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Reeves MJ, Fonarow GC, Smith EE, Sheth KN, Messe SR, Schwamm LH. Twenty Years of Get With The Guidelines-Stroke: Celebrating Past Successes, Lessons Learned, and Future Challenges. Stroke 2024; 55:1689-1698. [PMID: 38738376 DOI: 10.1161/strokeaha.124.046527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
The Get With The Guidelines-Stroke program which, began 20 years ago, is one of the largest and most important nationally representative disease registries in the United States. Its importance to the stroke community can be gauged by its sustained growth and widespread dissemination of findings that demonstrate sustained increases in both the quality of care and patient outcomes over time. The objectives of this narrative review are to provide a brief history of Get With The Guidelines-Stroke, summarize its major successes and impact, and highlight lessons learned. Looking to the next 20 years, we discuss potential challenges and opportunities for the program.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine, University of California Los Angeles (G.C.F.)
| | - Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada (E.E.S.)
| | - Kevin N Sheth
- Center for Brain & Mind Health, Departments of Neurology & Neurosurgery (K.N.S.), Yale School of Medicine, New Haven, CT
| | - Steven R Messe
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.R.M.)
| | - Lee H Schwamm
- Department of Neurology and Bioinformatics and Data Sciences (L.H.S.), Yale School of Medicine, New Haven, CT
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2
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Guldemond N. What is meant by 'integrated personalized diabetes management': A view into the future and what success should look like. Diabetes Obes Metab 2024; 26 Suppl 1:14-29. [PMID: 38328815 DOI: 10.1111/dom.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Integrated personalized diabetes management (IPDM) has emerged as a promising approach to improving outcomes in patients with diabetes mellitus (DM). This care approach emphasizes the integration and coordination of different providers, including physicians, nurses, dietitians, social workers and pharmacists. The goal of IPDM is to provide patients with personalized care that is tailored to their needs. This review addresses the concept of integrated care and the use of technology (including data, software applications and artificial intelligence) as well as managerial, regulatory and financial aspects. The implementation and upscaling of digitally enabled IPDM are discussed, with elaboration of successful practices and related evidence. Finally, recommendations are made. It is concluded that the adoption of digitally enabled IPDM on a global level is inevitable, considering the challenges created by an increasing prevalence of patients with DM and the need for better outcomes and improvement of health system sustainability.
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Affiliation(s)
- Nick Guldemond
- Department of Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, Netherlands
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3
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Ormond KE, Bavamian S, Becherer C, Currat C, Joerger F, Geiger TR, Hiendlmeyer E, Maurer J, Staub T, Vayena E. What are the bottlenecks to health data sharing in Switzerland? An interview study. Swiss Med Wkly 2024; 154:3538. [PMID: 38579329 DOI: 10.57187/s.3538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND While health data sharing for research purposes is strongly supported in principle, it can be challenging to implement in practice. Little is known about the actual bottlenecks to health data sharing in Switzerland. AIMS OF THE STUDY This study aimed to assess the obstacles to Swiss health data sharing, including legal, ethical and logistical bottlenecks. METHODS We identified 37 key stakeholders in data sharing via the Swiss Personalised Health Network ecosystem, defined as being an expert on sharing sensitive health data for research purposes at a Swiss university hospital (or a Swiss disease cohort) or being a stakeholder in data sharing at a public or private institution that uses such data. We conducted semi-structured interviews, which were transcribed, translated when necessary, and de-identified. The entire research team discussed the transcripts and notes taken during each interview before an inductive coding process occurred. RESULTS Eleven semi-structured interviews were conducted (primarily in English) with 17 individuals representing lawyers, data protection officers, ethics committee members, scientists, project managers, bioinformaticians, clinical trials unit members, and biobank stakeholders. Most respondents felt that it was not the actual data transfer that was the bottleneck but rather the processes and systems around it, which were considered time-intensive and confusing. The templates developed by the Swiss Personalised Health Network and the Swiss General Consent process were generally felt to have streamlined processes significantly. However, these logistics and data quality issues remain practical bottlenecks in Swiss health data sharing. Areas of legal uncertainty include privacy laws when sharing data internationally, questions of "who owns the data", inconsistencies created because the Swiss general consent is perceived as being implemented differently across different institutions, and definitions and operationalisation of anonymisation and pseudo-anonymisation. Many participants desired to create a "culture of data sharing" and to recognise that data sharing is a process with many steps, not an event, that requires sustainability efforts and personnel. Some participants also stressed a desire to move away from data sharing and the current privacy focus towards processes that facilitate data access. CONCLUSIONS Facilitating a data access culture in Switzerland may require legal clarifications, further education about the process and resources to support data sharing, and further investment in sustainable infrastructureby funders and institutions.
