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Sinyard RD, Cauley CE. Implementing mobile health in your surgical practice: Results of a multidisciplinary convening. Surgery 2024; 175:1608-1610. [PMID: 38458819 DOI: 10.1016/j.surg.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 03/10/2024]
Abstract
The perioperative journey remains complex and difficult to navigate for patients and caregivers. Poor communication and lack of care coordination lead to diminished patient satisfaction, outcomes, and system performance. Mobile health platforms have the potential to overcome some of these issues by improving care delivery through timely individualized assessments, improved patient education, and care coordination. Yet mobile health implementation in surgical practice remains limited. Based on a convening of experts using human-centered design techniques, an implementation guide for the integration of mobile health in perioperative care was created to assist with (1) identification of the use of mobile health within a specific surgical practice, (2) identification of the pathway to mobile health implementation, and (3) measurement of successful implementation including patient and surgical system impact. This article reviews those recommendations and provides references to additional literature, including the full implementation guide, to aid those seeking to implement mobile health in a surgical practice or system.
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Affiliation(s)
- Robert D Sinyard
- Ariadne Labs, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Christy E Cauley
- Ariadne Labs, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA.
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Hudelson C, Gunderson MA, Pestka D, Christiaansen T, Stotka B, Kissock L, Markowitz R, Badlani S, Melton GB. Selection and Implementation of Virtual Scribe Solutions to Reduce Documentation Burden: A Mixed Methods Pilot. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:230-238. [PMID: 38827085 PMCID: PMC11141854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Electronic health record (EHR) documentation is a leading reason for clinician burnout. While technology-enabled solutions like virtual and digital scribes aim to improve this, there is limited evidence of their effectiveness and minimal guidance for healthcare systems around solution selection and implementation. A transdisciplinary approach, informed by clinician interviews and other considerations, was used to evaluate and select a virtual scribe solution to pilot in a rapid iterative sprint over 12 weeks. Surveys, interviews, and EHR metadata were analyzed over a staggered 30 day implementation with live and asynchronous virtual scribe solutions. Among 16 pilot clinicians, documentation burden metrics decreased for some but not all. Some clinicians had highly positive comments, and others had concerns regarding scribe training and quality. Our findings demonstrate that virtual scribes may reduce documentation burden for some clinicians and describe a method for a collaborative and iterative technology selection process for digital tools in practice.
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Affiliation(s)
- Carly Hudelson
- Departments of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
| | - Melissa A Gunderson
- Departments of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
- Surgery, University of Minnesota, Minneapolis, Minnesota
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
| | - Debbie Pestka
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Tori Christiaansen
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
- M Health Fairview, Minneapolis MN
| | | | | | - Rebecca Markowitz
- Medicine, University of Minnesota, Minneapolis, Minnesota
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
- M Health Fairview, Minneapolis MN
| | - Sameer Badlani
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
- M Health Fairview, Minneapolis MN
| | - Genevieve B Melton
- Surgery, University of Minnesota, Minneapolis, Minnesota
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, Minnesota
- M Health Fairview, Minneapolis MN
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Poddar M, Marwaha JS, Yuan W, Romero-Brufau S, Brat GA. An operational guide to translational clinical machine learning in academic medical centers. NPJ Digit Med 2024; 7:129. [PMID: 38760407 PMCID: PMC11101468 DOI: 10.1038/s41746-024-01094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/29/2024] [Indexed: 05/19/2024] Open
Abstract
Few published data science tools are ever translated from academia to real-world clinical settings for which they were intended. One dimension of this problem is the software engineering task of turning published academic projects into tools that are usable at the bedside. Given the complexity of the data ecosystem in large health systems, this task often represents a significant barrier to the real-world deployment of data science tools for prospective piloting and evaluation. Many information technology companies have created Machine Learning Operations (MLOps) teams to help with such tasks at scale, but the low penetration of home-grown data science tools in regular clinical practice precludes the formation of such teams in healthcare organizations. Based on experiences deploying data science tools at two large academic medical centers (Beth Israel Deaconess Medical Center, Boston, MA; Mayo Clinic, Rochester, MN), we propose a strategy to facilitate this transition from academic product to operational tool, defining the responsibilities of the principal investigator, data scientist, machine learning engineer, health system IT administrator, and clinician end-user throughout the process. We first enumerate the technical resources and stakeholders needed to prepare for model deployment. We then propose an approach to planning how the final product will work from data extraction and analysis to visualization of model outputs. Finally, we describe how the team should execute on this plan. We hope to guide health systems aiming to deploy minimum viable data science tools and realize their value in clinical practice.
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Affiliation(s)
- Mukund Poddar
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jayson S Marwaha
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - William Yuan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Santiago Romero-Brufau
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Otolaryngology Head & Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gabriel A Brat
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
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Maaß L, Zeeb H, Rothgang H. International perspectives on measuring national digital public health system maturity through a multidisciplinary Delphi study. NPJ Digit Med 2024; 7:92. [PMID: 38609458 PMCID: PMC11014962 DOI: 10.1038/s41746-024-01078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Unlocking the full potential of digital public health (DiPH) systems requires a comprehensive tool to assess their maturity. While the World Health Organization and the International Telecommunication Union released a toolkit in 2012 covering various aspects of digitalizing national healthcare systems, a holistic maturity assessment tool has been lacking ever since. To bridge this gap, we conducted a pioneering Delphi study, to which 54 experts from diverse continents and academic fields actively contributed to at least one of three rounds. 54 experts participated in developing and rating multidisciplinary quality indicators to measure the maturity of national digital public health systems. Participants established consensus on these indicators with a threshold of 70% agreement on indicator importance. Eventually, 96 indicators were identified and agreed upon by experts. Notably, 48% of these indicators were found to align with existing validated tools, highlighting their relevance and reliability. However, further investigation is required to assess the suitability and applicability of all the suggestions put forward by our participants. Nevertheless, this Delphi study is an essential initial stride toward a comprehensive measurement tool for DiPH system maturity. By working towards a standardized assessment of DiPH system maturity, we aim to empower decision-makers to make informed choices, optimize resource allocation, and drive innovation in healthcare delivery. The results of this study mark a significant milestone in advancing DiPH on a global scale.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany.
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany.
| | - Hajo Zeeb
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Department Prevention and Evaluation, Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
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Cevasco KE, Morrison Brown RE, Woldeselassie R, Kaplan S. Patient Engagement with Conversational Agents in Health Applications 2016-2022: A Systematic Review and Meta-Analysis. J Med Syst 2024; 48:40. [PMID: 38594411 PMCID: PMC11004048 DOI: 10.1007/s10916-024-02059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Clinicians and patients seeking electronic health applications face challenges in selecting effective solutions due to a high market failure rate. Conversational agent applications ("chatbots") show promise in increasing healthcare user engagement by creating bonds between the applications and users. It is unclear if chatbots improve patient adherence or if past trends to include chatbots in electronic health applications were due to technology hype dynamics and competitive pressure to innovate. We conducted a systematic literature review using Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology on health chatbot randomized control trials. The goal of this review was to identify if user engagement indicators are published in eHealth chatbot studies. A meta-analysis examined patient clinical trial retention of chatbot apps. The results showed no chatbot arm patient retention effect. The small number of studies suggests a need for ongoing eHealth chatbot research, especially given the claims regarding their effectiveness made outside the scientific literatures.
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Affiliation(s)
- Kevin E Cevasco
- Department of Global and Community Health, George Mason University, 4400 University Dr., Fairfax, 22030, VA, USA.
| | - Rachel E Morrison Brown
- Department of Global and Community Health, George Mason University, 4400 University Dr., Fairfax, 22030, VA, USA
| | - Rediet Woldeselassie
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Seth Kaplan
- Department of Psychology, George Mason University, Fairfax, VA, USA
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Lau-Min KS, Marini J, Shah NK, Pucci D, Blauch AN, Cambareri C, Mooney B, Agarwal P, Johnston C, Schumacher RP, White K, Gabriel PE, Rosin R, Jacobs LA, Shulman LN. Pilot Study of a Mobile Phone Chatbot for Medication Adherence and Toxicity Management Among Patients With GI Cancers on Capecitabine. JCO Oncol Pract 2024; 20:483-490. [PMID: 38237102 DOI: 10.1200/op.23.00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Capecitabine is an oral chemotherapy used to treat many gastrointestinal cancers. Its complex dosing and narrow therapeutic index make medication adherence and toxicity management crucial for quality care. METHODS We conducted a pilot study of PENNY-GI, a mobile phone text messaging-based chatbot that leverages algorithmic surveys and natural language processing to promote medication adherence and toxicity management among patients with gastrointestinal cancers on capecitabine. Eligibility initially included all capecitabine-containing regimens but was subsequently restricted to capecitabine monotherapy because of challenges in integrating PENNY-GI with radiation and intravenous chemotherapy schedules. We used design thinking principles and real-time data on safety, accuracy, and usefulness to make iterative refinements to PENNY-GI with the goal of minimizing the proportion of text messaging exchanges with incorrect medication or symptom management recommendations. All patients were invited to participate in structured exit interviews to provide feedback on PENNY-GI. RESULTS We enrolled 40 patients (median age 64.5 years, 52.5% male, 62.5% White, 55.0% with colorectal cancer, 50.0% on capecitabine monotherapy). We identified 284 of 3,895 (7.3%) medication-related and 13 of 527 (2.5%) symptom-related text messaging exchanges with incorrect recommendations. In exit interviews with 24 patients, participants reported finding the medication reminders reliable and user-friendly, but the symptom management tool was too simplistic to be helpful. CONCLUSION Although PENNY-GI provided accurate recommendations in >90% of text messaging exchanges, we identified multiple limitations with respect to the intervention's generalizability, usefulness, and scalability. Lessons from this pilot study should inform future efforts to develop and implement digital health interventions in oncology.
