to put in place IT security and privacy measures consistent with their use of IT resources. Objective: In this study, 2 main objectives are pursued: (1) to assess the state of the implementation of IT security and privacy practices in European hospitals and (2) to assess to what extent these hospitals enhance their IT security and privacy practices as they move from paper-based systems toward fully electronic-based systems. Methods: Drawing on data from the European Commission electronic health survey, we performed a cluster analysis based on IT security and privacy practices implemented in 1723 European hospitals. We also developed an IT security index, a compounded measure of implemented IT security and privacy practices, and compared it with the hospitals? level in their transition from a paper-based system toward a fully electronic-based system. Results: A total of 3 clearly distinct patterns of health IT?related security and privacy practices were unveiled. These patterns, as well as the IT security index, indicate that most of the sampled hospitals (70.2%) failed to implement basic security and privacy measures consistent with their digitization level. Conclusions: Even though, on average, the most electronically advanced hospitals display a higher IT security index than hospitals where the paper system still dominates, surprisingly, it appears that the enhancement of IT security and privacy practices as the health information digitization advances in European hospitals is neither systematic nor strong enough regarding the IT-security requirements. This study will contribute to raising awareness among hospitals? managers as to the importance of enhancing their IT security and privacy measures so that they can keep up with the security threats inherently related to the digitization of health care organizations. UR - http://medinform.jmir.org/2019/1/e11211/ UR - http://dx.doi.org/10.2196/11211 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907732 ID - info:doi/10.2196/11211 ER - TY - JOUR AU - Li, Chen AU - Xu, Xiangdong AU - Zhou, Guanghua AU - He, Kai AU - Qi, Tianliang AU - Zhang, Wei AU - Tian, Feng AU - Zheng, Qinghua AU - Hu, Jianping PY - 2019/02/21 TI - Implementation of National Health Informatization in China: Survey About the Status Quo JO - JMIR Med Inform SP - e12238 VL - 7 IS - 1 KW - health policy KW - health informatization KW - electronic health record N2 - Background: The National Health and Family Planning Commission (NHFPC) in China organized a nationwide survey to investigate the informatization in hospitals and regional Health and Family Planning Commissions (HFPCs) in 2017. The survey obtained valid results from 79.69% (2021/2536) of major hospitals and 81% (26/32) of provincial and 73.1% (307/420) of municipal HFPCs. The investigated topics covered hardware infrastructure, information resources, applications, systems, and organizations in health informatics. Objective: This study aimed to provide evidence collected from the survey regarding China?s health informatization and assist policy making regarding health informatics in the 13th Five-Year Plan of China. Methods: Based on the survey, the paper presented the status quo of China?s health informatization and analyzed the progress and potential problems in terms of the country?s health information development policies. Results: Related policies have helped to construct 4-level information platforms and start converging the regional data to the 3 centralized databases. The principle of informatics has been transiting from finance-centered to people-centered. Alternatively, the quality, usability, and interoperability of the data still need to be improved. Conclusions: The nationwide survey shows that China?s health informatization is rapidly developing. Current information platforms and databases technically support data exchanging between all provinces and cities. As China is continuing to improve the infrastructure, more advanced applications are being developed upon it. UR - http://medinform.jmir.org/2019/1/e12238/ UR - http://dx.doi.org/10.2196/12238 UR - http://www.ncbi.nlm.nih.gov/pubmed/30789350 ID - info:doi/10.2196/12238 ER - TY - JOUR AU - Fischer, Emilio Alex AU - Sebidi, Jane AU - Barron, Peter AU - Lalla-Edward, Tresha Samanta PY - 2019/02/13 TI - The MomConnect Nurses and Midwives Support Platform (NurseConnect): A Qualitative Process Evaluation JO - JMIR Mhealth Uhealth SP - e11644 VL - 7 IS - 2 KW - evaluation KW - mHealth KW - mobile phone KW - MomConnect KW - NurseConnect KW - South Africa N2 - Background: Over the past decade, mobile health has steadily increased in low-income and middle-income countries. However, few platforms have been able to sustainably scale up like the MomConnect program in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in maternal and child health. The National Department of Health has committed to expanding NurseConnect to all nurses across the country, and an evaluation of the current user experience was conducted to inform a successful scale up. Objective: This study aims to evaluate the perception and use of NurseConnect by nurses and midwives to produce feedback that can be used to optimize the user experience as the platform continues to scale up. Methods: We conducted focus group discussions and in-depth interviews with 110 nurses and midwives from 18 randomly selected health care facilities across South Africa. Questions focused on mobile phone use, access to medical information and their experience with NurseConnect registration, as well as the content and different platforms. Results: All participants had mobile phones and communication through calls and messaging was the main use in both personal and work settings. Of 110 participants, 108 (98.2%) had data-enabled phones, and the internet, Google, and apps (South African National Department of Health Guidelines, iTriage, Drugs.com) were commonly used, especially to find information in the work setting. Of 110 participants, 62 (56.4%) were registered NurseConnect users and liked the message content, especially listeriosis and motivational messages, which created behavioral change in some instances. The mobisite and helpdesk, however, were underutilized because of a lack of information surrounding these platforms. Some participants did not trust medical information from websites and had more confidence in apps, while others associated a ?helpdesk? with a call-in service, not a messaging one. Many of the unregistered participants had not heard of NurseConnect, and some cited data and time constraints as barriers to both registration and uptake. Conclusions: Mobile and smartphone penetration was very high, and participants often used their phone to find medical information. The NurseConnect messages were well-liked by all registered participants; however, the mobisite and helpdesk were underutilized owing to a lack of information and training around these platforms. Enhanced marketing and training initiatives that optimize existing social networks, as well as the provision of data and Wi-Fi, should be explored to ensure that registration improves, and that users are active across all platforms. UR - http://mhealth.jmir.org/2019/2/e11644/ UR - http://dx.doi.org/10.2196/11644 UR - http://www.ncbi.nlm.nih.gov/pubmed/30758298 ID - info:doi/10.2196/11644 ER - TY - JOUR AU - Mandl, D. Kenneth AU - Gottlieb, Daniel AU - Ellis, Alyssa PY - 2019/02/01 TI - Beyond One-Off Integrations: A Commercial, Substitutable, Reusable, Standards-Based, Electronic Health Record?Connected App JO - J Med Internet Res SP - e12902 VL - 21 IS - 2 KW - electronic medical records KW - application programming interfaces UR - http://www.jmir.org/2019/2/e12902/ UR - http://dx.doi.org/10.2196/12902 UR - http://www.ncbi.nlm.nih.gov/pubmed/30707097 ID - info:doi/10.2196/12902 ER - TY - JOUR AU - Delvaux, Nicolas AU - Aertgeerts, Bert AU - van Bussel, CH Johan AU - Goderis, Geert AU - Vaes, Bert AU - Vermandere, Mieke PY - 2018/11/19 TI - Health Data for Research Through a Nationwide Privacy-Proof System in Belgium: Design and Implementation JO - JMIR Med Inform SP - e11428 VL - 6 IS - 4 KW - electronic health records KW - health information exchange KW - health information interoperability KW - learning health systems KW - medical