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Affiliation(s)
- Kelly E Ormond
- D-HEST, Health Ethics and Policy Lab, ETH-Zurich, Zurich, Switzerland
| | | | - Claudia Becherer
- Swiss Clinical Trial Organisation, Bern, Switzerland
- Department Clinical Research (DKF), University Basel, University Hospital Basel, Basel, Switzerland
| | | | - Francisca Joerger
- Swiss Clinical Trial Organisation, Bern, Switzerland
- Clinical Trials Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas R Geiger
- Swiss Personalized Health Network (SPHN), Swiss Academy of Medical Sciences, Bern, Switzerland
| | - Elke Hiendlmeyer
- Swiss Clinical Trial Organisation, Bern, Switzerland
- Clinical trials unit (CTU), Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Julia Maurer
- Personalized Health Informatics Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Timo Staub
- Bern Center for Precision Medicine, University of Bern, Bern, Switzerland
| | - Effy Vayena
- D-HEST,Health Ethics and Policy Lab, ETH-Zurich, Zurich, Switzerland
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Karargyris A, Umeton R, Sheller MJ, Aristizabal A, George J, Wuest A, Pati S, Kassem H, Zenk M, Baid U, Narayana Moorthy P, Chowdhury A, Guo J, Nalawade S, Rosenthal J, Kanter D, Xenochristou M, Beutel DJ, Chung V, Bergquist T, Eddy J, Abid A, Tunstall L, Sanseviero O, Dimitriadis D, Qian Y, Xu X, Liu Y, Goh RSM, Bala S, Bittorf V, Reddy Puchala S, Ricciuti B, Samineni S, Sengupta E, Chaudhari A, Coleman C, Desinghu B, Diamos G, Dutta D, Feddema D, Fursin G, Huang X, Kashyap S, Lane N, Mallick I, Mascagni P, Mehta V, Ferro Moraes C, Natarajan V, Nikolov N, Padoy N, Pekhimenko G, Reddi VJ, Reina GA, Ribalta P, Singh A, Thiagarajan JJ, Albrecht J, Wolf T, Miller G, Fu H, Shah P, Xu D, Yadav P, Talby D, Awad MM, Howard JP, Rosenthal M, Marchionni L, Loda M, Johnson JM, Bakas S, Mattson P. Federated benchmarking of medical artificial intelligence with MedPerf. NAT MACH INTELL 2023; 5:799-810. [PMID: 38706981 PMCID: PMC11068064 DOI: 10.1038/s42256-023-00652-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/06/2023] [Indexed: 05/07/2024]
Abstract
Medical artificial intelligence (AI) has tremendous potential to advance healthcare by supporting and contributing to the evidence-based practice of medicine, personalizing patient treatment, reducing costs, and improving both healthcare provider and patient experience. Unlocking this potential requires systematic, quantitative evaluation of the performance of medical AI models on large-scale, heterogeneous data capturing diverse patient populations. Here, to meet this need, we introduce MedPerf, an open platform for benchmarking AI models in the medical domain. MedPerf focuses on enabling federated evaluation of AI models, by securely distributing them to different facilities, such as healthcare organizations. This process of bringing the model to the data empowers each facility to assess and verify the performance of AI models in an efficient and human-supervised process, while prioritizing privacy. We describe the current challenges healthcare and AI communities face, the need for an open platform, the design philosophy of MedPerf, its current implementation status and real-world deployment, our roadmap and, importantly, the use of MedPerf with multiple international institutions within cloud-based technology and on-premises scenarios. Finally, we welcome new contributions by researchers and organizations to further strengthen MedPerf as an open benchmarking platform.
