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Ramamoorthi K, Stamenova V, Liu RH, Bhattacharyya O. The Implementation of Federated Digital Identifiers in Health Care: Rapid Review. J Med Internet Res 2024; 26:e45751. [PMID: 38329799 PMCID: PMC10884916 DOI: 10.2196/45751] [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: 01/16/2023] [Revised: 08/04/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Federated digital identifiers (FDIs) have been cited to improve the interoperability of data and information management while enhancing the privacy of individuals verifying their identity on the web. Many countries around the world have implemented FDIs in various sectors, such as banking and government. Similarly, FDIs could improve the experience for those wanting to access their health care information; however, they have only been introduced in a few jurisdictions around the world, and their impact remains unclear. OBJECTIVE The main objective of this environmental scan was to describe how FDIs have been established and implemented to enable patients' access to health care. METHODS We conducted this study in 2 stages, with the primary stage being a rapid review, which was supplemented by a targeted gray literature search. Specifically, the rapid review was conducted through a database search of MEDLINE and Embase, which generated a list of countries and their services that use FDIs in health care. This list was then used to conduct a targeted gray literature search using the Google search engine. RESULTS A total of 93 references from the database and targeted Google searches were included in this rapid review. FDIs were implemented in health care in 11 countries (Australia, Belgium, Canada, Denmark, Estonia, Finland, Iceland, Norway, Singapore, Sweden, and Taiwan) and exclusively used with a patient-accessible electronic health record system through a single sign-on interface. The most common FDIs were implemented nationally or provincially, and establishing them usually required individuals to visit a bank or government office in person. In contrast, some countries, such as Australia, allow individuals to verify their identities entirely on the web. We found that despite the potential of FDIs for use in health care to facilitate the amalgamation of health information from different data sources into one platform, the adoption of most health care services that use FDIs remained below 30%. The exception to this was Australia, which had an adoption rate of 90%, which could be correlated with the fact that it leveraged an opt-out consent model. CONCLUSIONS This rapid review highlights key features of FDIs across regions and elements associated with higher adoption of the patient-accessible electronic health record systems that use them, like opt-out registration. Although FDIs have been reported to facilitate the collation of data from multiple sources through a single sign-on interface, there is little information on their impact on care or patient experience. If FDIs are used to their fullest potential and implemented across sectors, adoption rates within health care may also improve.
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Affiliation(s)
- Karishini Ramamoorthi
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Rebecca H Liu
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Thai K, Tsiandoulas KH, Stephenson EA, Menna-Dack D, Zlotnik Shaul R, Anderson JA, Shinewald AR, Ampofo A, McCradden MD. Perspectives of Youths on the Ethical Use of Artificial Intelligence in Health Care Research and Clinical Care. JAMA Netw Open 2023; 6:e2310659. [PMID: 37126349 PMCID: PMC10152306 DOI: 10.1001/jamanetworkopen.2023.10659] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Importance Understanding the views and values of patients is of substantial importance to developing the ethical parameters of artificial intelligence (AI) use in medicine. Thus far, there is limited study on the views of children and youths. Their perspectives contribute meaningfully to the integration of AI in medicine. Objective To explore the moral attitudes and views of children and youths regarding research and clinical care involving health AI at the point of care. Design, Setting, and Participants This qualitative study recruited participants younger than 18 years during a 1-year period (October 2021 to March 2022) at a large urban pediatric hospital. A total of 44 individuals who were receiving or had previously received care at a hospital or rehabilitation clinic contacted the research team, but 15 were found to be ineligible. Of the 29 who consented to participate, 1 was lost to follow-up, resulting in 28 participants who completed the interview. Exposures Participants were interviewed using vignettes on 3 main themes: (1) health data research, (2) clinical AI trials, and (3) clinical use of AI. Main Outcomes and Measures Thematic description of values surrounding health data research, interventional AI research, and clinical use of AI. Results The 28 participants included 6 children (ages, 10-12 years) and 22 youths (ages, 13-17 years) (16 female, 10 male, and 3 trans/nonbinary/gender diverse). Mean (SD) age was 15 (2) years. Participants were highly engaged and quite knowledgeable about AI. They expressed a positive view of research intended to help others and had strong feelings about the uses of their health data for AI. Participants expressed appreciation for the vulnerability of potential participants in interventional AI trials and reinforced the importance of respect for their preferences regardless of their decisional capacity. A strong theme for the prospective use of clinical AI was the desire to maintain bedside interaction between the patient and their physician. Conclusions and Relevance In this study, children and youths reported generally positive views of AI, expressing strong interest and advocacy for their involvement in AI research and inclusion of their voices for shared decision-making with AI in clinical care. These findings suggest the need for more engagement of children and youths in health care AI research and integration.