record linkage N2 - Background: Health data collected during routine care have important potential for reuse for other purposes, especially as part of a learning health system to advance the quality of care. Many sources of bias have been identified through the lifecycle of health data that could compromise the scientific integrity of these data. New data protection legislation requires research facilities to improve safety measures and, thus, ensure privacy. Objective: This study aims to address the question on how health data can be transferred from various sources and using multiple systems to a centralized platform, called Healthdata.be, while ensuring the accuracy, validity, safety, and privacy. In addition, the study demonstrates how these processes can be used in various research designs relevant for learning health systems. Methods: The Healthdata.be platform urges uniformity of the data registration at the primary source through the use of detailed clinical models. Data retrieval and transfer are organized through end-to-end encrypted electronic health channels, and data are encoded using token keys. In addition, patient identifiers are pseudonymized so that health data from the same patient collected across various sources can still be linked without compromising the deidentification. Results: The Healthdata.be platform currently collects data for >150 clinical registries in Belgium. We demonstrated how the data collection for the Belgian primary care morbidity register INTEGO is organized and how the Healthdata.be platform can be used for a cluster randomized trial. Conclusions: Collecting health data in various sources and linking these data to a single patient is a promising feature that can potentially address important concerns on the validity and quality of health data. Safe methods of data transfer without compromising privacy are capable of transporting these data from the primary data provider or clinician to a research facility. More research is required to demonstrate that these methods improve the quality of data collection, allowing researchers to rely on electronic health records as a valid source for scientific data. UR - http://medinform.jmir.org/2018/4/e11428/ UR - http://dx.doi.org/10.2196/11428 UR - http://www.ncbi.nlm.nih.gov/pubmed/30455164 ID - info:doi/10.2196/11428 ER - TY - JOUR AU - Walonoski, Jason AU - Scanlon, Robert AU - Dowling, Conor AU - Hyland, Mario AU - Ettema, Richard AU - Posnack, Steven PY - 2018/10/23 TI - Validation and Testing of Fast Healthcare Interoperability Resources Standards Compliance: Data Analysis JO - JMIR Med Inform SP - e10870 VL - 6 IS - 4 KW - electronic health records KW - health data interoperability KW - test-driven development KW - practice makes perfect N2 - Background: There is wide recognition that the lack of health data interoperability has significant impacts. Traditionally, health data standards are complex and test-driven methods played important roles in achieving interoperability. The Health Level Seven International (HL7) standard Fast Healthcare Interoperability Resources (FHIR) may be a technical solution that aligns with policy, but systems need to be validated and tested. Objective: Our objective is to explore the question of whether or not the regular use of validation and testing tools improves server compliance with the HL7 FHIR specification. Methods: We used two independent validation and testing tools, Crucible and Touchstone, and analyzed the usage and result data to determine their impact on server compliance with the HL7 FHIR specification. Results: The use of validation and testing tools such as Crucible and Touchstone are strongly correlated with increased compliance and ?practice makes perfect.? Frequent and thorough testing has clear implications for health data interoperability. Additional data analysis reveals trends over time with respect to vendors, use cases, and FHIR versions. Conclusions: Validation and testing tools can aid in the transition to an interoperable health care infrastructure. Developers that use testing and validation tools tend to produce more compliant FHIR implementations. When it comes to health data interoperability, ?practice makes perfect.? UR - http://medinform.jmir.org/2018/4/e10870/ UR - http://dx.doi.org/10.2196/10870 UR - http://www.ncbi.nlm.nih.gov/pubmed/30355549 ID - info:doi/10.2196/10870 ER - TY - JOUR AU - Lucas, R. Alexander AU - Bass, B. Michael AU - Rothrock, E. Nan AU - O'Connor, L. Mary AU - Sorkin, R. Mia AU - Nawyn, Jason AU - Albinali, Fahd AU - Wagner, I. Lynne PY - 2018/10/22 TI - Development of an eHealth System to Capture and Analyze Patient Sensor and Self-Report Data: Mixed-Methods Assessment of Potential Applications to Improve Cancer Care Delivery JO - JMIR Med Inform SP - e46 VL - 6 IS - 4 KW - cancer KW - care delivery KW - decision support KW - eHealth KW - mobile phone KW - survivorship KW - symptom monitoring N2 - Background: Capturing and Analyzing Sensor and Self-Report Data for Clinicians and Researchers (COMPASS) is an electronic health (eHealth) platform designed to improve cancer care delivery through passive monitoring of patients? health status and delivering customizable reports to clinicians. Based on data from sensors and context-driven administration of patient-reported outcome (PRO) measures, key indices of patients? functional status can be collected between regular clinic visits, supporting clinicians in the delivery of patient care. Objective: The first phase of this project aimed to systematically collect input from oncology providers and patients on potential clinical applications for COMPASS to refine the system. Methods: Ten clinicians representing various oncology specialties and disciplines completed semi-structured interviews designed to solicit clinician input on how COMPASS can best support clinical care delivery. Three cancer patients tested a prototype of COMPASS for 7 days and provided feedback. Interview data were tabulated using thematic content analysis to identify the most clinically relevant objective and PRO domains. Results: Thematic content analysis revealed that clinicians were most interested in monitoring vital statistics, symptoms, and functional status, including the physical activity level (n=9), weight (n=5), fatigue (n=9), sleep quality (n=8), and anxiety (n=7). Patients (2 in active treatment and 1 in remission) reported that they would use such a device, were enthusiastic about their clinicians monitoring their health status, especially the tracking of symptoms, and felt knowing their clinicians were monitoring and reviewing their health status provided valuable reassurance. Patients would, however, like to provide some context to their data. Conclusions: Clinicians and patients both articulated potential benefits of the COMPASS system in improving cancer care. From a clinician standpoint, data need to be easily interpretable and actionable. The fact that patients and clinicians both see potential value in eHealth systems suggests wider adoption and utilization could prove to be a useful tool for improving care delivery. UR - http://medinform.jmir.org/2018/4/e46/ UR - http://dx.doi.org/10.2196/medinform.9525 UR - http://www.ncbi.nlm.nih.gov/pubmed/30348634 ID - info:doi/10.2196/medinform.9525 ER - TY - JOUR AU - Graham, AD Timothy AU - Ballermann, Mark AU - Lang, Eddy AU - Bullard, J. Michael AU - Parsons, Denise AU - Mercuur, Gabriella AU - San Agustin, Pat AU - Ali, Samina PY - 2018/9/25 TI - Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study JO - JMIR Med Inform SP - e10184 VL - 6 IS - 3 KW - ambulatory care facilities KW - cross-sectional studies KW - electronic health records KW - utilization KW - hospital emergency service KW - statistics and numerical data KW - health information exchange KW - humans KW - information dissemination KW - medical record linkage KW - program evaluation N2 - Background: The adoption and use of an electronic health record (EHR) can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable EHRs (iEHRs) to facilitate health information exchange, but the clinical use and utility of iEHRs has not been well described. Objective: The aim of this study was to describe the use of a provincial iEHR known as the Alberta Netcare Portal (ANP) in 4 urban Alberta