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Affiliation(s)
- Kelsey S Lau-Min
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jessica Marini
- Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA
| | - Nishant K Shah
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Donna Pucci
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abigail N Blauch
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Bethany Mooney
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Parul Agarwal
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Peter E Gabriel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Roy Rosin
- Center for Health Care Innovation, Penn Medicine, Philadelphia, PA
| | - Linda A Jacobs
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Shaw J, Agarwal P, Bhattacharyya O. Implementing Multiple Digital Technologies in Health Care: Seeing the Unintended Consequences for Patient Safety. Jt Comm J Qual Patient Saf 2024; 50:233-234. [PMID: 38368188 DOI: 10.1016/j.jcjq.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
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Kuznetsova M, Kim AY, Scully DA, Wolski P, Syrowatka A, Bates DW, Dykes PC. Implementation of a Continuous Patient Monitoring System in the Hospital Setting: A Qualitative Study. Jt Comm J Qual Patient Saf 2024; 50:235-246. [PMID: 38101994 DOI: 10.1016/j.jcjq.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Technology can improve care delivery, patient outcomes, and staff satisfaction, but integration into the clinical workflow remains challenging. To contribute to this knowledge area, this study examined the implementation continuum of a contact-free, continuous monitoring system (CFCM) in an inpatient setting. CFCM monitors vital signs and uses the information to alert clinicians of important changes, enabling early detection of patient deterioration. METHODS Data were collected throughout the entire implementation continuum at a community teaching hospital. Throughout the study, 3 group and 24 individual interviews and five process observations were conducted. Postimplementation alarm response data were collected. Analysis was conducted using triangulation of information sources and two-coder consensus. RESULTS Preimplementation perceived barriers were alarm fatigue, questions about accuracy and trust, impact on patient experience, and challenges to the status quo. Stakeholders identified the value of CFCM as preventing deterioration and benefitting patients who are not good candidates for telemetry. Educational materials addressed each barrier and emphasized the shared CFCM values. Mean alarm response times were below the desired target of two minutes. Postimplementation interview analysis themes revealed lessened concerns of alarm fatigue and improved trust in CFCM than anticipated. Postimplementation challenges included insufficient training for secondary users and impact on patient experience. CONCLUSION In addition to understanding the preimplementation anticipated barriers to implementation and establishing shared value before implementation, future recommendations include studying strategies for optimal tailoring of education to each user group, identifying and reinforcing positive process changes after implementation, and including patient experience as the overarching element in frameworks for digital tool implementation.
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9
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Aimo A, Tono I, Benelli E, Morfino P, Panichella G, Damone AL, Speltri MF, Airò E, Monti S, Passino C, Lazzarini M, De Rosis S, Nuti S, Morelli MS, Evangelista C, Poletti R, Emdin M, Bergamasco M. The Fondazione Toscana Gabriele Monasterio app: a digital health system to improve wellbeing of inpatients with heart or lung disease. J Cardiovasc Med (Hagerstown) 2024; 25:294-302. [PMID: 38305137 DOI: 10.2459/jcm.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND An app providing material for education and entertaining is a possible way to support patients and healthcare providers in achieving person-centered care. METHODS An app tailored on the Fondazione Toscana Gabriele Monasterio (FTGM), a research hospital treating cardiac and lung disorders, was created. A pilot evaluation project was conducted on consecutive patients hospitalized for heart or lung disorders. Patients were asked to complete an assessment questionnaire. RESULTS The FTGM app provides information on diagnostic and therapeutic investigations, hospital and healthcare personnel, and includes content for entertainment and learning. It was tested on 215 consecutive patients (75% men, 66% aged >60 years, and 40% with a primary or middle school degree). Sixty-nine percentage of patients used the FTGM app, including 67% of patients aged >80 years and 65% of those with an elementary education (65%). Patients gave positive feedback on the app layout. Many (76%) looked for information on doctors and nurses in the 'People' section. Sixty-five percent of responders had used at least one of the sections called 'Music' and 'Museum visits'. The app helped many patients perceive the hospital as a more liveable place (68%), and to feel less anxious (76%), and more engaged in the diagnostic and therapeutic workup (65%). Overall, the majority of responders (87%) rated the app as 'excellent' or 'good', and almost all (95%) would have recommended other patients to use the app. CONCLUSIONS The FTGM app is a possible tool to improve patient wellbeing during hospitalization.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | - Ilaria Tono
- Fondazione Toscana Gabriele Monasterio
- Istituto di Management e Sanità
| | | | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
| | | | | | | | | | - Claudio Passino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | | | - Sabina De Rosis
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Istituto di Management e Sanità
| | - Sabina Nuti
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Istituto di Management e Sanità
| | | | - Chiara Evangelista
- Istituto di Intelligenza Meccanica, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | - Massimo Bergamasco
- Istituto di Intelligenza Meccanica, Scuola Superiore Sant'Anna, Pisa, Italy
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Dunn J, Coravos A, Fanarjian M, Ginsburg GS, Steinhubl SR. Remote digital health technologies for improving the care of people with respiratory disorders. Lancet Digit Health 2024; 6:e291-e298. [PMID: 38402128 PMCID: PMC10960683 DOI: 10.1016/s2589-7500(23)00248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 11/30/2023] [Indexed: 02/26/2024]
Abstract
Respiratory diseases are a leading cause of morbidity and mortality globally. However, existing systems of care, built around scheduled appointments, are not well designed to support the needs of people with chronic and acute respiratory conditions that can change rapidly and unexpectedly. Home-based and personal digital health technologies (DHTs) allow implementation of new models of care catering to the unique needs of individuals. The high number of respiratory triggers and unique responses to them require a personalised solution for each patient. The real-world, repetitive monitoring capabilities of DHTs enable identification of the normal operating characteristics for each individual and, therefore, recognition of the earliest deviations from that state. However, despite this potential, the number of clinical efficacy studies of DHTs is quite small. Evaluation of clinical effectiveness of DHTs in improving health quality in real-world settings is urgently needed.
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Affiliation(s)
- Jessilyn Dunn
- Biomedical Engineering Department, Duke University, Durham, NC, USA
| | | | | | - Geoffrey S Ginsburg
- Department of Medicine, Duke University, Durham, NC, USA; All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Steven R Steinhubl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
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Braddock AS, Bosworth KT, Ghosh P, Proffitt R, Flowers L, Montgomery E, Wilson G, Tosh AK, Koopman RJ. Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study. Appl Clin Inform 2024; 15:368-377. [PMID: 38458233 PMCID: PMC11078569 DOI: 10.1055/a-2283-9036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. METHODS In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. RESULTS Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. CONCLUSION Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
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Affiliation(s)
- Amy S. Braddock
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - K. Taylor Bosworth
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, Missouri, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Emma Montgomery
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Gwendolyn Wilson
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Aneesh K. Tosh
- Department of Child Health, University of Missouri, Columbia, Missouri, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
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Pattanshetty S, Dsouza VS, Shekharappa A, Yagantigari M, Raj R, Inamdar A, Alsamara I, Rajvanshi H, Brand H. A Scoping Review on Malaria Prevention and Control Intervention in Fragile and Conflict-Affected States (FCAS): A Need for Renewed Focus to Enhance International Cooperation. J Epidemiol Glob Health 2024; 14:4-12. [PMID: 38224386 PMCID: PMC11043240 DOI: 10.1007/s44197-023-00180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS.
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Affiliation(s)
- Sanjay Pattanshetty
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Viola Savy Dsouza
- Centre for Regulatory Science, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Anupama Shekharappa
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Rohit Raj
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Jamshedpur, India
| | - Aniruddha Inamdar
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Issam Alsamara
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | - Helmut Brand
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mennella C, Maniscalco U, De Pietro G, Esposito M. Ethical and regulatory challenges of AI technologies in healthcare: A narrative review. Heliyon 2024; 10:e26297. [PMID: 38384518 PMCID: PMC10879008 DOI: 10.1016/j.heliyon.2024.e26297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
Over the past decade, there has been a notable surge in AI-driven research, specifically geared toward enhancing crucial clinical processes and outcomes. The potential of AI-powered decision support systems to streamline clinical workflows, assist in diagnostics, and enable personalized treatment is increasingly evident. Nevertheless, the introduction of these cutting-edge solutions poses substantial challenges in clinical and care environments, necessitating a thorough exploration of ethical, legal, and regulatory considerations. A robust governance framework is imperative to foster the acceptance and successful implementation of AI in healthcare. This article delves deep into the critical ethical and regulatory concerns entangled with the deployment of AI systems in clinical practice. It not only provides a comprehensive overview of the role of AI technologies but also offers an insightful perspective on the ethical and regulatory challenges, making a pioneering contribution to the field. This research aims to address the current challenges in digital healthcare by presenting valuable recommendations for all stakeholders eager to advance the development and implementation of innovative AI systems.
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Affiliation(s)
- Ciro Mennella
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
| | - Umberto Maniscalco
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
| | - Giuseppe De Pietro
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
| | - Massimo Esposito
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
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Stephan J, Gehrmann J, Stullich A, Hoffmann L, Richter M. Development, piloting and evaluation of an app-supported psychosocial prevention intervention to strengthen participation in working life: a study protocol of a mixed-methods approach. BMJ Open 2024; 14:e081390. [PMID: 38367971 PMCID: PMC10875476 DOI: 10.1136/bmjopen-2023-081390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Rates of incapacity to work due to mental disorders have increased in many European countries. The consequences of persistent stress can impact individuals' physical and psychological well-being and gradually develop into chronic stress. Mental disorders or symptoms of burn-out syndrome can have severe consequences. Mental disorders leading to work incapacity significantly burden the health system. Prevention interventions can protect against burn-out, depression, anxiety and other mental health disorders. Digital health is a promising approach to increase the utilisation of effective prevention interventions. This mixed-methods study evaluates a newly developed app-supported psychosocial prevention intervention called 'RV Fit Mental Health' to strengthen participation in working life. METHODS AND ANALYSIS The study uses a three-stage parallel mixed-methods design. This study accompanies the development (stage 1), piloting (stage 2) and evaluation (stage 3) of the new intervention. Within the stages, there is a quantitative as well as a qualitative research strand. Employed persons with an incipient mental disorder will be included. Additionally, experts within the project or connected areas will be included. Quantitative data will be analysed using multifactorial variance analyses in a pre-post design. Qualitative data will be analysed using qualitative content analysis. The study is a comprehensive research approach to investigate the development, piloting and evaluation of an app-supported psychosocial app-based prevention intervention. The rigour of the study will be achieved through data triangulation. ETHICS AND DISSEMINATION All participants will receive detailed study information and give written informed consent before data collection. Ethical approval was obtained from the Technical University of Munich Ethics Committee. All data collection will follow all legislative rules regarding data protection, also following the Declaration of Helsinki. The study results will be disseminated in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBERS DRKS00030818 and DRKS00033080.
