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Zafar SN, Hazlewood G, Dhiman K, Charlton A, Then KL, Dempsey E, Lester R, Hoens AM, Lacaille D, Barnabe C, Rankin J, Mosher D, Barber CEH. "How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis. ACR Open Rheumatol 2024; 6:276-286. [PMID: 38376004 PMCID: PMC11089442 DOI: 10.1002/acr2.11652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. METHODS Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. RESULTS Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. CONCLUSIONS Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.
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Affiliation(s)
- Saania N. Zafar
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - Glen Hazlewood
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | | | | | - Karen L. Then
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Erika Dempsey
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Richard Lester
- University of British Columbia and WelTel IncVancouverBritish ColumbiaCanada
| | - Alison M. Hoens
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Diane Lacaille
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cheryl Barnabe
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - James Rankin
- University of Calgary, Calgary, Alberta, Canada, and Thompson Rivers UniversityKamloopsBritish ColumbiaCanada
| | - Dianne Mosher
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Claire E. H. Barber
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
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Thielmann RR, Hoving C, Cals JW, Crutzen R. Patient online access to medical records in general practice: Perceived effects after one year follow-up. Patient Educ Couns 2024; 125:108309. [PMID: 38705022 DOI: 10.1016/j.pec.2024.108309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Online access to medical records is expected to foster patient empowerment and patient-centred healthcare. However, data on actual experienced effects remain limited. We aimed to examine the development of effects patients perceive from online access. METHODS A nationwide online survey (N = 1769) evaluated Dutch patients' use of online access and beliefs about its effects on 16 outcomes at baseline and one-year follow-up. Analyses of Variance (ANOVA) were used to examine within-person belief changes across three user groups: patients who 1) used online access before the study, 2) started use during the study, and 3) did not use it at all. RESULTS There was a small decline in five beliefs around online access facilitating patient empowerment and participation in participants who started using online access during the study compared to at least one other user group. Most changes in beliefs did not differ between groups. CONCLUSION No evidence of benefits from online access was found. The findings might indicate inadequacies in the current system of online access. Possibly, the benefits of online access are contingent upon portal improvements and changes in documentation practices. PRACTICE IMPLICATION Records need to be easily accessible and comprehensible for patients. Consultation practices should enable patient participation.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University, the Netherlands
| | - Jochen Wl Cals
- Department of Family Medicine, Maastricht University, the Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University, the Netherlands
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McDermott JH, Sharma V, Newman WG, Wilson P, Payne K, Wright S. Public preferences for pharmacogenetic testing in the NHS: Embedding a discrete choice experiment within service design to better meet user needs. Br J Clin Pharmacol 2024. [PMID: 38616172 DOI: 10.1111/bcp.16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024] Open
Abstract
AIMS Genetic testing can be used to improve the safety and effectiveness of commonly prescribed medicines-a concept known as pharmacogenetics. This study aimed to quantify members of the UK public's preferences for a pharmacogenetic service to be delivered in primary care in the National Health Service. METHODS Members of the UK population were surveyed via an online panel company. Respondents completed 1 of 2 survey versions, asking respondents to select their preferred pharmacogenetic testing service in the context of a presentation of low mood or pain. A conditional logit model was estimated, before the best functional form for the dataset was identified. Preference heterogeneity was identified via latent class analysis. Coefficients from the final selected models were used to estimate uptake in the context of different hypothetical pharmacogenetic services. RESULTS Responses from 1993 individuals were included in the analysis. There were no differences observed in preference between the 2 clinical scenarios. Conditional logit analysis, using maximum likelihood estimation, indicated that respondents preferred to have noninvasive tests and wanted their data to be shared between different healthcare organizations to guide future prescribing. There was a preference for regional over national data sharing initiatives, and respondents preferred to have access to their data. Predicted uptake varied considerably, ranging from 51% to >99%, depending on design of the service. CONCLUSION This study identifies public preferences for a pharmacogenetic testing service and demonstrates how predicted uptake can be impacted by relatively minor adaptations. This highlights areas for prioritization during development of future pharmacogenetic services.
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Affiliation(s)
- John H McDermott
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Videha Sharma
- Division of Informatics, Centre for Health Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Stuart Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
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Armoundas AA, Narayan SM, Arnett DK, Spector-Bagdady K, Bennett DA, Celi LA, Friedman PA, Gollob MH, Hall JL, Kwitek AE, Lett E, Menon BK, Sheehan KA, Al-Zaiti SS. Use of Artificial Intelligence in Improving Outcomes in Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1028-e1050. [PMID: 38415358 PMCID: PMC11042786 DOI: 10.1161/cir.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
A major focus of academia, industry, and global governmental agencies is to develop and apply artificial intelligence and other advanced analytical tools to transform health care delivery. The American Heart Association supports the creation of tools and services that would further the science and practice of precision medicine by enabling more precise approaches to cardiovascular and stroke research, prevention, and care of individuals and populations. Nevertheless, several challenges exist, and few artificial intelligence tools have been shown to improve cardiovascular and stroke care sufficiently to be widely adopted. This scientific statement outlines the current state of the art on the use of artificial intelligence algorithms and data science in the diagnosis, classification, and treatment of cardiovascular disease. It also sets out to advance this mission, focusing on how digital tools and, in particular, artificial intelligence may provide clinical and mechanistic insights, address bias in clinical studies, and facilitate education and implementation science to improve cardiovascular and stroke outcomes. Last, a key objective of this scientific statement is to further the field by identifying best practices, gaps, and challenges for interested stakeholders.