emergency departments. The secondary objectives were to characterize the time spent using the respective electronic tools and identify the aspects that were perceived as most useful by emergency department physicians. Methods: In this study, we have included 4 emergency departments, 2 using paper-based ordering (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and 2 using a commercial vendor clinical information system (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]). Structured clinical observations of ANP use and system audit logs analysis were compared at the 4 sites from October 2014 to March 2016. Results: Observers followed 142 physicians for a total of 566 hours over 376 occasions. The median percentage of observed time spent using ANP was 8.5% at UAH (interquartile range, IQR, 3.7%-13.3%), 4.4% at GNCH (IQR 2.4%-4.4%), 4.6% at FMC (IQR 2.4%-7.6%), and 5.1% at PLC (IQR 3.0%-7.7%). By combining administrative and access audit data, the median number of ANP screens (ie, results and reports displayed on a screen) accessed per patient visit were 20 at UAH (IQR 6-67), 9 at GNCH (IQR 4-29), 7 at FMC (IQR 2-18), and 5 at PLC (IQR 2-14). When compared with the structured clinical observations, the statistical analysis of screen access data showed that ANP was used more at UAH than the other sites. Conclusions: This study shows that the iEHR is well utilized at the 4 sites studied, and the usage patterns implied clinical value. Use of the ANP was highest in a paper-based academic center and lower in the centers using a commercial emergency department clinical information system. More study about the clinical impacts of using iEHRs in the Canadian context including longer term impacts on quality of practice and safety are required. UR - http://medinform.jmir.org/2018/3/e10184/ UR - http://dx.doi.org/10.2196/10184 UR - http://www.ncbi.nlm.nih.gov/pubmed/30274967 ID - info:doi/10.2196/10184 ER - TY - JOUR AU - McGovern, Marcella AU - Quinlan, Maria AU - Doyle, Gerardine AU - Moore, Gemma AU - Geiger, Susi PY - 2018/07/18 TI - Implementing a National Electronic Referral Program: Qualitative Study JO - JMIR Med Inform SP - e10488 VL - 6 IS - 3 KW - electronic referrals KW - scale-up KW - eHealth KW - implementation KW - policy N2 - Background: Electronic referrals or e-referrals can be defined as the electronic transmission of patient data and clinical requests between health service providers. National electronic referral systems have proved challenging to implement due to problems of fit between the technical systems proposed and the existing sociotechnical systems. In seeming contradiction to a sociotechnical approach, the Irish Health Service Executive initiated an incremental implementation of a National Electronic Referral Programme (NERP), with step 1 including only the technical capability for general practitioners to submit electronic referral requests to hospital outpatient departments. The technology component of the program was specified, but any changes required to embed that technology in the existing sociotechnical system were not specified. Objective: This study aimed to theoretically frame the lessons learned from the NERP step 1 on the design and implementation of a national health information technology program. Methods: A case study design was employed, using qualitative interviews with key stakeholders of the NERP step 1 (N=41). A theory-driven thematic analysis of the interview data was conducted, using Barker et al?s Framework for Going to Full Scale. Results: The NERP step 1 was broadly welcomed by key stakeholders as the first step in the implementation of electronic referrals?delivering improvements in the speed, completeness of demographic information, and legibility and traceability of referral requests. National leadership and digitalized health records in general practice were critical enabling factors. Inhibiting factors included policy uncertainty about the future organizational structures within which electronic referrals would be implemented; the need to establish a central referral office consistent with these organizational structures; outstanding interoperability issues between the electronic referral solution and hospital patient administration systems; and an anticipated need to develop specialist referral templates for some specialties. A lack of specification of the sociotechnical elements of the NERP step 1 inhibited the necessary testing and refinement of the change package used to implement the program. Conclusions: The key strengths of the NERP step 1 are patient safety benefits. The NERP was progressed beyond the pilot stage despite limited resources and outstanding interoperability issues. In addition, a new electronic health unit in Ireland (eHealth Ireland) gained credibility in delivering national health information technology programs. Limitations of the program are its poor integration in the wider policy and quality improvement agenda of the Health Service Executive. The lack of specification of the sociotechnical elements of the program created challenges in communicating the program scope to key stakeholders and restricted the ability of program managers and implementers to test and refine the change package. This study concludes that while the sociotechnical elements of a national health information technology program do not need to be specified in tandem with technical elements, they do need to be specified early in the implementation process so that the change package used to implement the program can be tested and refined. UR - http://medinform.jmir.org/2018/3/e10488/ UR - http://dx.doi.org/10.2196/10488 UR - http://www.ncbi.nlm.nih.gov/pubmed/30021709 ID - info:doi/10.2196/10488 ER - TY - JOUR AU - Balsari, Satchit AU - Fortenko, Alexander AU - Blaya, A. Joaquín AU - Gropper, Adrian AU - Jayaram, Malavika AU - Matthan, Rahul AU - Sahasranam, Ram AU - Shankar, Mark AU - Sarbadhikari, N. Suptendra AU - Bierer, E. Barbara AU - Mandl, D. Kenneth AU - Mehendale, Sanjay AU - Khanna, Tarun PY - 2018/07/13 TI - Reimagining Health Data Exchange: An Application Programming Interface?Enabled Roadmap for India JO - J Med Internet Res SP - e10725 VL - 20 IS - 7 KW - health information exchange KW - India KW - health APIs UR - http://www.jmir.org/2018/7/e10725/ UR - http://dx.doi.org/10.2196/10725 UR - http://www.ncbi.nlm.nih.gov/pubmed/30006325 ID - info:doi/10.2196/10725 ER - TY - JOUR AU - Gao, Fangjian AU - Thiebes, Scott AU - Sunyaev, Ali PY - 2018/07/11 TI - Rethinking the Meaning of Cloud Computing for Health Care: A Taxonomic Perspective and Future Research Directions JO - J Med Internet Res SP - e10041 VL - 20 IS - 7 KW - cloud computing KW - taxonomy KW - health IT innovation N2 - Background: Cloud computing is an innovative paradigm that provides users with on-demand access to a shared pool of configurable computing resources such as servers, storage, and applications. Researchers claim that information technology (IT) services delivered via the cloud computing paradigm (ie, cloud computing services) provide major benefits for health care. However, due to a mismatch between our conceptual understanding of cloud computing for health care and the actual phenomenon in practice, the meaningful use of it for the health care industry cannot always be ensured. Although some studies have tried to conceptualize cloud computing or interpret this phenomenon for health care settings, they have mainly relied on its interpretation in a common context or have been heavily based on a general understanding of traditional health IT artifacts, leading to an insufficient or unspecific conceptual understanding of cloud computing for health care. Objective: We aim to generate insights into the concept of cloud computing for health IT research. We propose a taxonomy that can serve as a fundamental mechanism for organizing knowledge about cloud computing services in health care organizations to gain a deepened, specific understanding of cloud computing in health care. With the taxonomy, we focus on conceptualizing the relevant properties of cloud computing for service delivery to health care organizations and highlighting their specific meanings for health care. Methods: We employed a 2-stage approach in developing a taxonomy of cloud computing