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Affiliation(s)
- Johannes Stephan
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Jan Gehrmann
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
- Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Department Clinical Medicine, Technical University of Munich, Munich, Germany
| | - Ananda Stullich
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Laura Hoffmann
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Matthias Richter
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
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15
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Allen MR, Webb S, Mandvi A, Frieden M, Tai-Seale M, Kallenberg G. Navigating the doctor-patient-AI relationship - a mixed-methods study of physician attitudes toward artificial intelligence in primary care. BMC PRIMARY CARE 2024; 25:42. [PMID: 38281026 PMCID: PMC10821550 DOI: 10.1186/s12875-024-02282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Artificial intelligence (AI) is a rapidly advancing field that is beginning to enter the practice of medicine. Primary care is a cornerstone of medicine and deals with challenges such as physician shortage and burnout which impact patient care. AI and its application via digital health is increasingly presented as a possible solution. However, there is a scarcity of research focusing on primary care physician (PCP) attitudes toward AI. This study examines PCP views on AI in primary care. We explore its potential impact on topics pertinent to primary care such as the doctor-patient relationship and clinical workflow. By doing so, we aim to inform primary care stakeholders to encourage successful, equitable uptake of future AI tools. Our study is the first to our knowledge to explore PCP attitudes using specific primary care AI use cases rather than discussing AI in medicine in general terms. METHODS From June to August 2023, we conducted a survey among 47 primary care physicians affiliated with a large academic health system in Southern California. The survey quantified attitudes toward AI in general as well as concerning two specific AI use cases. Additionally, we conducted interviews with 15 survey respondents. RESULTS Our findings suggest that PCPs have largely positive views of AI. However, attitudes often hinged on the context of adoption. While some concerns reported by PCPs regarding AI in primary care focused on technology (accuracy, safety, bias), many focused on people-and-process factors (workflow, equity, reimbursement, doctor-patient relationship). CONCLUSION Our study offers nuanced insights into PCP attitudes towards AI in primary care and highlights the need for primary care stakeholder alignment on key issues raised by PCPs. AI initiatives that fail to address both the technological and people-and-process concerns raised by PCPs may struggle to make an impact.
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Affiliation(s)
- Matthew R Allen
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
- Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Sophie Webb
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ammar Mandvi
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Marshall Frieden
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ming Tai-Seale
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Gene Kallenberg
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
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16
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Lou SS, Liu Y, Cohen ME, Ko CY, Hall BL, Kannampallil T. National Multi-Institutional Validation of a Surgical Transfusion Risk Prediction Model. J Am Coll Surg 2024; 238:99-105. [PMID: 37737660 DOI: 10.1097/xcs.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Accurate estimation of surgical transfusion risk is important for many aspects of surgical planning, yet few methods for estimating are available for estimating such risk. There is a need for reliable validated methods for transfusion risk stratification to support effective perioperative planning and resource stewardship. STUDY DESIGN This study was conducted using the American College of Surgeons NSQIP datafile from 2019. S-PATH performance was evaluated at each contributing hospital, with and without hospital-specific model tuning. Linear regression was used to assess the relationship between hospital characteristics and area under the receiver operating characteristic (AUROC) curve. RESULTS A total of 1,000,927 surgical cases from 414 hospitals were evaluated. Aggregate AUROC was 0.910 (95% CI 0.904 to 0.916) without model tuning and 0.925 (95% CI 0.919 to 0.931) with model tuning. AUROC varied across individual hospitals (median 0.900, interquartile range 0.849 to 0.944), but no statistically significant relationships were found between hospital-level characteristics studied and model AUROC. CONCLUSIONS S-PATH demonstrated excellent discriminative performance, although there was variation across hospitals that was not well-explained by hospital-level characteristics. These results highlight the S-PATH's viability as a generalizable surgical transfusion risk prediction tool.
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Affiliation(s)
- Sunny S Lou
- From the Department of Anesthesiology, Washington University School of Medicine, St Louis, MO (Lou, Kannampallil)
| | - Yaoming Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Liu, Ko, Hall, Cohen)
| | - Mark E Cohen
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Liu, Ko, Hall, Cohen)
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Liu, Ko, Hall, Cohen)
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, and the VA Greater Los Angeles Health System, Los Angeles, CA (Ko)
| | - Bruce L Hall
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Liu, Ko, Hall, Cohen)
- Department of Surgery, Washington University School of Medicine; Center for Health Policy and the Olin Business School at Washington University in St Louis; John Cochran Veterans Affairs Medical Center; and BJC Healthcare, St Louis, MO (Hall)
| | - Thomas Kannampallil
- From the Department of Anesthesiology, Washington University School of Medicine, St Louis, MO (Lou, Kannampallil)
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17
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Scheibein F, Caballeria E, Taher MA, Arya S, Bancroft A, Dannatt L, De Kock C, Chaudhary NI, Gayo RP, Ghosh A, Gelberg L, Goos C, Gordon R, Gual A, Hill P, Jeziorska I, Kurcevič E, Lakhov A, Maharjan I, Matrai S, Morgan N, Paraskevopoulos I, Puharić Z, Sibeko G, Stola J, Tiburcio M, Tay Wee Teck J, Tsereteli Z, López-Pelayo H. Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise. JMIR Hum Factors 2023; 10:e46678. [PMID: 38085569 PMCID: PMC10751634 DOI: 10.2196/46678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.
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Affiliation(s)
- Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Elsa Caballeria
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Md Abu Taher
- United Nations Office of Drugs and Crime, Dhaka, Bangladesh
| | - Sidharth Arya
- Institute of Mental Health, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte De Kock
- Institute for Social Drug Research, Ghent University, Ghent, Belgium
| | - Nazish Idrees Chaudhary
- International Grace Rehab, Lahore School of Behavioral Sciences, The University of Lahore, Lahore, Pakistan
| | | | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cees Goos
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Rebecca Gordon
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antoni Gual
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Penelope Hill
- The National Centre for Clinical Research on Emerging Drugs, Randwick, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Iga Jeziorska
- Correlation European Harm Reduction Network, Amsterdam, Netherlands
- Department of Public Policy, Institute of Social and Political Sciences, Corvinus University of Budapest, Budapest, Hungary
| | | | - Aleksey Lakhov
- Humanitarian Action Charitable Fund, St Petersburg, Russian Federation
| | | | - Silvia Matrai
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Nirvana Morgan
- Network of Early Career Professionals in Addiction Medicine, Seligenstadt, Germany
| | | | - Zrinka Puharić
- Faculty of Dental Medicine and Health Osijek, Bjelovar University of Applied Sciences, Bjelovar, Croatia
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jan Stola
- Youth Organisations for Drug Action, Warsaw, Poland
| | - Marcela Tiburcio
- Head of the Department of Social Sciences in Health, Directorate of Epidemiological and Psychosocial Research, Mexico City, Mexico
| | - Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Zaza Tsereteli
- Alcohol and Substance Use Expert Group, Northern Dimension Partnership in Public Health and Social Well-Being, Tallinn, Estonia
| | - Hugo López-Pelayo
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Sanderson BJ, Field JD, Kocaballi AB, Estcourt LJ, Magrabi F, Wood EM, Coiera E. Clinical decision support versus a paper-based protocol for massive transfusion: Impact on decision outcomes in a simulation study. Transfusion 2023; 63:2225-2233. [PMID: 37921017 DOI: 10.1111/trf.17580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Management of major hemorrhage frequently requires massive transfusion (MT) support, which should be delivered effectively and efficiently. We have previously developed a clinical decision support system (CDS) for MT using a multicenter multidisciplinary user-centered design study. Here we examine its impact when administering a MT. STUDY DESIGN AND METHODS We conducted a randomized simulation trial to compare a CDS for MT with a paper-based MT protocol for the management of simulated hemorrhage. A total of 44 specialist physicians, trainees (residents), and nurses were recruited across critical care to participate in two 20-min simulated bleeding scenarios. The primary outcome was the decision velocity (correct decisions per hour) and overall task completion. Secondary outcomes included cognitive workload and System Usability Scale (SUS). RESULTS There was a statistically significant increase in decision velocity for CDS-based management (mean 8.5 decisions per hour) compared to paper based (mean 6.9 decisions per hour; p .003, 95% CI 0.6-2.6). There was no significant difference in the overall task completion using CDS-based management (mean 13.3) compared to paper-based (mean 13.2; p .92, 95% CI -1.2-1.3). Cognitive workload was statistically significantly lower using the CDS compared to the paper protocol (mean 57.1 vs. mean 64.5, p .005, 95% CI 2.4-12.5). CDS usability was assessed as a SUS score of 82.5 (IQR 75-87.5). DISCUSSION Compared to paper-based management, CDS-based MT supports more time-efficient decision-making by users with limited CDS training and achieves similar overall task completion while reducing cognitive load. Clinical implementation will determine whether the benefits demonstrated translate to improved patient outcomes.
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Affiliation(s)
- Brenton J Sanderson
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Jeremy D Field
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Ahmet B Kocaballi
- School of Computer Science, University of Technology, Sydney, Australia
| | | | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Sydney, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Monash Health, Melbourne, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Sydney, Australia
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19
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Dullabh P, Heaney-Huls KK, Chiao AB, Callaham MG, Desai P, Gauthreaux NA, Kashyap N, Lobach DF, Boxwala A. Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection. JAMIA Open 2023; 6:ooad098. [PMID: 38028731 PMCID: PMC10646567 DOI: 10.1093/jamiaopen/ooad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/02/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Remote monitoring of women experiencing hypertensive disorders of pregnancy (HDP) can provide timely life-saving data, particularly if these data are integrated into existing patient and clinical workflows. This pilot intervention of a smartphone application (app) for postpartum monitoring of hypertensive disorders integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the evaluation of the pilot highlight the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. The implementation team's key observations included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
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Affiliation(s)
- Prashila Dullabh
- Health Sciences Department, NORC at the University of Chicago, Bethesda, MD 20814, United States
| | - Krysta K Heaney-Huls
- Health Sciences Department, NORC at the University of Chicago, Bethesda, MD 20814, United States
| | - Andrew B Chiao
- Health Sciences Department, NORC at the University of Chicago, Bethesda, MD 20814, United States
| | - Melissa G Callaham
- Health Sciences Department, NORC at the University of Chicago, Bethesda, MD 20814, United States
| | - Priyanka Desai
- Health Sciences Department, NORC at the University of Chicago, Bethesda, MD 20814, United States
| | - Nicole A Gauthreaux
- Health Sciences Department, NORC at the University of Chicago, Bethesda, MD 20814, United States
| | - Nitu Kashyap
- Department of Medicine,Yale New Haven Health, New Haven, CT 06510, United States
| | | | - Aziz Boxwala
- Elimu Informatics, El Cerrito, CA 94530, United States
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20
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McIntyre RS, Greenleaf W, Bulaj G, Taylor ST, Mitsi G, Saliu D, Czysz A, Silvesti G, Garcia M, Jain R. Digital health technologies and major depressive disorder. CNS Spectr 2023; 28:662-673. [PMID: 37042341 DOI: 10.1017/s1092852923002225] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Walter Greenleaf
- Virtual Human Interaction Lab, Stanford University, San Francisco, CA, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Steven T Taylor
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, McLean Hospital, Boston, MA, USA
| | | | | | - Andy Czysz
- Sage Therapeutics, Inc., Cambridge, MA, USA
| | | | | | - Rakesh Jain
- Department of Psychiatry, Texas Tech University School of Medicine, Lubbock, TX, USA
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21
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Kaihlanen AM, Virtanen L, Kainiemi E, Heponiemi T. Professionals Evaluating Clients' Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments. J Med Internet Res 2023; 25:e51450. [PMID: 38032707 PMCID: PMC10722370 DOI: 10.2196/51450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Increased digital health and social care services are generally considered to improve people's access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients' suitability for digital solutions, but to succeed, they need information about what to evaluate and how. OBJECTIVE This scoping review aimed to identify evaluation tools that professionals can use when assessing clients' suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments. METHODS The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute's Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients' suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals' practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed. RESULTS A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client's suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals' possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients. CONCLUSIONS Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients' prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals' busy work (both in health and social care) with defined threshold values for suitability.