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Varela JL, Sperling SA, Block C, O’Leary K, Hart ES, Kiselica AM. A survey of neuropsychological assessment feedback practices among neuropsychologists. Clin Neuropsychol 2024; 38:529-556. [PMID: 37438247 PMCID: PMC10784416 DOI: 10.1080/13854046.2023.2233738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Feedback on neuropsychological assessment is a critical part of clinical practice, but there are few empirical papers on neuropsychological feedback practices. We sought to fill this gap in the literature by surveying practicing neuropsychologists in the United States. Questions addressed how they provide verbal and written feedback to patients and referral sources. Survey questions also addressed billing practices and training in the provision of feedback. METHODS A survey was developed using Qualtrics XM to survey currently licensed, independently practicing clinical neuropsychologists in the United States about their feedback practices. The survey was completed by 184 individuals. RESULTS Nearly all respondents reported that they provide verbal feedback to patients, most often in-person, within three weeks following testing. Typically, verbal feedback sessions with patients last 45 min. Verbal feedback was provided to referrals by about half of our sample, typically via a brief phone call. Most participants also reported providing written feedback to both the patient and referring provider, most commonly via the written report within three weeks after testing. Regarding billing, most respondents use neuropsychological testing evaluation codes. The COVID-19 pandemic appeared to have had a limited impact on the perceived effectiveness and quality of verbal feedback sessions. Finally, respondents reported that across major stages of professional development, training in the provision of feedback gradually increased but was considered inadequate by many participants. CONCLUSIONS Results provide an empirical summary of the "state of current practice" for providing neuropsychological assessment feedback. Further experimental research is needed to develop an evidence-base for effective feedback practices.
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Affiliation(s)
- Jacob L. Varela
- University of Missouri, Columbia, MO, 65211, USA
- Regent University, Virginia Beach, VA, 23464, USA
| | | | - Cady Block
- Emory University, Atlanta, GA, 30322, USA
| | | | - Eric S. Hart
- University of Missouri, Columbia, MO, 65211, USA
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Bogulski CA, Andersen JA, Eswaran S, Willis DE, Edem D, McElfish PA. Factors Associated with Online Patient Portal Utilization Experience in an Arkansas Phone Survey. Telemed J E Health 2024; 30:e1148-e1156. [PMID: 38011711 PMCID: PMC11035923 DOI: 10.1089/tmj.2023.0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Introduction: Accessing electronic health record information through a patient portal is associated with numerous benefits to both health care providers and patients. However, patient portal utilization remains low. Little is known about the factors associated with patient portal utilization following the onset of the COVID-19 pandemic. Methods: In March 2022, we conducted a random digit dial phone survey of both cell phones and landlines of adults living in Arkansas that asked numerous demographic and health-related measures, including patient portal utilization in the past 12 months. A total of 2,201 adult Arkansans completed the survey between March 1 and March 28, 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity (72% White, 15% Black/African American, 7.8% Hispanic, 4.9% other race/ethnicity), age (73% 18-39, 32% 40-59, and 31% 60+), and gender (49% male, 51% female). We fit the data to a logistic regression model. Results: We found that education, employment, prior telehealth experience, having a check-up in the past 2 years, and having a primary care provider were all positively associated with patient portal utilization. We also found that non-Hispanic Black/African-American respondents were less likely to access a patient portal relative to non-Hispanic White respondents. Discussion: Patient portal utilization is related to several demographic and health-related factors among an adult population in Arkansas. Given that the documented benefits of patient portal utilization are broad, under-utilization by groups that already experience relatively worse health outcomes could reproduce or even exacerbate existing health disparities. Additional research is needed to further investigate what barriers to patient portal utilization remain for these populations.
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Affiliation(s)
- Cari A. Bogulski
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Surabhee Eswaran
- Department of Environmental Studies, Tulane University, New Orleans, Louisiana, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
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Grant D, Smith J, Bottoms L. Assessing the role of biomarker feedback in a 12-week community weight management programme among overweight men: A pilot study. PLoS One 2024; 19:e0299636. [PMID: 38547224 PMCID: PMC10977703 DOI: 10.1371/journal.pone.0299636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The primary objective of this study was to examine the feasibility of recruitment, retention, and delivery of biomarker feedback among men partaking in Shape Up, a physical activity for health programme. Secondarily, it explored the potential effects of biomarker feedback on participants' adherence and motivation levels. METHODS In this two-arm non-randomised pilot study, 46 men (mean±SD age 46.0±8.6 years) participating in the 12-week Shape Up programme were assigned to a control group or biomarker feedback group. Biomarker feedback consisted of 3 blood test panels: at baseline, 12 weeks, and 24 weeks (follow-up), each with a doctor's report. Both groups completed questionnaires (Short Active Lives Survey [SALS], Treatment Self-Regulation Questionnaire [TSRQ], and EQ-5D-5L) to gauge levels of motivation and engagement. The mean difference was calculated between baseline and programme end. Recruitment, retention, and attendance rates were determined. RESULTS Mean recruitment (approach-to-consent), retention, and attendance rates were 96.3%, 92.3%, and 83.7% in the control group, and 85.2%, 86.2%, and 81.5% in the biomarker feedback group, respectively. Of biomarker feedback group participants, 86.4% attended their 12-week blood test and 45.5% attended their follow-up blood test. The mean 12-week differences (95% CI) for the control group and biomarker feedback group were 138.1 (2.7, 273.5) and 467.3 (249.4, 685.2) for active minutes per week, 0.2 (-0.8, 1.2) and 0.4 (0.0, 0.8) for autonomous TSRQ domains, 0.2 (-0.3, 0.8) and 0.8 (0.1, 1.4) for controlled TSRQ domains, and 19 (12.7, 26.5) and 27.2 (19.8, 34.6) for EQ-5D-5L scores, respectively. CONCLUSION Biomarker feedback was well-received by participants and deemed feasible, with high recruitment and retention rates for the duration of the 12-week programme. Biomarker feedback may affect aspects of motivation but did not appear to influence adherence to the programme. Biomarker data may provide additional evidence of programme efficacy. Important design considerations are provided for definitive larger-scale trials.