services for health care organizations. We conducted a structured literature review and 24 semistructured expert interviews in stage 1, drawing on data from theory and practice. In stage 2, we applied a systematic approach and relied on data from stage 1 to develop and evaluate the taxonomy using 14 iterations. Results: Our taxonomy is composed of 8 dimensions and 28 characteristics that are relevant for cloud computing services in health care organizations. By applying the taxonomy to classify existing cloud computing services identified from the literature and expert interviews, which also serves as a part of the taxonomy, we identified 7 specificities of cloud computing in health care. These specificities challenge what we have learned about cloud computing in general contexts or in traditional health IT from the previous literature. The summarized specificities suggest research opportunities and exemplary research questions for future health IT research on cloud computing. Conclusions: By relying on perspectives from a taxonomy for cloud computing services for health care organizations, this study provides a solid conceptual cornerstone for cloud computing in health care. Moreover, the identified specificities of cloud computing and the related future research opportunities will serve as a valuable roadmap to facilitate more research into cloud computing in health care. UR - http://www.jmir.org/2018/7/e10041/ UR - http://dx.doi.org/10.2196/10041 UR - http://www.ncbi.nlm.nih.gov/pubmed/29997108 ID - info:doi/10.2196/10041 ER - TY - JOUR AU - Reis, Nogueira Zilma Silveira AU - Maia, Abreu Thais AU - Marcolino, Soriano Milena AU - Becerra-Posada, Francisco AU - Novillo-Ortiz, David AU - Ribeiro, Pinho Antonio Luiz PY - 2017/08/29 TI - Is There Evidence of Cost Benefits of Electronic Medical Records, Standards, or Interoperability in Hospital Information Systems? Overview of Systematic Reviews JO - JMIR Med Inform SP - e26 VL - 5 IS - 3 KW - electronic medical records KW - standards KW - medical information exchange KW - health information exchange KW - cost KW - benefits and costs N2 - Background: Electronic health (eHealth) interventions may improve the quality of care by providing timely, accessible information about one patient or an entire population. Electronic patient care information forms the nucleus of computerized health information systems. However, interoperability among systems depends on the adoption of information standards. Additionally, investing in technology systems requires cost-effectiveness studies to ensure the sustainability of processes for stakeholders. Objective: The objective of this study was to assess cost-effectiveness of the use of electronically available inpatient data systems, health information exchange, or standards to support interoperability among systems. Methods: An overview of systematic reviews was conducted, assessing the MEDLINE, Cochrane Library, LILACS, and IEEE Library databases to identify relevant studies published through February 2016. The search was supplemented by citations from the selected papers. The primary outcome sought the cost-effectiveness, and the secondary outcome was the impact on quality of care. Independent reviewers selected studies, and disagreement was resolved by consensus. The quality of the included studies was evaluated using a measurement tool to assess systematic reviews (AMSTAR). Results: The primary search identified 286 papers, and two papers were manually included. A total of 211 were systematic reviews. From the 20 studies that were selected after screening the title and abstract, 14 were deemed ineligible, and six met the inclusion criteria. The interventions did not show a measurable effect on cost-effectiveness. Despite the limited number of studies, the heterogeneity of electronic systems reported, and the types of intervention in hospital routines, it was possible to identify some preliminary benefits in quality of care. Hospital information systems, along with information sharing, had the potential to improve clinical practice by reducing staff errors or incidents, improving automated harm detection, monitoring infections more effectively, and enhancing the continuity of care during physician handoffs. Conclusions: This review identified some benefits in the quality of care but did not provide evidence that the implementation of eHealth interventions had a measurable impact on cost-effectiveness in hospital settings. However, further evidence is needed to infer the impact of standards adoption or interoperability in cost benefits of health care; this in turn requires further research. UR - http://medinform.jmir.org/2017/3/e26/ UR - http://dx.doi.org/10.2196/medinform.7400 UR - http://www.ncbi.nlm.nih.gov/pubmed/28851681 ID - info:doi/10.2196/medinform.7400 ER - TY - JOUR AU - Wang, Yaogang AU - Sun, Li AU - Hou, Jie PY - 2017/08/08 TI - Hierarchical Medical System Based on Big Data and Mobile Internet: A New Strategic Choice in Health Care JO - JMIR Med Inform SP - e22 VL - 5 IS - 3 KW - medical services KW - continuity of patient care KW - mobile health UR - http://medinform.jmir.org/2017/3/e22/ UR - http://dx.doi.org/10.2196/medinform.6799 UR - http://www.ncbi.nlm.nih.gov/pubmed/28790024 ID - info:doi/10.2196/medinform.6799 ER - TY - JOUR AU - Fernandes, Oliveira Chrystinne AU - Lucena, De Carlos José Pereira PY - 2017/03/27 TI - A Software Framework for Remote Patient Monitoring by Using Multi-Agent Systems Support JO - JMIR Med Inform SP - e9 VL - 5 IS - 1 KW - eHealth systems KW - remote patient monitoring KW - biometric sensors N2 - Background: Although there have been significant advances in network, hardware, and software technologies, the health care environment has not taken advantage of these developments to solve many of its inherent problems. Research activities in these 3 areas make it possible to apply advanced technologies to address many of these issues such as real-time monitoring of a large number of patients, particularly where a timely response is critical. Objective: The objective of this research was to design and develop innovative technological solutions to offer a more proactive and reliable medical care environment. The short-term and primary goal was to construct IoT4Health, a flexible software framework to generate a range of Internet of things (IoT) applications, containing components such as multi-agent systems that are designed to perform Remote Patient Monitoring (RPM) activities autonomously. An investigation into its full potential to conduct such patient monitoring activities in a more proactive way is an expected future step. Methods: A framework methodology was selected to evaluate whether the RPM domain had the potential to generate customized applications that could achieve the stated goal of being responsive and flexible within the RPM domain. As a proof of concept of the software framework?s flexibility, 3 applications were developed with different implementations for each framework hot spot to demonstrate potential. Agents4Health was selected to illustrate the instantiation process and IoT4Health?s operation. To develop more concrete indicators of the responsiveness of the simulated care environment, an experiment was conducted while Agents4Health was operating, to measure the number of delays incurred in monitoring the tasks performed by agents. Results: IoT4Health?s construction can be highlighted as our contribution to the development of eHealth solutions. As a software framework, IoT4Health offers extensibility points for the generation of applications. Applications can extend the framework in the following ways: identification, collection, storage, recovery, visualization, monitoring, anomalies detection, resource notification, and dynamic reconfiguration. Based on other outcomes involving observation of the resulting applications, it was noted that its design contributed toward more proactive patient monitoring. Through these experimental systems, anomalies were detected in real time, with agents sending notifications instantly to the health providers. Conclusions: We conclude that the cost-benefit of the construction of a more generic and complex system instead of a custom-made software system demonstrated the worth of the approach, making it possible