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Affiliation(s)
- Alexandros Karargyris
- IHU Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- These authors contributed equally: Alexandros Karargyris, Renato Umeton, Micah J. Sheller
| | - Renato Umeton
- Dana-Farber Cancer Institute, Boston, MA, USA
- Weill Cornell Medicine, New York, NY, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Massachusetts Institute of Technology, Cambridge, MA, USA
- These authors contributed equally: Alexandros Karargyris, Renato Umeton, Micah J. Sheller
| | - Micah J. Sheller
- Intel, Santa Clara, CA, USA
- These authors contributed equally: Alexandros Karargyris, Renato Umeton, Micah J. Sheller
| | | | | | - Anna Wuest
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarthak Pati
- Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maximilian Zenk
- German Cancer Research Center, Heidelberg, Germany
- University of Heidelberg, Heidelberg, Germany
| | - Ujjwal Baid
- Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Junyi Guo
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Jacob Rosenthal
- Dana-Farber Cancer Institute, Boston, MA, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | | | - Daniel J. Beutel
- University of Cambridge, Cambridge, UK
- Flower Labs, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akshay Chaudhari
- Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | | | - Nicholas Lane
- University of Cambridge, Cambridge, UK
- Flower Labs, Hamburg, Germany
| | | | | | | | | | - Pietro Mascagni
- IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | - Nicolas Padoy
- IHU Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Gennady Pekhimenko
- University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | | | | | | | - Abhishek Singh
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | | | | | | | | | | | | | - Mark M. Awad
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeremy P. Howard
- fast.ai, San Francisco, CA, USA
- University of Queensland, Brisbane, Queensland, Australia
| | - Michael Rosenthal
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Massimo Loda
- Dana-Farber Cancer Institute, Boston, MA, USA
- Weill Cornell Medicine, New York, NY, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Spyridon Bakas
- Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
- These authors jointly supervised this work: Spyridon Bakas, Peter Mattson
| | - Peter Mattson
- MLCommons, San Francisco, CA, USA
- Google, Mountain View, CA, USA
- These authors jointly supervised this work: Spyridon Bakas, Peter Mattson
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Hrymak H, Hrymak C, Ratana P, Leeies M. Legal issues pertaining to the collection of sociodemographic data in emergency departments. Acad Emerg Med 2023; 30:760-764. [PMID: 36869627 DOI: 10.1111/acem.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Haley Hrymak
- Peter A. Allard School of Law, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Ratana
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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6
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Sonin J, Becker A, Nipp K. Designing health outcomes through patient data ownership. J Hosp Med 2023. [PMID: 37321927 DOI: 10.1002/jhm.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Juhan Sonin
- University of Illinois at Champaign-Urbana, Champaign, Illinois, USA
- GoInvo.com (LLC), Arlington, Massachusetts, USA
- Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States
| | - Annie Becker
- University of North Carolina Gillings School for Global Public Health, Chapel Hill, North Carolina, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Kim Nipp
- University of Toronto, Toronto, Ontario, Canada
- University of British Columbia, Vancouver, University of British Columbia, Canada
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Tommel J, Kenis D, Lambrechts N, Brohet RM, Swysen J, Mollen L, Hoefmans MJF, Pusparum M, Evers AWM, Ertaylan G, Roos M, Hens K, Houwink EJF. Personal Genomes in Practice: Exploring Citizen and Healthcare Professionals’ Perspectives on Personalized Genomic Medicine and Personal Health Data Spaces Using a Mixed-Methods Design. Genes (Basel) 2023; 14:genes14040786. [PMID: 37107544 PMCID: PMC10137790 DOI: 10.3390/genes14040786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Ongoing health challenges, such as the increased global burden of chronic disease, are increasingly answered by calls for personalized approaches to healthcare. Genomic medicine, a