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Affiliation(s)
- Daniel Grant
- Medichecks, Ranch House, Chapel Lane, Bingham, Nottingham, United Kingdom
| | - Joshua Smith
- Medichecks, Ranch House, Chapel Lane, Bingham, Nottingham, United Kingdom
| | - Lindsay Bottoms
- Centre for Research in Psychology and Sport Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Kim J, Villarreal M, Arya S, Hernandez A, Moreira A. Bridging the Gap: Exploring Bronchopulmonary Dysplasia through the Lens of Biomedical Informatics. J Clin Med 2024; 13:1077. [PMID: 38398389 PMCID: PMC10889493 DOI: 10.3390/jcm13041077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Bronchopulmonary dysplasia (BPD), a chronic lung disease predominantly affecting premature infants, poses substantial clinical challenges. This review delves into the promise of biomedical informatics (BMI) in reshaping BPD research and care. We commence by highlighting the escalating prevalence and healthcare impact of BPD, emphasizing the necessity for innovative strategies to comprehend its intricate nature. To this end, we introduce BMI as a potent toolset adept at managing and analyzing extensive, diverse biomedical data. The challenges intrinsic to BPD research are addressed, underscoring the inadequacies of conventional approaches and the compelling need for data-driven solutions. We subsequently explore how BMI can revolutionize BPD research, encompassing genomics and personalized medicine to reveal potential biomarkers and individualized treatment strategies. Predictive analytics emerges as a pivotal facet of BMI, enabling early diagnosis and risk assessment for timely interventions. Moreover, we examine how mobile health technologies facilitate real-time monitoring and enhance patient engagement, ultimately refining BPD management. Ethical and legal considerations surrounding BMI implementation in BPD research are discussed, accentuating issues of privacy, data security, and informed consent. In summation, this review highlights BMI's transformative potential in advancing BPD research, addressing challenges, and opening avenues for personalized medicine and predictive analytics.
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Affiliation(s)
- Jennifer Kim
- Division of Neonatology, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (J.K.); (M.V.); (A.H.)
| | - Mariela Villarreal
- Division of Neonatology, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (J.K.); (M.V.); (A.H.)
| | - Shreyas Arya
- Division of Neonatal-Perinatal Medicine, Dayton Children’s Hospital, Dayton, OH 45404, USA
| | - Antonio Hernandez
- Division of Neonatology, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (J.K.); (M.V.); (A.H.)
| | - Alvaro Moreira
- Division of Neonatology, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (J.K.); (M.V.); (A.H.)
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Wang B, Kristiansen E, Fagerlund AJ, Zanaboni P, Hägglund M, Bärkås A, Kujala S, Cajander Å, Blease C, Kharko A, Huvila I, Kane B, Johansen MA. Users' Experiences With Online Access to Electronic Health Records in Mental and Somatic Health Care: Cross-Sectional Study. J Med Internet Res 2023; 25:e47840. [PMID: 38145466 PMCID: PMC10775043 DOI: 10.2196/47840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Patient-accessible electronic health records (PAEHRs) hold promise for empowering patients, but their impact may vary between mental and somatic health care. Medical professionals and ethicists have expressed concerns about the potential challenges of PAEHRs for patients, especially those receiving mental health care. OBJECTIVE This study aims to investigate variations in the experiences of online access to electronic health records (EHRs) among persons receiving mental and somatic health care, as well as to understand how these experiences and perceptions vary among those receiving mental health care at different levels of point of care. METHODS Using Norwegian data from the NORDeHEALTH 2022 Patient Survey, we conducted a cross-sectional descriptive analysis of service use and perceptions of perceived mistakes, omissions, and offensive comments by mental and somatic health care respondents. Content analysis was used to analyze free-text responses to understand how respondents experienced the most serious errors in their EHR. RESULTS Among 9505 survey participants, we identified 2008 mental health care respondents and 7086 somatic health care respondents. A higher percentage of mental health care respondents (1385/2008, 68.97%) reported that using PAEHR increased their trust in health care professionals compared with somatic health care respondents (4251/7086, 59.99%). However, a significantly larger proportion (P<.001) of mental health care respondents (976/2008, 48.61%) reported perceiving errors in their EHR compared with somatic health care respondents (1893/7086, 26.71%). Mental health care respondents also reported significantly higher odds (P<.001) of identifying omissions (758/2008, 37.75%) and offensive comments (729/2008, 36.3%) in their EHR compared with the somatic health care group (1867/7086, 26.35% and 826/7086, 11.66%, respectively). Mental health care respondents in hospital inpatient settings were more likely to identify errors (398/588, 67.7%; P<.001) and omissions (251/588, 42.7%; P<.001) than those in outpatient care (errors: 422/837, 50.4% and omissions: 336/837, 40.1%; P<.001) and primary care (errors: 32/100, 32% and omissions: 29/100, 29%; P<.001). Hospital inpatients also reported feeling more offended (344/588, 58.5%; P<.001) by certain content in their EHR compared with respondents in primary (21/100, 21%) and outpatient care (287/837, 34.3%) settings. Our qualitative findings showed that both mental and somatic health care respondents identified the most serious errors in their EHR in terms of medical history, communication, diagnosis, and medication. CONCLUSIONS Most mental and somatic health care respondents showed a positive attitude toward PAEHRs. However, mental health care respondents, especially those with severe and chronic concerns, expressed a more critical attitude toward certain content in their EHR compared with somatic health care respondents. A PAEHR can provide valuable information and foster trust, but it requires careful attention to the use of clinical terminology to ensure accurate, nonjudgmental documentation, especially for persons belonging to health care groups with unique sensitivities.
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Affiliation(s)
- Bo Wang
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anna Kharko
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Isto Huvila
- Department of Archives, Libraries & Museums, Uppsala University, Uppsala, Sweden
| | - Bridget Kane
- Business School, Karlstad University, Karlstad, Sweden
| | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Kc S, Tewolde S, Laverty AA, Costelloe C, Papoutsi C, Reidy C, Gudgin B, Shenton C, Majeed A, Powell J, Greaves F. Uptake and adoption of the NHS App in England: an observational study. Br J Gen Pract 2023; 73:e932-e940. [PMID: 37783512 PMCID: PMC10562999 DOI: 10.3399/bjgp.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/30/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Technological advances have led to the use of patient portals that give people digital access to their personal health information. The NHS App was launched in January 2019 as a 'front door' to digitally enabled health services. AIM To evaluate patterns of uptake of the NHS App, subgroup differences in registration, and the impact of COVID-19. DESIGN AND SETTING An observational study using monthly NHS App user data at general-practice level in England was conducted. METHOD Descriptive statistics and time-series analysis explored monthly NHS App use from January 2019-May 2021. Interrupted time-series models were used to identify changes in the level and trend of use of different functionalities, before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in app registration by markers of general-practice level sociodemographic variables. RESULT Between January 2019 and May 2021, there were 8 524 882 NHS App downloads and 4 449 869 registrations, with a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by sociodemographic data found 25% lower registrations in the most deprived practices (P<0.001), and 44% more registrations in the largest sized practices (P<0.001). Registration rates were 36% higher in practices with the highest proportion of registered White patients (P<0.001), 23% higher in practices with the largest proportion of 15-34-year-olds (P<0.001) and 2% lower in practices with highest proportion of people with long-term care needs (P<0.001). CONCLUSION The uptake of the NHS App substantially increased post-lockdown, most significantly after the NHS COVID Pass feature was introduced. An unequal pattern of app registration was identified, and the use of different functions varied. Further research is needed to understand these patterns of inequalities and their impact on patient experience.