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Affiliation(s)
- Kelly Thai
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada
| | - Kate H Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth A Stephenson
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dolly Menna-Dack
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Randi Zlotnik Shaul
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Cheng C, Gearon E, Hawkins M, McPhee C, Hanna L, Batterham R, Osborne RH. Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study. J Med Internet Res 2022; 24:e35772. [PMID: 36112404 PMCID: PMC9526109 DOI: 10.2196/35772] [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: 12/17/2021] [Revised: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.
Objective
With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).
Methods
A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.
Results
A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.
Conclusions
This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Emma Gearon
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | | | - Lisa Hanna
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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Thabrew H, Aljawahiri N, Kumar H, Bowden N, Milne B, Prictor M, Jordan V, Breedvelt J, Shepherd T, Hetrick S. 'As Long as It's Used for Beneficial Things': An Investigation of non-Māori, Māori and Young People's Perceptions Regarding the Research use of the Aotearoa New Zealand Integrated Data Infrastructure (IDI). J Empir Res Hum Res Ethics 2022; 17:471-482. [PMID: 35849389 DOI: 10.1177/15562646221111294] [Citation(s) in RCA: 4] [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: 11/16/2022]
Abstract
The Aotearoa New Zealand Integrated Data Infrastructure (IDI) is a national database containing a wide range of data about people and households. There is limited information about public views regarding its use for research.A qualitative study was undertaken to examine the views of forty individuals attending a large hospital in Auckland, including those of Māori ethnicity and young people. Semi-structured interview data were analysed using Braun and Clarke's method of thematic analysis.Seven key themes emerged: 1) Limited knowledge about medical data held in national databases; 2) Conditional support for the use of the IDI, including for research; 3) Concerns regarding the misuse of IDI data; 4) The importance of privacy; 5) Different views regarding consent for use of data for research; 6) Desire for access to personal data and the results of research; and 7) Concerns regarding third party and commercial use. Young people and those of Māori ethnicity were more wary of data misuse than others.Although there is reasonable support for the secondary use of public administrative data in the IDI for research, there is more work to be done to ensure ethical and culturally appropriate use of this data via improved consent privacy management processes and researcher training.
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Affiliation(s)
- Hiran Thabrew
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,Consult Liaison Team, 36716Starship Hospital, Auckland, New Zealand
| | - Noor Aljawahiri
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Harshali Kumar
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- 161293Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start National Science Challenge, Liggins Institute, The University of Auckland, Auckland, New Zealand.,589107Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Megan Prictor
- Health, Law and Emerging Technologies programme, 90147Melbourne Law School, The University of Melbourne, Carlton, Australia
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, 62710Faculty of Medical and Health Sciences, Auckland, New Zealand
| | | | - Toni Shepherd
- Consult Liaison Team, 36716Starship Hospital, Auckland, New Zealand
| | - Sarah Hetrick
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Lee YL, Lee HA, Hsu CY, Kung HH, Chiu HW. SEMRES - A Triple Security Protected Blockchain Based Medical Record Exchange Structure. Comput Methods Programs Biomed 2022; 215:106595. [PMID: 34999532 PMCID: PMC8735893 DOI: 10.1016/j.cmpb.2021.106595] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE COVID-19, a serious infectious disease outbreak started in the end of 2019, has caused a strong impact on the overall medical system, which reflects the gap in the volume and capacity of medical services and highlights the importance of clinical data ex-change and application. The most important concerns of medical records in the medical field include data privacy, data correctness, and data security. By realizing these three goals, medical records can be made available to different hospital information systems to achieve the most complete medical care services. The privacy and protection of health data require detailed specification and usage requirements, which is particularly important for cross-agency data exchange. METHODS This research is composed of three main modules. "Combined Encryption and Decryption Architecture", which includes the hybrid double encryption mechanism of AES and RSA, and encrypts medical records to produce "Secured Encrypted Medical Record". "Decentralize EMR Repository", which includes data decryption and an exchange mechanism. After a data transmission is completed, the content verification and data decryption process will be launched to confirm the correctness of the data and obtain the data. A blockchain architecture is used to store the hash value of the encrypted EMR, and completes the correctness verification of the EMR after transmission through the hash value. RESULTS The results of this study provide an efficient triple encryption mechanism for electronic medical records. SEMRES ensures the correctness of data through the non-repudiation feature of a blockchain open ledger, and complete integrated information security protection and data verification architecture, in order that medical data can be exchanged, verified, and applied in different locations. After the patient receives medical services, the medical record is re-encrypted and verified and stored in the patient's medical record. The blockchain architecture is used to ensure the verification of non-repudiation of medical service, and finally to complete the payment for medical services. CONCLUSIONS The main aim of this study was to complete a security architecture for medical data, and develop a triple encryption authentication architecture to help data owners easily and securely share personal medical records with medical service personnel.