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Affiliation(s)
| | - Lotta Virtanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Emma Kainiemi
- Finnish Institute for Health and Welfare, Helsinki, Finland
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22
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Jibb LA, Sivaratnam S, Hashemi E, Chu CH, Nathan PC, Chartrand J, Alberts NM, Masama T, Pease HG, Torres LB, Cortes HG, Zworth M, Kuczynski S, Fortier MA. Parent and clinician perceptions and recommendations on a pediatric cancer pain management app: A qualitative co-design study. PLOS DIGITAL HEALTH 2023; 2:e0000169. [PMID: 38019890 PMCID: PMC10686487 DOI: 10.1371/journal.pdig.0000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/14/2023] [Indexed: 12/01/2023]
Abstract
Pain is one of the most prevalent and burdensome pediatric cancer symptoms for young children and their families. A significant proportion of pain episodes are experienced in environments where management options are limited, including at home. Digital innovations such as apps may have positive impacts on pain outcomes for young children in these environments. Our overall aim is to co-design such an app and the objective of this study was to explore the perceptions of children's parents about app utility, needed system features, and challenges. We recruited parents of young children with cancer and multidisciplinary pediatric oncology clinicians from two pediatric cancer care centers to participate in audio-recorded, semi-structured, co-design interviews. We conducted interviews structured around technology acceptance and family caregiving theories until data saturation was reached. Audio-recordings were then transcribed, coded, and analyzed using thematic analysis. Forty-two participants took part in the process. Participants endorsed the concept of an app as a useful, safe, and convenient way to engage caregivers in managing their young child's pain. Overall, the app was valued as a means to provide real-time, multimodal informational and procedural pain support to parents, while also reducing the emotional burden of pain care. Recommendations for intervention design included accessibility-focused features, comprehensive symptom tracking, and embedded scientific- and clinically-sound symptom assessments and management advice. Predicted challenges to app use included the workload burden it may place on parents and clinicians. The insights gathered will inform the design principles of our future childhood cancer pain digital research.
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Affiliation(s)
- Lindsay A. Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elham Hashemi
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul C. Nathan
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Tatenda Masama
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Hannah G. Pease
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
| | - Lessley B. Torres
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Haydee G. Cortes
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Mallory Zworth
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Toronto, Canada
| | - Michelle A. Fortier
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
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23
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Ecker S, Kirisits C, Schmid M, Knoth J, Heilemann G, De Leeuw A, Sturdza A, Kirchheiner K, Jensen N, Nout R, Jürgenliemk-Schulz I, Pötter R, Spampinato S, Tanderup K, Eder-Nesvacil N. EviGUIDE - a tool for evidence-based decision making in image-guided adaptive brachytherapy for cervical cancer. Radiother Oncol 2023; 186:109748. [PMID: 37330055 DOI: 10.1016/j.radonc.2023.109748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To develop a novel decision-support system for radiation oncology that incorporates clinical, treatment and outcome data, as well as outcome models from a large clinical trial on magnetic resonance image-guided adaptive brachytherapy (MR-IGABT) for locally advanced cervical cancer (LACC). METHODS A system, called EviGUIDE, was developed that combines dosimetric information from the treatment planning system, patient and treatment characteristics, and established tumor control probability (TCP), and normal tissue complication probability (NTCP) models, to predict clinical outcome of radiotherapy treatment of LACC. Six Cox Proportional Hazards models based on data from 1341 patients of the EMBRACE-I study have been integrated. One TCP model for local tumor control, and five NTCP models for OAR morbidities. RESULTS EviGUIDE incorporates TCP-NTCP graphs to help users visualize the clinical impact of different treatment plans and provides feedback on achievable doses based on a large reference population. It enables holistic assessment of the interplay between multiple clinical endpoints and tumour and treatment variables. Retrospective analysis of 45 patients treated with MR-IGABT showed that there exists a sub-cohort of patients (20%) with increased risk factors, that could greatly benefit from the quantitative and visual feedback. CONCLUSION A novel digital concept was developed that can enhance clinical decision- making and facilitate personalized treatment. It serves as a proof of concept for a new generation of decision support systems in radiation oncology, which incorporate outcome models and high-quality reference data, and aids the dissemination of evidence-based knowledge about optimal treatment and serve as a blueprint for other sites in radiation oncology.
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Affiliation(s)
- Stefan Ecker
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria.
| | - Christian Kirisits
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Maximilian Schmid
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Johannes Knoth
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Gerd Heilemann
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Astrid De Leeuw
- University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, the Netherlands
| | - Alina Sturdza
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Kathrin Kirchheiner
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Nina Jensen
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Remi Nout
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Ina Jürgenliemk-Schulz
- University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, the Netherlands
| | - Richard Pötter
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Sofia Spampinato
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
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24
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Hurvitz N, Ilan Y. The Constrained-Disorder Principle Assists in Overcoming Significant Challenges in Digital Health: Moving from "Nice to Have" to Mandatory Systems. Clin Pract 2023; 13:994-1014. [PMID: 37623270 PMCID: PMC10453547 DOI: 10.3390/clinpract13040089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
The success of artificial intelligence depends on whether it can penetrate the boundaries of evidence-based medicine, the lack of policies, and the resistance of medical professionals to its use. The failure of digital health to meet expectations requires rethinking some of the challenges faced. We discuss some of the most significant challenges faced by patients, physicians, payers, pharmaceutical companies, and health systems in the digital world. The goal of healthcare systems is to improve outcomes. Assisting in diagnosing, collecting data, and simplifying processes is a "nice to have" tool, but it is not essential. Many of these systems have yet to be shown to improve outcomes. Current outcome-based expectations and economic constraints make "nice to have," "assists," and "ease processes" insufficient. Complex biological systems are defined by their inherent disorder, bounded by dynamic boundaries, as described by the constrained disorder principle (CDP). It provides a platform for correcting systems' malfunctions by regulating their degree of variability. A CDP-based second-generation artificial intelligence system provides solutions to some challenges digital health faces. Therapeutic interventions are held to improve outcomes with these systems. In addition to improving clinically meaningful endpoints, CDP-based second-generation algorithms ensure patient and physician engagement and reduce the health system's costs.
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Affiliation(s)
| | - Yaron Ilan
- Hadassah Medical Center, Department of Medicine, Faculty of Medicine, Hebrew University, POB 1200, Jerusalem IL91120, Israel;
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25
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Livesay K, Petersen S, Walter R, Zhao L, Butler-Henderson K, Abdolkhani R. Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study. JMIR Nurs 2023; 6:e46819. [PMID: 37585256 PMCID: PMC10468699 DOI: 10.2196/46819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic. OBJECTIVE This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce. METHODS Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use. RESULTS Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses' lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making. CONCLUSIONS Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce.
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Affiliation(s)
- Karen Livesay
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Sacha Petersen
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Ruby Walter
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Lin Zhao
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Kerryn Butler-Henderson
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Robab Abdolkhani
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
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26
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Wainstein M, Flanagan E, Johnson DW, Shrapnel S. Systematic review of externally validated machine learning models for predicting acute kidney injury in general hospital patients. FRONTIERS IN NEPHROLOGY 2023; 3:1220214. [PMID: 37675372 PMCID: PMC10479567 DOI: 10.3389/fneph.2023.1220214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
Acute kidney injury (AKI) is one of the most common and consequential complications among hospitalized patients. Timely AKI risk prediction may allow simple interventions that can minimize or avoid the harm associated with its development. Given the multifactorial and complex etiology of AKI, machine learning (ML) models may be best placed to process the available health data to generate accurate and timely predictions. Accordingly, we searched the literature for externally validated ML models developed from general hospital populations using the current definition of AKI. Of 889 studies screened, only three were retrieved that fit these criteria. While most models performed well and had a sound methodological approach, the main concerns relate to their development and validation in populations with limited diversity, comparable digital ecosystems, use of a vast number of predictor variables and over-reliance on an easily accessible biomarker of kidney injury. These are potentially critical limitations to their applicability in diverse socioeconomic and cultural settings, prompting a need for simpler, more transportable prediction models which can offer a competitive advantage over the current tools used to predict and diagnose AKI.
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Affiliation(s)
- Marina Wainstein
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Medicine, West Moreton Kidney Health Service, Ipswich Hospital, Brisbane, QLD, Australia
| | - Emily Flanagan
- Faculty of Science, University of Queensland, Brisbane, QLD, Australia
| | - David W. Johnson
- Metro South Kidney and Transplant Services (MSKATS), Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, QLD, Australia
| | - Sally Shrapnel
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Australian Research Council (ARC) Centre of Excellence for Engineered Quantum Systems, School of Mathematics and Physics, University of Queensland, Brisbane, QLD, Australia
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27
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Shaw RJ. Access to Technology and Digital Literacy as Determinants of Health and Health Care. Creat Nurs 2023; 29:258-263. [PMID: 37909069 DOI: 10.1177/10784535231211682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Access to and the skills to use technology provide the digital equity necessary for civic and cultural participation, employment, lifelong learning, and access to essential services. However, existing digital disparities and the resultant 'digital divide' risk exacerbating health and health-care inequalities. The COVID-19 pandemic amplified these disparities and accelerated the adoption of technology-driven health care such as telehealth, electronic health records, and digital health technologies. Unfortunately, pre-existing disparities influence the adoption and utilization of these technologies, often leaving disadvantaged groups further behind. Efforts toward digital inclusion, access to technology, and digital literacy are necessary to ensure universal access to and meaningful engagement with digital resources. Nurses play a vital role in promoting digital equity, serving as educators, advocates, and digital navigators, guiding patients through the complexities of the digital health landscape.