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Affiliation(s)
- Sukriti Kc
- Department of Primary Care and Public Health, Imperial College London
| | - Salina Tewolde
- Department of Primary Care and Public Health, Imperial College London
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Bernard Gudgin
- Patient and public involvement representative and a member of the University of Oxford Advanced Research Computing board
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, UK
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC Prim Care 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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12
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Kyi K, Gilmore N, Kadambi S, Loh KP, Magnuson A. Stigmatizing language in caring for older adults with cancer: Common patterns of use and mechanisms to change the culture. J Geriatr Oncol 2023; 14:101593. [PMID: 37524648 PMCID: PMC10823037 DOI: 10.1016/j.jgo.2023.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Kaitlin Kyi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester, Medical Center, Rochester, NY, USA
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA.
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13
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Raab R, Küderle A, Zakreuskaya A, Stern AD, Klucken J, Kaissis G, Rueckert D, Boll S, Eils R, Wagener H, Eskofier BM. Federated electronic health records for the European Health Data Space. Lancet Digit Health 2023; 5:e840-e847. [PMID: 37741765 DOI: 10.1016/s2589-7500(23)00156-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/11/2023] [Accepted: 08/02/2023] [Indexed: 09/25/2023]
Abstract
The European Commission's draft for the European Health Data Space (EHDS) aims to empower citizens to access their personal health data and share it with physicians and other health-care providers. It further defines procedures for the secondary use of electronic health data for research and development. Although this planned legislation is undoubtedly a step in the right direction, implementation approaches could potentially result in centralised data silos that pose data privacy and security risks for individuals. To address this concern, we propose federated personal health data spaces, a novel architecture for storing, managing, and sharing personal electronic health records that puts citizens at the centre-both conceptually and technologically. The proposed architecture puts citizens in control by storing personal health data on a combination of personal devices rather than in centralised data silos. We describe how this federated architecture fits within the EHDS and can enable the same features as centralised systems while protecting the privacy of citizens. We further argue that increased privacy and control do not contradict the use of electronic health data for research and development. Instead, data sovereignty and transparency encourage active participation in studies and data sharing. This combination of privacy-by-design and transparent, privacy-preserving data sharing can enable health-care leaders to break the privacy-exploitation barrier, which currently limits the secondary use of health data in many cases.
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Affiliation(s)
- René Raab
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arne Küderle
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anastasiya Zakreuskaya
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ariel D Stern
- Harvard Business School and Harvard-MIT Center for Regulatory Science, Boston, MA, USA
| | - Jochen Klucken
- Chair of Digital Medicine, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Digital Medicine Group, Luxembourg Institute of Health, Strassen, Luxembourg; Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Georgios Kaissis
- Klinikum Rechts der Isar, Technical University of Munich, Institute for Artificial Intelligence and Informatics in Medicine, Munich, Germany; Helmholtz Munich, Institute for Machine Learning in Biomedical Imaging, Neuherberg, Germany; Department of Computing, Imperial College London, London, UK
| | - Daniel Rueckert
- Klinikum Rechts der Isar, Technical University of Munich, Institute for Artificial Intelligence and Informatics in Medicine, Munich, Germany; Department of Computing, Imperial College London, London, UK
| | - Susanne Boll
- OFFIS-Institut für Informatik, Oldenburg, Germany
| | - Roland Eils
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Digital Health Center, Berlin, Germany
| | - Harald Wagener
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Digital Health Center, Berlin, Germany
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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14
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Lamar CE, Jain D, Schmitz KH. Perils of Auto-Population of Newborn EHR With Maternal Intimate Partner Violence History. Pediatrics 2023; 152:e2022060189. [PMID: 37712123 DOI: 10.1542/peds.2022-060189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 09/16/2023] Open
Abstract
In 2020, the 21st Century Cures Act was enacted, mandating that patients have access to their electronic health record. This has the potential to benefit both patients and clinicians by increasing communication, transparency, and patient autonomy. However, with the onset of the act, a number of unintended consequences of the act have been identified. Presently, we discuss a case where documentation of intimate partner violence and the safety plan documented in a mother's electronic health record automatically populated her newborn's admission note. This confidential information inadvertently became accessible to the perpetrator: the infant's father.
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Affiliation(s)
- Casey E Lamar
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Deepak Jain
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kristine H Schmitz
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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15
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Rogers C, Willis S, Gillard S, Chudleigh J. Patient experience of imaging reports: A systematic literature review. Ultrasound 2023; 31:164-175. [PMID: 37538965 PMCID: PMC10395377 DOI: 10.1177/1742271x221140024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/25/2022] [Indexed: 08/05/2023]
Abstract
Introduction Written reports are often the sole form of communication from diagnostic imaging. Reports are increasingly being accessed by patients through electronic records. Experiencing medical terminology can be confusing and lead to miscommunication, a decrease in involvement and increased anxiety for patients. Methods This systematic review was designed to include predefined study selection criteria and was registered prospectively on PROSPERO (CRD42020221734). MEDLINE, CINAHL, Academic Search Complete (EBSCOhost), EMBASE, Scopus and EThOS were searched to identify articles meeting the inclusion criteria. Studies were assessed against the Mixed-Methods Appraisal Tool version 2018 for quality. A segregated approach was used to synthesise data. A thematic synthesis of the qualitative data and a narrative review of the quantitative data were performed, and findings of both syntheses were then integrated. Findings Twelve articles reporting 13 studies were included. This review found that patients' experiences of imaging reports included positive and negative aspects. The study identified two main themes encompassing both qualitative and quantitative findings. Patients reported their experiences regarding their understanding of reports and self-management. Discussion Patient understanding of imaging reports is multi factorial including medical terminology, communication aids and errors. Self-management through direct access is important to patients. While receiving bad news is a concern, responsibility for accessing this is accepted. Conclusion A patient-centred approach to writing imaging reports may help to improve the quality of service, patient experience and wider health outcomes.