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Affiliation(s)
- Yen-Liang Lee
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Internet of Things Laboratory, Chunghwa Telecom Laboratories, Tao Yuen, Taiwan.
| | - Hsiu-An Lee
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan; Standards and Interoperability Lab, Smart Healthcare Center of Excellence, Taipei, Taiwan; Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Chien-Yeh Hsu
- Standards and Interoperability Lab, Smart Healthcare Center of Excellence, Taipei, Taiwan; Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Master Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan.
| | - Hsin-Hua Kung
- Standards and Interoperability Lab, Smart Healthcare Center of Excellence, Taipei, Taiwan; Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei City, Taiwan.
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Kahouei M, Soleimani M, Mirmohammadkhani M, Doghozlou SN, Valizadeh Z. Nurses' attitudes of a web patient portal prior to its implementation in home health care nursing. Health Policy and Technology 2021. [DOI: 10.1016/j.hlpt.2021.100524] [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: 11/24/2022]
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7
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Moerenhout T, Devisch I, Cooreman L, Bernaerdt J, De Sutter A, Provoost V. Patients' moral attitudes toward electronic health records: Survey study with vignettes and statements. Health Informatics J 2021; 27:1460458220980039. [PMID: 33446034 DOI: 10.1177/1460458220980039] [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: 11/17/2022]
Abstract
Patient access to electronic health records gives rise to ethical questions related to the patient-doctor-computer relationship. Our study aims to examine patients' moral attitudes toward a shared EHR, with a focus on autonomy, information access, and responsibility. A de novo self-administered questionnaire containing three vignettes and 15 statements was distributed among patients in four different settings. A total of 1688 valid questionnaires were collected. Patients' mean age was 51 years, 61% was female, 50% had a higher degree (college or university), and almost 50% suffered from a chronic illness. Respondents were hesitant to hide sensitive information electronically from their care providers. They also strongly believed hiding information could negatively affect the quality of care provided. Participants preferred to be informed about negative test results in a face-to-face conversation, or would have every patient decide individually how they want to receive results. Patients generally had little experience using patient portal systems and expressed a need for more information on EHRs in this survey. They tended to be hesitant to take up control over their medical data in the EHR and deemed patients share a responsibility for the accuracy of information in their record.
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Kosari S, Yee KC, Mulhall S, Thomas J, Jackson SL, Peterson GM, Rudgley A, Walker I, Naunton M. Pharmacists' Perspectives on the Use of My Health Record. Pharmacy (Basel) 2020; 8:E190. [PMID: 33066569 DOI: 10.3390/pharmacy8040190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: My Health Record (MHR) is a relatively new nationwide Australian digital health record system accessible by patients and a range of healthcare professionals. Pharmacists will be key contributors and users of the MHR system, yet little is known about the perceived barriers and benefits of use. (2) Objective: To explore pharmacists' perspectives related to potential benefits and barriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated. The survey was advertised to Australian pharmacists on pharmacy professional bodies' websites. This was a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used to describe the distribution of the data. Chi-square, Kendall's tau coefficient (tau-c) and Kruskal-Wallis tests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacists completed the survey. The majority of respondents worked in a metropolitan area (74%), and the most common workplace setting was community pharmacy (65%). Perceived benefits identified by responders include that the use of MHR would help with continuity of care (90%), and that it would improve the safety (71%) and quality (75%) of care they provided. Importantly, more than half of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing (57%) and could improve professional relationships with patients (57%) and general practitioners (59%). Potential barriers identified by pharmacists included patients' concerns about privacy (81%), pharmacists' own concern about privacy (46%), lack of training, access to and confidence in using the system. Sixty six percent of respondents had concerns about the accuracy of information contained within MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almost half (44%) had concerns about the security of information in the system, mainly pharmacists working at general practice and providing medication review services (p = 0.007). Overall satisfaction with MHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, with a higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacists considered that the MHR offered key potential benefits, notably improving the safety and quality of care provided. To optimize the use of MHR, there is a need to improve privacy and data security measures, and to ensure adequate provision of user support and education surrounding the ability to integrate use of MHR with existing workflows and software.