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Affiliation(s)
- Ryan J Shaw
- School of Nursing, Duke University, Durham, North Carolina, US
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28
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Canning C, Guo J, Narang A, Thomas JD, Ahmad FS. The Emerging Role of Artificial Intelligence in Valvular Heart Disease. Heart Fail Clin 2023; 19:391-405. [PMID: 37230652 DOI: 10.1016/j.hfc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Valvular heart disease (VHD) is a morbid condition in which timely identification and evidence-based treatments can lead to improved outcomes. Artificial intelligence broadly refers to the ability for computers to perform tasks and problem solve like the human mind. Studies applying AI to VHD have used a variety of structured (eg, sociodemographic, clinical) and unstructured (eg, electrocardiogram, phonocardiogram, and echocardiograms) and machine learning modeling approaches. Additional researches in diverse populations, including prospective clinical trials, are needed to evaluate the effectiveness and value of AI-enabled medical technologies in clinical care for patients with VHD.
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Affiliation(s)
- Caroline Canning
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, IL, USA. https://twitter.com/carolinecanning
| | - James Guo
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, IL, USA
| | - Akhil Narang
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, IL, USA. https://twitter.com/AkhilNarangMD
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, IL, USA. https://twitter.com/jamesdthomasMD1
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, IL, USA; Division of Health and Biomedical informatics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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29
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Spoer DL, Junn A, Bovill JD, Haffner ZK, Abadeer AI, Baker SB. Evolving the Cybersecurity of Clinical Photography in Plastic Surgery. Arch Plast Surg 2023; 50:443-444. [PMID: 37564722 PMCID: PMC10411159 DOI: 10.1055/a-2103-4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/03/2023] [Indexed: 08/12/2023] Open
Abstract
Point-of-care photography and photo sharing optimize patient outcomes and facilitate remote consultation imperative for resident surgeons. This literature review and external pilot survey study highlight the risks associated with current practices concerning patient privacy and biometric security. In a survey of 30 plastic surgeon residents and attendings, we found that the majority took photos of patients with their iPhones and shared them with colleagues via Apple iMessage. These findings corroborate previous reports and highlight a lack of physician user acceptance of secure photo-sharing platforms. Finally, we frame a successful example from the literature in the context of a postulated framework for institutional change. Prioritizing the privacy and safety of patients requires a strategic approach that preserves the ease and frequency of use of current practices.
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Affiliation(s)
- Daisy L. Spoer
- Department of Plastic Surgery, Georgetown University School of Medicine, Washington, District of Columbia
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Alexandra Junn
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - John D. Bovill
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Zoë K. Haffner
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andrew I. Abadeer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Stephen B. Baker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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30
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Al Kuwaiti A, Nazer K, Al-Reedy A, Al-Shehri S, Al-Muhanna A, Subbarayalu AV, Al Muhanna D, Al-Muhanna FA. A Review of the Role of Artificial Intelligence in Healthcare. J Pers Med 2023; 13:951. [PMID: 37373940 PMCID: PMC10301994 DOI: 10.3390/jpm13060951] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
Artificial intelligence (AI) applications have transformed healthcare. This study is based on a general literature review uncovering the role of AI in healthcare and focuses on the following key aspects: (i) medical imaging and diagnostics, (ii) virtual patient care, (iii) medical research and drug discovery, (iv) patient engagement and compliance, (v) rehabilitation, and (vi) other administrative applications. The impact of AI is observed in detecting clinical conditions in medical imaging and diagnostic services, controlling the outbreak of coronavirus disease 2019 (COVID-19) with early diagnosis, providing virtual patient care using AI-powered tools, managing electronic health records, augmenting patient engagement and compliance with the treatment plan, reducing the administrative workload of healthcare professionals (HCPs), discovering new drugs and vaccines, spotting medical prescription errors, extensive data storage and analysis, and technology-assisted rehabilitation. Nevertheless, this science pitch meets several technical, ethical, and social challenges, including privacy, safety, the right to decide and try, costs, information and consent, access, and efficacy, while integrating AI into healthcare. The governance of AI applications is crucial for patient safety and accountability and for raising HCPs' belief in enhancing acceptance and boosting significant health consequences. Effective governance is a prerequisite to precisely address regulatory, ethical, and trust issues while advancing the acceptance and implementation of AI. Since COVID-19 hit the global health system, the concept of AI has created a revolution in healthcare, and such an uprising could be another step forward to meet future healthcare needs.
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Affiliation(s)
- Ahmed Al Kuwaiti
- Department of Dental Education, College of Dentistry, Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Khalid Nazer
- Department of Information and Technology, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Health Information Department, King Fahad hospital of the University, Al-Khobar 31952, Saudi Arabia
| | - Abdullah Al-Reedy
- Department of Information and Technology, Family and Community Medicine Department, Family and Community Medicine Centre, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Shaher Al-Shehri
- Faculty of Medicine, Family and Community Medicine Department, Family and Community Medicine Centre, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Afnan Al-Muhanna
- Breast Imaging Division, Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Radiology Department, King Fahad hospital of the University, Al-Khobar 31952, Saudi Arabia
| | - Arun Vijay Subbarayalu
- Quality Studies and Research Unit, Vice Deanship of Quality, Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Dhoha Al Muhanna
- NDirectorate of Quality and Patient Safety, Family and Community Medicine Center, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Fahad A. Al-Muhanna
- Nephrology Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Medicine Department, King Fahad hospital of the University, Al-Khobar 31952, Saudi Arabia
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31
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Long H, Li S, Chen Y. Digital health in chronic obstructive pulmonary disease. Chronic Dis Transl Med 2023; 9:90-103. [PMID: 37305103 PMCID: PMC10249197 DOI: 10.1002/cdt3.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/11/2023] [Accepted: 04/03/2023] [Indexed: 06/13/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) can be prevented and treated through effective care, reducing exacerbations and hospitalizations. Early identification of individuals at high risk of COPD exacerbation is an opportunity for preventive measures. However, many patients struggle to follow their treatment plans because of a lack of knowledge about the disease, limited access to resources, and insufficient clinical support. The growth of digital health-which encompasses advancements in health information technology, artificial intelligence, telehealth, the Internet of Things, mobile health, wearable technology, and digital therapeutics-offers opportunities for improving the early diagnosis and management of COPD. This study reviewed the field of digital health in terms of COPD. The findings showed that despite significant advances in digital health, there are still obstacles impeding its effectiveness. Finally, we highlighted some of the major challenges and possibilities for developing and integrating digital health in COPD management.
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Affiliation(s)
- Huanyu Long
- Department of Pulmonary and Critical Care MedicinePeking University Third HospitalBeijingChina
| | - Shurun Li
- Peking University Health Science CenterBeijingChina
| | - Yahong Chen
- Department of Pulmonary and Critical Care MedicinePeking University Third HospitalBeijingChina
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32
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Marwaha JS, Raza MM, Kvedar JC. The digital transformation of surgery. NPJ Digit Med 2023; 6:103. [PMID: 37258642 PMCID: PMC10232406 DOI: 10.1038/s41746-023-00846-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
Rapid advances in digital technology and artificial intelligence in recent years have already begun to transform many industries, and are beginning to make headway into healthcare. There is tremendous potential for new digital technologies to improve the care of surgical patients. In this piece, we highlight work being done to advance surgical care using machine learning, computer vision, wearable devices, remote patient monitoring, and virtual and augmented reality. We describe ways these technologies can be used to improve the practice of surgery, and discuss opportunities and challenges to their widespread adoption and use in operating rooms and at the bedside.
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Affiliation(s)
- Jayson S Marwaha
- Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | | | - Joseph C Kvedar
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham, Boston, MA, USA
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33
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Perrin Franck C, Babington-Ashaye A, Dietrich D, Bediang G, Veltsos P, Gupta PP, Juech C, Kadam R, Collin M, Setian L, Serrano Pons J, Kwankam SY, Garrette B, Barbe S, Bagayoko CO, Mehl G, Lovis C, Geissbuhler A. iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations. J Med Internet Res 2023; 25:e46694. [PMID: 37163336 PMCID: PMC10209789 DOI: 10.2196/46694] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. OBJECTIVE A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced "I checked") to improve the completeness of reporting on digital health implementations. METHODS A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. RESULTS The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. CONCLUSIONS Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes.
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Affiliation(s)
- Caroline Perrin Franck
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Geneva Digital Health Hub, Geneva, Switzerland
| | - Awa Babington-Ashaye
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Geneva Digital Health Hub, Geneva, Switzerland
| | | | - Georges Bediang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Claudia Juech
- Government Innovation, Bloomberg Philanthropies, New York, NY, United States
| | - Rigveda Kadam
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | | | | | - S Yunkap Kwankam
- International Society for Telemedicine & eHealth, Basel, Switzerland
| | | | | | - Cheick Oumar Bagayoko
- Centre d'Innovation et de Santé Digitale, DigiSanté-Mali, Université des sciences, des techniques et des technologies de Bamako, Bamako, Mali
- Centre d'Expertise et de Recherche en Télémédecine et E-Santé, Bamako, Mali
| | - Garrett Mehl
- Department of Digital Health and Innovation, World Health Organization, Geneva, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Geissbuhler
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Geneva Digital Health Hub, Geneva, Switzerland
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
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Lazarevic N, Pizzuti C, Rosic G, Bœhm C, Williams K, Caillaud C. A mixed-methods study exploring women's perceptions and recommendations for a pregnancy app with monitoring tools. NPJ Digit Med 2023; 6:50. [PMID: 36964179 PMCID: PMC10036977 DOI: 10.1038/s41746-023-00792-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/04/2023] [Indexed: 03/26/2023] Open
Abstract
Digital health tools such as apps are being increasingly used by women to access pregnancy-related information. Conducted during the COVID-19 pandemic, this study investigated: (i) pregnant women's current usage of digital health tools to self-monitor and (ii) their interest in theoretical pregnancy app features (a direct patient-to-healthcare-professional communication tool and a body measurement tool). Using a mixed methods approach, 108 pregnant women were surveyed and 15 currently or recently pregnant women were interviewed online. We found that pregnant women used digital health tools to mainly access pregnancy related information and less so to self-monitor. Most participants were interested and enthusiastic about a patient-to-healthcare-professional communication tool. About half of the survey participants (49%) felt comfortable using a body measurement tool to monitor their body parts and 80% of interview participants were interested in using the body measurement to track leg/ankle swelling. Participants also shared additional pregnancy app features that they thought would be beneficial such as a "Digital Wallet" and a desire for a holistic pregnancy app that allowed for more continuous and personalised care. This study highlights the gaps and needs of pregnant women and should inform all stakeholders designing pregnancy digital healthcare. This study offers a unique insight into the needs of pregnant women during a very particular and unique period in human history.