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16
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Reynolds TL, Cobb JG, Steitz BD, Ancker JS, Rosenbloom ST. The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating. Appl Clin Inform 2023; 14:654-669. [PMID: 37611795 PMCID: PMC10446914 DOI: 10.1055/s-0043-1770901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Recent external factors-the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic-have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. METHODS To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. RESULTS Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). CONCLUSION Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.
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Affiliation(s)
- Tera L. Reynolds
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, United States
| | - Jared Guthrie Cobb
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - S. Trent Rosenbloom
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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17
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Tchapmi DP, Agyingi C, Egbe A, Marcus GM, Noubiap JJ. The use of digital health in heart rhythm care. Expert Rev Cardiovasc Ther 2023; 21:553-563. [PMID: 37322576 DOI: 10.1080/14779072.2023.2226868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Digital health is a broad term that includes telecommunication technologies to collect, share and manipulate health information to improve patient health and health care services. With the growing use of wearables, artificial intelligence, machine learning, and other novel technologies, digital health is particularly relevant to the field of cardiac arrhythmias, with roles pertinent to education, prevention, diagnosis, management, prognosis, and surveillance. AREAS COVERED This review summarizes information on the clinical use of digital health technology in arrhythmia care and discusses its opportunities and challenges. EXPERT OPINION Digital health has begun to play an essential role in arrhythmia care regarding diagnostics, long-term monitoring, patient education and shared decision making, management, medication adherence, and research. Despite remarkable advances, integrating digital health technologies into healthcare faces challenges, including patient usability, privacy, system interoperability, physician liability, analysis and incorporation of the huge amount of real-time information from wearables, and reimbursement. Successful implementation of digital health technologies requires clear objectives and deep changes to existing workflows and responsibilities.
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Affiliation(s)
- Donald P Tchapmi
- Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Chris Agyingi
- Department of Medicine, Woodhull Medical Center, Brooklyn, NY, USA
| | - Antoine Egbe
- Department of Medicine, Beaumont Hospital, Dearborn, MI, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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18
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Thielmann RRLC, Hoving C, Cals JWL, Crutzen R. The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study. J Med Internet Res 2023; 25:e47659. [PMID: 37266981 DOI: 10.2196/47659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested. OBJECTIVE This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients. METHODS A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders. RESULTS Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects. CONCLUSIONS Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.
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Affiliation(s)
- Rosa R L C Thielmann
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jochen W L Cals
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Huber J, Borgmann H, Miller K, Merseburger AS, Krege S, Gratzke C. [Urology 2030: Why it is key to promote digitisation in urology today to maintain medical care in the future - an expert consensus]. Aktuelle Urol 2023; 54:213-219. [PMID: 37224859 DOI: 10.1055/a-2071-4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Due to demographic change associated with an increase in patient numbers as well as the existing shortage of medical personnel, the German healthcare system will face a major challenge in patient care. In order to maintain high-quality patient care at a high level, the digitisation of urology should be driven forward promptly and forcefully as digital applications such as online appointment scheduling, video consultations, digital health applications (DiGAs) and others could significantly improve treatment efficiency. The long-planned introduction of the electronic patient record (ePA) will hopefully accelerate this process, and medical online platforms could also become a permanent part of new treatment methods, which could emerge from the urgently needed structural change towards more digital medicine, including questionnaire-based telemedicine. This transformation, which, already today, is urgently needed in the healthcare system, must be demanded and promoted by service providers, but also by policymakers and administration, in order to achieve the positive development of digitisation in (urological) medicine.
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Affiliation(s)
- Johannes Huber
- Klinik für Urologie, Philipps-Universität Marburg, Marburg, Germany
| | - Hendrik Borgmann
- Klinik und Poliklinik für Urologie, Johannes Gutenberg Universitat Universitatsmedizin, Mainz, Germany
| | - Kurt Miller
- Urologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Axel S Merseburger
- Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Susanne Krege
- Klinik für Urologie, Kinderurologie & Urologische Onkologie, Evang. Kliniken Essen-Mitte Evang. Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | - Christian Gratzke
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
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20
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Rathbone A, Stumpf S, Claisse C, Sillence E, Coventry L, Brown RD, Durrant AC. People with long-term conditions sharing personal health data via digital health technologies: A scoping review to inform design. PLOS Digit Health 2023; 2:e0000264. [PMID: 37224154 DOI: 10.1371/journal.pdig.0000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
The use of digital technology amongst people living with a range of long-term health conditions to support self-management has increased dramatically. More recently, digital health technologies to share and exchange personal health data with others have been investigated. Sharing personal health data with others is not without its risks: sharing data creates threats to the privacy and security of personal data and plays a role in trust, adoption and continued use of digital health technology. Our work aims to inform the design of these digital health technologies by investigating the reported intentions of sharing health data with others, the associated user experiences when using these digital health technologies and the trust, identity, privacy and security (TIPS) considerations for designing digital health technologies that support the trusted sharing of personal health data to support the self-management of long-term health conditions. To address these aims, we conducted a scoping review, analysing over 12,000 papers in the area of digital health technologies. We conducted a reflexive thematic analysis of 17 papers that described digital health technologies that support sharing of personal health data, and extracted design implications that could enhance the future development of trusted, private and secure digital health technologies.