to generate applications in this domain in a more timely fashion. UR - http://medinform.jmir.org/2017/1/e9/ UR - http://dx.doi.org/10.2196/medinform.6693 UR - http://www.ncbi.nlm.nih.gov/pubmed/28347973 ID - info:doi/10.2196/medinform.6693 ER - TY - JOUR AU - Gordon, S. Aliza AU - Adamson, C. Wallace AU - DeVries, R. Andrea PY - 2017/02/17 TI - Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization JO - J Med Internet Res SP - e35 VL - 19 IS - 2 KW - virtual visit KW - health care utilization KW - claims analysis N2 - Background: Expansion of virtual health care?real-time video consultation with a physician via the Internet?will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. Objective: The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions. Methods: A cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy. Results: A total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, P<.001; UCC: 39.01%, P<.001; ED: 53.15%, P<.001; PCP: 37.40%, P<.001), and imaging rates for virtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, P<.001; ED: 43.06%, P<.001; PCP: 11.26%, P<.001). RHC, UCC, ED, and PCP were estimated to be $36, $153, $1735, and $162 more expensive than virtual visit episodes, respectively, including medical and pharmacy costs. Conclusions: Virtual care appears to be a low-cost alternative to care administered in other settings with lower testing rates. The similar follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care. UR - http://www.jmir.org/2017/2/e35/ UR - http://dx.doi.org/10.2196/jmir.6783 UR - http://www.ncbi.nlm.nih.gov/pubmed/28213342 ID - info:doi/10.2196/jmir.6783 ER - TY - JOUR AU - Lennon, R. Marilyn AU - Bouamrane, Matt-Mouley AU - Devlin, M. Alison AU - O'Connor, Siobhan AU - O'Donnell, Catherine AU - Chetty, Ula AU - Agbakoba, Ruth AU - Bikker, Annemieke AU - Grieve, Eleanor AU - Finch, Tracy AU - Watson, Nicholas AU - Wyke, Sally AU - Mair, S. Frances PY - 2017/02/16 TI - Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom JO - J Med Internet Res SP - e42 VL - 19 IS - 2 KW - telemedicine KW - health plan implementation KW - community health services KW - health services research KW - electronic health records KW - instrumentation KW - qualitative research KW - diffusion of innovation KW - medical informatics N2 - Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ?Delivering Assisted Living Lifestyles at Scale? (dallas) from 2012-2015. Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results: We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale. UR - http://www.jmir.org/2017/2/e42/ UR - http://dx.doi.org/10.2196/jmir.6900 UR - http://www.ncbi.nlm.nih.gov/pubmed/28209558 ID - info:doi/10.2196/jmir.6900 ER - TY - JOUR AU - Phanareth, Klaus AU - Vingtoft, Søren AU - Christensen, Skovbo Anders AU - Nielsen, Sylvest Jakob AU - Svenstrup, Jørgen AU - Berntsen, Rosvold Gro Karine AU - Newman, Peter Stanton AU - Kayser, Lars PY - 2017/01/16 TI - The Epital Care Model: A New Person-Centered Model of Technology-Enabled Integrated Care for People With Long Term Conditions JO - JMIR Res Protoc SP - e6 VL - 6 IS - 1 KW - integrated care KW - technology enabled KW - innovative care KW - chronic obstructive pulmonary disease (COPD) KW - frail N2 - Background: There is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports the intentions of the World Health Organization (WHO) to have integrated people-centered care. Objective: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care, and embraces the use of digital technology. Methods: The overall research method was inspired by action research and used an agile, iterative approach. In 2012, a living lab was established in a Danish municipality which allowed for the freedom of redesigning health care processes. As the first step, a wide group of stakeholders was gathered to create a layout for the reorganization of services and development of technology, based on established principles for innovative management of people with chronic conditions. The next three steps were (1) a proof of concept in 2012, (2) a pilot study, and (3) a feasibility study from 2013 to 2015, in which a total of 93 chronic obstructive pulmonary disease (COPD) patients were enrolled. Citizens were provided a tablet-based solution for remote follow-up and communication purposes, and access to a 24/7 response and coordination center that coordinated both virtual and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed function. Results: Based on the findings from the iterative process, and evolving technology and workflow solutions, we propose a robust and feasible model that can provide a framework for developing solutions to support an active life with one or more LTCs. The resulting Epital Care Model (ECM) consists of six stages, and serves as a template for how a digitally-enhanced health service can be provided based on patients? medical needs. The model is designed to be a proactive, preventive, and monitoring health care system that involves individuals in the management of their own health conditions. Conclusions: The ECM is in accordance with WHO?s framework for integrated people-centered health services, and may serve as a framework for the development of new technologies and provide a template for future reorganization. UR - http://www.researchprotocols.org/2017/1/e6/ UR - http://dx.doi.org/10.2196/resprot.6506 UR - http://www.ncbi.nlm.nih.gov/pubmed/28093379 ID - info:doi/10.2196/resprot.6506 ER - TY - JOUR AU - Vannieuwenborg, Frederic AU - Van der Auwermeulen, Thomas AU - Van Ooteghem, Jan AU - Jacobs, An AU - Verbrugge, Sofie AU - Colle, Didier PY - 2016/10/31 TI - Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study JO - JMIR Med Inform SP - e33 VL - 4 IS - 4 KW - medical informatics applications KW - home care services KW - ambulatory care information systems KW - evaluation studies as topic KW - cost-benefit analysis N2 - Background: In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. Objective: The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Methods: Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. Results: The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Conclusions: Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. UR - http://medinform.jmir.org/2016/4/e33/ UR - http://dx.doi.org/10.2196/medinform.5012 UR - http://www.ncbi.nlm.nih.gov/pubmed/27799137 ID - info:doi/10.2196/medinform.5012 ER - TY - JOUR AU - Lea, Christopher Nathan AU - Nicholls, Jacqueline AU - Dobbs, Christine AU - Sethi, Nayha AU - Cunningham, James AU - Ainsworth, John AU - Heaven, Martin AU - Peacock, Trevor AU - Peacock, Anthony AU - Jones, Kerina AU - Laurie, Graeme AU - Kalra, Dipak PY - 2016/06/21 TI - Data Safe Havens and Trust: Toward a Common Understanding of Trusted Research Platforms for Governing Secure and Ethical Health Research JO - JMIR Med Inform SP - e22 VL - 4 IS - 2 KW - trusted research platforms KW - data safe havens KW - trusted researchers KW - legislative and regulatory compliance KW - public engagement KW - public involvement KW - clinical research support KW - health record linkage supported research KW - genomics research support UR - http://medinform.jmir.org/2016/2/e22/ UR - http://dx.doi.org/10.2196/medinform.5571 UR - http://www.ncbi.nlm.nih.gov/pubmed/27329087 ID - info:doi/10.2196/medinform.5571 ER - TY - JOUR AU - Thilakanathan, Danan AU - Calvo, A. Rafael AU - Chen, Shiping AU - Nepal, Surya AU - Glozier, Nick PY - 2016/05/27 TI - Facilitating Secure Sharing of Personal Health Data in the Cloud JO - JMIR Med Inform SP - e15 VL - 4 IS - 2 KW - self care KW - telemedicine KW - privacy KW - computer security KW - information dissemination N2 - Background: Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective: This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods: We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results: We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions: We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. UR - http://medinform.jmir.org/2016/2/e15/ UR - http://dx.doi.org/10.2196/medinform.4756 UR - http://www.ncbi.nlm.nih.gov/pubmed/27234691 ID - info:doi/10.2196/medinform.4756 ER - TY - JOUR AU - Bosworth, B. Hayden AU - Zullig, L. Leah AU - Mendys, Phil AU - Ho, Michael AU - Trygstad, Troy AU - Granger, Christopher