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Affiliation(s)
- Natasa Lazarevic
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Carol Pizzuti
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Gillian Rosic
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Nepean Blue Mountains Family Metabolic Health Service, Department of Endocrinology, Nepean Hospital, Sydney, NSW, Australia
| | - Céline Bœhm
- School of Physics, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Kathryn Williams
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Nepean Blue Mountains Family Metabolic Health Service, Department of Endocrinology, Nepean Hospital, Sydney, NSW, Australia
| | - Corinne Caillaud
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
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APLUS: A Python library for usefulness simulations of machine learning models in healthcare. J Biomed Inform 2023; 139:104319. [PMID: 36791900 DOI: 10.1016/j.jbi.2023.104319] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Despite the creation of thousands of machine learning (ML) models, the promise of improving patient care with ML remains largely unrealized. Adoption into clinical practice is lagging, in large part due to disconnects between how ML practitioners evaluate models and what is required for their successful integration into care delivery. Models are just one component of care delivery workflows whose constraints determine clinicians' abilities to act on models' outputs. However, methods to evaluate the usefulness of models in the context of their corresponding workflows are currently limited. To bridge this gap we developed APLUS, a reusable framework for quantitatively assessing via simulation the utility gained from integrating a model into a clinical workflow. We describe the APLUS simulation engine and workflow specification language, and apply it to evaluate a novel ML-based screening pathway for detecting peripheral artery disease at Stanford Health Care.
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Donovan T, Abell B, Fernando M, McPhail SM, Carter HE. Implementation costs of hospital-based computerised decision support systems: a systematic review. Implement Sci 2023; 18:7. [PMID: 36829247 PMCID: PMC9960445 DOI: 10.1186/s13012-023-01261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The importance of accurately costing implementation strategies is increasingly recognised within the field of implementation science. However, there is a lack of methodological guidance for costing implementation, particularly within digital health settings. This study reports on a systematic review of costing analyses conducted alongside implementation of hospital-based computerised decision support systems. METHODS PubMed, Embase, Scopus and CINAHL databases were searched between January 2010 and August 2021. Two reviewers independently screened and selected original research studies that were conducted in a hospital setting, examined the implementation of a computerised decision support systems and reported implementation costs. The Expert Recommendations for Implementing Change Framework was used to identify and categorise implementation strategies into clusters. A previously published costing framework was applied to describe the methods used to measure and value implementation costs. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Titles and abstracts of 1836 articles were screened, with nine articles eligible for inclusion in the review. Implementation costs were most frequently reported under the 'evaluative and iterative strategies' cluster, followed by 'provide interactive assistance'. Labour was the largest implementation-related cost in the included papers, irrespective of implementation strategy. Other reported costs included consumables, durable assets and physical space, which was mostly associated with stakeholder training. The methods used to cost implementation were often unclear. There was variation across studies in the overall quality of reporting. CONCLUSIONS A relatively small number of papers have described computerised decision support systems implementation costs, and the methods used to measure and value these costs were not well reported. Priorities for future research should include establishing consistent terminology and appropriate methods for estimating and reporting on implementation costs. TRIAL REGISTRATION The review protocol is registered with PROSPERO (ID: CRD42021272948).
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Affiliation(s)
- Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Bridget Abell
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Manasha Fernando
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Steven M. McPhail
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia ,grid.474142.0Digital Health and Informatics, Metro South Health, Brisbane, QLD Australia
| | - Hannah E. Carter
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
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Delaforce A, Li J, Grujovski M, Parkinson J, Richards P, Fahy M, Good N, Jayasena R. Creating an Implementation Enhancement Plan for a Digital Patient Fall Prevention Platform Using the CFIR-ERIC Approach: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3794. [PMID: 36900804 PMCID: PMC10001076 DOI: 10.3390/ijerph20053794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow. (2) Methods: A qualitative approach using focus groups/interview included 12 participants across four inpatient wards, from a newly built, 300-bed rural referral hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan. (3) Results: The most prevalent CFIR enablers included: relative advantage (n = 12), access to knowledge and information (n = 11), leadership engagement (n = 9), patient needs and resources (n = 8), cosmopolitanism (n = 5), knowledge and beliefs about the intervention (n = 5), self-efficacy (n = 5) and formally appointed internal implementation leaders (n = 5). Commonly mentioned CFIR barriers included: access to knowledge and information (n = 11), available resources (n = 8), compatibility (n = 8), patient needs and resources (n = 8), design quality and packaging (n = 10), adaptability (n = 7) and executing (n = 7). After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations. (4) Conclusions: The enablers and barriers identified are similar to those described in the literature. Given there is close agreement between the ERIC consensus framework recommendations and the evidence, this approach will likely assist in enhancing the implementation of Rauland's Concentric Care fall prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routines. The results of this study will provide a blueprint to enhance implementation that will be tested for effectiveness at a later stage.
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Affiliation(s)
- Alana Delaforce
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Herston, QLD 4029, Australia
| | - Jane Li
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Westmead, NSW 2145, Australia
| | - Melisa Grujovski
- Nursing and Midwifery Services, Maitland Hospital, Hunter New England Local Health District, Maitland, NSW 2323, Australia
| | - Joy Parkinson
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Herston, QLD 4029, Australia
| | - Paula Richards
- Nursing and Midwifery Services, Maitland Hospital, Hunter New England Local Health District, Maitland, NSW 2323, Australia
| | - Michael Fahy
- Nursing and Midwifery Services, Maitland Hospital, Hunter New England Local Health District, Maitland, NSW 2323, Australia
| | - Norman Good
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Herston, QLD 4029, Australia
| | - Rajiv Jayasena
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Parkville, VIC 3052, Australia
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Turner D, Yu J, Murphy D, Chiew A. Triage to electrocardiogram sign-off time in patients with acute coronary syndrome at a metropolitan Sydney hospital. Emerg Med Australas 2023. [PMID: 36796425 DOI: 10.1111/1742-6723.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To compare the time from triage to ECG sign-off in patients with acute coronary syndrome, before and after the introduction of an electronic medical record-integrated ECG workflow system (Epiphany). Additionally, to assess for any correlation between patient characteristics and ECG sign-off times. METHODS A retrospective, single-centre cohort study was performed at Prince of Wales Hospital, Sydney. Patients were included if they were over 18 years, presented to Prince of Wales Hospital ED during 2021, had an ED diagnosis code of 'ACS', 'UA', 'NSTEMI' or 'STEMI' and were subsequently admitted under the cardiology team. ECG sign-off times and demographic data were compared between patients presenting prior to 29 June (pre-Epiphany group) and those presenting after (post-Epiphany group). Those without ECGs signed-off were excluded. RESULTS There were 200 patients (100 each group) included in the statistical analysis. There was a significant decrease in the median triage to ECG sign-off time, from 35 min (IQR 18-69) pre-Epiphany, to 21 min (IQR 13-37) post-Epiphany. There were only 10 (5%) patients in the pre-Epiphany group and 16 (8%) in the post-Epiphany group, who had ECG sign-off times less than the 10-min. There was no correlation between gender, triage category, age or time of shift with triage to ECG sign-off time. CONCLUSIONS The introduction of the Epiphany system has significantly reduced the triage to ECG sign-off time in the ED. Despite this, there remains a large proportion of patients with acute coronary syndrome who do not have an ECG signed-off within the guideline-recommended 10 min.
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Affiliation(s)
- Dane Turner
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Yu
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Cardiology Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - David Murphy
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Angela Chiew
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Eysenbach G, Hagens S, Kemp J, Roble H, Carter-Langford A, Shen N. Patient Perspectives and Preferences for Consent in the Digital Health Context: State-of-the-art Literature Review. J Med Internet Res 2023; 25:e42507. [PMID: 36763409 PMCID: PMC9960046 DOI: 10.2196/42507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The increasing integration of digital health tools into care may result in a greater flow of personal health information (PHI) between patients and providers. Although privacy legislation governs how entities may collect, use, or share PHI, such legislation has not kept pace with digital health innovations, resulting in a lack of guidance on implementing meaningful consent. Understanding patient perspectives when implementing meaningful consent is critical to ensure that it meets their needs. Consent for research in the context of digital health is limited. OBJECTIVE This state-of-the-art review aimed to understand the current state of research as it relates to patient perspectives on digital health consent. Its objectives were to explore what is known about the patient perspective and experience with digital health consent and provide recommendations on designing and implementing digital health consent based on the findings. METHODS A structured literature search was developed and deployed in 4 electronic databases-MEDLINE, IEEE Xplore, Scopus, and Web of Science-for articles published after January 2010. The initial literature search was conducted in March 2021 and updated in March 2022. Articles were eligible for inclusion if they discussed electronic consent or consent, focused on the patient perspective or preference, and were related to digital health or digital PHI. Data were extracted using an extraction template and analyzed using qualitative content analysis. RESULTS In total, 75 articles were included for analysis. Most studies were published within the last 5 years (58/75, 77%) and conducted in a clinical care context (33/75, 44%) and in the United States (48/75, 64%). Most studies aimed to understand participants' willingness to share PHI (25/75, 33%) and participants' perceived usability and comprehension of an electronic consent notice (25/75, 33%). More than half (40/75, 53%) of the studies did not describe the type of consent model used. The broad open consent model was the most explored (11/75, 15%). Of the 75 studies, 68 (91%) found that participants were willing to provide consent; however, their consent behaviors and preferences were context-dependent. Common patient consent requirements included clear and digestible information detailing who can access PHI, for what purpose their PHI will be used, and how privacy will be ensured. CONCLUSIONS There is growing interest in understanding the patient perspective on digital health consent in the context of providing clinical care. There is evidence suggesting that many patients are willing to consent for various purposes, especially when there is greater transparency on how the PHI is used and oversight mechanisms are in place. Providing this transparency is critical for fostering trust in digital health tools and the innovative uses of data to optimize health and system outcomes.
