Essential Considerations for Successful Consumer Health Informatics Solutions

Consumer Health Informatics to Advance Precision Prevention

OBJECTIVE

Consumer health informatics (CHI) has the potential to disrupt traditional but unsustainable break-fix models of healthcare and catalyse precision prevention of chronic disease - a preventable global burden. This perspective article reviewed how consumer health informatics can advance precision prevention across four research and practice areas: (1) public health policy and practice (2) individualised disease risk assessment (3) early detection and monitoring of disease (4) tailored intervention of modifiable health determinants.

METHODS

We review and narratively synthesise methods and published recent (2018 onwards) research evidence of interventional studies of consumer health informatics for precision prevention. An analysis of research trends, ethical considerations, and future directions is presented as a guide for consumers, researchers, and practitioners to collectively prioritise advancing two interlinked fields towards high-quality evidence generation to support practice translation. A health consumer co-author provided critical review at all stages of manuscript preparation, moderating the allied health, medical and nursing researcher perspectives represented in the authorship team.

RESULTS

Precision prevention of chronic disease is enabled by consumer health informatics methods and interventions in population health surveillance using real-world data (e.g., genomics) (public health policy and practice), disease prognosis (regression modelling, machine learning) (individualized disease risk assessment), wearable devices and mobile health (mHealth) applications that generate digital phenotypes (early detection and monitoring), and targeted behaviour change interventions based upon personalized risk algorithms (tailored intervention of modifiable health determinants). In our disease case studies, there was mixed evidence for the effectiveness of consumer health informatics to improve risk-stratified or behavioural prevention-related health outcomes. Research trends comprise both consumer-centred and healthcare-centred innovations, with emphasis on inclusive design methodologies, social licence of health data use, and federated learning to preserve data sovereignty and maximise cross-jurisdictional analytical power.

CONCLUSIONS

Together, CHI and precision prevention represent a potential future vanguard in shifting from traditional and inefficient break-fix to predict-prevent models of healthcare. Meaningful researcher, practitioner, and consumer partnerships must focus on generating high-quality evidence from methodologically robust study designs to support consumer health informatics as a core enabler of precision prevention.

Characterizing terminology applied by authors and database producers to informatics literature on consumer engagement with wearable devices

OBJECTIVE

Identifying consumer health informatics (CHI) literature is challenging. To recommend strategies to improve discoverability, we aimed to characterize controlled vocabulary and author terminology applied to a subset of CHI literature on wearable technologies.

MATERIALS AND METHODS

To retrieve articles from PubMed that addressed patient/consumer engagement with wearables, we developed a search strategy of textwords and Medical Subject Headings (MeSH). To refine our methodology, we used a random sample of 200 articles from 2016 to 2018. A descriptive analysis of articles (N = 2522) from 2019 identified 308 (12.2%) CHI-related articles, for which we characterized their assigned terminology. We visualized the 100 most frequent terms assigned to the articles from MeSH, author keywords, CINAHL, and Engineering Databases (Compendex and Inspec together). We assessed the overlap of CHI terms among sources and evaluated terms related to consumer engagement.

RESULTS

The 308 articles were published in 181 journals, more in health journals (82%) than informatics (11%). Only 44% were indexed with the MeSH term "wearable electronic devices." Author keywords were common (91%) but rarely represented consumer engagement with device data, eg, self-monitoring (n = 12, 0.7%) or self-management (n = 9, 0.5%). Only 10 articles (3%) had terminology from all sources (authors, PubMed, CINAHL, Compendex, and Inspec).

DISCUSSION

Our main finding was that consumer engagement was not well represented in health and engineering database thesauri.

CONCLUSIONS

Authors of CHI studies should indicate consumer/patient engagement and the specific technology investigated in titles, abstracts, and author keywords to facilitate discovery by readers and expand vocabularies and indexing.

Design of Generalized Search Interfaces for Health Informatics

In this paper, we investigate ontology-supported interfaces for health informatics search tasks involving large document sets. We begin by providing background on health informatics, machine learning, and ontologies. We review leading research on health informatics search tasks to help formulate high-level design criteria. We use these criteria to examine traditional design strategies for search interfaces. To demonstrate the utility of the criteria, we apply them to the design of ONTology-supported Search Interface (ONTSI), a demonstrative, prototype system. ONTSI allows users to plug-and-play document sets and expert-defined domain ontologies through a generalized search interface. ONTSI’s goal is to help align users’ common vocabulary with the domain-specific vocabulary of the plug-and-play document set. We describe the functioning and utility of ONTSI in health informatics search tasks through a workflow and a scenario. We conclude with a summary of ongoing evaluations, limitations, and future research.

Understanding the evaluation of mHealth app features based on a cross-country Kano analysis

While mobile health (mHealth) apps play an increasingly important role in digitalized health care, little is known regarding the effects of specific mHealth app features on user satisfaction across different healthcare system contexts. Using personal health record (PHR) apps as an example, this study identifies how potential users in Germany and Denmark evaluate a set of 26 app features, and whether evaluation differences can be explained by the differences in four pertinent user characteristics, namely privacy concerns, mHealth literacy, mHealth self-efficacy, and adult playfulness. Based on survey data from both countries, we employed the Kano method to evaluate PHR features and applied a quartile-based sample-split approach to understand the underlying relationships between user characteristics and their perceptions of features. Our results not only reveal significant differences in 14 of the features between Germans and Danes, they also demonstrate which of the user characteristics best explain each of these differences. Our two key contributions are, first, to explain the evaluation of specific PHR app features on user satisfaction in two different healthcare contexts and, second, to demonstrate how to extend the Kano method in terms of explaining subgroup differences through user characteristic antecedents. The implications for app providers and policymakers are discussed.

Health Care Professionals' Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study

BACKGROUND

Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care.

OBJECTIVE

The objective of our study was to describe health care staff's experience with a digital communication system intended for patient-staff encounters via a digital route in primary care.

METHODS

In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis.

RESULTS

While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient's voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service-at least for a while-if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers.

CONCLUSIONS

A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.