AU - Oakes, M. Megan AU - Granger, B. Bradi PY - 2016/03/15 TI - Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence JO - JMIR Med Inform SP - e9 VL - 4 IS - 1 KW - medication adherence KW - compliance KW - health information technology N2 - Background: The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. Objective: The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. Methods: We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. Results: The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. Conclusion: To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues. UR - http://medinform.jmir.org/2016/1/e9/ UR - http://dx.doi.org/10.2196/medinform.4326 UR - http://www.ncbi.nlm.nih.gov/pubmed/26980270 ID - info:doi/10.2196/medinform.4326 ER - TY - JOUR AU - Dixon, E. Brian AU - Alzeer, H. Abdullah AU - Phillips, O'Kelly Erin AU - Marrero, G. David PY - 2016/02/08 TI - Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study JO - JMIR Med Inform SP - e4 VL - 4 IS - 1 KW - medication adherence KW - barriers to medication use KW - diabetes mellitus KW - type 2 KW - medical records systems KW - computerized KW - health records KW - personal KW - physician-patient relations KW - drug monitoring KW - patient-centered care N2 - Background: Patients with diabetes often have poor adherence to using medications as prescribed. The reasons why, however, are not well understood. Furthermore, most health care delivery processes do not routinely assess medication adherence or the factors that contribute to poor adherence. Objective: The objective of the study was to assess the feasibility of an integrated informatics approach to aggregating and displaying clinically relevant data with the potential to identify issues that may interfere with appropriate medication utilization and facilitate patient-provider communication during clinical encounters about strategies to improve medication use. Methods: We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a patient portal. Next, we implemented the dashboard into three community health centers. Health care providers (n=15) and patients with diabetes (n=96) were enrolled in a before-after pilot to test the system?s impact on medication adherence and clinical outcomes. To measure adherence, we calculated the proportion of days covered using pharmacy claims. Demographic, laboratory, and visit data from the EHR were analyzed using pairwise t tests. Perceived barriers to adherence were self-reported by patients. Providers were surveyed about their use and perceptions of the clinical dashboard. Results: Adherence significantly and meaningfully improved (improvements ranged from 6%-20%) consistently across diabetes as well as cardiovascular drug classes. Clinical outcomes, including HbA1c, blood pressure, lipid control, and emergency department utilization remained unchanged. Only a quarter of patients (n=24) logged into the patient portal and completed psychosocial questionnaires about their barriers to taking medications. Conclusions: Integrated approaches using advanced EHR, clinical decision support, and patient-controlled technologies show promise for improving appropriate medication use and supporting better management of chronic conditions. Future research and development is necessary to design, implement, and integrate the myriad of EHR and clinical decision support systems as well as patient-focused information systems into routine care and patient processes that together support health and well-being. UR - http://medinform.jmir.org/2016/1/e4/ UR - http://dx.doi.org/10.2196/medinform.4739 UR - http://www.ncbi.nlm.nih.gov/pubmed/26858218 ID - info:doi/10.2196/medinform.4739 ER - TY - JOUR AU - Kern, Raimar AU - Haase, Rocco AU - Eisele, Christina Judith AU - Thomas, Katja AU - Ziemssen, Tjalf PY - 2016/01/08 TI - Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System JO - Interact J Med Res SP - e2 VL - 5 IS - 1 KW - health information technology KW - computers KW - Internet KW - multiple sclerosis KW - eHealth KW - disease management N2 - Background: Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Objective: Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. Methods: We conducted a paper-and-pencil?based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians? attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians? knowledge about the Multiple Sclerosis Documentation System (3 items). Results: From 600 mailed surveys, 74 completed surveys were returned. As much as 9 of the 10 practices were already connected to the Internet (67/74), but only 49% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 43% opted for an online interface, whereas 58% decided on an offline method of data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient communication, and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 91% welcomed the opportunity of a specific clinical documentation for MS and 87% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74). Conclusions: Physicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Many aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS-specific eHealth services were highly appreciated, but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients. UR - http://www.i-jmr.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/ijmr.4549 UR - http://www.ncbi.nlm.nih.gov/pubmed/26746977 ID - info:doi/10.2196/ijmr.4549 ER - TY - JOUR AU - Hersh, R. William AU - Totten, M. Annette AU - Eden, B. Karen AU - Devine, Beth AU - Gorman, Paul AU - Kassakian, Z. Steven AU - Woods, S. Susan AU - Daeges, Monica AU - Pappas, Miranda AU - McDonagh, S. Marian PY - 2015/12/15 TI - Outcomes From Health Information Exchange: Systematic Review and Future Research Needs JO - JMIR Med Inform SP - e39 VL - 3 IS - 4 KW - diagnostic tests KW - health information exchange KW - outcome assessment (health care) KW - patient readmission KW - routine KW - systematic review N2 - Background: Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations, has been promoted to improve the efficiency, cost-effectiveness, quality, and safety of health care delivery. Objective: To systematically review the available research on HIE outcomes and analyze future research needs. Methods: Data sources included citations from selected databases from January 1990 to February 2015. We included English-language studies of HIE in clinical or public health settings in any country. Data were extracted using dual review with adjudication of disagreements. Results: We identified 34 studies on outcomes of HIE. No studies reported on clinical outcomes (eg, mortality and morbidity) or identified harms. Low-quality evidence generally finds that HIE reduces duplicative laboratory and radiology testing, emergency department costs, hospital admissions (less so for readmissions), and improves public health reporting, ambulatory quality of care, and disability claims processing. Most clinicians attributed positive changes in care coordination, communication, and knowledge about patients to HIE. Conclusions: Although the evidence supports benefits of HIE in reducing the use of specific resources and improving the quality of care, the full impact of HIE on clinical outcomes and potential harms are inadequately studied. Future studies must address comprehensive questions, use more rigorous designs, and employ a standard for describing types of HIE. Trial Registration: PROSPERO Registry No CRD42014013285; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42014013285 (Archived by WebCite at http://www.webcitation.org/6dZhqDM8t). UR - http://medinform.jmir.org/2015/4/e39/ UR - http://dx.doi.org/10.2196/medinform.5215 UR - http://www.ncbi.nlm.nih.gov/pubmed/26678413 ID - info:doi/10.2196/medinform.5215 ER - TY - JOUR AU - Gay, Valerie AU - Leijdekkers, Peter PY - 2015/11/18 TI - Bringing Health and Fitness Data Together for Connected Health Care: Mobile Apps as Enablers of Interoperability JO - J Med Internet Res SP - e260 VL - 17 IS - 11 KW - health informatics KW - connected health KW - pervasive and mobile computing KW - ubiquitous and mobile devices N2 - Background: A transformation is underway regarding how we deal with our health. Mobile devices make it possible to have continuous access to personal health information. Wearable devices, such