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Affiliation(s)
| | | | - Jessica Kemp
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Heba Roble
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Nelson Shen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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40
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Woods L, Eden R, Canfell OJ, Nguyen KH, Comans T, Sullivan C. Show me the money: how do we justify spending health care dollars on digital health? Med J Aust 2023; 218:53-57. [PMID: 36502453 PMCID: PMC10107451 DOI: 10.5694/mja2.51799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW
| | - Rebekah Eden
- Queensland University of Technology, Brisbane, QLD
| | - Oliver J Canfell
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW.,University of Queensland, Brisbane, QLD
| | - Kim-Huong Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Global Brain Health Institute, Trinity College Dublin and University California, San Francisco, Dublin, Ireland
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Clair Sullivan
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD
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Hogg HDJ, Al-Zubaidy M, Talks J, Denniston AK, Kelly CJ, Malawana J, Papoutsi C, Teare MD, Keane PA, Beyer FR, Maniatopoulos G. Stakeholder Perspectives of Clinical Artificial Intelligence Implementation: Systematic Review of Qualitative Evidence. J Med Internet Res 2023; 25:e39742. [PMID: 36626192 PMCID: PMC9875023 DOI: 10.2196/39742] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The rhetoric surrounding clinical artificial intelligence (AI) often exaggerates its effect on real-world care. Limited understanding of the factors that influence its implementation can perpetuate this. OBJECTIVE In this qualitative systematic review, we aimed to identify key stakeholders, consolidate their perspectives on clinical AI implementation, and characterize the evidence gaps that future qualitative research should target. METHODS Ovid-MEDLINE, EBSCO-CINAHL, ACM Digital Library, Science Citation Index-Web of Science, and Scopus were searched for primary qualitative studies on individuals' perspectives on any application of clinical AI worldwide (January 2014-April 2021). The definition of clinical AI includes both rule-based and machine learning-enabled or non-rule-based decision support tools. The language of the reports was not an exclusion criterion. Two independent reviewers performed title, abstract, and full-text screening with a third arbiter of disagreement. Two reviewers assigned the Joanna Briggs Institute 10-point checklist for qualitative research scores for each study. A single reviewer extracted free-text data relevant to clinical AI implementation, noting the stakeholders contributing to each excerpt. The best-fit framework synthesis used the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. To validate the data and improve accessibility, coauthors representing each emergent stakeholder group codeveloped summaries of the factors most relevant to their respective groups. RESULTS The initial search yielded 4437 deduplicated articles, with 111 (2.5%) eligible for inclusion (median Joanna Briggs Institute 10-point checklist for qualitative research score, 8/10). Five distinct stakeholder groups emerged from the data: health care professionals (HCPs), patients, carers and other members of the public, developers, health care managers and leaders, and regulators or policy makers, contributing 1204 (70%), 196 (11.4%), 133 (7.7%), 129 (7.5%), and 59 (3.4%) of 1721 eligible excerpts, respectively. All stakeholder groups independently identified a breadth of implementation factors, with each producing data that were mapped between 17 and 24 of the 27 adapted Nonadoption, Abandonment, Scale-up, Spread, and Sustainability subdomains. Most of the factors that stakeholders found influential in the implementation of rule-based clinical AI also applied to non-rule-based clinical AI, with the exception of intellectual property, regulation, and sociocultural attitudes. CONCLUSIONS Clinical AI implementation is influenced by many interdependent factors, which are in turn influenced by at least 5 distinct stakeholder groups. This implies that effective research and practice of clinical AI implementation should consider multiple stakeholder perspectives. The current underrepresentation of perspectives from stakeholders other than HCPs in the literature may limit the anticipation and management of the factors that influence successful clinical AI implementation. Future research should not only widen the representation of tools and contexts in qualitative research but also specifically investigate the perspectives of all stakeholder HCPs and emerging aspects of non-rule-based clinical AI implementation. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42021256005; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256005. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33145.
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Affiliation(s)
- Henry David Jeffry Hogg
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mohaimen Al-Zubaidy
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James Talks
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Johann Malawana
- The Healthcare Leadership Academy, London, United Kingdom
- The Institute of Leadership and Management, Birmingham, United Kingdom
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Healthcare Sciences, Oxford University, Oxford, United Kingdom
| | - Marion Dawn Teare
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Fiona R Beyer
- Evidence Synthesis Group, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gregory Maniatopoulos
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Faculty of Business and Law, Northumbria University, Newcastle upon Tyne, United Kingdom
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Boyle LD, Husebo BS, Vislapuu M. Promotors and barriers to the implementation and adoption of assistive technology and telecare for people with dementia and their caregivers: a systematic review of the literature. BMC Health Serv Res 2022; 22:1573. [PMID: 36550456 PMCID: PMC9780101 DOI: 10.1186/s12913-022-08968-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND One of the most pressing issues in our society is the provision of proper care and treatment for the growing global health challenge of ageing. Assistive Technology and Telecare (ATT) is a key component in facilitation of safer, longer, and independent living for people with dementia (PwD) and has the potential to extend valuable care and support for caregivers globally. The objective of this study was to identify promotors and barriers to implementation and adoption of ATT for PwD and their informal (family and friends) and formal (healthcare professionals) caregivers. METHODS Five databases Medline (Ovid), CINAHL, Web of Science, APA PsycINFO and EMBASE were searched. PRISMA guidelines have been used to guide all processes and results. Retrieved studies were qualitative, mixed-method and quantitative, screened using Rayyan and overall quality assessed using Critical Appraisal Skills Programme (CASP) and Mixed Methods Assessment Tool (MMAT). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria and assigned within categories of high, moderate, or low. NVivo was used for synthesis and analysis of article content. A narrative synthesis combines the study findings. RESULTS Thirty studies (7 quantitative, 19 qualitative and 4 mixed methods) met the inclusion criteria. Identified primary promotors for the implementation and adoption of ATT were: personalized training and co-designed solutions, safety for the PwD, involvement of all relevant stakeholders, ease of use and support, and cultural relevance. Main barriers for the implementation and adoption of ATT included: unintended adverse consequences, timing and disease progress, technology anxiety, system failures, digital divide, and lack of access to or knowledge of available ATT. CONCLUSION The most crucial elements for the adoption of ATT in the future will be a focus on co-design, improved involvement of relevant stakeholders, and the adaptability (tailoring related to context) of ATT solutions over time (disease process).
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Affiliation(s)
- Lydia D. Boyle
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Neuro-SysMed Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norge
| | - Bettina S. Husebo
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Neuro-SysMed Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norge
| | - Maarja Vislapuu
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Neuro-SysMed Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norge
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Joyce C, Markossian TW, Nikolaides J, Ramsey E, Thompson HM, Rojas JC, Sharma B, Dligach D, Oguss MK, Cooper RS, Afshar M. The Evaluation of a Clinical Decision Support Tool Using Natural Language Processing to Screen Hospitalized Adults for Unhealthy Substance Use: Protocol for a Quasi-Experimental Design. JMIR Res Protoc 2022; 11:e42971. [PMID: 36534461 PMCID: PMC9808720 DOI: 10.2196/42971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Automated and data-driven methods for screening using natural language processing (NLP) and machine learning may replace resource-intensive manual approaches in the usual care of patients hospitalized with conditions related to unhealthy substance use. The rigorous evaluation of tools that use artificial intelligence (AI) is necessary to demonstrate effectiveness before system-wide implementation. An NLP tool to use routinely collected data in the electronic health record was previously validated for diagnostic accuracy in a retrospective study for screening unhealthy substance use. Our next step is a noninferiority design incorporated into a research protocol for clinical implementation with prospective evaluation of clinical effectiveness in a large health system. OBJECTIVE This study aims to provide a study protocol to evaluate health outcomes and the costs and benefits of an AI-driven automated screener compared to manual human screening for unhealthy substance use. METHODS A pre-post design is proposed to evaluate 12 months of manual screening followed by 12 months of automated screening across surgical and medical wards at a single medical center. The preintervention period consists of usual care with manual screening by nurses and social workers and referrals to a multidisciplinary Substance Use Intervention Team (SUIT). Facilitated by a NLP pipeline in the postintervention period, clinical notes from the first 24 hours of hospitalization will be processed and scored by a machine learning model, and the SUIT will be similarly alerted to patients who flagged positive for substance misuse. Flowsheets within the electronic health record have been updated to capture rates of interventions for the primary outcome (brief intervention/motivational interviewing, medication-assisted treatment, naloxone dispensing, and referral to outpatient care). Effectiveness in terms of patient outcomes will be determined by noninferior rates of interventions (primary outcome), as well as rates of readmission within 6 months, average time to consult, and discharge rates against medical advice (secondary outcomes) in the postintervention period by a SUIT compared to the preintervention period. A separate analysis will be performed to assess the costs and benefits to the health system by using automated screening. Changes from the pre- to postintervention period will be assessed in covariate-adjusted generalized linear mixed-effects models. RESULTS The study will begin in September 2022. Monthly data monitoring and Data Safety Monitoring Board reporting are scheduled every 6 months throughout the study period. We anticipate reporting final results by June 2025. CONCLUSIONS The use of augmented intelligence for clinical decision support is growing with an increasing number of AI tools. We provide a research protocol for prospective evaluation of an automated NLP system for screening unhealthy substance use using a noninferiority design to demonstrate comprehensive screening that may be as effective as manual screening but less costly via automated solutions. TRIAL REGISTRATION ClinicalTrials.gov NCT03833804; https://clinicaltrials.gov/ct2/show/NCT03833804. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42971.
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Affiliation(s)
- Cara Joyce
- Department of Computer Science, Loyola University Chicago, Chicago, IL, United States
| | - Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Jenna Nikolaides
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Elisabeth Ramsey
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Hale M Thompson
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Juan C Rojas
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Brihat Sharma
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL, United States
| | - Madeline K Oguss
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Richard S Cooper
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Majid Afshar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
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Harish V, Samson TG, Diemert L, Tuite A, Mamdani M, Khan K, McGahan A, Shaw JA, Das S, Rosella LC. Governing partnerships with technology companies as part of the COVID-19 response in Canada: A qualitative case study. PLOS DIGITAL HEALTH 2022; 1:e0000164. [PMID: 36812643 PMCID: PMC9931354 DOI: 10.1371/journal.pdig.0000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
Cross-sector partnerships are vital for maintaining resilient health systems; however, few studies have sought to empirically assess the barriers and enablers of effective and responsible partnerships during public health emergencies. Through a qualitative, multiple case study, we analyzed 210 documents and conducted 26 interviews with stakeholders in three real-world partnerships between Canadian health organizations and private technology startups during the COVID-19 pandemic. The three partnerships involved: 1) deploying a virtual care platform to care for COVID-19 patients at one hospital, 2) deploying a secure messaging platform for physicians at another hospital, and 3) using data science to support a public health organization. Our results demonstrate that a public health emergency created time and resource pressures throughout a partnership. Given these constraints, early and sustained alignment on the core problem was critical for success. Moreover, governance processes designed for normal operations, such as procurement, were triaged and streamlined. Social learning, or the process of learning from observing others, offset some time and resource pressures. Social learning took many forms ranging from informal conversations between individuals at peer organisations (e.g., hospital chief information officers) to standing meetings at the local university's city-wide COVID-19 response table. We also found that startups' flexibility and understanding of the local context enabled them to play a highly valuable role in emergency response. However, pandemic fueled "hypergrowth" created risks for startups, such as introducing opportunities for deviation away from their core value proposition. Finally, we found each partnership navigated intense workloads, burnout, and personnel turnover through the pandemic. Strong partnerships required healthy, motivated teams. Visibility into and engagement in partnership governance, belief in partnership impact, and strong emotional intelligence in managers promoted team well-being. Taken together, these findings can help to bridge the theory-to-practice gap and guide effective cross-sector partnerships during public health emergencies.