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McCradden MD, Baba A, Saha A, Ahmad S, Boparai K, Fadaiefard P, Cusimano MD. Ethical concerns around use of artificial intelligence in health care research from the perspective of patients with meningioma, caregivers and health care providers: a qualitative study. CMAJ Open 2020; 8:E90-E95. [PMID: 32071143 PMCID: PMC7028163 DOI: 10.9778/cmajo.20190151] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As artificial intelligence (AI) approaches in research increase and AI becomes more integrated into medicine, there is a need to understand perspectives from members of the Canadian public and medical community. The aim of this project was to investigate current perspectives on ethical issues surrounding AI in health care. METHODS In this qualitative study, adult patients with meningioma and their caregivers were recruited consecutively (August 2018-February 2019) from a neurosurgical clinic in Toronto. Health care providers caring for these patients were recruited through snowball sampling. Based on a nonsystematic literature search, we constructed 3 vignettes that sought participants' views on hypothetical issues surrounding potential AI applications in health care. The vignettes were presented to participants in interviews, which lasted 15-45 minutes. Responses were transcribed and coded for concepts, frequency of response types and larger concepts emerging from the interview. RESULTS We interviewed 30 participants: 18 patients, 7 caregivers and 5 health care providers. For each question, a variable number of responses were recorded. The majority of participants endorsed nonconsented use of health data but advocated for disclosure and transparency. Few patients and caregivers felt that allocation of health resources should be done via computerized output, and a majority stated that it was inappropriate to delegate such decisions to a computer. Almost all participants felt that selling health data should be prohibited, and a minority stated that less privacy is acceptable for the goal of improving health. Certain caveats were identified, including the desire for deidentification of data and use within trusted institutions. INTERPRETATION In this preliminary study, patients and caregivers reported a mixture of hopefulness and concern around the use of AI in health care research, whereas providers were generally more skeptical. These findings provide a point of departure for institutions adopting health AI solutions to consider the ethical implications of this work by understanding stakeholders' perspectives.
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Affiliation(s)
- Melissa D McCradden
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont.
| | - Ami Baba
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Ashirbani Saha
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Sidra Ahmad
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Kanwar Boparai
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Pantea Fadaiefard
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
| | - Michael D Cusimano
- Division of Neurosurgery (McCradden, Baba, Saha, Boparai, Fadaiefard, Cusimano), St. Michael's Hospital, Unity Health Toronto; Dalla Lana School of Public Health (Cusimano), University of Toronto, Toronto, Ont
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Senanayake B, Tyagi N, Zhou X, Edirippulige S. Workforce Readiness and Digital Health Integration. Opportunities and Challenges in Digital Healthcare Innovation 2020. [DOI: 10.4018/978-1-7998-3274-4.ch010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The benefits that digital health may offer include clinical, administrative, research, and educational. Research shows that if used in the right circumstances, digital health may increase access to healthcare services, improve clinical outcomes, safety, and quality of care. Digital health also has the potential to improve organisational efficiencies by reducing duplication and unnecessary diagnostic testing. From a healthcare consumer perspective, there is an expectation that healthcare services need to be provided in a more flexible and cost-effective way as in other spheres such as banking, commerce, and media. This is another important driver for consideration to integrate digital health in healthcare services. As digital health continues to be used in routine healthcare services, practitioners may require new knowledge, skills, and competencies to make the best use of this innovative method. Education and training relating to digital health have been recognised as a priority for developing the future healthcare workforce.