as Fitbit and Apple?s smartwatch, can collect data continuously and provide insights into our health and fitness. However, lack of interoperability and the presence of data silos prevent users and health professionals from getting an integrated view of health and fitness data. To provide better health outcomes, a complete picture is needed which combines informal health and fitness data collected by the user together with official health records collected by health professionals. Mobile apps are well positioned to play an important role in the aggregation since they can tap into these official and informal health and data silos. Objective: The objective of this paper is to demonstrate that a mobile app can be used to aggregate health and fitness data and can enable interoperability. It discusses various technical interoperability challenges encountered while integrating data into one place. Methods: For 8 years, we have worked with third-party partners, including wearable device manufacturers, electronic health record providers, and app developers, to connect an Android app to their (wearable) devices, back-end servers, and systems. Results: The result of this research is a health and fitness app called myFitnessCompanion, which enables users to aggregate their data in one place. Over 6000 users use the app worldwide to aggregate their health and fitness data. It demonstrates that mobile apps can be used to enable interoperability. Challenges encountered in the research process included the different wireless protocols and standards used to communicate with wireless devices, the diversity of security and authorization protocols used to be able to exchange data with servers, and lack of standards usage, such as Health Level Seven, for medical information exchange. Conclusions: By limiting the negative effects of health data silos, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care. UR - http://www.jmir.org/2015/11/e260/ UR - http://dx.doi.org/10.2196/jmir.5094 UR - http://www.ncbi.nlm.nih.gov/pubmed/26581920 ID - info:doi/10.2196/jmir.5094 ER - TY - JOUR AU - de la Torre- Díez, Isabel AU - Lopez-Coronado, Miguel AU - Garcia-Zapirain Soto, Begonya AU - Mendez-Zorrilla, Amaia PY - 2015/07/27 TI - Secure Cloud-Based Solutions for Different eHealth Services in Spanish Rural Health Centers JO - J Med Internet Res SP - e157 VL - 17 IS - 7 KW - cloud KW - eHealth services KW - rural KW - security N2 - Background: The combination of eHealth applications and/or services with cloud technology provides health care staff?with sufficient mobility and accessibility for them?to be able to transparently check any data they may need without having to worry about its physical location. Objective: The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis. Methods: The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service. Results: We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of ?500/month. Conclusions: The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost. UR - http://www.jmir.org/2015/7/e157/ UR - http://dx.doi.org/10.2196/jmir.4422 UR - http://www.ncbi.nlm.nih.gov/pubmed/26215155 ID - info:doi/10.2196/jmir.4422 ER - TY - JOUR AU - Lyngstad, Merete AU - Hofoss, Dag AU - Grimsmo, Anders AU - Hellesø, Ragnhild PY - 2015/02/17 TI - Predictors for Assessing Electronic Messaging Between Nurses and General Practitioners as a Useful Tool for Communication in Home Health Care Services: A Cross-Sectional Study JO - J Med Internet Res SP - e47 VL - 17 IS - 2 KW - electronic mail KW - home healthcare nursing KW - collaborating KW - general practitioners N2 - Background: Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. Objective: The aim of this study was to explore home health care nurses? assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. Methods: The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Results: Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). Conclusions: This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses? assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services. UR - http://www.jmir.org/2015/2/e47/ UR - http://dx.doi.org/10.2196/jmir.4056 UR - http://www.ncbi.nlm.nih.gov/pubmed/25691234 ID - info:doi/10.2196/jmir.4056 ER - TY - JOUR AU - Rodriguez, L. Keri AU - Burkitt, H. Kelly AU - Bayliss, K. Nichole AU - Skoko, E. Jennifer AU - Switzer, E. Galen AU - Zickmund, L. Susan AU - Fine, J. Michael AU - Macpherson, S. David PY - 2015/01/14 TI - Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation JO - JMIR Med Inform SP - e5 VL - 3 IS - 1 KW - access KW - rural health KW - referral and consultation KW - patient satisfaction KW - veterans N2 - 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. UR - http://medinform.jmir.org/2015/1/e5/ UR - http://dx.doi.org/10.2196/medinform.3725 UR - http://www.ncbi.nlm.nih.gov/pubmed/25589233 ID - info:doi/10.2196/medinform.3725 ER - TY - JOUR AU - Hu, Zhongkai AU - Jin, Bo AU - Shin, Y. Andrew AU - Zhu, Chunqing AU - Zhao, Yifan AU - Hao, Shiying AU - Zheng, Le AU - Fu, Changlin AU - Wen, Qiaojun AU - Ji, Jun AU - Li, Zhen AU - Wang, Yong AU - Zheng, Xiaolin AU - Dai, Dorothy AU - Culver, S. Devore AU - Alfreds, T. Shaun AU - Rogow, Todd AU - Stearns, Frank AU - Sylvester, G. Karl AU - Widen, Eric AU - Ling, B. Xuefeng PY - 2015/01/13 TI - Real-Time Web-Based Assessment of Total Population Risk of Future Emergency Department Utilization: Statewide Prospective Active Case Finding Study JO - Interact J Med Res SP - e2 VL - 4 IS - 1 KW - ED KW - machine learning KW - HIE KW - EMR KW - modeling N2 - Background: An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Objective: Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Methods: Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine?s Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. Results: The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple ?anchoring? demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. Conclusions: The active case finding model and associated real-time Web-based app were designed to track the evolving nature of total population risk, in a longitudinal manner, for ED visits across all payers, all diseases, and all age groups. Therefore, providers can implement targeted care management strategies to the patient subgroups with similar patterns of clinical histories, driving the delivery of more efficient and effective health care interventions. To the best of our knowledge, this prospectively validated EMR-based, Web-based tool is the first one to allow real-time total population risk assessment for statewide ED visits. UR - http://www.i-jmr.org/2015/1/e2/ UR - http://dx.doi.org/10.2196/ijmr.4022 UR - http://www.ncbi.nlm.nih.gov/pubmed/25586600 ID - info:doi/10.2196/ijmr.4022 ER - TY - JOUR AU - Korosec, Lauren AU - Balenko, Krista AU - Hagens, Simon PY - 2015/01/08 TI - Impact of Information Technology on Information Gaps in Canadian Ambulatory Care Encounters JO - JMIR Med Inform SP - e1 VL - 3 IS - 1 KW - digital health KW - information gaps KW - ambulatory KW - outpatient N2 - Background: Specialist physicians require clinical information for patient visits in ambulatory encounters, some of which they may access via digital health solutions. Objective: This study explored the completeness of information for patient care and the consequences of gaps for ambulatory specialist services provided in ambulatory settings in Canada. Methods: A sample of specialist physicians practising in outpatient clinics was recruited from a health care provider research panel. The study (n=1800 patient encounters) looked at the completeness of patient information experienced by physicians who work in environments with rich health information exchange (Connected) and a comparison cohort with less information available electronically (Unconnected). Results: Unconnected physicians were significantly more likely to be missing information they needed for patient encounters (13% of encounters for Unconnected physicians vs 7% for Connected physicians). Unconnected physicians were also more likely to report that missing information had consequences (23% vs 13% of encounters). Lab results were the most common type of patient information missing for both Unconnected and Connected specialists (25% for Unconnected physicians vs 