vital component of these personalization strategies, is applied in risk assessment, prevention, prognostication, and therapeutic targeting. However, several practical, ethical, and technological challenges remain. Across Europe, Personal Health Data Space (PHDS) projects are under development aiming to establish patient-centered, interoperable data ecosystems balancing data access, control, and use for individual citizens to complement the research and commercial focus of the European Health Data Space provisions. The current study explores healthcare users’ and health care professionals’ perspectives on personalized genomic medicine and PHDS solutions, in casu the Personal Genetic Locker (PGL). A mixed-methods design was used, including surveys, interviews, and focus groups. Several meta-themes were generated from the data: (i) participants were interested in genomic information; (ii) participants valued data control, robust infrastructure, and sharing data with non-commercial stakeholders; (iii) autonomy was a central concern for all participants; (iv) institutional and interpersonal trust were highly significant for genomic medicine; and (v) participants encouraged the implementation of PHDSs since PHDSs were thought to promote the use of genomic data and enhance patients’ control over their data. To conclude, we formulated several facilitators to implement genomic medicine in healthcare based on the perspectives of a diverse set of stakeholders.
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Affiliation(s)
- Judith Tommel
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Correspondence: (J.T.); (D.K.)
| | - Daan Kenis
- Department of Philosophy, University of Antwerp, Rodestraat 14, 2000 Antwerp, Belgium
- Correspondence: (J.T.); (D.K.)
| | | | - Richard M. Brohet
- Department of Epidemiology and Statistics, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | | | | | | | - Murih Pusparum
- VITO Health, Boeretang 200, 2400 Mol, Belgium
- Data Science Institute, I-Biostat, Hasselt University, 3500 Hasselt, Belgium
| | - Andrea W. M. Evers
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | | | - Marco Roos
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Kristien Hens
- Department of Philosophy, University of Antwerp, Rodestraat 14, 2000 Antwerp, Belgium
| | - Elisa J. F. Houwink
- Department of Family Medicine, Mayo Clinic, 221 Fourth Avenue SW, Rochester, MN 55905, USA
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Towards the European Health Data Space (EHDS) ecosystem: A survey research on future health data scenarios. Int J Med Inform 2023; 170:104949. [PMID: 36521422 DOI: 10.1016/j.ijmedinf.2022.104949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The European Health Data Space (EHDS) aims to provide better exchange and expand access to health data across Europe. In this way, the EHDS will support healthcare delivery (known as the "primary use of data") and facilitate access to health data for research and policy-making purposes (known as the "secondary use of data"). To achieve this goal, we need to build the required ecosystem of the EHDS with all healthcare stakeholders. MATERIALS AND METHODS We conducted a survey research study to explore the health informaticians' recommendations on future health data scenarios shaping the EHDS ecosystem. We created an anonymous- online questionnaire and disseminated it through wide international networks of health informaticians. In addition, we conducted a workshop during the Medical Informatics Europe Conference (MIE2022) and invited the attendees to complete the questionnaire during the workshop. RESULTS We received 43 responses to our questionnaire from 15 European Union (EU) countries and 7 non-EU countries. Most respondents described the current health data scenario in their countries as a traditional healthcare system with moderate growth (25.6 %, n = 11). The second selected scenario was the reinventing healthcare scenario in a data-driven one-world framework (23.3 %, n = 10). DISCUSSION The results of this work are matched with the findings of the recently published study on digital health implementation in the EU (conducted by the French government in April 2022). This also reflects the current ongoing efforts in the EU countries to deploy national infrastructure for health data management, exchange, and sharing. CONCLUSIONS Upon the respondents' recommendations, there is a strong need to support the health democratization scenarios in Europe, as the main driver for building the EHDS ecosystem.