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Affiliation(s)
- Amy Rathbone
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simone Stumpf
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Claisse
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Sillence
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lynne Coventry
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - Richard D Brown
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Abigail C Durrant
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
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21
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Moldovan F, Moldovan L, Bataga T. Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability. Medicina (Kaunas) 2023; 59:medicina59040796. [PMID: 37109755 PMCID: PMC10143905 DOI: 10.3390/medicina59040796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Quality Engineering Research Center, Faculty of Engineering and Information Technology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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22
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Rezaee R, Khashayar M, Saeedinezhad S, Nasiri M, Zare S. Critical Criteria and Countermeasures for Mobile Health Developers to Ensure Mobile Health Privacy and Security: Mixed Methods Study. JMIR Mhealth Uhealth 2023; 11:e39055. [PMID: 36862494 PMCID: PMC10020905 DOI: 10.2196/39055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Despite the importance of the privacy and confidentiality of patients' information, mobile health (mHealth) apps can raise the risk of violating users' privacy and confidentiality. Research has shown that many apps provide an insecure infrastructure and that security is not a priority for developers. OBJECTIVE This study aims to develop and validate a comprehensive tool to be considered by developers for assessing the security and privacy of mHealth apps. METHODS A literature search was performed to identify papers on app development, and those papers reporting criteria for the security and privacy of mHealth were assessed. The criteria were extracted using content analysis and presented to experts. An expert panel was held for determining the categories and subcategories of the criteria according to meaning, repetition, and overlap; impact scores were also measured. Quantitative and qualitative methods were used for validating the criteria. The validity and reliability of the instrument were calculated to present an assessment instrument. RESULTS The search strategy identified 8190 papers, of which 33 (0.4%) were deemed eligible. A total of 218 criteria were extracted based on the literature search; of these, 119 (54.6%) criteria were removed as duplicates and 10 (4.6%) were deemed irrelevant to the security or privacy of mHealth apps. The remaining 89 (40.8%) criteria were presented to the expert panel. After calculating impact scores, the content validity ratio (CVR), and the content validity index (CVI), 63 (70.8%) criteria were confirmed. The mean CVR and CVI of the instrument were 0.72 and 0.86, respectively. The criteria were grouped into 8 categories: authentication and authorization, access management, security, data storage, integrity, encryption and decryption, privacy, and privacy policy content. CONCLUSIONS The proposed comprehensive criteria can be used as a guide for app designers, developers, and even researchers. The criteria and the countermeasures presented in this study can be considered to improve the privacy and security of mHealth apps before releasing the apps into the market. Regulators are recommended to consider an established standard using such criteria for the accreditation process, since the available self-certification of developers is not reliable enough.
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Affiliation(s)
- Rita Rezaee
- Department of Health Information Technology, Shiraz University of Medical Sciences, Shiraz, Iran.,Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Khashayar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Saeedinezhad
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Nasiri
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Computer Engineering and Information Technology, Shiraz University of Technology, Shiraz, Iran
| | - Sahar Zare
- Health Information Management Research Center (HIMRC), Kashan University of Medical Sciences, Kashan, Iran
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23
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Ignatovski M. For-profit versus non-profit cybersecurity posture: breach types and locations in healthcare organisations. HEALTH INF MANAG J 2023:18333583231158886. [PMID: 36840419 DOI: 10.1177/18333583231158886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The implementation of emerging technologies has resulted in an increase of data breaches in healthcare organisations, especially during the COVID-19 pandemic. Health information and cybersecurity managers need to understand if, and to what extent, breach types and locations are associated with their organisation's business type. OBJECTIVE To investigate if breach type and breach location are associated with business type, and if so, investigate how these factors affect information systems and protected health information in for-profit versus non-profit organisations. METHOD The quantitative study was performed using chi-square tests for association and post-hoc comparison of column proportions analysis on an archival data set of reported healthcare data breaches from 2020 to 2022. Data from the Department of Health and Human Services website was retrieved and each organisation classified as for-profit or non-profit. RESULTS For-profit organisations experienced a significantly higher number of breaches due to theft, and non-profit organisations experienced a significantly higher number of breaches due to unauthorised access. Furthermore, the number of breaches that occurred on laptops and paper/films was significantly higher in for-profit organisations. CONCLUSION While the threat level of hacking techniques is the same in for-profit and non-profit organisations, certain breach types are more likely to occur within specific breach locations based on the organisation's business type. To protect the privacy and security of medical information, health information and cybersecurity managers need to align with industry-leading frameworks and controls to prevent specific breach types that occur in specific locations within their environments.
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24
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Hulter P, Langendoen W, Pluut B, Schoonman GG, Luijten R, van Wetten F, Ahaus K, Weggelaar-Jansen AM. Patients' choices regarding online access to laboratory, radiology and pathology test results on a hospital patient portal. PLoS One 2023; 18:e0280768. [PMID: 36735739 PMCID: PMC9897579 DOI: 10.1371/journal.pone.0280768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/08/2023] [Indexed: 02/04/2023] Open
Abstract
The disclosure of online test results (i.e., laboratory, radiology and pathology results) on patient portals can vary from immediate disclosure (in real-time) via a delay of up to 28 days to non-disclosure. Although a few studies explored patient opinions regarding test results release, we have no insight into actual patients' preferences. To address this, we allowed patients to register their choices on a hospital patient portal. Our research question was: When do patients want their test results to be disclosed on the patient portal and what are the reasons for these choices? We used a mixed methods sequential explanatory design that included 1) patient choices on preferred time delay to test result disclosure on the patient portal for different medical specialties (N = 4592) and 2) semi-structured interviews with patients who changed their mind on their initial choice (N = 7). For laboratory (blood and urine) results, 3530 (76.9%) patients chose a delay of 1 day and 912 (19.9%) patients chose a delay of 7 days. For radiology and pathology results 4352 (94.8%) patients chose a delay of 7 days. 43 patients changed their mind about when they wanted to receive their results. By interviewing seven patients (16%) from this group we learned that some participants did not remember why they made changes. Four participants wanted a shorter delay to achieve transparency in health-related information and communication; to have time to process bad results; for reassurance; to prepare for a medical consultation; monitoring and acting on deviating results to prevent worsening of their disease; and to share results with their general practitioner. Three participants extended their chosen delay to avoid the disappointment about the content and anxiety of receiving incomprehensible information. Our study indicates that most patients prefer transparency in health-related information and want their test results to be disclosed as soon as possible.