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Affiliation(s)
- Buddhika Senanayake
- Centre for Health Services Research, The University of Queensland, Australia
| | - Nirupama Tyagi
- Centre for Health Services Research, The University of Queensland, Australia
| | - Xiaoyun Zhou
- Centre for Health Services Research, The University of Queensland, Australia
| | - Sisira Edirippulige
- Centre for Health Services Research, The University of Queensland, Australia
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11
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Beltran-Aroca CM, Labella F, Font-Ugalde P, Girela-Lopez E. Assessment of Doctors' Knowledge and Attitudes Towards Confidentiality in Hospital Care. Sci Eng Ethics 2019; 25:1531-1548. [PMID: 30604354 DOI: 10.1007/s11948-018-0078-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
The physician's duty of confidentiality is based on the observance of the patient's privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients' data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. The present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents (37.5%) with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital (74%). The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups (≤ 30 vs. ≥ 51 years) and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices.
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Affiliation(s)
- Cristina M Beltran-Aroca
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Fernando Labella
- Sección de Oftalmología, Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Pilar Font-Ugalde
- Sección de Bioestadística, Departamento de Medicina, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Eloy Girela-Lopez
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
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12
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Lupton D. 'I'd like to think you could trust the government, but I don't really think we can': Australian women's attitudes to and experiences of My Health Record. Digit Health 2019; 5:2055207619847017. [PMID: 31069106 PMCID: PMC6492356 DOI: 10.1177/2055207619847017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/07/2019] [Indexed: 12/17/2022] Open
Abstract
The Australian government’s Australian Digital Health Agency is working towards
its goal of enrolling every Australian in My Health Record, its national
electronic health record system. This article reports findings from a
qualitative project involving interviews and focus groups with Australian women
about their use of digital health across the range of technologies available to
them, including their attitudes to and experiences of My Health Record. A
feminist new materialism perspective informed the project, working to surface
the affordances, affective forces and relational connections that contributed to
the opening up or closing off potential agential capacities when people come
together with digitised systems such as My Health Record. These findings
demonstrate that people’s personal experiences and feelings, the actions of
others such as the agencies responsible for system implementation and function,
their healthcare providers and broader social, cultural, technological and
political factors are important in shaping their knowledge, interest in and
acceptance of an electronic health record system. Even among this group of
participants, who were experienced and active in finding and engaging with
health information online, uncertainty and a lack of awareness of and interest
in My Health Record were evident among many. Affordances such as technical
difficulties were major barriers to enrolling and using the system successfully.
No participants had yet found any benefit or use for it. Affective forces such
as lack of trust and faith in the Australian government’s general technological
expertise and concerns about data privacy and security were also key in many
participants’ accounts.
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Affiliation(s)
- Deborah Lupton
- News & Media Research Centre, University of Canberra, Australia
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13
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Carroll J, Butler-Henderson K. MyHealthRecord in Australian Primary Health Care: An Attitudinal Evaluation Study. J Med Syst 2017; 41:158. [PMID: 28866846 DOI: 10.1007/s10916-017-0807-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/27/2016] [Accepted: 08/25/2017] [Indexed: 11/29/2022]
Abstract
Australia's investment in the national MyHealthRecord has not been successfully communicated to the myriad of stakeholder groups, resulting in negative perceptions about the system and serious consequences for the uptake of the MyHealthRecord. Local stakeholder attitudes and perceptions will be crucial in setting the scene for success or failure with MyHealthRecord. A survey was undertaken to identify primary healthcare provider perceptions of the MyHealthRecord system, and capture the perceived enablers and barriers for use of the MyHealthRecord system. Almost all (89%) of the twenty-seven (27) respondents had previously heard of the MyHealthRecord system prior to completing the survey. Enablers included a decrease in duplication of effort and an increase in continuity of care. However, concerns about the perceived impact on healthcare provider time, privacy, access controls, and the need for full participation will need to be managed if MyHealthRecord is to be successfully implemented. The MyHealthRecord system will only be perceived as trustworthy when there is full participation by healthcare organisations, providers, and consumers. If Australian consumers become participants in an opt-out approach, it will be a catalyst for participation by healthcare organisations and providers. Incentives to encourage MyHealthRecord participation need to be extended to all healthcare providers as healthcare provider attitudes are influential with consumers. Therefore MyHealthRecord training and education needs to be targeted towards healthcare providers. Research into the attitudes of the local healthcare provider cohort is valuable in creating a change management strategy for maximising local success.