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Lazarevic N, Lecoq M, Bœhm C, Caillaud C. Pregnancy Apps for Self-Monitoring: Scoping Review of the Most Popular Global Apps Available in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1012. [PMID: 36673768 PMCID: PMC9858738 DOI: 10.3390/ijerph20021012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Digital health tools, such as apps, have the potential to promote healthy behaviours, especially self-monitoring, which can facilitate pregnancy management and reduce the risk of associated pregnancy health conditions. While pregnancy apps are popular amongst pregnant women, there is limited information about the overall quality of their content or self-monitoring tools and the number of behaviour change techniques (BCTs) that they include. The aim of this study was thus to assess the quality of pregnancy apps for self-monitoring, and their usage of BCTs. We identified pregnancy apps by web scraping the most popular global apps for self-monitoring in the Apple App Store and Google Play Store available in Australia. The app quality was evaluated using the scorecard approach and the inclusion of BCTs was evaluated using the ABACUS tool. We identified 31 pregnancy apps that met our eligibility criteria. We found that pregnancy apps tended to score the highest in the domains of 'cost and time', 'usability', and 'technical', and lowest on 'clinical' and 'end-user requirements'. Additionally, the majority of apps contained minimal BCTs. Based on our findings, we propose a digital health scorecard visualisation that would break down app quality criteria and present them in a more accessible way to clinicians and pregnant users. We conclude that these findings highlight the shortcomings of available commercial pregnancy apps and the utility of a digital health scorecard visualisation that would empower users to make more informed decisions about which apps are the most appropriate for their needs.
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Affiliation(s)
- Natasa Lazarevic
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Marie Lecoq
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- AgroParisTech, Universite Paris-Saclay, CEDEX, 91 123 Palaiseau, France
| | - Céline Bœhm
- School of Physics, Faculty of Science, Physics Building, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Corinne Caillaud
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
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10
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Müller S. Is there a civic duty to support medical AI development by sharing electronic health records? BMC Med Ethics 2022; 23:134. [PMID: 36496427 PMCID: PMC9736708 DOI: 10.1186/s12910-022-00871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Medical artificial intelligence (AI) is considered to be one of the most important assets for the future of innovative individual and public health care. To develop innovative medical AI, it is necessary to repurpose data that are primarily generated in and for the health care context. Usually, health data can only be put to a secondary use if data subjects provide their informed consent (IC). This regulation, however, is believed to slow down or even prevent vital medical research, including AI development. For this reason, a number of scholars advocate a moral civic duty to share electronic health records (EHRs) that overrides IC requirements in certain contexts. In the medical AI context, the common arguments for such a duty have not been subjected to a comprehensive challenge. This article sheds light on the correlation between two normative discourses concerning informed consent for secondary health record use and the development and use of medical AI. There are three main arguments in favour of a civic duty to support certain developments in medical AI by sharing EHRs: the 'rule to rescue argument', the 'low risks, high benefits argument', and the 'property rights argument'. This article critiques all three arguments because they either derive a civic duty from premises that do not apply to the medical AI context, or they rely on inappropriate analogies, or they ignore significant risks entailed by the EHR sharing process and the use of medical AI. Given this result, the article proposes an alternative civic responsibility approach that can attribute different responsibilities to different social groups and individuals and that can contextualise those responsibilities for the purpose of medical AI development.