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Affiliation(s)
- Pauline Hulter
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- * E-mail:
| | - Wesley Langendoen
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Guus G. Schoonman
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Remco Luijten
- Department of Rheumatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- ETZ Digital, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Femke van Wetten
- ETZ Digital, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- D&A Medical Group B.V., Waardenburg, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Clinical Informatics, Eindhoven University of Technology, Eindhoven, The Netherlands
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25
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Hossain A, Hannan A. Empowering underserved groups through access to electronic health records. BMJ 2023; 380:247. [PMID: 36720484 DOI: 10.1136/bmj.p247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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26
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Thielmann RR, Hoving C, Schutgens-Kok E, Cals JW, Crutzen R. Patient online access to general practice medical records: A qualitative study on patients' needs and expectations. HEALTH INF MANAG J 2023:18333583221144666. [PMID: 36655702 DOI: 10.1177/18333583221144666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient online access to medical records is assumed to foster patient empowerment and advance patient-centred healthcare. Since July 2020, patients in the Netherlands have been legally entitled to electronically access their medical record in general practice. Experience from pioneering countries has shown that despite high patient interest, user rates often remain low. How to best support implementation depends on individual needs and expectations of patient populations, which are as yet unknown in the Dutch context. OBJECTIVE To understand Dutch patients' needs and expectations with regard to online access to their medical record in general practice. METHOD Twenty participants completed semi-structured individual interviews via video or telephone call. Transcripts of interviews underwent template analysis combining deductive and inductive coding using Atlas.ti software. RESULTS Patients' needs and expectations ranged across three overlapping areas: (i) prerequisites for getting online access; (ii) using online access; and (iii) the impact on interaction with healthcare providers. Patients expected benefits from online access such as better overview, empowerment and improved communication with their general practitioner but identified needs regarding technological difficulties, data privacy and complex medical language in their record. CONCLUSION The concerns and obstacles participants identified point towards the need for organisational changes in general practice, for example, adjusted documentation practices, and the key role of the general practitioner and staff in promoting and facilitating online access. IMPLICATIONS Implementation strategies addressing needs identified in this study may help to unlock the full potential of online access to achieve desired outcomes of patient involvement and satisfaction.
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Affiliation(s)
- Rosa Rlc Thielmann
- Department of Health Promotion, Care and Public Health Research Institute, 5211Maastricht University, Maastricht, The Netherlands
| | - Ciska Hoving
- Department of Health Promotion, Care and Public Health Research Institute, 5211Maastricht University, Maastricht, The Netherlands
| | - Esther Schutgens-Kok
- Department of Health Promotion, Care and Public Health Research Institute, 5211Maastricht University, Maastricht, The Netherlands
| | - Jochen Wl Cals
- Department of Family Medicine, Care and Public Health Research Institute, 5211Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, 5211Maastricht University, Maastricht, The Netherlands
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27
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Wang H, Shen C, Barbaro M, Ho AF, Pathak M, Dunn C, Sambamoorthi U. A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity. Int J Environ Res Public Health 2023; 20:1231. [PMID: 36673986 PMCID: PMC9859180 DOI: 10.3390/ijerph20021231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Background: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). Methods: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients’ neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. Results: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07−6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23−2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. Conclusions: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, PA 17033, USA
| | - Michael Barbaro
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Amy F. Ho
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Mona Pathak
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Cita Dunn
- TCU and UNTHSC School of Medicine, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Usha Sambamoorthi
- Texas Center for Health Disparities, Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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28
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Affiliation(s)
- Sam Patel
- NHS Education for Scotland, Glasgow G3 8BW, UK
| | - Ann Slee
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Anthony Avery
- Centre for Academic Primary Care, School of Medicine University of Nottingham, Nottingham NG7 2RD, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK
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29
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Yousef CC, Salgado TM, Burnett K, Aldossary I, McClelland LE, Alhamdan HS, Khoshhal S, Aldossary I, Alyas OA, DeShazo JP. Perceived barriers and enablers of a personal health record from the healthcare provider perspective. Health Informatics J 2023; 29:14604582231152190. [PMID: 36645335 DOI: 10.1177/14604582231152190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Personal health records (PHRs) have been implemented around the world as a means to increase the safety, quality, and efficiency of health care. The Ministry of National Guard Health Affairs in the Kingdom of Saudi Arabia launched their PHR in 2018. This study aimed to explore healthcare provider (HCP) perspectives of barriers to and enablers of PHR adoption in Saudi Arabia. The 291 participating HCPs (40.5% nurses, 23.0% pharmacists, 17.2% physicians, 15.5% technicians, and 3.8% other) selected the following as top-3 barriers to PHR adoption: 1) lack of patient awareness (19.4%), 2) patient low literacy (17.7%), and 3) patient resistance to new technologies (12.5%). Of these, 36 responded to the open-ended question gauging feedback on the PHR. Three main themes were identified from the comments: 1) general perceptions of the PHR (positive attitudes, negative attitudes, additional features); 2) patient engagement as a requirement for the successful implementation of the PHR; and 3) education/training of HCPs, patients, and caregivers. This analysis extends our understanding of HCP perspectives of barriers and enablers to PHR adoption. Further qualitative research with patients is required to confirm our findings.
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Affiliation(s)
- Consuela C Yousef
- Department of Pharmaceutical Care, 47798Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia.,King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, 6889Virginia Commonwealth University, Richmond, VA, USA
| | - Keisha Burnett
- Department of Clinical Laboratory Sciences, Cytopathology Practice Program, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia.,Pharmaceutical Care Department, 47798Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Laura E McClelland
- Department of Health Administration, 6889Virginia Commonwealth University, Richmond, VA, USA
| | - Hani S Alhamdan
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia.,Department of Allied Health, 47798Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Sahal Khoshhal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia.,Pharmaceutical Care Department, 47798Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia.,Pharmaceutical Care Department, 47798Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Omar A Alyas
- College of Medicine, 123320Royal College of Surgeons in Ireland-Medical University of Bahrain, Kingdom of Bahrain
| | - Jonathan P DeShazo
- Department of Health Administration, 6889Virginia Commonwealth University, Richmond, VA, USA
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30
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Richards T, Coulter A, McMillan B, Hagglund M. Patient access to full general practice health records. BMJ 2022; 379:o3019. [PMID: 36535705 DOI: 10.1136/bmj.o3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Maria Hagglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Sweden
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31
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Affiliation(s)
- Julia L Rogers
- Julia L. Rogers is an assistant professor at Purdue University Northwest College of Nursing, Hammond, Ind., and an NP at Midwest Health Medical Group, Pulmonary and Critical Care Medicine, Valparaiso, Ind
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32
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Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Liz Salmi
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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33
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Kim OT. Patient safety as a global health priority. Cardiovasc Ther Prev 2022. [DOI: 10.15829/1728-8800-2022-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.