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Affiliation(s)
| | - Kerryn Butler-Henderson
- Australian Institute of Health Service Management, Tasmanian School of Business & Economics, University of Tasmania, Locked Bag 1317, Launceston, 7250, Australia.
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Hanna L, Gill SD, Newstead L, Hawkins M, Osborne RH. Patient perspectives on a personally controlled electronic health record used in regional Australia. Health Inf Manag 2016; 46:42-48. [PMID: 27486184 DOI: 10.1177/1833358316661063] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 11/16/2022]
Abstract
BACKGROUND Personally controlled electronic health records (PCEHRs) are being implemented throughout Australia; yet few studies have investigated patients' experiences of using a PCEHR. AIM To explore patients' experiences and perspectives of using a locally developed PCEHR implemented in an Australian health service. METHOD Twelve patients completed individual semi-structured telephone interviews, which underwent inductive analysis. RESULTS Participants described two main interdependent advantages of PCEHRs: improved quality of healthcare through better information sharing and enhanced patient capacity for self-management. To realise these advantages, widespread acceptance and use of PCEHRs by healthcare providers is required, and PCEHRs need to be simple to use and accessible. CONCLUSION PCEHRs can produce tangible benefits for patients. However, maximum benefits will be realised when PCEHRs contain a complete collection of relevant health information and are carefully designed for easy use.
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15
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Eassey D, Smith L, Krass I, McLAchlan A, Brien JA. Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study. Int J Qual Health Care 2016; 28:391-7. [DOI: 10.1093/intqhc/mzw047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 01/19/2023] Open
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16
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Lehnbom EC, Douglas HE, Makeham MAB. Positive beliefs and privacy concerns shape the future for the Personally Controlled Electronic Health Record. Intern Med J 2016; 46:108-11. [PMID: 26813902 DOI: 10.1111/imj.12956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 04/20/2015] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 11/28/2022]
Abstract
The uptake of the Personally Controlled Electronic Health Record (PCEHR) has been slowly building momentum in Australia. The purpose of the PCEHR is to collect clinically important information from multiple healthcare providers to provide a secure electronic record to patients and their authorised healthcare providers that will ultimately enhance the efficiency and effectiveness of healthcare delivery. Reasons for the slow uptake of the PCEHR and future directions to improve its usefulness is discussed later.
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Affiliation(s)
- E C Lehnbom
- Faculty of Pharmacy, The University of Sydney, Australia
| | - H E Douglas
- Centre for Health Systems and Safety Research, Faculty of Medicine and Health Sciences, Macquarie University, Sydney New South Wales, Australia
| | - M A B Makeham
- Centre for Health Systems and Safety Research, Faculty of Medicine and Health Sciences, Macquarie University, Sydney New South Wales, Australia
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17
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Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016; 2:2055207616668431. [PMID: 29942567 PMCID: PMC6001208 DOI: 10.1177/2055207616668431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/29/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Patients Know Best (PKB) provides a patient portal with integrated, patient-controlled digital care records. Patient-controlled personal health records facilitate coordinated management of chronic disease through improved communications among, and about, patients across professional and organisational boundaries. An NHS foundation trust hospital has used PKB to support self-management in patients with inflammatory bowel disease; this paper presents a case study of usage. METHODS The stakeholder empowered adoption model provided a framework for consulting variously placed stakeholders. Qualitative interviews with clinical stakeholders and a patient survey. RESULTS Clinicians reported PKB to have enabled a new way of managing stable patients, this facilitated clinical and cost effective use of specialist nurses; improved two-way communications, and more optimal use of outpatient appointments and consultant time. The portal also facilitated a single, rationalised pathway for stable patients, enabling access to information and pro-active support. For patients, the system was a source of support when unwell and facilitated improved communication with specialists. Three main barriers to adoption were identified; these related to concerns over security, risk averse attitudes of users and problems with data integration. CONCLUSIONS Patient-controlled personal health records offer significant potential in supporting self-management. Digital connection to healthcare can help patients to understand their condition better and access appropriate, timely clinical advice.
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Affiliation(s)
- Elaine Bidmead
- Cumbrian Centre for Health Technologies
(CaCHeT), University of Cumbria, Carlisle, UK
| | - Alison Marshall
- Cumbrian Centre for Health Technologies
(CaCHeT), University of Cumbria, Lancaster, UK
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