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Affiliation(s)
- Sebastian Müller
- grid.10388.320000 0001 2240 3300Center for Life Ethics/Heinrich Hertz Chair TRA4, University of Bonn, Schaumburg- Lippe-Straße 5-7, 53113 Bonn, Germany
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12
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Durieux BN, DeCamp M, Lindvall C. 21st Century Cures Act: ethical recommendations for new patient-facing products. J Am Med Inform Assoc 2022; 29:1818-1822. [PMID: 35876830 PMCID: PMC9471700 DOI: 10.1093/jamia/ocac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent legislation ensuring patient access to their electronic health records represents a promising national commitment to patient empowerment. Access and interoperability rules seek to empower individuals as well as increase opportunities for data sharing by hospitals, apps, and other parties for research and innovation. However, there are trade-offs between data accessibility and oversight. Some third-party apps may not be covered by federal regulations, and receiving records directly from individuals may render some services in possession of health data. To promote consumer trust, these services should follow ethical standards regardless of regulatory status. ACTIONABLE PRINCIPLES This Perspective proposes 3 actionable principles, grounded in medical ethics, for services making use of health data: services should (1) provide informed, dynamic, regular consent, including control over data sharing, (2) promote inclusivity and equity, and (3) intentionally focus on consumer trust and the perception of value in the service provided.
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Affiliation(s)
- Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew DeCamp
- Division of General Internal Medicine, Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Reflections on ‘Decolonizing’ Big Data in Global Health. Ann Glob Health 2022; 88:56. [PMID: 35936229 PMCID: PMC9306674 DOI: 10.5334/aogh.3709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
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Silva P, Dahlke DV, Smith ML, Charles W, Gomez J, Ory MG, Ramos KS. An Idealized Clinicogenomic Registry to Engage Underrepresented Populations Using Innovative Technology. J Pers Med 2022; 12:jpm12050713. [PMID: 35629136 PMCID: PMC9144063 DOI: 10.3390/jpm12050713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Current best practices in tumor registries provide a glimpse into a limited time frame over the natural history of disease, usually a narrow window around diagnosis and biopsy. This creates challenges meeting public health and healthcare reimbursement policies that increasingly require robust documentation of long-term clinical trajectories, quality of life, and health economics outcomes. These challenges are amplified for underrepresented minority (URM) and other disadvantaged populations, who tend to view the institution of clinical research with skepticism. Participation gaps leave such populations underrepresented in clinical research and, importantly, in policy decisions about treatment choices and reimbursement, thus further augmenting health, social, and economic disparities. Cloud computing, mobile computing, digital ledgers, tokenization, and artificial intelligence technologies are powerful tools that promise to enhance longitudinal patient engagement across the natural history of disease. These tools also promise to enhance engagement by giving participants agency over their data and addressing a major impediment to research participation. This will only occur if these tools are available for use with all patients. Distributed ledger technologies (specifically blockchain) converge these tools and offer a significant element of trust that can be used to engage URM populations more substantively in clinical research. This is a crucial step toward linking composite cohorts for training and optimization of the artificial intelligence tools for enhancing public health in the future. The parameters of an idealized clinical genomic registry are presented.
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Affiliation(s)
- Patrick Silva
- Health Science Center, Texas A&M University, 8441 Riverside Pkwy, Bryan, TX 77807, USA; (J.G.); (K.S.R.)
- Correspondence: ; Tel.: +1-979-436-9055
| | - Deborah Vollmer Dahlke
- School of Public Health, Texas A&M Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, USA; (D.V.D.); (M.L.S.); (M.G.O.)
| | - Matthew Lee Smith
- School of Public Health, Texas A&M Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, USA; (D.V.D.); (M.L.S.); (M.G.O.)
| | - Wendy Charles
- BurstIQ, 9635 Maroon Circle, #310, Englewood, CO 80112, USA;
| | - Jorge Gomez
- Health Science Center, Texas A&M University, 8441 Riverside Pkwy, Bryan, TX 77807, USA; (J.G.); (K.S.R.)
| | - Marcia G. Ory
- School of Public Health, Texas A&M Health Science Center, 212 Adriance Lab Rd., College Station, TX 77843, USA; (D.V.D.); (M.L.S.); (M.G.O.)
| | - Kenneth S. Ramos
- Health Science Center, Texas A&M University, 8441 Riverside Pkwy, Bryan, TX 77807, USA; (J.G.); (K.S.R.)
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