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Affiliation(s)
- O. T. Kim
- National Medical Research Center for Therapy and Preventive Medicine
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34
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Vachon E, Robb BW, Haggstrom DA. Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study. JMIR Cancer 2022; 8:e34851. [PMID: 35969424 PMCID: PMC9412760 DOI: 10.2196/34851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. OBJECTIVE The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. METHODS A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. RESULTS The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. CONCLUSIONS This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.
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Affiliation(s)
- Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN, United States
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Bruce W Robb
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
- Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
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35
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Kujala S, Hörhammer I, Väyrynen A, Holmroos M, Nättiaho-Rönnholm M, Hägglund M, Johansen MA. Patients' Experiences of Web-Based Access to Electronic Health Records in Finland: Cross-sectional Survey. J Med Internet Res 2022; 24:e37438. [PMID: 35666563 PMCID: PMC9210208 DOI: 10.2196/37438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023] Open
Abstract
Background Patient portals that provide access to electronic health records offer a means for patients to better understand and self-manage their health. Yet, patient access to electronic health records raises many concerns among physicians, and little is known about the use practices and experiences of patients who access their electronic health records via a mature patient portal that has been available for citizens for over five years. Objective We aimed to identify patients’ experiences using a national patient portal to access their electronic health records. In particular, we focused on understanding usability-related perceptions and the benefits and challenges of reading clinical notes written by health care professionals. Methods Data were collected from 3135 patient users of the Finnish My Kanta patient portal through a web-based survey in June 2021 (response rate: 0.7%). Patients received an invitation to complete the questionnaire when they logged out of the patient portal. Respondents were asked to rate the usability of the patient portal, and the ratings were used to calculate approximations of the System Usability Scale score. Patients were also asked about the usefulness of features, and whether they had discussed the notes with health professionals. Open-ended questions were used to ask patients about their experiences of the benefits and challenges related to reading health professionals’ notes. Results Overall, patient evaluations of My Kanta were positive, and its usability was rated as good (System Usability Scale score approximation: mean 72.7, SD 15.9). Patients found the portal to be the most useful for managing prescriptions and viewing the results of examinations and medical notes. Viewing notes was the most frequent reason (978/3135, 31.2%) for visiting the portal. Benefits of reading the notes mentioned by patients included remembering and understanding what was said by health professionals and the instructions given during an appointment, the convenience of receiving information about health and care, the capability to check the accuracy of notes, and using the information to support self-management. However, there were challenges related to difficulty in understanding medical terminology, incorrect or inadequate notes, missing notes, and usability. Conclusions Patients actively used medical notes to receive information to follow professionals' instructions to take care of their health, and patient access to electronic health records can support self-management. However, for the benefits to be realized, improvements in the quality and availability of medical professionals’ notes are necessary. Providing a standard information structure could help patients find the information they need. Furthermore, linking notes to vocabularies and other information sources could also improve the understandability of medical terminology; patient agency could be supported by allowing them to add comments to their notes, and patient trust of the system could be improved by allowing them to control the visibility of the professionals’ notes.
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Affiliation(s)
- Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Iiris Hörhammer
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Akseli Väyrynen
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Mari Holmroos
- Kela, The Social Insurance Institution of Finland, Helsinki, Finland
| | | | - Maria Hägglund
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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36
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Fant C, Adelman D, Zak C. Post-Cures Act: Implications for Nurse Practitioners. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Kong Lee Y, Jenn Ng C, Reza Syahirah M, Malik Tun Firzara A, Kian Chiew T, Yein Lee P, Abdullah A, Chin Ai Lee C, Khaizura K, Yamin Ahmad M, Zahir Ahmad M. Effectiveness of a web-based, electronic medical records-integrated patient agenda tool to improve doctor-patient communication in primary care consultations: a pragmatic cluster-randomized controlled trial study. Int J Med Inform 2022; 162:104761. [DOI: 10.1016/j.ijmedinf.2022.104761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Asaad Assiri G. The Impact of Patient Access to Their Electronic Health Record on Medication Management Safety: A Narrative Review. Saudi Pharm J 2022. [PMID: 35498224 PMCID: PMC9051961 DOI: 10.1016/j.jsps.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/05/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction As the American’s Federal Health Insurance Portability and Accountability Act (HIPAA) stated that patients should be allowed to review their medical records, and as information technology is ever more widely used by healthcare professionals and patients, providing patients with online access to their own medical records through a patient portal is becoming increasingly popular. Previous research has been done regarding the impact on the quality and safety of patients’ care, rather than explicitly on medication safety, when providing those patients with access to their electronic health records (EHRs). Aim This narrative review aims to summarise the results from previous studies on the impact on medication management safety concepts of adult patients accessing information contained in their own EHRs. Result A total of 24 studies were included in this review. The most two commonly studied measures of safety in medication management were: (a) medication adherence and (b) patient-reported experience. Other measures, such as: discrepancies, medication errors, appropriateness and Adverse Drug Events (ADEs) were the least studied. Conclusion The results suggest that providing patients with access to their EHRs can improve medication management safety. Patients pointed out improvements to the safety of their medications and perceived stronger medication control. The data from these studies lay the foundation for future research.
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Yousef CC, Salgado TM, Farooq A, Burnett K, McClelland LE, Abu Esba LC, Alhamdan HS, Khoshhal S, Aldossary IF, Alyas OA, DeShazo JP. Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study. J Med Internet Res 2021; 23:e31582. [PMID: 34569943 PMCID: PMC8569534 DOI: 10.2196/31582] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia. OBJECTIVE The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. METHODS This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. RESULTS Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (β=.17, P=.03) and attitude (β=.61, P<.01). No moderating effects were present. CONCLUSIONS This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Teresa M Salgado
- Department of Pharmacotherapy & Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States
| | - Ali Farooq
- Department of Computing, University of Turku, Turku, Finland
| | - Keisha Burnett
- Department of Clinical Laboratory Sciences, Cytopathology Practice Program, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Laura E McClelland
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, United States
| | - Laila Carolina Abu Esba
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hani Solaiman Alhamdan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sahal Khoshhal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Madinah, Saudi Arabia
| | - Ibrahim Fahad Aldossary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
| | - Omar Anwar Alyas
- Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Jonathan P DeShazo
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, United States
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