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Affiliation(s)
- Vinyas Harish
- MD/PhD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Vector Institute for Artificial Intelligence, Toronto, Canada
- Schwartz Reisman Institute for Technology and Society, Toronto, Canada
- Ethics of AI Lab, Centre for Ethics, University of Toronto, Toronto, Canada
| | - Thomas G. Samson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lori Diemert
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ashleigh Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Vector Institute for Artificial Intelligence, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Kamran Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anita McGahan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rotman School of Management, University of Toronto, Toronto, Canada
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
| | - James A. Shaw
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Canada
| | - Sunit Das
- Ethics of AI Lab, Centre for Ethics, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, Temerty Faculty of Medicine, Toronto, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Vector Institute for Artificial Intelligence, Toronto, Canada
- Schwartz Reisman Institute for Technology and Society, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
- * E-mail:
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Binuya MAE, Engelhardt EG, Schats W, Schmidt MK, Steyerberg EW. Methodological guidance for the evaluation and updating of clinical prediction models: a systematic review. BMC Med Res Methodol 2022; 22:316. [PMID: 36510134 PMCID: PMC9742671 DOI: 10.1186/s12874-022-01801-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clinical prediction models are often not evaluated properly in specific settings or updated, for instance, with information from new markers. These key steps are needed such that models are fit for purpose and remain relevant in the long-term. We aimed to present an overview of methodological guidance for the evaluation (i.e., validation and impact assessment) and updating of clinical prediction models. METHODS We systematically searched nine databases from January 2000 to January 2022 for articles in English with methodological recommendations for the post-derivation stages of interest. Qualitative analysis was used to summarize the 70 selected guidance papers. RESULTS Key aspects for validation are the assessment of statistical performance using measures for discrimination (e.g., C-statistic) and calibration (e.g., calibration-in-the-large and calibration slope). For assessing impact or usefulness in clinical decision-making, recent papers advise using decision-analytic measures (e.g., the Net Benefit) over simplistic classification measures that ignore clinical consequences (e.g., accuracy, overall Net Reclassification Index). Commonly recommended methods for model updating are recalibration (i.e., adjustment of intercept or baseline hazard and/or slope), revision (i.e., re-estimation of individual predictor effects), and extension (i.e., addition of new markers). Additional methodological guidance is needed for newer types of updating (e.g., meta-model and dynamic updating) and machine learning-based models. CONCLUSION Substantial guidance was found for model evaluation and more conventional updating of regression-based models. An important development in model evaluation is the introduction of a decision-analytic framework for assessing clinical usefulness. Consensus is emerging on methods for model updating.
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Affiliation(s)
- M. A. E. Binuya
- grid.430814.a0000 0001 0674 1393Division of Molecular Pathology, the Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - E. G. Engelhardt
- grid.430814.a0000 0001 0674 1393Division of Molecular Pathology, the Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,grid.430814.a0000 0001 0674 1393Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - W. Schats
- grid.430814.a0000 0001 0674 1393Scientific Information Service, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M. K. Schmidt
- grid.430814.a0000 0001 0674 1393Division of Molecular Pathology, the Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - E. W. Steyerberg
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Karamagi HC, Muneene D, Droti B, Jepchumba V, Okeibunor JC, Nabyonga J, Asamani JA, Traore M, Kipruto H. eHealth or e-Chaos: The use of Digital Health Interventions for Health Systems Strengthening in sub-Saharan Africa over the last 10 years: A scoping review. J Glob Health 2022; 12:04090. [PMID: 36462201 PMCID: PMC9718445 DOI: 10.7189/jogh.12.04090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Digital health solutions are a potent and complementary intervention in health system strengthening to accelerate universal access to health services. Implementing scalable, sustainable, and integrated digital solutions in a coordinated manner is necessary to experience the benefits of digital interventions in health systems. We sought to establish the breadth and scope of available digital health interventions (DHIs) and their functions in sub-Saharan Africa. Methods We conducted a scoping review according to the Joanne Briggs Institute's reviewers manual and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation. We retrieved data from the WHO Digital Health Atlas (DHA), the WHO e-Health country profiles report of 2015, and electronic databases. The protocol has been deposited in an open-source platform - the Open Science Framework at https://osf.io/5kzq7. Results The researchers retrieved 983 digital tools used to strengthen health systems in sub-Saharan Africa over the past 10 years. We included 738 DHIs in the analysis while 245 were excluded for not meeting the inclusion criteria. We observed a disproportionate distribution of DHIs towards service delivery (81.7%, n = 603), health care providers (91.8%, n = 678), and access and use of information (84.1%, n = 621). Fifty-three percent (53.4%, n = 394) of the solutions are established and 47.5% (n = 582) were aligned to 20% (n = 5) of the system categories. Conclusions Sub-Saharan Africa is endowed with digital health solutions in both numbers and distinct functions. It is lacking in coordination, integration, scalability, sustainability, and equitable distribution of investments in digital health. Digital health policymakers in sub-Saharan Africa need to urgently institute coordination mechanisms to terminate unending duplication and disjointed vertical implementations and manage solutions for scale. Central to this would be to build digital health leadership in countries within SSA, adopt standards and interoperability frameworks; advocate for more investments into lagging components, and promote multi-purpose solutions to halt the seeming "e-chaos" and progress to sustainable e-health solutions.
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Affiliation(s)
- Humphrey C Karamagi
- World Health Organization – Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Benson Droti
- World Health Organization – Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Joseph C Okeibunor
- World Health Organization – Regional Office for Africa, Brazzaville, Republic of Congo
| | - Juliet Nabyonga
- World Health Organization, Harare, Zimbabwe,North-West University, Potchefstroom, Mahikeng, Vanderbijlpark, South Africa
| | | | - Moussa Traore
- World Health Organization, Ouagadougou, Burkina Faso
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A Systematic Review of Artificial Intelligence Applications in Plastic Surgery: Looking to the Future. Plast Reconstr Surg Glob Open 2022; 10:e4608. [PMID: 36479133 PMCID: PMC9722565 DOI: 10.1097/gox.0000000000004608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/24/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED Artificial intelligence (AI) is presently employed in several medical specialties, particularly those that rely on large quantities of standardized data. The integration of AI in surgical subspecialties is under preclinical investigation but is yet to be widely implemented. Plastic surgeons collect standardized data in various settings and could benefit from AI. This systematic review investigates the current clinical applications of AI in plastic and reconstructive surgery. METHODS A comprehensive literature search of the Medline, EMBASE, Cochrane, and PubMed databases was conducted for AI studies with multiple search terms. Articles that progressed beyond the title and abstract screening were then subcategorized based on the plastic surgery subspecialty and AI application. RESULTS The systematic search yielded a total of 1820 articles. Forty-four studies met inclusion criteria warranting further analysis. Subcategorization of articles by plastic surgery subspecialties revealed that most studies fell into aesthetic and breast surgery (27%), craniofacial surgery (23%), or microsurgery (14%). Analysis of the research study phase of included articles indicated that the current research is primarily in phase 0 (discovery and invention; 43.2%), phase 1 (technical performance and safety; 27.3%), or phase 2 (efficacy, quality improvement, and algorithm performance in a medical setting; 27.3%). Only one study demonstrated translation to clinical practice. CONCLUSIONS The potential of AI to optimize clinical efficiency is being investigated in every subfield of plastic surgery, but much of the research to date remains in the preclinical status. Future implementation of AI into everyday clinical practice will require collaborative efforts.
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Public awareness and use of health tools provided by the portal of the Ministry of Health of Saudi Arabia. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Faruki AA, Zane RD, Wiler JL. The Role of Academic Health Systems in Leading the "Third Wave" of Digital Health Innovation. JMIR MEDICAL EDUCATION 2022; 8:e32679. [PMID: 36350700 PMCID: PMC9685508 DOI: 10.2196/32679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/23/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Investors, entrepreneurs, health care pundits, and venture capital firms all agree that the health care sector is awaiting a digital revolution. Steven Case, in 2016, predicted a "third wave" of innovation that would leverage big data, artificial intelligence, and machine learning to transform medicine and finally achieve reduced costs, improved efficiency, and better patient outcomes. Academic medical centers (AMCs) have the infrastructure and resources needed by digital health intrapreneurs and entrepreneurs to innovate, iterate, and optimize technology solutions for the major pain points of modern medicine. With large unique patient data sets, strong research programs, and subject matter experts, AMCs have the ability to assess, optimize, and integrate new digital health tools with feedback at the point of care and research-based clinical validation. As AMCs begin to explore digital health solutions, they must decide between forming internal teams to develop these innovations or collaborating with external companies. Although each has its drawbacks and benefits, AMCs can both benefit from and drive forward the digital health innovations that will result from this journey. This viewpoint will provide an explanation as to why AMCs are ideal incubators for digital health solutions and describe what these organizations will need to be successful in leading this "third wave" of innovation.
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Affiliation(s)
- Adeel A Faruki
- Department of Anesthesiology, University of Colorado Hospital School of Medicine, Aurora, CO, United States
| | - Richard D Zane
- Department of Emergency Medicine, University of Colorado Hospital School of Medicine, Aurora, CO, United States
| | - Jennifer L Wiler
- Department of Emergency Medicine, University of Colorado Hospital School of Medicine, Aurora, CO, United States
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50
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Jaworski BK, Webb Hooper M, Aklin WM, Jean-Francois B, Elwood WN, Belis D, Riley WT, Hunter CM. Advancing digital health Equity: Directions for behavioral and social science research. Transl Behav Med 2022; 13:132-139. [PMID: 36318232 DOI: 10.1093/tbm/ibac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
The field of digital health is evolving rapidly and encompasses a wide range of complex and changing technologies used to support individual and population health. The COVID-19 pandemic has augmented digital health expansion and significantly changed how digital health technologies are used. To ensure that these technologies do not create or exacerbate existing health disparities, a multi-pronged and comprehensive research approach is needed. In this commentary, we outline five recommendations for behavioral and social science researchers that are critical to promoting digital health equity. These recommendations include: (i) centering equity in research teams and theoretical approaches, (ii) focusing on issues of digital health literacy and engagement, (iii) using methods that elevate perspectives and needs of underserved populations, (iv) ensuring ethical approaches for collecting and using digital health data, and (v) developing strategies for integrating digital health tools within and across systems and settings. Taken together, these recommendations can help advance the science of digital health equity and justice.
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Affiliation(s)
- Beth K Jaworski
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda, MD , USA
| | - Will M Aklin
- National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
| | - Beda Jean-Francois
- National Center for Complementary and Integrative Health, National Institutes of Health , Bethesda, MD , USA
| | - William N Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Deshirée Belis
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - William T Riley
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
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