11% Connected physicians). Conclusions: The results from this study indicate that Canadian physicians commonly experience information gaps in ambulatory encounters, and that many of these gaps are of consequence to themselves, their patients, and the healthcare system. Wasting physician and patient time, as well as being forced to proceed with incomplete information, were the most common consequences of information gaps reported. UR - http://medinform.jmir.org/2015/1/e1/ UR - http://dx.doi.org/10.2196/medinform.4066 UR - http://www.ncbi.nlm.nih.gov/pubmed/25595130 ID - info:doi/10.2196/medinform.4066 ER - TY - JOUR AU - Phillips, L. Jennifer AU - Shea, M. Jennifer AU - Leung, Valerie AU - MacDonald, Don PY - 2015/01/06 TI - Impact of Early Electronic Prescribing on Pharmacists? Clarification Calls in Four Community Pharmacies Located in St John?s, Newfoundland JO - JMIR Med Inform SP - e2 VL - 3 IS - 1 KW - electronic prescribing KW - pharmacy KW - pharmacists KW - Clinical Pharmacy Information Systems N2 - Background: Electronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems. Objective: The purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwritten prescriptions. Methods: Four community pharmacies in St John?s, Newfoundland, Canada prospectively collected information on clarification calls to prescribers for new prescriptions over a period of 17 to 19 weeks. Four semistructured interviews were conducted following the data collection period to gain further insight. Results: An estimated 1.33% of handwritten prescriptions required clarification compared with 0.66% of EMR-generated prescriptions. Overall, 1.11% of prescriptions required clarification with the prescriber. While illegibility was eliminated with EMR-generated prescriptions, clarification was still required for missing information (24%) and appropriateness (51%). Key themes, including errors unique to EMR-generated prescriptions, emerged from the qualitative interviews. Conclusions: Advanced e-prescribing functionality will enable secure transmission of prescriptions from prescribers to a patient?s pharmacy of choice through a provincial electronic Drug Information System (DIS)/Pharmacy Network, which will lessen the need for clarification calls, especially in the domains of missing information and appropriateness of the prescription. This exploratory study provides valuable insight into the benefits and gaps of early e-prescribing. Advanced e-prescribing systems will provide an opportunity for further realization of quality and safety benefits related to medication prescribing. UR - http://medinform.jmir.org/2015/1/e2/ UR - http://dx.doi.org/10.2196/medinform.3541 UR - http://www.ncbi.nlm.nih.gov/pubmed/25595165 ID - info:doi/10.2196/medinform.3541 ER - TY - JOUR AU - Tedim Cruz, Vítor AU - Pais, Joana AU - Ruano, Luis AU - Mateus, Cátia AU - Colunas, Márcio AU - Alves, Ivânia AU - Barreto, Rui AU - Conde, Eduardo AU - Sousa, Andreia AU - Araújo, Isabel AU - Bento, Virgílio AU - Coutinho, Paula AU - Rocha, Nelson AU - PY - 2014/11/27 TI - Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training ? COGWEB Network JO - JMIR Mental Health SP - e2 VL - 1 IS - 1 KW - cognitive training KW - neurorehabilitation KW - eHealth systems KW - memory clinic KW - collaborative network KW - stroke KW - dementia KW - schizophrenia KW - mental health services N2 - Background: Cognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector. Objective: The objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB). Methods: The setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled. Results: The network included 68 professionals from 41 centers, (33/41) 80% clinical, (8/41) 19% nonclinical. A total of 298 patients received cognitive training; 45.3% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6%), (2) structural brain lesions (63/298, 21.1%), (3) autoimmune (40/298, 13.4%), (4) schizophrenia (30/298, 10.1%), and (5) others (50/298, 16.8%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education. Conclusions: Over its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden. UR - http://www.jmir.org/2014/1/e2/ UR - http://dx.doi.org/10.2196/mental.3840 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543902 ID - info:doi/10.2196/mental.3840 ER - TY - JOUR AU - Motta, Bezerra Gustavo Henrique Matos PY - 2014/10/03 TI - Towards Social Radiology as an Information Infrastructure: Reconciling the Local With the Global JO - JMIR Med Inform SP - e27 VL - 2 IS - 2 KW - information infrastructures KW - social radiology KW - teleradiology KW - picture archive and communication systems (PACS) KW - sociotechnical systems UR - http://medinform.jmir.org/2014/2/e27/ UR - http://dx.doi.org/10.2196/medinform.3648 UR - http://www.ncbi.nlm.nih.gov/pubmed/25600710 ID - info:doi/10.2196/medinform.3648 ER - TY - JOUR AU - Haque, Waqar AU - Urquhart, Bonnie AU - Berg, Emery AU - Dhanoa, Ramandeep PY - 2014/08/06 TI - Using Business Intelligence to Analyze and Share Health System Infrastructure Data in a Rural Health Authority JO - JMIR Med Inform SP - e16 VL - 2 IS - 2 KW - business intelligence KW - health care systems KW - availability of health services KW - data visualization N2 - Background: Health care organizations gather large volumes of data, which has been traditionally stored in legacy formats making it difficult to analyze or use effectively. Though recent government-funded initiatives have improved the situation, the quality of most existing data is poor, suffers from inconsistencies, and lacks integrity. Generating reports from such data is generally not considered feasible due to extensive labor, lack of reliability, and time constraints. Advanced data analytics is one way of extracting useful information from such data. Objective: The intent of this study was to propose how Business Intelligence (BI) techniques can be applied to health system infrastructure data in order to make this information more accessible and comprehensible for a broader group of people. Methods: An integration process was developed to cleanse and integrate data from disparate sources into a data warehouse. An Online Analytical Processing (OLAP) cube was then built to allow slicing along multiple dimensions determined by various key performance indicators (KPIs), representing population and patient profiles, case mix groups, and healthy community indicators. The use of mapping tools, customized shape files, and embedded objects further augment the navigation. Finally, Web forms provide a mechanism for remote uploading of data and transparent processing of the cube. For privileged information, access controls were implemented. Results: Data visualization has eliminated tedious analysis through legacy reports and provided a mechanism for optimally aligning resources with needs. Stakeholders are able to visualize KPIs on a main dashboard, slice-and-dice data, generate ad hoc reports, and quickly find the desired information. In addition, comparison, availability, and service level reports can also be generated on demand. All reports can be drilled down for navigation at a finer granularity. Conclusions: We have demonstrated how BI techniques and tools can be used in the health care environment to make informed decisions with reference to resource allocation and enhancement of the quality of patient care. The data can be uploaded immediately upon collection, thus keeping reports current. The modular design can be expanded to add new datasets such as for smoking rates, teen pregnancies, human immunodeficiency virus (HIV) rates, immunization coverage, and vital statistical summaries. UR - http://medinform.jmir.org/2014/2/e16/ UR - http://dx.doi.org/10.2196/medinform.3590 UR - http://www.ncbi.nlm.nih.gov/pubmed/25599727 ID - info:doi/10.2196/medinform.3590 ER - TY - JOUR AU - Zhong, Daidi AU - Kirwan, J. Michael AU - Duan, Xiaolian PY - 2013/07/12 TI - Regulatory Barriers Blocking Standardization of Interoperability JO - JMIR Mhealth Uhealth SP - e13 VL - 1 IS - 2 KW - medical device regulation KW - device interoperability KW - personal health device KW - standardization UR - http://mhealth.jmir.org/2013/2/e13/ UR - http://dx.doi.org/10.2196/mhealth.2654 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098204 ID - info:doi/10.2196/mhealth.2654 ER -